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Vincent SJ, Cho P, Chan KY, Fadel D, Ghorbani-Mojarrad N, González-Méijome JM, Johnson L, Kang P, Michaud L, Simard P, Jones L. CLEAR - Orthokeratology. Cont Lens Anterior Eye 2021; 44:240-269. [DOI: 10.1016/j.clae.2021.02.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 02/01/2021] [Indexed: 12/25/2022]
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Xu J, Tao C, Mao X, Lu X, Bao J, Drobe B, Chen H. Blur Detection Sensitivity Increases in Children Using Orthokeratology. Front Neurosci 2021; 15:630844. [PMID: 33790734 PMCID: PMC8006440 DOI: 10.3389/fnins.2021.630844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 02/24/2021] [Indexed: 11/29/2022] Open
Abstract
Purpose To investigate changes in blur detection sensitivity in children using orthokeratology (Ortho-K) and explore the relationships between blur detection thresholds (BDTs) and aberrations and accommodative function. Methods Thirty-two children aged 8–14 years old who underwent Ortho-K treatment participated in and completed this study. Their BDTs, aberrations, and accommodative responses (ARs) were measured before and after a month of Ortho-K treatment. A two forced-choice double-staircase procedure with varying extents of blur in three images (Tumbling Es, Lena, and Street View) was used to measure the BDTs. The participants were required to judge whether the images looked blurry. The BDT of each of the images (BDT_Es, BDT_Lena, and BDT_Street) was the average value of the last three reversals. The accommodative lag was quantified by the difference between the AR and the accommodative demand (AD). Changes in the BDTs, aberrations, and accommodative lags and their relationships were analyzed. Results After a month of wearing Ortho-K lenses, the children’s BDT_Es and BDT_Lena values decreased, the aberrations increased significantly (for all, P ≤0.050), and the accommodative lag decreased to a certain extent [T(31) = 2.029, P = 0.051]. Before Ortho-K treatment, higher-order aberrations (HOAs) were related to BDT_Lena (r = 0.463, P = 0.008) and the accommodative lag was related to BDT_Es (r = −0.356, P = −0.046). After one month, no significant correlations were found between the BDTs and aberrations or accommodative lags, as well as between the variations of them (for all, P ≥ 0.069). Conclusion Ortho-K treatment increased the children’s level of blur detection sensitivity, which may have contributed to their good visual acuity.
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Affiliation(s)
- Jingjing Xu
- School of Ophthalmology and Optometry, Affiliated Eye Hospital, State Key Laboratory of Ophthalmology, Optometry and Vision Science, Wenzhou Medical University, Wenzhou, China.,WEIRC, Wenzhou Medical University-Essilor International Research Center, Wenzhou, China
| | - Chunwen Tao
- School of Ophthalmology and Optometry, Affiliated Eye Hospital, State Key Laboratory of Ophthalmology, Optometry and Vision Science, Wenzhou Medical University, Wenzhou, China
| | - Xinjie Mao
- School of Ophthalmology and Optometry, Affiliated Eye Hospital, State Key Laboratory of Ophthalmology, Optometry and Vision Science, Wenzhou Medical University, Wenzhou, China.,WEIRC, Wenzhou Medical University-Essilor International Research Center, Wenzhou, China
| | - Xin Lu
- School of Ophthalmology and Optometry, Affiliated Eye Hospital, State Key Laboratory of Ophthalmology, Optometry and Vision Science, Wenzhou Medical University, Wenzhou, China
| | - Jinhua Bao
- School of Ophthalmology and Optometry, Affiliated Eye Hospital, State Key Laboratory of Ophthalmology, Optometry and Vision Science, Wenzhou Medical University, Wenzhou, China.,WEIRC, Wenzhou Medical University-Essilor International Research Center, Wenzhou, China
| | - Björn Drobe
- WEIRC, Wenzhou Medical University-Essilor International Research Center, Wenzhou, China.,R&D AMERA, Essilor International, Singapore, Singapore
| | - Hao Chen
- School of Ophthalmology and Optometry, Affiliated Eye Hospital, State Key Laboratory of Ophthalmology, Optometry and Vision Science, Wenzhou Medical University, Wenzhou, China.,WEIRC, Wenzhou Medical University-Essilor International Research Center, Wenzhou, China
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Is It Possible to Predict Progression of Childhood Myopia Using Short-Term Axial Change After Orthokeratology? Eye Contact Lens 2021; 46:136-140. [PMID: 31842031 DOI: 10.1097/icl.0000000000000665] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES To investigate changes in axial length in children undergoing orthokeratology (OK) and evaluate short-term axial change in predicting post-OK myopia progression. METHODS In this retrospective study, the subjects included 70 myopic children aged 8 to 15 years wearing OK contact lenses for more than 3 years. Axial length changes at 0.5, 1, 2, and 3 years relative to the baseline were measured. Patients were evaluated for age, spherical equivalent refraction (SER), pupil size, and half-year axial change using repeated analysis of variance and multivariate linear regression analysis to predict half to 3 year-axial elongation (AE, seventh-36th month post-OK). RESULTS The axial length grew significantly during the 3 years; the mean annual axial growth was 0.20±0.12 mm. The half-year axial change was 0.04±0.12 mm. The univariate linear analyses showed that half to 3-year AE was correlated with baseline age (r=-0.393, P<0.001) and half-year axial change (r=0.379, P=0.001), but not pupil diameter (P=0.692) or SER (P=0.673). In a multiple linear regression model, the half to 3-year AE was related with the baseline age (standardized β=-0.312, P=0.007) and half-year axial change (standardized β=0.293, P=0.01). The model was fair (adjusted R=0.21) and statistically significant (F=10.24, P<0.001). CONCLUSIONS It is practical to predict long-term AE with half-year axial change for children with OK correction. Therefore, this may aid in fast and timely measures in children who are predicted to have rapid myopia progression.
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Chen Z, Zhou J, Xue F, Qu X, Zhou X. Two-year add-on effect of using low concentration atropine in poor responders of orthokeratology in myopic children. Br J Ophthalmol 2021; 106:1069-1072. [PMID: 33707188 DOI: 10.1136/bjophthalmol-2020-317980] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 02/09/2021] [Accepted: 02/16/2021] [Indexed: 12/13/2022]
Abstract
METHODS Axial elongation in 73 eyes of 73 subjects who completed 3 years of orthokeratology (ortho-k) treatment was retrospectively reviewed. During their first year of ortho-k treatment (phase 1), they all demonstrated an axial elongation of 0.30 mm or greater. They were then divided into two groups: orthokeratology and atropine (OKA) group (n=37) being treated with nightly 0.01% atropine in addition to ortho-k treatment for another 2 years and orthokeratology (OK) group (n=36) continued to be treated with ortho-k without atropine (phase 2). Axial elongation over time and between groups was compared. RESULTS Baseline biometrics was similar between the two groups in phase 1 (all p>0.05). The mean axial elongation was 0.47±0.15, 0.21±0.15, 0.23±0.13 mm for the OKA group and 0.41±0.09, 0.30±0.11, 0.20±0.13 mm for the OK group during the first, second and third year, respectively. The cumulative axial elongation over 3 years was 0.91±0.30 mm for the OKA group and 0.91±0.24 mm for the OK group. The overall AL change was not significantly different between the two groups (p=0.262). Baseline myopic refractive error had a significant impact on axial elongation over 3 years of treatment (p<0.001). None of baseline age (p=0.129), lens design (p=0.890) or treatment modality (p=0.579) had a significant impact on axial elongation. CONCLUSIONS For fast myopia progressors and poor responders of ortho-k, combining 0.01% nightly atropine did not significantly change the3-year axial elongation outcome as compared to ortho-k mono-therapy.
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Affiliation(s)
- Zhi Chen
- Ophthalmology and Visual Science, Fudan University Eye Ear Nose and Throat Hospital, Shanghai, Shanghai, China
| | - Jiaqi Zhou
- Ophthalmology and Visual Science, Fudan University Eye Ear Nose and Throat Hospital, Shanghai, Shanghai, China
| | - Feng Xue
- Ophthalmology and Visual Science, Fudan University Eye Ear Nose and Throat Hospital, Shanghai, Shanghai, China
| | - Xiaomei Qu
- Ophthalmology and Visual Science, Fudan University Eye Ear Nose and Throat Hospital, Shanghai, Shanghai, China
| | - Xingtao Zhou
- Ophthalmology and Visual Science, Fudan University Eye Ear Nose and Throat Hospital, Shanghai, Shanghai, China
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Lyu Y, Ji N, Fu AC, Wang WQ, Wei L, Qin J, Zhao BX. Comparison of Administration of 0.02% Atropine and Orthokeratology for Myopia Control. Eye Contact Lens 2021; 47:81-85. [PMID: 32443010 DOI: 10.1097/icl.0000000000000699] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To compare the efficacies of 0.02% atropine eye drops and orthokeratology to control axial length (AL) elongation in children with myopia. METHODS In this historical control study, 247 children with myopia whose administration of 0.02% atropine (n=142) or underwent orthokeratology from an earlier study (n=105, control group) were enrolled. Data on AL and other baseline parameters were recorded at baseline and after 1 and 2 years of treatment. RESULTS The mean changes in AL in the first and second years of treatment were 0.30±0.21 and 0.28±0.20 mm, respectively, in the 0.02% atropine group and 0.16±0.20 and 0.20±0.16 mm, respectively, in the orthokeratology group. Axial length elongations after 2 years of treatment were 0.58±0.35 and 0.36±0.30 mm (P=0.007) in the 0.02% atropine and orthokeratology groups, respectively. Multivariate regression analyses showed that the AL elongation was significantly faster in the 0.02% atropine group than in the orthokeratology group (β=0.18, P=0.009). In multivariate regression analyses, younger age and shorter baseline AL were associated with a rapid AL elongation in the 0.02% atropine group (βage=-0.04, P=0.01; βAL=-0.17, P=0.03), while younger age, lower baseline spherical equivalent refractive error (SER), and shorter baseline AL were associated with a greater increase in AL in the orthokeratology group (βage=-0.03, P=0.04; βSER=0.06, P=0.03; βAL=-0.11, P=0.009). Faster AL elongation was found in the 0.02% atropine group compared with the orthokeratology group at higher baseline SER (P=0.04, interaction test). CONCLUSION Within the limits of this study design, orthokeratology seems to be a better method for controlling AL elongation compared with administration of 0.02% atropine in children with higher myopia over a treatment period of 2 years.
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Affiliation(s)
- Yong Lyu
- Ophthalmology, The First Affiliated Hospital of Zhengzhou University (Y.L., A.-C.F., W.-Q.W., L.W., B.-X.Z.), Zhengzhou, China ; Ophthalmology, The Affiliated Eye Hospital of Suzhou Vocational Health College (N.J.), Suzhou, China ; and Ophthalmology, Provincial People's Hospital (J.Q.), Henan Eye Hospital, Zhengzhou, China
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Brennan NA, Toubouti YM, Cheng X, Bullimore MA. Efficacy in myopia control. Prog Retin Eye Res 2020; 83:100923. [PMID: 33253901 DOI: 10.1016/j.preteyeres.2020.100923] [Citation(s) in RCA: 132] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 11/17/2020] [Accepted: 11/23/2020] [Indexed: 12/14/2022]
Abstract
There is rapidly expanding interest in interventions to slow myopia progression in children and teenagers, with the intent of reducing risk of myopia-associated complications later in life. Despite many publications dedicated to the topic, little attention has been devoted to understanding 'efficacy' in myopia control and its application. Treatment effect has been expressed in multiple ways, making comparison between therapies and prognosis for an individual patient difficult. Available efficacy data are generally limited to two to three years making long-term treatment effect uncertain. From an evidence-based perspective, efficacy projection should be conservative and not extend beyond that which has been empirically established. Using this principle, review of the literature, data from our own clinical studies, assessment of demonstrated myopia control treatments and allowance for the limitations and context of available data, we arrive at the following important interpretations: (i) axial elongation is the preferred endpoint for assessing myopic progression; (ii) there is insufficient evidence to suggest that faster progressors, or younger myopes, derive greater benefit from treatment; (iii) the initial rate of reduction of axial elongation by myopia control treatments is not sustained; (iv) consequently, using percentage reduction in progression as an index to describe treatment effect can be very misleading and (v) cumulative absolute reduction in axial elongation (CARE) emerges as a preferred efficacy metric; (vi) maximum CARE that has been measured for existing myopia control treatments is 0.44 mm (which equates to about 1 D); (vii) there is no apparent superior method of treatment, although commonly prescribed therapies such as 0.01% atropine and progressive addition spectacles lenses have not consistently provided clinically important effects; (viii) while different treatments have shown divergent efficacy in the first year, they have shown only small differences after this; (ix) rebound should be assumed until proven otherwise; (x) an illusion of inflated efficacy is created by measurement error in refraction, sample bias in only treating 'measured' fast progressors and regression to the mean; (xi) decision to treat should be based on age of onset (or refraction at a given age), not past progression; (xii) the decreased risk of complications later in life provided by even modest reductions in progression suggest treatment is advised for all young myopes and, because of limitations of available interventions, should be aggressive.
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Affiliation(s)
- Noel A Brennan
- Johnson & Johnson Vision, 7500 Centurion Pkwy, Jacksonville, FL, 32256, USA.
| | - Youssef M Toubouti
- Johnson & Johnson Vision, 7500 Centurion Pkwy, Jacksonville, FL, 32256, USA
| | - Xu Cheng
- Johnson & Johnson Vision, 7500 Centurion Pkwy, Jacksonville, FL, 32256, USA
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Vincent SJ, Tan Q, Ng ALK, Cheng GPM, Woo VCP, Cho P. Higher order aberrations and axial elongation in combined 0.01% atropine with orthokeratology for myopia control. Ophthalmic Physiol Opt 2020; 40:728-737. [PMID: 32888318 DOI: 10.1111/opo.12730] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 06/30/2020] [Accepted: 08/03/2020] [Indexed: 12/22/2022]
Abstract
PURPOSE To compare the changes in higher order aberrations (HOA's) for photopic and mesopic pupil diameters in children undergoing orthokeratology treatment (OK) or combined 0.01% atropine with orthokeratology treatment (AOK), and their association with axial elongation. METHODS Children aged 6 to <11 years with 1.00-4.00 D of myopia were randomly assigned to each treatment group. Photopic and mesopic pupil diameters were quantified using automated pupillometry and HOA's were measured with a Hartmann-Shack aberrometer and Badal system to control for accommodation. HOA's were rescaled to photopic and mesopic pupil diameters and fitted with a 6th order Zernike polynomial expansion. Axial length was measured using an optical biometer under cycloplegia. RESULTS Baseline and six-month data from 25 AOK and 28 OK participants were analysed. At the six-month visit, pupil diameter was larger in the AOK group under photopic conditions (3.70 ± 0.42 vs 3.12 ± 0.33 mm, p < 0.001), along with a range of HOA metrics [3rd to 6th order and higher order root mean square error values (HO RMS), all p ≤ 0.003] and individual Zernike terms (primary spherical aberration, and oblique quadrafoil, both p ≤ 0.03). Axial elongation was greater in the OK treatment group (0.05 ± 0.08 vs -0.01 ± 0.12 mm, p = 0.02). In the AOK group, axial elongation was correlated with the increase in photopic pupil diameter (r = -0.45, p = 0.02) and with several HOA metrics; however, these associations were not observed in the OK group. CONCLUSION AOK treatment resulted in increased photopic pupil size and HOA's, and significantly less axial elongation over a six-month period compared to OK treatment alone. The improved myopia control observed with combination 0.01% atropine and orthokeratology may be a result of an enhanced optical effect due to a larger photopic pupil size.
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Affiliation(s)
- Stephen J Vincent
- Contact Lens and Visual Optics Laboratory, School of Optometry and Vision Science, Centre for Vision and Eye Research, Queensland University of Technology, Brisbane, Australia
| | - Qi Tan
- School of Optometry, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Alex L K Ng
- Department of Ophthalmology, The University of Hong Kong, Hong Kong, Hong Kong.,Hong Kong Ophthalmic Associates, Hong Kong, Hong Kong
| | | | - Victor C P Woo
- Department of Ophthalmology, The University of Hong Kong, Hong Kong, Hong Kong.,Hong Kong Ophthalmic Associates, Hong Kong, Hong Kong
| | - Pauline Cho
- School of Optometry, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
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Zhong Y, Ke L, Qiong W, Liu F. Orthokeratology lens for management of myopia in anisometropic children: A contralateral study. Cont Lens Anterior Eye 2020; 43:40-43. [DOI: 10.1016/j.clae.2019.03.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 03/07/2019] [Accepted: 03/18/2019] [Indexed: 10/27/2022]
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Walline JJ, Lindsley KB, Vedula SS, Cotter SA, Mutti DO, Ng SM, Twelker JD. Interventions to slow progression of myopia in children. Cochrane Database Syst Rev 2020; 1:CD004916. [PMID: 31930781 PMCID: PMC6984636 DOI: 10.1002/14651858.cd004916.pub4] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Nearsightedness (myopia) causes blurry vision when one is looking at distant objects. Interventions to slow the progression of myopia in children include multifocal spectacles, contact lenses, and pharmaceutical agents. OBJECTIVES To assess the effects of interventions, including spectacles, contact lenses, and pharmaceutical agents in slowing myopia progression in children. SEARCH METHODS We searched CENTRAL; Ovid MEDLINE; Embase.com; PubMed; the LILACS Database; and two trial registrations up to February 2018. A top up search was done in February 2019. SELECTION CRITERIA We included randomized controlled trials (RCTs). We excluded studies when most participants were older than 18 years at baseline. We also excluded studies when participants had less than -0.25 diopters (D) spherical equivalent myopia. DATA COLLECTION AND ANALYSIS We followed standard Cochrane methods. MAIN RESULTS We included 41 studies (6772 participants). Twenty-one studies contributed data to at least one meta-analysis. Interventions included spectacles, contact lenses, pharmaceutical agents, and combination treatments. Most studies were conducted in Asia or in the United States. Except one, all studies included children 18 years or younger. Many studies were at high risk of performance and attrition bias. Spectacle lenses: undercorrection of myopia increased myopia progression slightly in two studies; children whose vision was undercorrected progressed on average -0.15 D (95% confidence interval [CI] -0.29 to 0.00; n = 142; low-certainty evidence) more than those wearing fully corrected single vision lenses (SVLs). In one study, axial length increased 0.05 mm (95% CI -0.01 to 0.11) more in the undercorrected group than in the fully corrected group (n = 94; low-certainty evidence). Multifocal lenses (bifocal spectacles or progressive addition lenses) yielded small effect in slowing myopia progression; children wearing multifocal lenses progressed on average 0.14 D (95% CI 0.08 to 0.21; n = 1463; moderate-certainty evidence) less than children wearing SVLs. In four studies, axial elongation was less for multifocal lens wearers than for SVL wearers (-0.06 mm, 95% CI -0.09 to -0.04; n = 896; moderate-certainty evidence). Three studies evaluating different peripheral plus spectacle lenses versus SVLs reported inconsistent results for refractive error and axial length outcomes (n = 597; low-certainty evidence). Contact lenses: there may be little or no difference between vision of children wearing bifocal soft contact lenses (SCLs) and children wearing single vision SCLs (mean difference (MD) 0.20D, 95% CI -0.06 to 0.47; n = 300; low-certainty evidence). Axial elongation was less for bifocal SCL wearers than for single vision SCL wearers (MD -0.11 mm, 95% CI -0.14 to -0.08; n = 300; low-certainty evidence). Two studies investigating rigid gas permeable contact lenses (RGPCLs) showed inconsistent results in myopia progression; these two studies also found no evidence of difference in axial elongation (MD 0.02mm, 95% CI -0.05 to 0.10; n = 415; very low-certainty evidence). Orthokeratology contact lenses were more effective than SVLs in slowing axial elongation (MD -0.28 mm, 95% CI -0.38 to -0.19; n = 106; moderate-certainty evidence). Two studies comparing spherical aberration SCLs with single vision SCLs reported no difference in myopia progression nor in axial length (n = 209; low-certainty evidence). Pharmaceutical agents: at one year, children receiving atropine eye drops (3 studies; n = 629), pirenzepine gel (2 studies; n = 326), or cyclopentolate eye drops (1 study; n = 64) showed significantly less myopic progression compared with children receiving placebo: MD 1.00 D (95% CI 0.93 to 1.07), 0.31 D (95% CI 0.17 to 0.44), and 0.34 (95% CI 0.08 to 0.60), respectively (moderate-certainty evidence). Axial elongation was less for children treated with atropine (MD -0.35 mm, 95% CI -0.38 to -0.31; n = 502) and pirenzepine (MD -0.13 mm, 95% CI -0.14 to -0.12; n = 326) than for those treated with placebo (moderate-certainty evidence) in two studies. Another study showed favorable results for three different doses of atropine eye drops compared with tropicamide eye drops (MD 0.78 D, 95% CI 0.49 to 1.07 for 0.1% atropine; MD 0.81 D, 95% CI 0.57 to 1.05 for 0.25% atropine; and MD 1.01 D, 95% CI 0.74 to 1.28 for 0.5% atropine; n = 196; low-certainty evidence) but did not report axial length. Systemic 7-methylxanthine had little to no effect on myopic progression (MD 0.07 D, 95% CI -0.09 to 0.24) nor on axial elongation (MD -0.03 mm, 95% CI -0.10 to 0.03) compared with placebo in one study (n = 77; moderate-certainty evidence). One study did not find slowed myopia progression when comparing timolol eye drops with no drops (MD -0.05 D, 95% CI -0.21 to 0.11; n = 95; low-certainty evidence). Combinations of interventions: two studies found that children treated with atropine plus multifocal spectacles progressed 0.78 D (95% CI 0.54 to 1.02) less than children treated with placebo plus SVLs (n = 191; moderate-certainty evidence). One study reported -0.37 mm (95% CI -0.47 to -0.27) axial elongation for atropine and multifocal spectacles when compared with placebo plus SVLs (n = 127; moderate-certainty evidence). Compared with children treated with cyclopentolate plus SVLs, those treated with atropine plus multifocal spectacles progressed 0.36 D less (95% CI 0.11 to 0.61; n = 64; moderate-certainty evidence). Bifocal spectacles showed small or negligible effect compared with SVLs plus timolol drops in one study (MD 0.19 D, 95% CI 0.06 to 0.32; n = 97; moderate-certainty evidence). One study comparing tropicamide plus bifocal spectacles versus SVLs reported no statistically significant differences between groups without quantitative results. No serious adverse events were reported across all interventions. Participants receiving antimuscarinic topical medications were more likely to experience accommodation difficulties (Risk Ratio [RR] 9.05, 95% CI 4.09 to 20.01) and papillae and follicles (RR 3.22, 95% CI 2.11 to 4.90) than participants receiving placebo (n=387; moderate-certainty evidence). AUTHORS' CONCLUSIONS Antimuscarinic topical medication is effective in slowing myopia progression in children. Multifocal lenses, either spectacles or contact lenses, may also confer a small benefit. Orthokeratology contact lenses, although not intended to modify refractive error, were more effective than SVLs in slowing axial elongation. We found only low or very low-certainty evidence to support RGPCLs and sperical aberration SCLs.
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Affiliation(s)
- Jeffrey J Walline
- The Ohio State University, College of Optometry, 338 West Tenth Avenue, Columbus, Ohio, USA, 43210-1240
| | - Kristina B Lindsley
- IBM Watson Health, Life Sciences, Oncology, & Genomics, Baltimore, Maryland, USA
| | - S Swaroop Vedula
- Johns Hopkins University, 3400 N. Charles Street, Baltimore, Maryland, USA, 21218
| | - Susan A Cotter
- Southern California College of Optometry, 2575 Yorba Linda Boulevard, Fullerton, California, USA, 92831
| | - Donald O Mutti
- The Ohio State University, College of Optometry, 338 West Tenth Avenue, Columbus, Ohio, USA, 43210-1240
| | - Sueko M Ng
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, 615 N. Wolfe Street, W5010, c/o Cochrane Eyes and Vision Group, Baltimore, Maryland, USA, 21205
| | - J Daniel Twelker
- University of Arizona, Department of Ophthalmology, 655 North Alvernon Way Suite 108, Tucson, Arizona, USA, 85711
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Abstract
SIGNIFICANCE Anisomyopia is a natural experimental paradigm that compares dose response between fellow eyes. This study is the first to explore whether orthokeratology (ortho-k) has a dose-response effect on axial length growth and reduces the interocular difference in axial length in anisomyopic children. PURPOSE The purpose of this study was to compare the effect of ortho-k on axial length elongation between the fellow eyes of anisomyopic children. METHODS In this retrospective study, 49 anisomyopic children who wore ortho-k lenses were assigned to the anisomyopic ortho-k group. Based on the one-to-one match principle (same age and proximate spherical equivalent), high-isomyopic and low-isomyopic groups each enrolled 49 isomyopic children who wore ortho-k lenses with spherical equivalent similar to that of the more myopic eye and the less myopic eye in the anisomyopic ortho-k group, respectively. Forty-nine anisomyopic children who wore spectacles were enrolled in the anisomyopic spectacle group. At baseline and at 1- and 2-year visits, axial length was measured. Axial length elongation and interocular difference in axial length were compared. RESULTS In the anisomyopic ortho-k group, the less myopic eyes exhibited more axial length elongation than did the more myopic eyes during 1- and 2-year treatment periods (P < .01). However, there was no significant difference in axial length elongation between the fellow eyes in the isomyopic groups and anisomyopic spectacle group. At the 2-year visit, the interocular difference in axial length of children in the anisomyopic ortho-k group significantly decreased from 0.72 ± 0.34 to 0.56 ± 0.38 mm (P < .05). In contrast, ortho-k lens-wearing isomyopic children or spectacle-wearing anisomyopic children did not show a significant change in interocular difference in axial length. CONCLUSIONS Orthokeratology could reduce the amount of anisomyopia in children primarily through stronger myopia control in the more myopic eye.
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Long W, Li Z, Hu Y, Cui D, Zhai Z, Yang X. Pattern of Axial Length Growth in Children Myopic Anisometropes with Orthokeratology Treatment. Curr Eye Res 2019; 45:834-838. [PMID: 31821058 DOI: 10.1080/02713683.2019.1701685] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
PURPOSE To compare the pattern of growth in axial length (AL) between children with anisometropia who wear orthokeratology (OK) lenses and those who wear spectacles (SP). METHODS A retrospective study was conducted. Data of baseline and 1 year from 252 children (8-14 years old) anisomyopes who sought refraction corrections at the Zhongshan Ophthalmic Center between October 2013 and June 2017 were reviewed. Seventy-nine unilateral myopic anisometropes (UMA) and 98 bilateral myopic anisometropes (BMA) treated with OK lenses were set as study groups (OK-UMA and OK-BMA groups). Age, refraction, and AL-matched unilateral (n = 38) and bilateral myopic anisometropes (n = 37) treated with spectacles were set as control groups (SP-UMA and SP-BMA groups). The 1-year change in AL between the study and control groups (OK-UMA vs. SP-UMA and OK-BMA vs. SP-BMA) was compared. RESULTS There were no significant differences in the baseline of age, refraction, and AL between OK-UMA and SP-UMA or OK-BMA and SP-BMA groups (all P > .05). Compared to the SP-UMA group, annual axial elongation of the myopic eyes of the OK-UMA group was smaller (0.05 ± 0.19 mm vs. 0.33 ± 0.29 mm, P < .001); however, AL elongation in the non-myopic eyes were comparable between SP-UMA and OK-UMA groups (P > .05). At the end of 1 year, the interocular difference in AL (aniso-AL) decreased by 0.29 ± 0.29 mm (P < .001) in the OK-UMA group but remained unchanged in SP-UMA group. Compared to the SP-BMA group, annual axial elongations of both eyes of the OK-BMA group were smaller (the more myopic eye, 0.05 ± 0.17 mm vs. 0.38 ± 0.21 mm; the less myopic eye, 0.15 ± 0.19 mm vs. 0.35 ± 0.28 mm; both P < .001). At the end of 1 year, aniso-AL decreased by 0.10 ± 0.15 mm (P < .001) in the OK-BMA group but remained unchanged in the SP-BMA group. CONCLUSION Orthokeratology is effective in reducing the interocular difference in AL of children anisomyopes through greater retardation of axial elongation of the more myopic eyes.
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Affiliation(s)
- Wen Long
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University , Guangzhou, China
| | - Zhouyue Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University , Guangzhou, China
| | - Yin Hu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University , Guangzhou, China
| | - Dongmei Cui
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University , Guangzhou, China
| | - Zhou Zhai
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University , Guangzhou, China
| | - Xiao Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University , Guangzhou, China
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Wildsoet CF, Chia A, Cho P, Guggenheim JA, Polling JR, Read S, Sankaridurg P, Saw SM, Trier K, Walline JJ, Wu PC, Wolffsohn JS. IMI - Interventions Myopia Institute: Interventions for Controlling Myopia Onset and Progression Report. Invest Ophthalmol Vis Sci 2019; 60:M106-M131. [PMID: 30817829 DOI: 10.1167/iovs.18-25958] [Citation(s) in RCA: 217] [Impact Index Per Article: 43.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Myopia has been predicted to affect approximately 50% of the world's population based on trending myopia prevalence figures. Critical to minimizing the associated adverse visual consequences of complicating ocular pathologies are interventions to prevent or delay the onset of myopia, slow its progression, and to address the problem of mechanical instability of highly myopic eyes. Although treatment approaches are growing in number, evidence of treatment efficacy is variable. This article reviews research behind such interventions under four categories: optical, pharmacological, environmental (behavioral), and surgical. In summarizing the evidence of efficacy, results from randomized controlled trials have been given most weight, although such data are very limited for some treatments. The overall conclusion of this review is that there are multiple avenues for intervention worthy of exploration in all categories, although in the case of optical, pharmacological, and behavioral interventions for preventing or slowing progression of myopia, treatment efficacy at an individual level appears quite variable, with no one treatment being 100% effective in all patients. Further research is critical to understanding the factors underlying such variability and underlying mechanisms, to guide recommendations for combined treatments. There is also room for research into novel treatment options.
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Affiliation(s)
- Christine F Wildsoet
- Berkeley Myopia Research Group, School of Optometry and Vision Science Program, University of California Berkeley, Berkeley, California, United States
| | - Audrey Chia
- Singapore Eye Research Institute and Singapore National Eye Center, Singapore
| | - Pauline Cho
- School of Optometry, The Hong Kong Polytechnic University, Hong Kong
| | - Jeremy A Guggenheim
- School of Optometry and Vision Sciences, Cardiff University, Cardiff, United Kingdom
| | - Jan Roelof Polling
- Erasmus MC Department of Ophthalmology, Rotterdam, The Netherlands.,HU University of Applied Sciences, Optometry and Orthoptics, Utrecht, The Netherlands
| | - Scott Read
- School of Optometry and Vision Science and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Padmaja Sankaridurg
- Brien Holden Vision Institute and School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Seang-Mei Saw
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Klaus Trier
- Trier Research Laboratories, Hellerup, Denmark
| | - Jeffrey J Walline
- The Ohio State University College of Optometry, Columbus, Ohio, United States
| | - Pei-Chang Wu
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - James S Wolffsohn
- Ophthalmic Research Group, Aston University, Birmingham, United Kingdom
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Wolffsohn JS, Kollbaum PS, Berntsen DA, Atchison DA, Benavente A, Bradley A, Buckhurst H, Collins M, Fujikado T, Hiraoka T, Hirota M, Jones D, Logan NS, Lundström L, Torii H, Read SA, Naidoo K. IMI - Clinical Myopia Control Trials and Instrumentation Report. Invest Ophthalmol Vis Sci 2019; 60:M132-M160. [PMID: 30817830 DOI: 10.1167/iovs.18-25955] [Citation(s) in RCA: 87] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The evidence-basis based on existing myopia control trials along with the supporting academic literature were reviewed; this informed recommendations on the outcomes suggested from clinical trials aimed at slowing myopia progression to show the effectiveness of treatments and the impact on patients. These outcomes were classified as primary (refractive error and/or axial length), secondary (patient reported outcomes and treatment compliance), and exploratory (peripheral refraction, accommodative changes, ocular alignment, pupil size, outdoor activity/lighting levels, anterior and posterior segment imaging, and tissue biomechanics). The currently available instrumentation, which the literature has shown to best achieve the primary and secondary outcomes, was reviewed and critiqued. Issues relating to study design and patient selection were also identified. These findings and consensus from the International Myopia Institute members led to final recommendations to inform future instrumentation development and to guide clinical trial protocols.
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Affiliation(s)
- James S Wolffsohn
- Ophthalmic Research Group, Aston University, Birmingham, United Kingdom
| | - Pete S Kollbaum
- Indiana University, School of Optometry, Bloomington, Indiana, United States
| | - David A Berntsen
- The Ocular Surface Institute, College of Optometry, University of Houston, Houston, Texas, United States
| | - David A Atchison
- School of Optometry and Vision Science, Institute of Health and Biomedical Innovation, Queensland University of Technology, Australia
| | | | - Arthur Bradley
- Indiana University, School of Optometry, Bloomington, Indiana, United States
| | - Hetal Buckhurst
- School of Health Professions, Peninsula Allied Health Centre, Plymouth University, Plymouth, United Kingdom
| | - Michael Collins
- School of Optometry and Vision Science, Institute of Health and Biomedical Innovation, Queensland University of Technology, Australia
| | - Takashi Fujikado
- Department of Applied Visual Science, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Takahiro Hiraoka
- Department of Ophthalmology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Masakazu Hirota
- Department of Applied Visual Science, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Debbie Jones
- School of Optometry and Vision Science, University of Waterloo, Waterloo, Ontario, Canada
| | - Nicola S Logan
- Ophthalmic Research Group, Aston University, Birmingham, United Kingdom
| | | | - Hidemasa Torii
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Scott A Read
- School of Optometry and Vision Science, Institute of Health and Biomedical Innovation, Queensland University of Technology, Australia
| | - Kovin Naidoo
- African Vision Research Institute, University of KwaZulu-Natal, Durban, South Africa
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Chen Z, Huang S, Zhou J, Xiaomei Q, Zhou X, Xue F. Adjunctive effect of orthokeratology and low dose atropine on axial elongation in fast-progressing myopic children—A preliminary retrospective study. Cont Lens Anterior Eye 2019; 42:439-442. [DOI: 10.1016/j.clae.2018.10.026] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 10/27/2018] [Accepted: 10/31/2018] [Indexed: 10/27/2022]
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Abstract
OBJECTIVE This study aims to compare the increase in refractive error and axial length, variation of endothelium cells, and ratio of corneal staining between two regimens of high myopia-partial reduction orthokeratology (ortho-k) in children. METHODS The present clinical prospective study recruited 102 high-myopia subjects (204 eyes). These subjects were randomly divided into three groups: (1) ortho-k group 1, subjects with a target myopia reduction of 6.00 D; (2) ortho-k group 2, subjects with a target myopia reduction of 4.00 D; and (3) control group, the refractive error of subjects was corrected using a pair of single-vision spectacles. Vision acuity, refractive error, and the cornea were examined at baseline, and at 2 days, 1 week, 1, 3, 6, and 12 months after commencing lens wear. The measurement of the axial length of the eyeball and a corneal endothelium examination were performed at baseline and at 12 months. RESULTS The uncorrected vision acuities improved in subjects in these groups after treatment with ortho-k. Furthermore, the diopters of myopia and corneal curvature significantly decreased at 1 month, and the values continuously improved at 12 months, when compared with subjects at 1 month (P<0.05). Subjects in the control group had a significant increase in refractive error (0.565±0.313 D) and axial length (0.294±0.136 mm), when compared with subjects in the ortho-k-treated groups (P<0.05). However, there were no significant differences in changes in refractive error and axial length between ortho-k groups 1 (0.101±0.176 mm) and 2 (0.123±0.193 mm) at 12 months (P>0.05). Furthermore, subjects in group 1 (28.97%) had a higher rate of corneal staining, when compared with subjects in group 2 (13.06%) (P<0.05). CONCLUSION The two ortho-k regimens, target reduction of 6.00 D and target of 4.00 D, had similar effects in controlling the increase in axial length and refractive error in high-myopia children. However, subjects with a target myopia reduction of 6.00 D had a higher rate of corneal staining than in subjects with a target myopia reduction of 4.00 D.
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Areal summed corneal power shift is an important determinant for axial length elongation in myopic children treated with overnight orthokeratology. Br J Ophthalmol 2019; 103:1571-1575. [DOI: 10.1136/bjophthalmol-2018-312933] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Revised: 11/18/2018] [Accepted: 12/26/2018] [Indexed: 11/03/2022]
Abstract
BackgroundThe myopia control effect of orthokeratology (OK) varies among individuals. The variation might relate to the proposed ‘areal summation effect’ of lens-induced visual signals. The current study evaluated the areal summed corneal power shift (ASCPS) in myopic children treated with OK lenses and assessed whether the ASCPS achieved at early post-OK visit can predict the lens long-term effect on the axial length (AL) elongation.MethodsStudy participants were 130 myopic children treated with OK lenses (age range, 8 to 15 years) in a prospective study. Corneal topography and AL were measured at baseline and 1, 3, 6, 9 and 12 months after OK lens wear. The ASCPS was derived from corneal topographic measurements and defined as the change in the areal summed corneal relative refraction at the follow-up visit from baseline. The impact of the ASCPS achieved at the 1 month post-OK visit on the 12 months AL elongation was examined using multivariate linear regression analysis.ResultsBaseline age of the study participants was 11.8 ± 1.8 years and their mean spherical equivalent was −3.00±0.92 D. The ASCPS was 6.90±6.09 D*mm at the 1 month visit and remained stable throughout the follow-up period (p=0.5508, repeated-measures analysis of variance). Greater 1 month ASCPS was associated with slower AL elongation at the 12 months visit (β=−0.007, p=0.001).ConclusionsThe ASCPS achieved at early post-OK visit is predictive for the lens long-term effect on the myopic AL elongation. The parameter is potential in guiding the OK lens practice to slow down axial growth in myopic children.
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Jung HG, Lee KY, Bae GH. Comparison of Myopic Progression before and after Orthokeratology Lens Treatment. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2019. [DOI: 10.3341/jkos.2019.60.7.620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Ho Gil Jung
- Department of Ophthalmology, Sahmyook Medical Center, Seoul, Korea
| | - Kyoung Yong Lee
- Department of Ophthalmology, Sahmyook Medical Center, Seoul, Korea
| | - Gi Hyun Bae
- Department of Ophthalmology, Sahmyook Medical Center, Seoul, Korea
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Villa-Collar C, Carracedo G, González-Méijome JM, Piñero-Llorens D. Myopia, the challenge of ophthalmology and its worldwide «explosive epidemic». ACTA ACUST UNITED AC 2018; 94:204-205. [PMID: 30502010 DOI: 10.1016/j.oftal.2018.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 10/03/2018] [Indexed: 11/25/2022]
Affiliation(s)
- C Villa-Collar
- Departamento de Farmacia, Biotecnología, Nutrición y Óptica y Optometría, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, España.
| | - G Carracedo
- Departamento de Óptica II, Universidad Complutense de Madrid, Madrid, España
| | - J M González-Méijome
- Departamento/Centro de Física, Clinical and Experimental Optometry Research Lab (CEORLab), Universidade do Minho, Braga, Portugal
| | - D Piñero-Llorens
- Departamento de Óptica, Farmacología y Anatomía, Universidad de Alicante, San Vicente del Raspeig, Alicante, España
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Wang J, Yang D, Bi H, Du B, Lin W, Gu T, Zhang B, Wei R. A New Method to Analyze the Relative Corneal Refractive Power and Its Association to Myopic Progression Control With Orthokeratology. Transl Vis Sci Technol 2018; 7:17. [PMID: 30533280 PMCID: PMC6269134 DOI: 10.1167/tvst.7.6.17] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 10/09/2018] [Indexed: 11/24/2022] Open
Abstract
Purpose We present a new method for analyzing relative corneal refractive power (RCRP) in children undergoing orthokeratology and explore its potential association to effective myopic control Methods A total of 55 children aged 8 to 12 years participated in the study. Axial growth was calculated as the difference in axial length before and 1 year after orthokeratology. Growth <0.30 mm was considered as effective control. Corneal topography was obtained before and 4 months after lens dispatch. The topography was divided into 36 10° slices and the maximal RCRP (mRCRP) in each was calculated and fitted into a model that integrated the effects of mean refractive power (M), corneal asymmetry (f1), and astigmatism (f2). The relationship between the probability of achieving effective control and the modulation of mRCRP was analyzed with logistic regression. Results A total of 45 subjects achieved effective control, but for 10 the treatment was ineffective. The M-values were not different between the groups. Modulations of mRCRP were significantly larger in the effective than the ineffective group (1.17 vs. 0.64 diopters [D] for f1, P = 0.02; 0.85 vs. 0.35 D for f2, P = 0.03). The probability to achieve effective control increased with modulation of mRCRP (P = 0.02). With a peak mRCRP > 4.5 D, a subject had an above 80% chance to achieve effective control. Conclusions The new method reveals that how the combination of spherical equivalent (SE), corneal asymmetry, and astigmatism determines modulation of the mRCRP and a large amplitude of modulation is associated with a higher probability of effective myopic control. Translational Relevance Our finding enables clinicians to estimate the outcome early and provides new insights to lens design.
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Affiliation(s)
- Jinghui Wang
- School of Optometry and Ophthalmology, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Dan Yang
- School of Optometry and Ophthalmology, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Hua Bi
- College of Optometry, Nova Southeastern University, Davie, FL, USA
| | - Bei Du
- School of Optometry and Ophthalmology, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Weiping Lin
- School of Optometry and Ophthalmology, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Tianpu Gu
- School of Optometry and Ophthalmology, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Bin Zhang
- College of Optometry, Nova Southeastern University, Davie, FL, USA
| | - Ruihua Wei
- School of Optometry and Ophthalmology, Tianjin Medical University Eye Hospital, Tianjin, China
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Short-Term and Long-Term Changes in Corneal Power Are Not Correlated With Axial Elongation of the Eye Induced by Orthokeratology in Children. Eye Contact Lens 2018; 44:260-267. [DOI: 10.1097/icl.0000000000000313] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Chen Z, Zhou J, Qu X, Zhou X, Xue F. Effects of orthokeratology on axial length growth in myopic anisometropes. Cont Lens Anterior Eye 2018; 41:263-266. [DOI: 10.1016/j.clae.2017.10.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 10/19/2017] [Accepted: 10/23/2017] [Indexed: 11/17/2022]
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Early Intervention and Nonpharmacological Therapy of Myopia in Young Adults. J Ophthalmol 2018; 2018:4680603. [PMID: 29576878 PMCID: PMC5822817 DOI: 10.1155/2018/4680603] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Accepted: 12/13/2017] [Indexed: 02/08/2023] Open
Abstract
Myopia is a condition of the eye where parallel rays focus in front of, instead of on, the retina, which results in excessive refractive power of the cornea or the lens or eyeball elongation. Studies carried out in recent years show that the etiology of myopia is complex with genetic and environmental factors playing a role. Refraction defects decrease the quality of vision, while progressing myopia can lead to partial loss of vision, which can be particularly dramatic in young adults. Therefore, it is so crucial to take appropriate actions aimed at preventing myopia progression. This is a review of nonpharmacological therapeutic possibilities of refraction defect prevention in young adults, with special regard to myofascial therapy, osteopathy, and massage of acupuncture points surrounding the eye.
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Kim TH, Kim MH, Kwag JY, Choi JS, Pak KH, Lee K, Park T, Chung SK, Hyun J. Comparative Effect of Spectacles and Orthokeratology Lenses on Axial Elongation in Children with Mild-to-Moderate Myopia. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2018. [DOI: 10.3341/jkos.2018.59.11.1009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | - Joo Hyun
- Saevit Eye Hospital, Goyang, Korea
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Short- and Long-Term Changes in Corneal Aberrations and Axial Length Induced by Orthokeratology in Children Are Not Correlated. Eye Contact Lens 2017; 43:358-363. [DOI: 10.1097/icl.0000000000000290] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Walline JJ, Giannoni AG, Sinnott LT, Chandler MA, Huang J, Mutti DO, Jones-Jordan LA, Berntsen DA. A Randomized Trial of Soft Multifocal Contact Lenses for Myopia Control: Baseline Data and Methods. Optom Vis Sci 2017; 94:856-866. [PMID: 28737608 PMCID: PMC5607949 DOI: 10.1097/opx.0000000000001106] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
SIGNIFICANCE The Bifocal Lenses In Nearsighted Kids (BLINK) study is the first soft multifocal contact lens myopia control study to compare add powers and measure peripheral refractive error in the vertical meridian, so it will provide important information about the potential mechanism of myopia control. PURPOSE The BLINK study is a National Eye Institute-sponsored, double-masked, randomized clinical trial to investigate the effects of soft multifocal contact lenses on myopia progression. This article describes the subjects' baseline characteristics and study methods. METHODS Subjects were 7 to 11 years old, had -0.75 to -5.00 spherical component and less than 1.00 diopter (D) astigmatism, and had 20/25 or better logMAR distance visual acuity with manifest refraction in each eye and with +2.50-D add soft bifocal contact lenses on both eyes. Children were randomly assigned to wear Biofinity single-vision, Biofinity Multifocal "D" with a +1.50-D add power, or Biofinity Multifocal "D" with a +2.50-D add power contact lenses. RESULTS We examined 443 subjects at the baseline visits, and 294 (66.4%) subjects were enrolled. Of the enrolled subjects, 177 (60.2%) were female, and 200 (68%) were white. The mean (± SD) age was 10.3 ± 1.2 years, and 117 (39.8%) of the eligible subjects were younger than 10 years. The mean spherical equivalent refractive error, measured by cycloplegic autorefraction was -2.39 ± 1.00 D. The best-corrected binocular logMAR visual acuity with glasses was +0.01 ± 0.06 (20/21) at distance and -0.03 ± 0.08 (20/18) at near. CONCLUSIONS The BLINK study subjects are similar to patients who would routinely be eligible for myopia control in practice, so the results will provide clinical information about soft bifocal contact lens myopia control as well as information about the mechanism of the treatment effect, if one occurs.
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Affiliation(s)
| | | | | | | | - Juan Huang
- The Ohio State University College of Optometry, Columbus, Ohio
| | - Donald O. Mutti
- The Ohio State University College of Optometry, Columbus, Ohio
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Changes in Peripheral Refraction, Higher-Order Aberrations, and Accommodative Lag With a Radial Refractive Gradient Contact Lens in Young Myopes. Eye Contact Lens 2017; 42:380-387. [PMID: 26808699 DOI: 10.1097/icl.0000000000000222] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE To evaluate changes in the peripheral refraction (PR), visual quality, and accommodative lag with a novel soft radial refractive gradient (SRRG) experimental contact lens that produces peripheral myopic defocus. METHODS 59 myopic right eyes were fitted with the lens. The PR was measured up to 30° in the nasal and temporal horizontal visual fields and compared with values obtained without the lens. The accommodative lag was measured monocularly using the distance-induced condition method at 40 cm, and the higher-order aberrations (HOAs) of the entire eye were obtained for 3- and 5-mm pupils by aberrometry. Visual performance was assessed through contrast sensitivity function (CSF). RESULTS With the lens, the relative PR became significantly less hyperopic from 30° to 15° temporally and 30° nasally in the M and J0 refractive components (P<0.05). Cylinder foci showed significant myopization from 30° to 15° temporally and 30° to 25° nasally (P<0.05). The HOAs increased significantly, the CSF decreased slightly but reached statistical significance for 6 and 12 cycles per degree (P<0.05), and the accommodative lag decreased significantly with the SRRG lens (P=0.0001). There was a moderate correlation between HOAs and CSF at medium and high spatial frequencies. CONCLUSION The SRRG lens induced a significant change in PR, particularly in the temporal retina. Tangential and sagittal foci changed significantly in the peripheral nasal and temporal retina. The decreased accommodative lag and increased HOAs particularly in coma-like aberration may positively affect myopia control. A longitudinal study is needed to confirm this potential.
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Wang B, Naidu RK, Qu X. Factors related to axial length elongation and myopia progression in orthokeratology practice. PLoS One 2017; 12:e0175913. [PMID: 28419129 PMCID: PMC5395222 DOI: 10.1371/journal.pone.0175913] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 04/02/2017] [Indexed: 12/26/2022] Open
Abstract
Purpose To investigate which baseline factors are predictive for axial length growth over an average period of 2.5 years in a group of children wearing orthokeratology (OK) contact lenses. Methods In this retrospective study, the clinical records of 249 new OK wearers between January 2012 and December 2013 from the contact lens clinic at the Eye and ENT Hospital of Fudan University were reviewed. The primary outcome measure was axial length change from baseline to the time of review (July-August 2015). Independent variables included baseline measures of age at initiation of OK wear, gender, refractive error (spherical equivalent), astigmatism, average keratometry, corneal toricity, central corneal thickness, white-to-white corneal diameter, pupil size, corneal topography eccentricity value (e-value), intraocular pressure (IOP) and total time in follow-up (months total). The contributions of all independent variables on axial length change at the time of review were assessed using univariate and multivariable regression analyses. Results Univariate analyses of the right eyes of 249 OK patients showed that smaller increases in axial length were associated with older age at the onset of OK lens wear, greater baseline spherical equivalent myopic refractive error, less time in follow-up and a smaller e-value. Multivariable analyses of the significant right eye variables showed that the factors associated with smaller axial length growth were older age at the onset of OK lens wear (p<0.0001), greater baseline spherical equivalent myopic refractive error (p = 0.0046) and less time in follow-up (p<0.0001). Conclusions The baseline factors demonstrating the greatest correlation with reduced axial length elongation during OK lens wear in myopic children included greater baseline spherical equivalent myopic refractive error and older age at the onset of OK lens wear.
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Affiliation(s)
- Bingjie Wang
- Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Rajeev K. Naidu
- School of Medicine, University of Sydney, Camperdown, NSW, Australia
| | - Xiaomei Qu
- Eye & ENT Hospital, Fudan University, Shanghai, China
- Key Laboratory of Myopia, Ministry of Health, Fudan University, Shanghai, China
- * E-mail:
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Yang X, Li Z, Zeng J. A Review of the Potential Factors Influencing Myopia Progression in Children Using Orthokeratology. Asia Pac J Ophthalmol (Phila) 2017; 5:429-433. [PMID: 27898447 DOI: 10.1097/apo.0000000000000242] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Myopia has become a worldwide public health issue. Recent studies have consistently reported that orthokeratology (Ortho-K) significantly inhibits the progression of myopia by slowing the elongation of axial length. It has been hypothesized that this effect results from the induction of peripheral myopic defocus, which is a result of the effects of the Ortho-K lenses on the midperipheral corneal topography. Previous studies have investigated the relationship between predicting factors and the inhibitory effect of Ortho-K for slowing childhood myopic progression and found some meaningful results; however, some of the findings are controversial. To enhance the understanding of the underlying mechanism of Ortho-K in slowing childhood myopic progression, the factors affecting this process were reviewed.
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Affiliation(s)
- Xiao Yang
- From the State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
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Lyu B, Hwang KY, Kim SY, Kim SY, Na KS. Effectiveness of Toric Orthokeratology in the Treatment of Patients with Combined Myopia and Astigmatism. KOREAN JOURNAL OF OPHTHALMOLOGY 2016; 30:434-442. [PMID: 27980362 PMCID: PMC5156617 DOI: 10.3341/kjo.2016.30.6.434] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The purpose of this multi-institute, single-group clinical trial was to evaluate the effectiveness and safety of toric orthokeratology lenses for the treatment of patients with combined myopia and astigmatism. METHODS A total of 44 patients were included in this clinical trial. The patients ranged in age from 7 to 49 years, with myopia of -0.75 to -6.0 diopters (D) and astigmatism of 1.25 to 4.0 D. After excluding 21 subjects, 23 subjects (39 eyes) were analyzed after toric orthokeratology lens use. The subjects underwent ophthalmologic examination after 1 day and 1, 2, 3, and 4 weeks of wearing overnight toric orthokeratology lenses. RESULTS A total of 19 subjects (31 eyes) completed the trial after five subjects (eight eyes) dropped out. In the patients who completed the study by wearing lenses for 4 weeks, the myopic refractive error decreased significantly by 2.60 ± 2.21 D (p < 0.001), from -3.65 ± 1.62 to -1.05 ± 1.64 D. The astigmatic refractive error were also significantly decreased by 0.63 ± 0.98 D (p = 0.001), from 2.07 ± 0.83 to 1.44 ± 0.99 D. The mean uncorrected and corrected visual acuities before wearing the lenses were 2.14 ± 0.80 logarithm of the logMAR (logMAR) and 0.05 ± 0.13 logMAR, respectively, which changed to 0.12 ± 0.30 logarithm of the logMAR (p < 0.001) and 0.01 ± 0.04 logMAR (p = 0.156) after 4 weeks. No serious adverse reactions were reported during the clinical trial. CONCLUSIONS Our results suggest that toric orthokeratology is an effective and safe treatment for correcting visual acuity in patients with combined myopia and astigmatism.
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Affiliation(s)
- Byul Lyu
- Department of Ophthalmology, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Kyu Yeon Hwang
- Department of Ophthalmology, Myunggok Medical Research Institute, Konyang University College of Medicine, Daejeon, Korea
| | - Sun Young Kim
- Department of Ophthalmology, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Su Young Kim
- Department of Ophthalmology, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Kyung Sun Na
- Department of Ophthalmology, The Catholic University of Korea College of Medicine, Seoul, Korea
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Santodomingo-Rubido J, Villa-Collar C, Gilmartin B, Gutiérrez-Ortega R, Sugimoto K. Long-term Efficacy of Orthokeratology Contact Lens Wear in Controlling the Progression of Childhood Myopia. Curr Eye Res 2016; 42:713-720. [PMID: 27767354 DOI: 10.1080/02713683.2016.1221979] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE The primary outcome of this study is to compare the axial length growth of white European myopic children wearing orthokeratology contact lenses (OK) to a control group (CT) over a 7-year period. METHODS Subjects 6-12 years of age with myopia -0.75 to -4.00DS and astigmatism ≤1.00DC were prospectively allocated OK or distance single-vision spectacles (SV) correction. Measurements of axial length (Zeiss IOLMaster), corneal topography, and cycloplegic refraction were taken at 6-month intervals over a 2-year period. Subjects were invited to return to the clinic approximately 5 years later (i.e., 7 years after the beginning of the study) for assessment of their ocular refractive and biometric components. The CT consisted of 4 SV and 12 subjects who switched from SV to soft contact lens wear after the initial 2 years of SV lens wear. Changes in axial length relative to baseline over a 7-year period were compared between groups. RESULTS Fourteen and 16 subjects from the OK and CT groups, respectively, were examined 6.7 ± 0.5 years after the beginning of the study. Statistically significant changes in the axial length were found over time and between groups (both p < 0.001), but not for the time*group interaction (p = 0.125). The change in the axial length for the OK group was 22% (p = 0.328), 42% (p = 0.007), 40% (p = 0.020), 41% (p = 0.013), and 33% (p = 0.062) lower than the CT group following 6, 12, 18, 24, and 84 months of lens wear, respectively. CONCLUSION A trend toward a reduction in the rate of axial elongation of the order of 33% was found in the OK group in comparison to the CT group following 7 years of lens wear.
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Affiliation(s)
| | - César Villa-Collar
- b Optics & Optometry Department, Faculty of Health Sciences , Universidad Europea , Madrid , Spain
| | - Bernard Gilmartin
- c School of Life and Health Sciences, Department of Optometry , Ophthalmic Research Group, Aston University , Birmingham , UK
| | - Ramón Gutiérrez-Ortega
- b Optics & Optometry Department, Faculty of Health Sciences , Universidad Europea , Madrid , Spain
| | - Keiji Sugimoto
- a Menicon R&D Innovation Center, Research & Development, Menicon Co., Ltd , Geneva , Switzerland
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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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Swarbrick HA, Alharbi A, Watt K, Lum E, Kang P. Myopia control during orthokeratology lens wear in children using a novel study design. Ophthalmology 2014; 122:620-30. [PMID: 25439432 DOI: 10.1016/j.ophtha.2014.09.028] [Citation(s) in RCA: 153] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Revised: 09/04/2014] [Accepted: 09/20/2014] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To investigate the effect of overnight orthokeratology (OK) contact lens wear on axial length growth in East Asian children with progressive myopia. DESIGN A prospective, randomized, contralateral-eye crossover study conducted over a 1-year period. PARTICIPANTS We enrolled 26 myopic children (age range, 10.8-17.0 years) of East Asian ethnicity. METHODS Subjects were fitted with overnight OK in 1 eye, chosen at random, and conventional rigid gas-permeable (GP) lenses for daytime wear in the contralateral eye. Lenses were worn for 6 months. After a 2-week recovery period without lens wear, lens-eye combinations were reversed and lens wear was continued for a further 6 months, followed by another 2-week recovery period without lens wear. Axial eye length was monitored at baseline and every 3 months using an IOLMaster biometer. Corneal topography (Medmont E300) and objective refraction (Shin-Nippon NVision-K 5001 autorefractor) were also measured to confirm that OK lens wear was efficacious in correcting myopia. MAIN OUTCOME MEASUREMENTS Axial length elongation and myopia progression with OK were compared with conventional daytime rigid contact lens wear. RESULTS After 6 months of lens wear, axial length had increased by 0.04±0.06 mm (mean±standard deviation) in the GP eye (P=0.011) but showed no change (-0.02±0.05 mm) in the OK eye (P=0.888). During the second 6-month phase of lens wear, in the OK eye there was no change from baseline in axial length at 12 months (-0.04±0.08 mm; P=0.218). However, in the GP eye, the 12-month increase in axial length was significant (0.09±0.09 mm; P<0.001). The GP lens-wearing eye showed progressive axial length growth throughout the study. CONCLUSIONS These results provide evidence that, at least in the initial months of lens wear, overnight OK inhibits axial eye growth and myopia progression compared with conventional GP lenses. Apparent shortening of axial length early in OK lens wear may reflect the contribution of OK-induced central corneal thinning, combined with choroidal thickening or recovery due to a reduction or neutralization of the myopiogenic stimulus to eye growth in these myopic children.
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Affiliation(s)
- Helen A Swarbrick
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia.
| | - Ahmed Alharbi
- Department of Optometry and Vision Science, King Saud University, Riyadh, Saudi Arabia
| | - Kathleen Watt
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Edward Lum
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Pauline Kang
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
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Short-Term Changes in Ocular Biometry and Refraction After Discontinuation of Long-Term Orthokeratology. Eye Contact Lens 2014; 40:84-90. [DOI: 10.1097/icl.0000000000000014] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Aller TA. Clinical management of progressive myopia. Eye (Lond) 2014; 28:147-53. [PMID: 24357844 PMCID: PMC3930271 DOI: 10.1038/eye.2013.259] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 11/06/2013] [Indexed: 11/08/2022] Open
Abstract
Myopia has been increasing in prevalence throughout the world, reaching over 90% in some East Asian populations. There is increasing evidence that whereas genetics clearly have an important role, the type of visual environment to which one is exposed to likely influences the onset, progression, and cessation of myopia. Consequently, attempts to either modify the environment or to reduce the exposure of the eye to various environmental stimuli to eye growth through the use of various optical devices are well under way at research centers around the globe. The most promising of current treatments include low-percentage atropine, bifocal soft contact lenses, orthokeratology, and multifocal spectacles. These methods are discussed briefly and are then categorized in terms of their expected degree of myopia progression control. A clinical strategy is presented for selecting the most effective treatment for the appropriate type of patient at the optimal stage of refractive development to achieve the maximum control of myopia progression.
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Affiliation(s)
- T A Aller
- Private Practice, San Bruno, CA, USA
- Vision Cooperative Research Centre, Sydney, NSW, Australia
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