About

Nathan Cheung is an Associate Professor of Ophthalmology at Duke University, specializing in Pediatric Ophthalmology and Strabismus. His role involves clinical care, education, and research within the field of ophthalmology, with a focus on pediatric eye conditions and strabismus. As part of the Duke Department of Ophthalmology, he contributes to the training of medical students, residents, and fellows, and is engaged in advancing knowledge and treatment in his specialty.

Research topics

• Medicine
• Surgery
• Ophthalmology
• Optometry
• Biology
• Pediatrics
• Psychology
• Endocrinology

Selected publications

• Virtual reality field testing in children with normal eyes and glaucoma: comparison of game-based versus Humphrey visual field–equivalent algorithms

  Journal of American Association for Pediatric Ophthalmology and Strabismus · 2025-11-20

  article
  PublisherDOI

• Optical correction of hyperopia in school-aged children: a scoping review protocol

  BMJ Open · 2025-08-01

  reviewOpen access

  INTRODUCTION: Prescribing patterns for hyperopia in children vary widely among eye care providers worldwide. This scoping review aims to identify and map the current literature on optical correction and catalogue outcomes reported, particularly in the domains of vision, vision-related functional outcomes and quality of life (QoL) in school-aged children with hyperopia. METHODS AND ANALYSIS: This protocol was developed in accordance with the Joanna Briggs Institute's Manual for Evidence Synthesis. We will include studies involving school-aged children with hyperopia without restrictions on sex, gender, race, ethnicity, type of optical correction, length of intervention, publication date or country of origin. We will include studies with internal or external comparison groups. We will exclude studies associated with myopia control treatments, ocular and visual pathway pathologies affecting vision or visual function. We will search Cochrane CENTRAL, Embase.com and PubMed. Examples of data to be extracted include population demographics, visual acuity, study-specific definitions for refractive error, treatment regimens for optical correction, vision and vision-related functional outcomes and QoL (general or vision-related) as quantified by validated instruments. ETHICS AND DISSEMINATION: Informed consent and Institutional Review Board approval will not be required, as this scoping review will only use published data. The results from the scoping review will be disseminated by publication in a peer-reviewed scientific journal and at professional conferences.

  PublisherDOI

• Pilot comparison of monocular and binocular modes of virtual reality field testing in strabismus

  Scientific Reports · 2025-12-26

  articleOpen access

  Virtual reality field (VRF) perimetry is a promising new tool for visual field assessments, offering both monocular and binocular testing modes. We aimed to examine whether ocular misalignment, known as strabismus, influences VRF outcomes between monocular and binocular testing modes, which is currently unknown. Children with non-amblyopic horizontal strabismus were enrolled and completed VRF testing (Olleyes VisuALL) in either the game-based or standard Humphrey visual field (HVF)-equivalent algorithm. Within their respective algorithms, participants completed tests in both monocular and binocular modes. Analyzed parameters included mean deviation (MD), pattern standard deviation (PSD), and foveal sensitivity (FS). Additionally, a masked ophthalmologist graded whether the VRF was abnormal. Twenty-two children (44 eyes) were enrolled with a mean age of 12.1 ± 2.7 years. Regarding MD, participants who took the game-based algorithm compared to the HVF-equivalent yielded better scores (P = 0.048). For PSD, older participants exhibited better scores than younger participants (P = 0.038). Binocular and monocular mode testing were similar across all parameters, and yielded equal rates of abnormal test results (22.7% vs. 22.7%; P = 1.00). Overall, non-amblyopic horizontally strabismic children demonstrated comparable VRF outcomes in both monocular and binocular testing modes, suggesting similar utility between exam options.

  PublisherOA PDFDOI

• Refractive Error Change and Overminus Lens Therapy for Childhood Intermittent Exotropia

  JAMA Ophthalmology · 2024-03-21 · 4 citations

  articleOpen access

  Importance: Increased myopic shift was found to be associated with 1 year of overminus spectacle treatment for children with intermittent exotropia (IXT). Persistence of myopic shift after discontinuing overminus spectacles is unknown. Objective: To compare refractive error change over 3 years in children with IXT originally treated with overminus vs nonoverminus spectacles. Design, Setting, and Participants: This study was an 18-month extension of the Trial of Overminus Spectacle Therapy for Intermittent Exotropia cohort, which previously randomized children aged 3 to 10 years with IXT and baseline spherical equivalent refractive error (SER) between -6.00 diopters (D) and 1.00 D to overminus spectacles (-2.50 D for 12 months, -1.25 D for 3 months, and nonoverminus for 3 months) or nonoverminus spectacles. Children were recruited from 56 sites from July 2010 to February 2022. Data were analyzed from February 2022 to January 2024. Interventions: After trial completion at 18 months, participants were followed up at 24 and 36 months. Treatment was at investigator discretion from 18 to 36 months. Main Outcomes and Measures: Change in SER (cycloplegic retinoscopy) from baseline to 36 months. Results: Of 386 children in the Trial of Overminus Spectacle Therapy for Intermittent Exotropia, 223 (57.8%) consented to 18 months of additional follow-up, including 124 of 196 (63.3%) in the overminus treatment group and 99 of 190 (52.1%) in the nonoverminus treatment group. Of 205 children who completed 36-month follow-up, 116 (56.6%) were female, and the mean (SD) age at randomization was 6.2 (2.1) years. Mean (SD) SER change from baseline to 36 months was greater in the overminus group (-0.74 [1.00] D) compared with the nonoverminus group (-0.44 [0.85] D; adjusted difference, -0.36 D; 95% CI, -0.59 to -0.12; P = .003), with 30 of 112 (26.8%) in the overminus group having more than 1 D of myopic shift compared with 14 of 91 (15%) in the nonoverminus group (risk ratio, 1.8; 95% CI, 1.0-3.0). From 12 to 36 months, mean (SD) myopic shift was -0.34 (0.67) D and -0.36 (0.66) D in the overminus and nonoverminus groups, respectively (adjusted difference, -0.001 D; 95% CI, -0.18 to 0.18; P = .99). Conclusions and Relevance: The greater myopic shift observed after 1 year of -2.50-D overminus lens treatment remained at 3 years. Both groups had similar myopic shift during the 2-year period after treatment weaning and cessation. The risk of myopic shift should be discussed with parents when considering overminus lens treatment. Trial Registration: ClinicalTrials.gov Identifier: NCT02807350.

  PublisherOA PDFDOI

• Performance of VisuALL virtual reality visual field testing in healthy children

  Journal of American Association for Pediatric Ophthalmology and Strabismus · 2024-01-18 · 8 citations

  articleOpen access
  PublisherOA PDFDOI

• Repeated Low‐level Red‐light Therapy: The Next Wave in Myopia Management?

  Optometry and Vision Science · 2023 · 31 citations

  • Medicine
  • Ophthalmology
  • Optometry

  SIGNIFICANCE: Exposure to long-wavelength light has been proposed as a potential intervention to slow myopia progression in children. This article provides an evidence-based review of the safety and myopia control efficacy of red light and discusses the potential mechanisms by which red light may work to slow childhood myopia progression.The spectral composition of the ambient light in the visual environment has powerful effects on eye growth and refractive development. Studies in mammalian and primate animal models (macaque monkeys and tree shrews) have shown that daily exposure to long-wavelength (red or amber) light promotes slower eye growth and hyperopia development and inhibits myopia induced by form deprivation or minus lens wear. Consistent with these results, several recent randomized controlled clinical trials in Chinese children have demonstrated that exposure to red light for 3 minutes twice a day significantly reduces myopia progression and axial elongation. These findings have collectively provided strong evidence for the potential of using red light as a myopia control intervention in clinical practice. However, several questions remain unanswered. In this article, we review the current evidence on the safety and efficacy of red light as a myopia control intervention, describe potential mechanisms, and discuss some key unresolved issues that require consideration before red light can be broadly translated into myopia control in children.

  PublisherDOI

• The Role of Contact Lenses in the Management of Ocular Surface Disease in Children

  2023-01-01

  book-chapter
  PublisherDOI

• Refractive Accuracy and Visual Outcome by Self-Refraction Using Adjustable-Focus Spectacles in Young Children

  JAMA Ophthalmology · 2023-08-24 · 9 citations

  articleOpen access

  Importance: Uncorrected refractive error is the most common cause of vision impairment in children. Most children 12 years or older can achieve visual acuity (VA) of 20/25 or better by self-refraction using adjustable-focus spectacles, but data on younger children are lacking. Objective: To assess refractive accuracy, corrected VA, and factors associated with not achieving VA of 20/25 or better among children aged 5 to 11 years performing self-refraction with Adspecs adjustable-focus spectacles (Adaptive Eyecare), compared with noncycloplegic autorefraction and cycloplegic refraction. Design, Setting, and Participants: This was a cross-sectional noninferiority trial conducted from September 2, 2015, to December 14, 2017. The study setting was an academic pediatric eye clinic. Children aged 5 to 11 years with uncorrected VA of 20/40 or worse in 1 or both eyes and without systemic or ocular conditions preventing best-corrected VA of 20/25 or better were enrolled. Children who had best-corrected VA worse than 20/25 were excluded. Study data were analyzed from September 2017 to June 2023. Exposures: Children were taught to self-refract with adjustable-focus spectacles. Main Outcomes and Measures: Spherical equivalent refractive error (using self-refraction, noncycloplegic autorefraction, and cycloplegic refraction) and VA (uncorrected and using self-refraction, noncycloplegic autorefraction, and cycloplegic refraction) for study eyes were evaluated. Potential predictors of failure to achieve VA of 20/25 or better with self-refraction were assessed using logistic regression. Results: A total of 127 consecutive children were enrolled. After exclusions, 112 children (median [IQR] age, 9.0 [8.0-10.3] years; 52 boys [46.4%]) were included in the study. Mean (SD) spherical equivalent refractive power was -2.00 (1.52) diopters (D) for self-refraction, -2.32 (1.43) D for noncycloplegic autorefraction, and -1.67 (1.49) D for cycloplegic refraction. Mean (SD) difference in refractive power between self-refraction and noncycloplegic autorefraction was 0.32 (1.11) D (97.5% 1-sided CI, 0.11 to ∞ D; P < .001) and between self-refraction and cycloplegic refraction was -0.33 (1.15) D (97.5% 1-sided CI, -0.54 to ∞ D; P = .77). The proportion of children with corrected VA of 20/25 or better was 79.5% (89 of 112) with self-refraction, 85.7% (96 of 112) with noncycloplegic autorefraction, and 79.5% (89 of 112) with cycloplegic refraction (self-refraction vs noncycloplegic autorefraction: McNemar P value = .27; self-refraction vs cycloplegic refraction: McNemar P value > .99). Those failing to achieve best-corrected VA of 20/25 or better with self-refraction had higher astigmatism (odds ratio [OR], 10.6; 95% CI, 3.1-36.4; P < .001) and younger age (OR, 1.5; 95% CI, 1.1-2.2; P = .02). Conclusions and Relevance: Self-refraction among children aged 5 to 11 years may result in more myopic power than cycloplegic refraction but not necessarily to a clinically relevant degree. Although the proportion of children achieving VA of 20/25 or better with self-refraction using adjustable-focus spectacles did not differ from cycloplegic refraction, it was less likely among younger children and those with higher astigmatism.

  PublisherOA PDFDOI

• Low- and Very Low-Dose Bevacizumab for Retinopathy of Prematurity

  Ophthalmology · 2022 · 25 citations

  • Medicine
  • Ophthalmology
  • Pediatrics
  PublisherOA PDFDOI

• Amblyopia (Lazy Eye)

  2021-04-12

  book-chapter1st authorCorresponding
  PublisherDOI

Frequent coauthors

• Sharon F. Freedman

  Duke Medical Center

  9 shared

• Jonathan M. Holmes

  University of Arizona

  8 shared

• Eric R. Crouch

  Virginia Eye Consultants

  7 shared

• Erin C. Jenewein

  Salus University

  7 shared

• Katherine K. Weise

  7 shared

• Raymond T. Kraker

  Jaeb Center for Health Research

  7 shared

• Sean P. Donahue

  6 shared

• S. Grace Prakalapakorn

  Duke Medical Center

  6 shared

Education

• Pediatric Optometry Resident, School of Optometry

  Ohio State University

  2016

• Doctor of Optometry, School of Optometry

  University of California Berkeley

  2015

• Life Sciences with Honors

  Queen's University

  2011