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Abstract
PURPOSE Higher myopic refractive errors are associated with serious ocular complications that can put visual function at risk. There is respective interest in slowing and if possible stopping myopia progression before it reaches a level associated with increased risk of secondary pathology. The purpose of this report was to review our understanding of the rationale(s) and success of contact lenses (CLs) used to reduce myopia progression. METHODS A review commenced by searching the PubMed database. The inclusion criteria stipulated publications of clinical trials evaluating the efficacy of CLs in regulating myopia progression based on the primary endpoint of changes in axial length measurements and published in peer-reviewed journals. Other publications from conference proceedings or patents were exceptionally considered when no peer-review articles were available. RESULTS The mechanisms that presently support myopia regulation with CLs are based on the change of relative peripheral defocus and changing the foveal image quality signal to potentially interfere with the accommodative system. Ten clinical trials addressing myopia regulation with CLs were reviewed, including corneal refractive therapy (orthokeratology), peripheral gradient lenses, and bifocal (dual-focus) and multifocal lenses. CONCLUSIONS CLs were reported to be well accepted, consistent, and safe methods to address myopia regulation in children. Corneal refractive therapy (orthokeratology) is so far the method with the largest demonstrated efficacy in myopia regulation across different ethnic groups. However, factors such as patient convenience, the degree of initial myopia, and non-CL treatments may also be considered. The combination of different strategies (i.e., central defocus, peripheral defocus, spectral filters, pharmaceutical delivery, and active lens-borne illumination) in a single device will present further testable hypotheses exploring how different mechanisms can reinforce or compete with each other to improve or reduce myopia regulation with CLs.
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You X, Wang L, Tan H, He X, Qu X, Shi H, Zhu J, Zou H. Near Work Related Behaviors Associated with Myopic Shifts among Primary School Students in the Jiading District of Shanghai: A School-Based One-Year Cohort Study. PLoS One 2016; 11:e0154671. [PMID: 27139017 PMCID: PMC4854402 DOI: 10.1371/journal.pone.0154671] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 04/18/2016] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To investigate the characteristics of various near work related behaviors among primary students and their associations with changes in myopia related ocular biometric parameters during one-year of follow up. METHODS A school-based sample of 4,814 primary 1st to 4th grade students aged 6-10 years old were selected by cluster randomization based on probability proportion to size in 2013. At baseline, students together with their parents filled in a self-administered questionnaire on 9 aspects of near work related behaviors and some important covariants of myopia. A comprehensive set of eye examinations including axial length (AL) and cycloplegic refraction was conducted both at baseline and one year later. RESULTS With the grade level increase, students did increasingly better at finding various ways to have an eye break, but they were increasingly likely to continuously do long-time near work without an eye break. Keeping a reasonable eye distance and correct hand posture for reading, writing, or watching TV became worse for the first time before grade 2, but then became better at grade 3. In contrast, selecting appropriate lighting environments or situations and keeping a balanced diet became better for the first time before grade 2, but then became worse at grade 3. At one-year follow up, the mean AL increased by 0.32 ± 0.35 mm, the ratio of AL divided by the mean corneal radius of curvature (AL/CR ratio) increased by 0.032 ± 0.054, the myopic spherical equivalent (SE) increased by -0.51 ± 0.51 diopters and the incidence of myopia was 16.0% (237/1,477). After controlling for the confounding effects of parental myopia, student's age, gender, height, daily near work time, daily outdoor activity time and all of the other near work related behaviors, keeping a reasonable distance when reading, writing and watching TV was associated with elongation of the AL [standard coefficient beta = -0.062, P = 0.004], a change in SE [beta = -0.072, P = 0.020] and incident myopia [adjusted odds ratio (aOR) = 0.90, 95% confidence interval (CI): 0.84-0.96]. Selecting an environment with adequate light for visual comfort to read and write was related to elongation of the AL [beta = -0.039, P = 0.034] and increase of AL/CR ratio [beta = -0.030, P = 0.048]. Also, not continuing to do near work for more than 30-40 minutes without an eye break was related to increase of the AL/CR ratio [beta = -0.028, P = 0.044] and a change in SE [beta = -0.064, P = 0.023]. CONCLUSION Various near work related behaviors changed according to grade level in primary school students. Independent of hereditary factors, daily near work load and outdoor activity, near work related behaviors such as keeping an inappropriate eye distance for near work, selecting inadequate lighting environments, and continuing to do near work without an eye break were risk factors for myopic shifts.
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Affiliation(s)
- Xiaofang You
- Department of Maternal and Child Health, School of Public Health, Key Laboratory of Public Health Safety, Ministry of Education, Fudan University, Shanghai, China
| | - Ling Wang
- Department of Maternal and Child Health, School of Public Health, Key Laboratory of Public Health Safety, Ministry of Education, Fudan University, Shanghai, China
| | - Hui Tan
- Department of Maternal and Child Health, School of Public Health, Key Laboratory of Public Health Safety, Ministry of Education, Fudan University, Shanghai, China
| | - Xiangui He
- Department of Maternal and Child Health, School of Public Health, Key Laboratory of Public Health Safety, Ministry of Education, Fudan University, Shanghai, China
- Department of Eye Disease Prevention, Shanghai Eye Disease Prevention & Treatment Center, Shanghai, China
| | - Xiaomei Qu
- Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Huijing Shi
- Department of Maternal and Child Health, School of Public Health, Key Laboratory of Public Health Safety, Ministry of Education, Fudan University, Shanghai, China
- * E-mail:
| | - Jianfeng Zhu
- Department of Eye Disease Prevention, Shanghai Eye Disease Prevention & Treatment Center, Shanghai, China
| | - Haidong Zou
- Department of Eye Disease Prevention, Shanghai Eye Disease Prevention & Treatment Center, Shanghai, China
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Foo VHX, Verkicharla PK, Ikram MK, Chua SYL, Cai S, Tan CS, Chong YS, Kwek K, Gluckman P, Wong TY, Ngo C, Saw SM, On Behalf Of The Gusto Study Group. Axial Length/Corneal Radius of Curvature Ratio and Myopia in 3-Year-Old Children. Transl Vis Sci Technol 2016; 5:5. [PMID: 26929885 PMCID: PMC4757459 DOI: 10.1167/tvst.5.1.5] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2015] [Accepted: 12/13/2015] [Indexed: 12/15/2022] Open
Abstract
PURPOSE This study investigated the association of axial length (AL) to corneal radius of curvature (CRC) ratio with spherical equivalent (SE) in a 3-year old Asian cohort. METHODS Three-hundred forty-nine 3-year old Asian children from The Growing Up in Singapore towards Healthy Outcomes (GUSTO) birth cohort study underwent AL and CRC measurements with a noncontact ocular biometer and cycloplegic refraction using an autorefractor. The ratio of AL to CRC (AL/CRC) was calculated for all the participants, and subsequently AL, CRC, and AL/CRC were analyzed in relationship to SE. RESULTS The SE showed better correlation with AL/CRC (Spearman's correlation coefficient, ρ = -0.53; 95% confidence interval [CI]: -0.66; -0.49; P < 0.001) compared to either AL or CRC alone ([ρ = -0.36; 95% CI: -0.51 to 0.51; P = 0.01] and [ρ = 0.05; 95% CI: -0.04 to 0.17; P = 0.34], respectively). Mean AL/CRC was 2.91 ± 0.06 among myopes and decreased to 2.79 ± 0.06 among hyperopes. Axial length to corneal radius of curvature was strongly correlated with SE in myopes (ρ = -0.78; 95% CI: -3.76; -0.79; P = < 0.001), but not in emmetropes and hyperopes ([ρ = -0.39; 95% CI: -10.73; -0.57; P = 0.01] and [ρ = -0.18; 95% CI: -17.28; 12.42; P = 0.38], respectively). Linear regression adjusted for gender and ethnicity showed a 0.74-diopter shift in SE towards myopia with every 0.1 increase in AL/CRC ratio (P < 0.001, r2 = 0.33). CONCLUSION The correlation between SE and AL/CRC is stronger than that between AL or CRC alone. This suggests that in a research setting, when cycloplegic refraction is difficult to perform on 3-year-old children, AL/CRC may be the next best reference for refractive error. TRANSLATIONAL RELEVANCE In the research setting, AL/CRC may be the next best reference for refractive error over AL alone when cycloplegic refraction is unavailable in 3-year old children.
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Affiliation(s)
| | | | - Mohammad Kamran Ikram
- Department of Ophthalmology, National University Hospital, National University Health System, Singapore, Singapore ; Memory Aging & Cognition Center, National University Health System, Singapore, Singapore
| | - Sharon Yu Lin Chua
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Shirong Cai
- Department of Obstetrics and Gynecology, National University Hospital, National University Health System, Singapore, Singapore
| | - Chuen Seng Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Yap-Seng Chong
- Department of Obstetrics and Gynecology, National University Hospital, National University Health System, Singapore, Singapore ; Singapore Institute for Clinical Sciences - ASTAR, Singapore, Singapore
| | - Kenneth Kwek
- KK Women's and Children's Hospital, Singapore, Singapore
| | - Peter Gluckman
- Singapore Institute for Clinical Sciences - ASTAR, Singapore, Singapore ; Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Tien-Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore ; Department of Ophthalmology, National University Hospital, National University Health System, Singapore, Singapore
| | - Cheryl Ngo
- Department of Ophthalmology, National University Hospital, National University Health System, Singapore, Singapore
| | - Seang-Mei Saw
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
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Fu AC, Chen XL, Lv Y, Wang SL, Shang LN, Li XH, Zhu Y. Higher spherical equivalent refractive errors is associated with slower axial elongation wearing orthokeratology. Cont Lens Anterior Eye 2016; 39:62-6. [DOI: 10.1016/j.clae.2015.07.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 06/18/2015] [Accepted: 07/17/2015] [Indexed: 10/23/2022]
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Hung GK, Mahadas K, Mohammad F. Eye growth and myopia development: Unifying theory and Matlab model. Comput Biol Med 2016; 70:106-118. [PMID: 26820446 DOI: 10.1016/j.compbiomed.2016.01.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 12/31/2015] [Accepted: 01/03/2016] [Indexed: 01/26/2023]
Abstract
The aim of this article is to present an updated unifying theory of the mechanisms underlying eye growth and myopia development. A series of model simulation programs were developed to illustrate the mechanism of eye growth regulation and myopia development. Two fundamental processes are presumed to govern the relationship between physiological optics and eye growth: genetically pre-programmed signaling and blur feedback. Cornea/lens is considered to have only a genetically pre-programmed component, whereas eye growth is considered to have both a genetically pre-programmed and a blur feedback component. Moreover, based on the Incremental Retinal-Defocus Theory (IRDT), the rate of change of blur size provides the direction for blur-driven regulation. The various factors affecting eye growth are shown in 5 simulations: (1 - unregulated eye growth): blur feedback is rendered ineffective, as in the case of form deprivation, so there is only genetically pre-programmed eye growth, generally resulting in myopia; (2 - regulated eye growth): blur feedback regulation demonstrates the emmetropization process, with abnormally excessive or reduced eye growth leading to myopia and hyperopia, respectively; (3 - repeated near-far viewing): simulation of large-to-small change in blur size as seen in the accommodative stimulus/response function, and via IRDT as well as nearwork-induced transient myopia (NITM), leading to the development of myopia; (4 - neurochemical bulk flow and diffusion): release of dopamine from the inner plexiform layer of the retina, and the subsequent diffusion and relay of neurochemical cascade show that a decrease in dopamine results in a reduction of proteoglycan synthesis rate, which leads to myopia; (5 - Simulink model): model of genetically pre-programmed signaling and blur feedback components that allows for different input functions to simulate experimental manipulations that result in hyperopia, emmetropia, and myopia. These model simulation programs (available upon request) can provide a useful tutorial for the general scientist and serve as a quantitative tool for researchers in eye growth and myopia.
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Affiliation(s)
- George K Hung
- Department of Biomedical Engineering, Rutgers University, 599 Taylor Road, Piscataway, NJ 08854, USA.
| | - Kausalendra Mahadas
- Department of Biomedical Engineering, Rutgers University, 599 Taylor Road, Piscataway, NJ 08854, USA
| | - Faisal Mohammad
- Department of Biomedical Engineering, Rutgers University, 599 Taylor Road, Piscataway, NJ 08854, USA
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Shams N, Mobaraki H, Kamali M, Jafarzadehpour E. Comparison of quality of life between myopic patients with spectacles and contact lenses, and patients who have undergone refractive surgery. J Curr Ophthalmol 2015; 27:32-6. [PMID: 27239572 PMCID: PMC4877719 DOI: 10.1016/j.joco.2015.10.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Purpose The present study aims at investigating and comparing the vision-related quality of life of myopic persons who wear spectacles or contact lenses with those who have undergone refractive surgery. It also compares the vision-related quality of life of these two groups with that of emmetropes. Method In this study, the questionnaire of evaluation instrument of refractive error in quality of life (NEI/RQL-42) was used to compare the quality of life between 154 myopic patients with spectacles and contact lenses, and 32 patients who have undergone refractive surgery. The two groups were also compared with 54 emmetropes. The questionnaire included 13 different subgroups (score 0–100) related to vision. Data was analyzed using SPSS software. Results The overall score of quality of life in emmetropes (95.11 ± 4.23) was more than that in persons who had undergone refractive surgery (86.98 ± 4.73), and it was the least in the group wearing spectacles or contact lenses (78.30 ± 9.21), (P < 0/001). Furthermore, except for a glare variable, the studied groups indicated a statistically significant difference in all the thirteen subgroups of vision-related quality of life. Conclusion Quality of life for people with myopia who had the refractive surgery was better than people with myopia who wore spectacles or contact lenses. Although quality of life in people with myopia who had the refractive surgery was less than emmetropia, it seems that refractive surgery improves quality of life of myopic patients.
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Lim LS, Chua S, Tan PT, Cai S, Chong YS, Kwek K, Gluckman PD, Fortier MV, Ngo C, Qiu A, Saw SM. Eye size and shape in newborn children and their relation to axial length and refraction at 3 years. Ophthalmic Physiol Opt 2015; 35:414-23. [PMID: 25958972 DOI: 10.1111/opo.12212] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 04/13/2015] [Indexed: 11/26/2022]
Abstract
PURPOSE To determine if eye size and shape at birth are associated with eye size and refractive error 3 years later. METHODS A subset of 173 full-term newborn infants from the Growing Up in Singapore Towards healthy Outcomes (GUSTO) birth cohort underwent magnetic resonance imaging (MRI) to measure the dimensions of the internal eye. Eye shape was assessed by an oblateness index, calculated as 1 - (axial length/width) or 1 - (axial length/height). Cycloplegic autorefraction (Canon Autorefractor RK-F1) and optical biometry (IOLMaster) were performed 3 years later. RESULTS Both eyes of 173 children were analysed. Eyes with longer axial length at birth had smaller increases in axial length at 3 years (p < 0.001). Eyes with larger baseline volumes and surface areas had smaller increases in axial length at 3 years (p < 0.001 for both). Eyes which were more oblate at birth had greater increases in axial length at 3 years (p < 0.001). Using width to calculate oblateness, prolate eyes had smaller increases in axial length at 3 years compared to oblate eyes (p < 0.001), and, using height, prolate and spherical eyes had smaller increases in axial length at 3 years compared to oblate eyes (p < 0.001 for both). There were no associations between eye size and shape at birth and refraction, corneal curvature or myopia at 3 years. CONCLUSIONS Eyes that are larger and have prolate or spherical shapes at birth exhibit smaller increases in axial length over the first 3 years of life. Eye size and shape at birth influence subsequent eye growth but not refractive error development.
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Affiliation(s)
| | - Sharon Chua
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore City, Singapore
| | - Pei Ting Tan
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore City, Singapore
| | - Shirong Cai
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore City, Singapore
| | - Yap-Seng Chong
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore City, Singapore.,Singapore Institute for Clinical Sciences, The Agency for Science, Technology and Research, Singapore City, Singapore
| | - Kenneth Kwek
- Department of Maternal Fetal Medicine, KK Women's and Children's Hospital, Singapore City, Singapore
| | - Peter D Gluckman
- Singapore Institute for Clinical Sciences, The Agency for Science, Technology and Research, Singapore City, Singapore.,Liggins Institute, University of Auckland, Auckland, New Zealand
| | | | - Cheryl Ngo
- Department of Ophthalmology, National University Hospital, Singapore City, Singapore
| | - Anqi Qiu
- Department of Biomedical Engineering, National University of Singapore, Singapore City, Singapore.,Clinical Imaging Research Center, National University of Singapore, Singapore City, Singapore
| | - Seang-Mei Saw
- Singapore Eye Research Institute, Singapore City, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore City, Singapore
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Wu LJ, Wang YX, You QS, Duan JL, Luo YX, Liu LJ, Li X, Gao Q, Zhu HP, He Y, Xu L, Song MS, Jonas JB, Guo XH, Wang W. Risk Factors of Myopic Shift among Primary School Children in Beijing, China: A Prospective Study. Int J Med Sci 2015; 12:633-8. [PMID: 26283882 PMCID: PMC4532970 DOI: 10.7150/ijms.12133] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Accepted: 07/06/2015] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVE To evaluate factors associated with myopic shift among primary school children. METHODS In a one-year prospective school-based study, 5052 children from ten schools were enrolled using a multi-stage random cluster approach. The baseline examination included non-cycloplegic auto-refractometry and questionnaire interview. Measurements were repeated at the follow-up. RESULTS Among 5052 students at baseline investigated, 4292 students (85.0%) returned for the follow-up examination. The mean refractive error (-1.13±1.57 diopters) had changed -0.52±0.73 diopters from the baseline to the follow-up examination. 2170 (51.0%) had a rate of significant myopic shift (significant myopic shift is defined as the change of spherical equivalent of the refraction ≤ -0.50D between the follow-up and baseline measures). We confirmed that common associated factors (older age, parental myopia, lower refractive status at baseline, shorter reading distance and lower frequency of outdoor activities during class recesses) were associated with greater shift towards myopia. After controlling for age, sex, region of habitation, parental myopia and refractive status at baseline, greater shift towards myopia was independently associated with distance from near-work (OR=1.48 , 95% CI=1.26-1.74, P<0.001) and longer time outdoors for leisure (OR=0.87, 95% CI=0.78-0.97, P<0.013). CONCLUSION Greater shift towards myopia was independently associated with modifiable factors (distance from near-work and longer time outdoors for leisure) might suggest that encouraging children to go outside for outdoor activities during class recess and after school may be a promising and feasible intervention against myopia development.
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Affiliation(s)
- Li-Juan Wu
- 1. School of Public Health, Capital Medical University, Beijing 100069, China ; 2. Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing 100069, China
| | - You-Xin Wang
- 1. School of Public Health, Capital Medical University, Beijing 100069, China ; 2. Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing 100069, China
| | - Qi-Sheng You
- 3. Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Science Key Lab, Beijing100005, China
| | - Jia-Li Duan
- 4. Beijing Center for Disease Prevention and Control, Beijing 100013, China
| | - Yan-Xia Luo
- 1. School of Public Health, Capital Medical University, Beijing 100069, China ; 2. Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing 100069, China
| | - Li-Juan Liu
- 3. Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Science Key Lab, Beijing100005, China
| | - Xia Li
- 1. School of Public Health, Capital Medical University, Beijing 100069, China ; 2. Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing 100069, China
| | - Qi Gao
- 1. School of Public Health, Capital Medical University, Beijing 100069, China ; 2. Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing 100069, China
| | - Hui-Ping Zhu
- 1. School of Public Health, Capital Medical University, Beijing 100069, China ; 2. Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing 100069, China
| | - Yan He
- 1. School of Public Health, Capital Medical University, Beijing 100069, China ; 2. Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing 100069, China
| | - Liang Xu
- 3. Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Science Key Lab, Beijing100005, China
| | - Man-Shu Song
- 1. School of Public Health, Capital Medical University, Beijing 100069, China ; 2. Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing 100069, China
| | - Jost B Jonas
- 3. Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Science Key Lab, Beijing100005, China ; 5. Department of Ophthalmology, Medical Faculty Mannheim of the Ruprecht-Karls-University Heidelberg, 68167 Mannheim, Germany
| | - Xiu-Hua Guo
- 1. School of Public Health, Capital Medical University, Beijing 100069, China ; 2. Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing 100069, China
| | - Wei Wang
- 1. School of Public Health, Capital Medical University, Beijing 100069, China ; 2. Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing 100069, China ; 6. School of Medical Science, Edith Cowan University, Perth 6027, Australia
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Hiraoka T, Kakita T, Okamoto F, Oshika T. Influence of ocular wavefront aberrations on axial length elongation in myopic children treated with overnight orthokeratology. Ophthalmology 2014; 122:93-100. [PMID: 25234013 DOI: 10.1016/j.ophtha.2014.07.042] [Citation(s) in RCA: 104] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 07/08/2014] [Accepted: 07/20/2014] [Indexed: 10/24/2022] Open
Abstract
PURPOSE To determine ocular optical parameters that affect axial length elongation in myopic children undergoing overnight orthokeratology. DESIGN Prospective, noncomparative study. PARTICIPANTS Fifty-nine subjects who met the inclusion criteria were enrolled in this study. METHODS Axial length and ocular wavefront aberration were assessed before and 1 year after the start of orthokeratology. Corneal topography was performed, and then corneal multifocality was calculated for a 4-mm pupil. After evaluating simple correlations between axial elongation and optical parameters, multiple linear regression analysis was performed to identify explanatory variables with a statistically significant contribution to axial elongation. MAIN OUTCOME MEASURES Axial length and ocular wavefront aberration before and 1 year after the start of orthokeratology. RESULTS Fifty-five subjects completed the 1-year follow-up examinations. At baseline, their age ranged from 7.2 to 12.0 years. The manifest spherical equivalent refractive error ranged from -3.50 to -0.75 diopters. The mean axial length significantly increased from 24.20 mm at baseline to 24.43 mm 1 year after treatment. The axial elongation showed significant simple correlations with the change in C2(0), change in second-order aberration, change in coma-like aberration, change in spherical-like aberration, change in total higher-order aberrations, change in corneal multifocality, baseline age, and baseline spherical equivalent refractive error, but not C4(0). Multiple linear regression analysis showed that the change in coma-like aberration was the most relevant variable. CONCLUSIONS Asymmetric corneal shapes, rather than concentric and radially symmetric shapes, have a considerable effect on retardation of axial elongation, suggesting that the inhibitory effect of orthokeratology on myopia progression is caused by mechanisms other than the reduction in peripheral hyperopic defocus.
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Affiliation(s)
- Takahiro Hiraoka
- Department of Ophthalmology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan.
| | | | - Fumiki Okamoto
- Department of Ophthalmology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Tetsuro Oshika
- Department of Ophthalmology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
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Wong YZ, Lam AKC. The Roles of Cornea and Axial Length in Corneal Hysteresis among Emmetropes and High Myopes: A Pilot Study. Curr Eye Res 2014; 40:282-9. [DOI: 10.3109/02713683.2014.922193] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Foster PJ, Jiang Y. Epidemiology of myopia. Eye (Lond) 2014; 28:202-8. [PMID: 24406412 DOI: 10.1038/eye.2013.280] [Citation(s) in RCA: 246] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Accepted: 11/21/2013] [Indexed: 11/09/2022] Open
Abstract
Myopia is one of the most prevalent disorders of the eye. Higher myopia is associated with comorbidities that increase risks of severe and irreversible loss of vision, such as retinal detachment, subretinal neovascularization, dense cataract, and glaucoma. In recent years, reports from population-based prevalence studies carried out in various geographical areas now give a clear picture of the current distribution of refractive error. The scarcity of data from well-designed longitudinal cohort studies is still yet to be addressed. These studies have confirmed the previous data indicating that prevalence of refractive error varies according to ethnicity and geographic regions, and also point to an increase in myopia prevalence over the past half-century. The problem is particularly pronounced in affluent, industrialised areas of East Asia. Environmental risk factors for myopia related to socioeconomic status and lifestyle have been identified. The past decade has seen a greater understanding of the molecular biological mechanisms that determine refractive error, giving further support to the belief that myopia is the result of a complex interaction between genetic predisposition and environmental exposures. This review summarizes data on the prevalence, incidence, progression, associations, risk factors, and impact from recent epidemiological studies on myopia.
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Affiliation(s)
- P J Foster
- 1] Division of Genetics & Epidemiology, UCL Institute of Ophthalmology, London, UK [2] NIHR Biomedical Research Centre, Moorfields Eye Hospital, London, UK
| | - Y Jiang
- Division of Genetics & Epidemiology, UCL Institute of Ophthalmology, London, UK
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Sherwin JC, Mackey DA. Update on the epidemiology and genetics of myopic refractive error. EXPERT REVIEW OF OPHTHALMOLOGY 2014. [DOI: 10.1586/eop.12.81] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Prevalence and risk factors for refractive errors: Korean National Health and Nutrition Examination Survey 2008-2011. PLoS One 2013; 8:e80361. [PMID: 24224049 PMCID: PMC3818255 DOI: 10.1371/journal.pone.0080361] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 10/11/2013] [Indexed: 11/24/2022] Open
Abstract
Purpose To examine the prevalence and risk factors of refractive errors in a representative Korean population aged 20 years old or older. Methods A total of 23,392 people aged 20+ years were selected for the Korean National Health and Nutrition Survey 2008–2011, using stratified, multistage, clustered sampling. Refractive error was measured by autorefraction without cycloplegia, and interviews were performed regarding associated risk factors including gender, age, height, education level, parent's education level, economic status, light exposure time, and current smoking history. Results Of 23,392 participants, refractive errors were examined in 22,562 persons, including 21,356 subjects with phakic eyes. The overall prevalences of myopia (< -0.5 D), high myopia (< -6.0 D), and hyperopia (> 0.5 D) were 48.1% (95% confidence interval [CI], 47.4–48.8), 4.0% (CI, 3.7–4.3), and 24.2% (CI, 23.6–24.8), respectively. The prevalence of myopia sharply decreased from 78.9% (CI, 77.4–80.4) in 20–29 year olds to 16.1% (CI, 14.9–17.3) in 60–69 year olds. In multivariable logistic regression analyses restricted to subjects aged 40+ years, myopia was associated with younger age (odds ratio [OR], 0.94; 95% Confidence Interval [CI], 0.93-0.94, p < 0.001), education level of university or higher (OR, 2.31; CI, 1.97–2.71, p < 0.001), and shorter sunlight exposure time (OR, 0.84; CI, 0.76–0.93, p = 0.002). Conclusions This study provides the first representative population-based data on refractive error for Korean adults. The prevalence of myopia in Korean adults in 40+ years (34.7%) was comparable to that in other Asian countries. These results show that the younger generations in Korea are much more myopic than previous generations, and that important factors associated with this increase are increased education levels and reduced sunlight exposures.
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Lam CSY, Tang WC, Tse DYY, Tang YY, To CH. Defocus Incorporated Soft Contact (DISC) lens slows myopia progression in Hong Kong Chinese schoolchildren: a 2-year randomised clinical trial. Br J Ophthalmol 2013; 98:40-5. [PMID: 24169657 PMCID: PMC3888618 DOI: 10.1136/bjophthalmol-2013-303914] [Citation(s) in RCA: 211] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Aims To determine if ‘Defocus Incorporated Soft Contact’ (DISC) lens wear slows childhood myopia progression. Methods A 2-year double-blind randomised controlled trial was carried out in 221 children aged 8–13 years, with myopia between −1.00 and −5.00 Dioptres (D) and astigmatism ≤1.00 D. Subjects were randomly assigned to the DISC (n=111) or single vision (SV; n=110) contact lens group. DISC lenses incorporated concentric rings, which provided an addition of +2.50 D, alternating with the normal distance correction. Refractive error (cycloplegic autorefraction) and axial length were measured at 6-month intervals. Differences between groups were analysed using unpaired t test. Results In total, 128 children completed the study, n=65 in the DISC group and n=63 in the SV group. Myopia progressed 25% more slowly for children in the DISC group compared with those in the control group (0.30 D/year; 95% CI −0.71 to −0.47 vs 0.4 D/year; 95% CI −0.93 to −0.65, p=0.031). Likewise, there was less axial elongation for children in the DISC versus SV groups (0.13 mm/year; 95% CI 0.20 to 0.31 vs 0.18 mm/year; 95% CI 0.30 to 0.43, p=0.009). Treatment effect correlated positively with DISC lens wearing time (r=0.342; p=0.005). Indeed, myopia in children who wore the DISC lenses for five or more hours/day progressed 46% (mean difference=−0.382 D, p=0.001; 95% CI −0.59 to −0.17) less than those in the SV group. Conclusions The daily wearing of DISC lens significantly slowed myopia progression and axial elongation in Hong Kong schoolchildren. The findings demonstrated that simultaneous clear vision with constant myopic defocus can retard myopia progression.
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Affiliation(s)
- Carly Siu Yin Lam
- Centre for Myopia Research, School of Optometry, The Hong Kong Polytechnic University, , Hung Hom, Kowloon, Hong Kong
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Drury VB, Saw SM, Finkelstein E, Wong TY, Tay PKC. A New Community-Based Outdoor Intervention to Increase Physical Activity in Singapore Children: Findings from Focus Groups. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2013. [DOI: 10.47102/annals-acadmedsg.v42n5p225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Introduction: Myopia is a significant public health problem in Singapore with estimates that more than 50% of the population is affected by it by the time of adulthood. Childhood obesity is also increasing and has been linked to long-term health problems. Recent studies have found that Singaporean children in Primary 1 spend less than 3 hours a day outdoors which is less than children in other countries. Physical activity has been shown to be protective against obesity and recently, there has been some evidence to suggest that time spent outdoors may reduce the prevalence and severity of myopia. This study aims to explore the barriers and enablers to children in Singapore participating in outdoor activities. Materials and Methods: Qualitative data, gathered from focus group discussions was thematically analysed against the PRECEDE component of the PRECEDE-PROCEED model which provided a conceptual framework for examining factors relevant to children participating in an outdoor activity intervention. A total of 31 people participated in 4 focus groups held over a 6-month period. Results: This feasibility study was exploratory in nature but provided valuable information concerning barriers and enablers to participation. Data informed the development of a larger study. Conclusion: Results indicated that families preferred structured activities such as orienteering and a choice of weekend attendance days and times.
Key words: Myopia, Physical activity, Qualitative research, Singapore
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Affiliation(s)
- Vicki B Drury
- Faculty of Health Sciences, School of Nursing and Midwifery University, Australia
| | - Seang Mei Saw
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | | | - Tien Yin Wong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Peter KC Tay
- Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore
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Yeh ML, Chen HH, Chung YC. One year study on the integrative intervention of acupressure and interactive multimedia for visual health in school children. Complement Ther Med 2012; 20:385-92. [PMID: 23131368 DOI: 10.1016/j.ctim.2012.09.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Revised: 09/07/2012] [Accepted: 09/13/2012] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE This study used a larger sample size, added a long-term observation of the effect of intervention, and provided an integrated intervention of acupressure and interactive multimedia of visual health instruction for school children. The short- and long-term effects of the interventions were then evaluated by visual health knowledge, visual acuity, and refractive error. DESIGN A repeated pretest-posttest controlled trial was used with two experimental groups and one control group. SETTING Four elementary schools in northern Taiwan. PARTICIPANTS 287 School children with visual impairment in fourth grade were recruited. METHOD One experimental group received the integrative intervention of acupressure and interactive multimedia of visual health instruction (ACIMU), and another received auricular acupressure (AC) alone; whereas a control group received no intervention. Two 10-week interventions were separately given in the fall and spring semesters. The short- and long-term effects of the interventions were then evaluated by visual health knowledge, visual acuity, and refractive error. RESULTS During the school year the visual health knowledge was significantly higher in the ACIMU group than the control group (p<0.001). A significant difference in the changing visual acuity was in the three groups (p<0.001), with the improvement in the ACIMU group. No difference in the refractive error was found between any two groups (p>0.05). CONCLUSIONS This study demonstrated that a long-term period of acupressure is required to improve school children's visual health. School children receiving the intervention of acupressure combined with interactive multimedia had better improvement of visual health and related knowledge than others. Further study is suggested in which visual health and preventative needs can be established for early childhood.
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Affiliation(s)
- Mei-Ling Yeh
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan, ROC.
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Abstract
BACKGROUND Myopia, the most common type of refractive error, is a complex trait including both genetic and environmental factors. Numerous studies have tried to elucidate the aetiology of myopia. However, the exact aetiology of myopia is still unclear. PURPOSE To summarize the worldwide patterns and trends for the prevalence of myopia and to evaluate the risk factors for myopia in population-based studies. RECENT FINDINGS The prevalences of myopia vary across populations of different regions and ethnicities. In population-based studies on children, the prevalence of myopia has been reported to be higher in urban areas and Chinese ethnicity. The regional and racial difference is not so obvious in adult populations aged over 40 years. More time spent on near work, less time outdoors, higher educational level and parental history of myopia have been reported to increase the risk of myopia. CONCLUSIONS Environmental factors play a crucial role in myopia development. The effect of gene-environment interaction on the aetiology of myopia is still controversial with inconsistent findings in different studies. A relatively hyperopic periphery can stimulate compensating eye growth in the centre. Longitudinal cohort studies or randomized clinical trials of community-based health behaviour interventions should be conducted to further clarify the aetiology of myopia.
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Affiliation(s)
- Chen-Wei Pan
- Department of Epidemiology and Public Health, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Anstice NS, Phillips JR. Effect of dual-focus soft contact lens wear on axial myopia progression in children. Ophthalmology 2011; 118:1152-61. [PMID: 21276616 DOI: 10.1016/j.ophtha.2010.10.035] [Citation(s) in RCA: 268] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2010] [Revised: 10/21/2010] [Accepted: 10/22/2010] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To test the efficacy of an experimental Dual-Focus (DF) soft contact lens in reducing myopia progression. DESIGN Prospective, randomized, paired-eye control, investigator-masked trial with cross-over. PARTICIPANTS Forty children, 11-14 years old, with mean spherical equivalent refraction (SER) of -2.71 ± 1.10 diopters (D). METHODS Dual-Focus lenses had a central zone that corrected refractive error and concentric treatment zones that created 2.00 D of simultaneous myopic retinal defocus during distance and near viewing. Control was a single vision distance (SVD) lens with the same parameters but without treatment zones. Children wore a DF lens in 1 randomly assigned eye and an SVD lens in the fellow eye for 10 months (period 1). Lens assignment was then swapped between eyes, and lenses were worn for a further 10 months (period 2). MAIN OUTCOME MEASURES Primary outcome was change in SER measured by cycloplegic autorefraction over 10 months. Secondary outcome was a change in axial eye length (AXL) measured by partial coherence interferometry over 10 months. Accommodation wearing DF lenses was assessed using an open-field autorefractor. RESULTS In period 1, the mean change in SER with DF lenses (-0.44 ± 0.33 D) was less than with SVD lenses (-0.69 ± 0.38 D; P < 0.001); mean increase in AXL was also less with DF lenses (0.11 ± 0.09 mm) than with SVD lenses (0.22 ± 0.10 mm; P < 0.001). In 70% of the children, myopia progression was reduced by 30% or more in the eye wearing the DF lens relative to that wearing the SVD lens. Similar reductions in myopia progression and axial eye elongation were also observed with DF lens wear during period 2. Visual acuity and contrast sensitivity with DF lenses were not significantly different than with SVD lenses. Accommodation to a target at 40 cm was driven through the central distance-correction zone of the DF lens. CONCLUSIONS Dual-Focus lenses provided normal acuity and contrast sensitivity and allowed accommodation to near targets. Myopia progression and eye elongation were reduced significantly in eyes wearing DF lenses. The data suggest that sustained myopic defocus, even when presented to the retina simultaneously with a clear image, can act to slow myopia progression without compromising visual function. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found after the references.
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Affiliation(s)
- Nicola S Anstice
- Department of Optometry and Vision Science, New Zealand National Eye Centre, The University of Auckland, New Zealand
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Abstract
PURPOSE To report the results of 12-month wear of three novel spectacle lens designs intended to reduce peripheral hyperopic defocus and one standard design control lens and their effect on the progression of myopia in Chinese children aged 6 to 16 years. METHODS Chinese children (n = 210) with myopia (-0.75 D to -3.50 D sphere, cylinder <or=-1.50 D) were randomized to one of four groups wearing either one of three novel spectacle lens designs (types I, II, or III) or conventional, single-vision spectacle lenses. Data were collected at 6 and 12 months. Primary and secondary outcome measures were the changes in central cycloplegic auto-refraction and eye axial length, respectively. Peripheral refraction along the horizontal meridian (nasal and temporal) was taken at baseline with and without spectacle lenses. Multivariate linear regression was used to adjust analyses for important covariates. RESULTS Progression in eyes wearing control spectacle lenses at 6 and 12 months was -0.55 D +/- 0.35 D and -0.78 +/- 0.50 D, respectively. For the entire group, no statistically significant differences were observed in the rates of progression with the novel designs in comparison to control spectacle lenses. However, in younger children (6 to 12 years) with parental history of myopia (n = 100), there was significantly less progression (-0.68 D +/- 0.47 D vs. -0.97 D +/- 0.48 D) with lens type III compared with control spectacles (mean difference, 0.29 D, std error, 0.11, p = 0.038). CONCLUSIONS There were no statistically significant differences in the rate of progression of myopia between the control and novel lens wearing eyes for the age group 6 to 16 years. The finding of reduced progression of myopia with type III lens design in younger children with parental myopia needs to be validated in a more targeted study.
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Lim LS, Gazzard G, Low YL, Choo R, Tan DT, Tong L, Yin Wong T, Saw SM. Dietary Factors, Myopia, and Axial Dimensions in Children. Ophthalmology 2010; 117:993-997.e4. [DOI: 10.1016/j.ophtha.2009.10.003] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2009] [Revised: 09/09/2009] [Accepted: 10/01/2009] [Indexed: 12/12/2022] Open
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