Clinical photograph of a patient undergoing a subjective refraction and visual acuity assessment. The patient is wearing an adjustable metal trial frame, an ophthalmic device featuring multiple slots designed to hold trial lenses for determining a patient's refractive error (myopia, hyperopia, or astigmatism). The examiner's hand is visible holding a pinhole occluder toward the patient's right eye. This specific tool is used in clinical practice to determine if a reduction in visual acuity is due to a refractive error—which typically improves when viewing through a small aperture—or an underlying organic pathology. The image demonstrates key steps in an optometric or ophthalmological examination, focusing on the diagnostic equipment used for determining the best-corrected visual acuity (BCVA). The setting is an eye care clinic, highlighting the procedural interaction between the clinician and the patient during vision screening.

<table><thead><tr><th>Condition</th><th>Frequency</th></tr></thead><tbody><tr><td>Refractive errors</td><td></td></tr><tr><td> Myopia (−0.75 D or more in eye with lesser refractive error)</td><td>0.7%–9.2%^{16, 17,18} (prevalence in children aged 5–17 years)</td></tr><tr><td> Myopia (more than -2.0 D)</td><td>0.2%–2%¹⁹ (prevalence in children aged 3–5 years)</td></tr><tr><td> Hyperopia (+3.0 D or more in eye with lesser refractive error)</td><td>4%–9%^{16, 17} (prevalence in children aged 5–17 years)</td></tr><tr><td> Hyperopia (more than +3.25 D)</td><td>6%–7%¹⁹ (prevalence in children aged 3–5 years)</td></tr><tr><td> Astigmatism (worse eye cylinder power 3.0 D or more)</td><td>0.5%–3%^{16, 20} (prevalence in children aged 5–17 years)</td></tr><tr><td> Astigmatism (cylinder power more than 1.5 D)</td><td>4%–11%¹⁹ (prevalence in children aged 3–5 years)</td></tr><tr><td>Amblyopia</td><td>0.8%–3%^21–25 (prevalence in children aged 6–72 months)</td></tr><tr><td></td><td>0.08%–4.6%^{19, 21–25} (prevalence in children aged 6–72 months)</td></tr><tr><td>Strabismus</td><td>1.2%–6.8% (prevalence in children aged 6–17 years)^26–32</td></tr><tr><td>Cerebral visual impairment, including traumatic brain injury</td><td>Accurate prevalence or incidence data are lacking</td></tr><tr><td></td><td>0.02%^{33, 34} (prevalence in children aged 0–1 year)</td></tr><tr><td></td><td>0.1%²⁴ (prevalence in children aged 6 months to 6 years)</td></tr><tr><td>Cataract</td><td>0.42%³⁵ (prevalence in children aged 6 to 15 years)</td></tr><tr><td></td><td>8.6%–9.2%^36–38 (incidence of severe ROP in cohorts 1000–1250 g [mean] at birth)</td></tr><tr><td>ROP</td><td>15.2%–18.3%^{39, 40} (incidence of severe ROP in cohorts 800–999 g [mean] at birth)</td></tr><tr><td>Congenital glaucoma</td><td>0.0015%–0.0054%^{41, 42} (prevalence in newborns)</td></tr><tr><td></td><td>0.0011%–0.0013%^43–46 (yearly incidence in children aged <5 years)</td></tr><tr><td>Retinoblastoma</td><td>0.00036%–0.00041%^{47, 48} (yearly incidence in children aged <15 years)</td></tr><tr><td>Pediatric uveitis</td><td>Incidence 0.004%⁴⁹ (yearly incidence in children aged <16 years)</td></tr></tbody></table> D = diopter; g = grams; ROP = retinopathy of prematurity.

This clinical photograph depicts a pediatric vision screening or eye examination being conducted on a school-aged child in a community setting. The image demonstrates a monocular visual acuity test procedure. The child is manually occluding his right eye with his palm, while an examiner uses an ophthalmic tool, likely a pinhole occluder or a specialized viewing aperture, over the left eye. The examiner’s hand is visible, stabilizing the tool and lifting the child's eyelid to ensure an unobstructed view of the ocular surface and pupil. This visual highlights public health efforts for early detection of refractive errors, such as myopia, in school-aged populations. The setting appears to be a school, indicated by the child's uniform and lanyard. Key educational concepts illustrated include clinical examination techniques for pediatric ophthalmology, the use of simple diagnostic occluders, and vision screening protocols for refractive error identification in low-resource environments.

This intraoperative clinical photograph captures the anterior segment of a human eye during a cataract surgery following a historical radial keratotomy (RK). The cornea demonstrates multiple distinct radial incisions, approximately 12 to 16 in number, which extend from the central pupillary zone toward the limbus, a hallmark of prior refractive surgery for myopia. These scars appear as linear, fibrotic tracks on the corneal surface. A surgical micro-blade with a yellow handle is visible on the right, performing a lateral clear corneal incision between two existing RK scars. On the left, a blunt stabilizer or surgical gloved finger provides globe immobilization. Speculums are in place to retract the eyelids, exposing the bulbar conjunctiva, which shows mild surgical hyperemia. The red reflex is visible through the pupil, highlighting the radial arrangement of the old incisions. This image illustrates the surgical challenge of creating new cataract incisions while avoiding intersection with unstable previous RK scars to prevent corneal dehiscence or irregular astigmatism.

Clinical photograph of the ocular fundus of both eyes (OD and OS) from a single patient, demonstrating advanced pathological changes associated with high myopia and symmetric Type I posterior staphyloma according to Curtin’s classification. Both images show a characteristic 'tessellated' appearance due to retinal pigment epithelium thinning. The optic discs in both eyes appear abnormally large and tilted with significant excavation (cupping), surrounded by extensive peripapillary chorioretinal atrophy. Multiple patches of white-to-pale yellow lacquer cracks and chorioretinal atrophic lesions are visible, particularly in the macula and peripapillary regions. The retinal vasculature exhibits stretching and straightening, with visible underlying choroidal vessels. The overall presentation illustrates a posterior staphyloma where the posterior pole is abnormally ectatic, leading to significant thinning of the retina and choroid. This educational material is relevant for ophthalmology, specifically for studying the progression and clinical manifestations of pathologic myopia and staphyloma classification.

This composite figure illustrates the clinical and diagnostic imaging findings of pathologic myopia and macular staphyloma using fundus photography and wide-field optical coherence tomography (WF-OCT). (A, D) Fundus photographs demonstrate characteristic myopic changes: Image A shows peripapillary diffuse chorioretinal atrophy (PDCA), while Image D reveals more advanced diffuse chorioretinal atrophy with multiple lacquer cracks and prominent tessellation. (B, C, E) Cross-sectional WF-OCT scans highlight the morphological alterations of a staphyloma. Key features include posterior displacement of the sclera in the staphylomatous area and localized scleral inward protrusions (indicated by yellow arrows) marking the staphyloma edge. The choroid displays dynamic thickness changes, thinning as it approaches the staphyloma edge and re-thickening toward the posterior pole or optic nerve. Red arrowheads point to areas where the inner sclera is displaced posteriorly corresponding with choroidal re-thickening. These images serve as educational tools for identifying the structural boundaries and retinal-choroidal thinning associated with high axial length and posterior staphyloma progression.

The visual content consists of a side-by-side comparison of a color fundus photograph and a cross-sectional optical coherence tomography (OCT) scan of a highly myopic eye. The fundus image on the left displays a classic 'tessellated' background, where thinning of the retinal pigment epithelium makes the underlying choroidal vessels prominently visible. A black arrow indicates 'lacquer cracks,' which represent linear ruptures in Bruch's membrane. A prominent peripapillary conus is also visible adjacent to the optic disc, characteristic of axial myopia. The OCT scan on the right demonstrates pathological changes in macular architecture, specifically inner foveoschisis characterized by intraretinal splitting or separation of the neurosensory retinal layers. The scan also reveals a significantly concave posterior staphyloma contour. This combined imaging set is essential for the diagnosis and staging of pathologic myopia, illustrating key complications like myopic traction maculopathy and degenerative Bruch's membrane changes. It serves as an educational tool for ophthalmology students and residents to differentiate between stages of myopic maculopathy using the ATN classification system.

Educational diagnostic comparison of two highly myopic eyes (OD and OS) featuring fundus photography and structural Optical Coherence Tomography (OCT). Panel A displays the right eye (OD) of a 70-year-old patient with an axial length of 29.21 mm. The fundus image shows a tessellated pattern characteristic of high myopia, a pale, well-defined optic disc, and peripapillary atrophy. The corresponding OCT B-scan demonstrates a normal retinal profile despite the elongated globe. Panel B displays the left eye (OS) of a 62-year-old patient with an axial length of 29.75 mm. The fundus reveals a similar tessellated appearance and clear retinal vasculature. The sub-adjacent OCT shows preserved foveal architecture and retinal layer integrity, with a caliper measurement of 212µm indicating local retinal thickness. The images illustrate types of non-macular posterior staphyloma (PS) in high myopia where the macula remains structurally intact on OCT despite significant axial elongation and global pathology.

Educational diagnostic comparison using horizontal Spectral-Domain Optical Coherence Tomography (SD-OCT) B-scans of the retina in high myopia. The image displays two distinct cases, labeled A and B, focusing on the microstructural relationship between macular Bruch's membrane (BM) length and beta-parapapillary atrophy (β-PPA). Case A shows a myopic eye with an axial length of 28.53 mm, characterized by the presence of PPA without Bruch's membrane (PPA-BM = 468 μm) and the absence of PPA with Bruch's membrane (PPA+BM = 0 μm), resulting in a macular BM length of 3466 μm. Case B illustrates a myopic eye with a shorter axial length (27.09 mm) but a longer macular BM length (4435 μm), featuring both PPA+BM (436 μm) and PPA-BM (405 μm). Key anatomical landmarks visible include the foveal depression, retinal layers, retinal pigment epithelium (RPE), and the termination points of the BM. This comparison demonstrates that macular BM length can be longer in eyes with PPA+BM regardless of axial length, illustrating complex morphological changes in myopic globe elongation.

This clinical imaging set presents a longitudinal comparison of fundus photographs from a myopic patient, captured in 2012 (top row, a and b) and 2016 (bottom row, c and d). The images demonstrate the progression of peripapillary atrophy, a common feature in high myopia. Panels (a) and (c) show the raw fundus photography of the left eye, centered on the posterior pole including the optic disc, macula, and retinal vasculature. Panels (b) and (d) are annotated versions where the peripapillary atrophic arc is highlighted in yellow adjacent to the temporal margin of the optic disc. Clinically, the case tracks a transition from mild atrophy in 2012 (spherical equivalent -2.50 D, axial length 25.04 mm) to moderate atrophy in 2016 (spherical equivalent -5.50 D, axial length 27.47 mm). The visual comparison highlights changes in the morphology and extent of the atrophic region relative to the optic disc over a four-year interval, providing a visual record of myopic chorioretinal degeneration.