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Akinbinu TR, Naidoo KS, Wajuihian SO. Myopia control in the 21st century: A review of optical methods (2000–2019). AFRICAN VISION AND EYE HEALTH 2020. [DOI: 10.4102/aveh.v79i1.499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Changes in axial length after orthokeratology lens treatment for myopia: a meta-analysis. Int Ophthalmol 2020; 40:255-265. [PMID: 31916062 DOI: 10.1007/s10792-019-01167-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Accepted: 09/19/2019] [Indexed: 12/17/2022]
Abstract
PURPOSE Orthokeratology (OK) lens is a popular optical method to control myopia progression. This study aimed to assess the effect of OK lens on axial length change compared with glasses. METHODS PubMed, Web of Science, and Embase were searched to retrieve the related articles. Then, the articles were selected according to predefined criteria. Standardized mean difference (SMD) and 95% confidence interval (CI) were selected as effect size for combining and analyzing the change in axial length. RESULTS A total of 13 articles were included in the present study. Different models were selected according to the heterogeneity of each analysis. The axial length change in OKs group was significantly smaller than control group; SMD (95% CI) of change in axial length was - 0.857 (- 1.146, - 0.568), p < 0.001 at the end of 1 year and - 0.701 (- 1.675, 0.272), p < 0.001 at the end of 2 years or longer time. CONCLUSIONS OK lens treatment appears more effective in slowing axial elongation than glasses during the early treatment of myopia in children.
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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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Assessing the change of anisometropia in unilateral myopic children receiving monocular orthokeratology treatment. J Formos Med Assoc 2019; 118:1122-1128. [DOI: 10.1016/j.jfma.2019.02.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Revised: 01/12/2019] [Accepted: 02/01/2019] [Indexed: 12/21/2022] Open
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VanderVeen DK, Kraker RT, Pineles SL, Hutchinson AK, Wilson LB, Galvin JA, Lambert SR. Use of Orthokeratology for the Prevention of Myopic Progression in Children. Ophthalmology 2019; 126:623-636. [DOI: 10.1016/j.ophtha.2018.11.026] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 11/20/2018] [Accepted: 11/20/2018] [Indexed: 11/17/2022] Open
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Tan Q, Ng AL, Cheng GP, Woo VC, Cho P. Combined Atropine with Orthokeratology for Myopia Control: Study Design and Preliminary Results. Curr Eye Res 2019; 44:671-678. [PMID: 30632410 DOI: 10.1080/02713683.2019.1568501] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Purpose: The purpose of this study is to present the study design and one month's preliminary results of a 2-year randomized trial, Combined Atropine with Orthokeratology (AOK), for myopia control study. Methods: Children aged 6 to <11 years and with 1.00-4.00 D myopia were randomly assigned to AOK group or ortho-k alone (OK) group. Subjects are required to attend routine ortho-k aftercare visits (first-overnight, 1 week, 2 weeks, 3 weeks, 1 month, and every 3 months after commencement of lens wear). Clinical outcomes, including lens performance, changes in refractive error, unaided vision, ocular adverse events, corneal staining, lens binding and centration, and axial length, are also assessed at 6-monthly data collection visit. Results: Data of 30 AOK and 34 OK subjects who had completed the 1-month visit were analyzed. No significant differences in baseline data were found between the two groups (P > 0.05). At the 1-month visit, first-fit success rate was 95%, with full myopia reduction. Mild corneal staining was observed in 23.3% and 30.9% and mild self-reported lens binding in 50% and 41% in AOK and OK groups, respectively, after 1-month lens wear. Mean (±standard deviation) change in axial length was significantly higher in AOK than OK subjects (AOK: -0.05 ± 0.05 mm; OK: -0.02 ± 0.03 mm) (P = 0.003). Conclusions: After 1 month of treatment, first-fit success rate of ortho-k lenses was high in both groups of subjects; addition of 0.01% atropine in AOK subjects did not affect the lens performance or clinical responses. These results provide the assurance that it is acceptable to continue this longitudinal study, as longer study duration, usually 2 years, is required to determine the effectiveness of treatment for myopia control.
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Affiliation(s)
- Qi Tan
- a School of Optometry , The Hong Kong Polytechnic University , Hung Hom , Hong Kong
| | - Alex Lk Ng
- b Department of Ophthalmology , The University of Hong Kong , Hong Kong.,c Hong Kong Ophthalmic Associates , Hong Kong
| | | | - Victor Cp Woo
- b Department of Ophthalmology , The University of Hong Kong , Hong Kong.,c Hong Kong Ophthalmic Associates , Hong Kong
| | - Pauline Cho
- a School of Optometry , The Hong Kong Polytechnic University , Hung Hom , Hong Kong
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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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Cho P, Tan Q. Myopia and orthokeratology for myopia control. Clin Exp Optom 2018; 102:364-377. [PMID: 30380591 DOI: 10.1111/cxo.12839] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 08/17/2018] [Accepted: 08/20/2018] [Indexed: 12/18/2022] Open
Abstract
The prevalence of myopia in children is increasing worldwide and is viewed as a major public health concern. This increase has driven interest in research into myopia prevention and control in children. Although there is still uncertainty in the risk factors underlying differences in myopia prevalence between ethnic groups, rates in children of East Asian descent are typically higher regardless of where they live. Mounting evidence also suggests that myopia prevalence in children increases with age. Earlier commencement and more rigorous education systems in these countries, resulting in more time spent on near-work activities and less time on outdoor activities, may be responsible for the earlier age of myopia onset. However, to date, the mechanisms regulating myopia onset and progression are still poorly understood. Findings from several studies have shown orthokeratology to be effective in slowing axial elongation and it is a well-accepted treatment, particularly in East Asian regions. While our understanding of this treatment has increased in the last decade, more work is required to answer questions, including: How long should the treatment be continued? Is there a rebound effect? Should the amount of myopia control be increased? To whom and when should the treatment be offered? Practitioners are now faced with the need to carefully guide and advise parents on whether and when to undertake a long somewhat complex intervention, which is costly, both in time and money. In the near future, a greater demand for effective prophylaxis against childhood myopia is envisaged. Other than orthokeratology, atropine therapy has been shown to be effective in slowing myopia progression. While its mechanism of control is also not fully understood, it is likely that it acts via a different mechanism from orthokeratology. Thus, a combined treatment of orthokeratology and atropine may have great potential to maximise the effectiveness of myopia control interventions.
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Affiliation(s)
- Pauline Cho
- School of Optometry, The Hong Kong Polytechnic University, Hong Kong, China
| | - Qi Tan
- School of Optometry, The Hong Kong Polytechnic University, Hong Kong, China
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Analysis of Two Orthokeratology Lens Designs and Comparison of Their Optical Effects on the Cornea. Eye Contact Lens 2018; 44:322-329. [PMID: 29489498 DOI: 10.1097/icl.0000000000000495] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE This study aims to analyze two commercial orthokeratology lens designs and compare their optical effects at the corneal level. METHODS This is a retrospective study on subjects seeking an orthokeratology fitting for myopia management at the Université de Montréal clinic between January 2013 and August 2015. Group A included the first 64 subjects fitted with a 4-curve lens design (Paragon CRT; Paragon) who met the inclusion criteria, whereas group B included the same number of subjects fitted with a 5-curve lens design (Dreamlens; Polymer Technology, Rochester, NY). Topographic tangential maps were collected at baseline and 3 months after fitting. The differential map was generated for each patient and analyzed, which involved determining the radius of the central distance zone (CDZ) and the power and width of the high convex zone (HCZ). Results were compared between the two groups, taking baseline refraction into account. Finally, a correlation was estimated between topographic data and corneal parameters (flat and steep K, the corneal eccentricity of each principal meridian). RESULTS The CDZ for group A is significantly larger than the one generated for group B both horizontally (t(126)=12.12, P<0.01) and vertically (t(126)=15.690, P<0.01). However, there was no significant difference regarding the HCZ power generated. The only correlations found were a strong positive association between CDZ radius and HCZ power generated by lens A nasally (r=0.450; P=0.000) and temporally (r=0.558; P=0.000), and a weaker association between the baseline refractive error, along with the nasal (r=0.237; P=0.033) and temporal (r=0.288; P=0.028) HCZ power for lens B. CONCLUSION The four- and five-curve orthokeratology lens designs generate significantly different optical modifications on the cornea. This can affect reports on orthokeratology efficacy for myopia management as well as the lens selection when used for myopia correction.
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Abstract
OBJECTIVES To investigate the level of compliance with orthokeratology (ortho-k) guidelines and the main behaviors of poor compliance to guide clinical care. METHODS A questionnaire was sent to ortho-k patients in the Eye Hospital of Wenzhou Medical University (EHWMU) in Mainland China who were prescribed ortho-k lenses after January 2013 and have worn ortho-k lenses for more than 1 year to determine the compliance rate for eight wear and care behaviors. Follow-up visit compliance was then investigated among these patients using a retrospective survey. RESULTS A total of 1,500 questionnaires were distributed, and 405 patients responded. The mean age of the patients was 13.1±3.9 years (range 9-22 years); 60.5% of the patients were female, and 98.3% were younger than 18 years. The full compliance rate was 14.1%, the compliance rate for wear and care behaviors was 18.5%, and the compliance rate for follow-up visits was 63.3%. The three highest noncompliance categories for wear and care behaviors were exposure to nonsterile solution, not removing lens depositions according to the eye care practitioners' (ECPs) recommendations and inadequate hand washing. No correlation was observed between the compliance for wear and care behaviors and age, sex, and wearing experience. The follow-up visit compliance rate significantly decreased from the third month to the ninth month. The common reasons for discontinuing follow-up were lack of time, no symptoms, and inconvenience. CONCLUSIONS The level of compliance with ortho-k lens wear in Mainland China is not high, necessitating ECPs to stress to patients the details of wear and care behaviors, especially avoiding exposing lenses to nonsterile solution. Improving monitoring of follow-up visits, particularly within the first 9 months of wearing ortho-k lenses, is needed.
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Axial Elongation in Myopic Children and its Association With Myopia Progression in the Correction of Myopia Evaluation Trial. Eye Contact Lens 2018; 44:248-259. [PMID: 29923883 DOI: 10.1097/icl.0000000000000505] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Describe axial elongation using 14-year longitudinal data in a large, ethnically diverse group of myopic children, estimate age and axial length (AL) at stabilization, and evaluate associations between the progression and stabilization of AL and myopia. METHODS Axial length was measured by A-scan ultrasonography annually. Axial length data were fit with individual polynomial functions and curve-based parameters (AL at stabilization and age at stabilization when annual rate of axial elongation ≤0.06 mm) were estimated. For myopia progression, noncycloplegic spherical equivalent refractions were fit with Gompertz functions. RESULTS Four hundred thirty-one participants, with AL and myopia data fit successfully, were classified into four cohorts: Younger (n=30); Older (n=334); AL Stabilized at Baseline (n=19); and AL Not Stabilized (n=48). At AL stabilization, for participants in the Younger and Older Cohorts, mean (SD) age and AL were 16.3 (2.4) years and 25.2 (0.9) mm, respectively. No associations were found between age at AL stabilization and ethnicity, sex, or number of myopic parents. At stabilization, sex and number of myopic parents (both P<0.003), but not ethnicity, were significantly associated with AL. Axial length and myopia progression curves were highly correlated overall (all r>0.77, P<0.0001). However, unlike AL, the amount of myopia did not differ significantly between males and females. CONCLUSIONS In most of the participants, AL increased rapidly at younger ages and then slowed and stabilized. The close association between growth and stabilization of AL and myopia is consistent with the suggestion that axial elongation is the primary ocular component in myopia progression and stabilization.
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Abstract
Myopia occurs in more than 50% of the population in many industrialized countries and is expected to increase; complications associated with axial elongation from myopia are the sixth leading cause of blindness. Thus, understanding its etiology, epidemiology, and the results of various treatment regiments may modify current care and result in a reduction in morbidity from progressive myopia. This rapid increase cannot be explained by genetics alone. Current animal and human research demonstrates that myopia development is a result of the interplay between genetic and the environmental factors. The prevalence of myopia is higher in individuals whose both parents are myopic, suggesting that genetic factors are clearly involved in myopia development. At the same time, population studies suggest that development of myopia is associated with education and the amount time spent doing near work; hence, activities increase the exposure to optical blur. Recently, there has been an increase in efforts to slow the progression of myopia because of its relationship to the development of serious pathological conditions such as macular degeneration, retinal detachments, glaucoma, and cataracts. We reviewed meta-analysis and other of current treatments that include: atropine, progressive addition spectacle lenses, orthokeratology, and multifocal contact lenses.
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Assessment of Clinical Trials for Devices Intended to Control Myopia Progression in Children. Eye Contact Lens 2018; 44:212-219. [DOI: 10.1097/icl.0000000000000476] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Na M, Yoo A. The effect of orthokeratology on axial length elongation in children with myopia: Contralateral comparison study. Jpn J Ophthalmol 2018. [PMID: 29524061 DOI: 10.1007/s10384-018-0573-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE To evaluate the effectiveness of the orthokeratology (OK) lens slowing myopic progression compared with no intervention in pediatric eyes METHODS: A retrospective review of medical records was performed on 45 monocular myopic subjects 7 to 13 years of age who were treated with monocular ortho-k lens and followed-up for more than 12 months. The monocular myopia in the subjects' eyes was -0.75 to -4.25 D (diopter), and near emmetropia in the contralateral and with-the-rule astigmatism no greater than -1.50 D. Axial elongation OU, reflecting the progression of myopia was measured at baseline using the same AL-Scan Optical Biometer and compared between the two eyes of each individual every six months for one year in all subjects and for two years in 9 subjects. RESULTS After 12 months of lens wear, axial length had increased by 0.36 ± 0.23mm in the control eyes (P < 0.001) but showed far less change (+0.07 ± 0.21 mm) in the OK eyes (P = 0.038). The nine subjects followed-up for 2 years showed no axial length change (+0.16 ± 0.25 mm) in the OK eyes (P = 0.095) after 24 months and significant axial length growth (+0.38 ± 0.26 mm; P = 0.002) in the control eyes. Control eyes showed progressive axial length growth throughout the study compared with the one OK lens eye. CONCLUSIONS Using a contralateral eye study design, which prevented the influence of potential confounding factors, Effectiveness of the OK lens was proved. Myopic progression within a subject was excellent compared with no intervention.
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Affiliation(s)
- Miri Na
- Department of Ophthalmology, Saevit Eye Hospital, 1065, Jungang-ro, Ilsandong-gu, Goyang, Gyeonggi-do, 10447, Republic of Korea
| | - Aeri Yoo
- Department of Ophthalmology, Saevit Eye Hospital, 1065, Jungang-ro, Ilsandong-gu, Goyang, Gyeonggi-do, 10447, Republic of Korea.
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Bacterial Bioburden Decrease in Orthokeratology Lens Storage Cases After Forewarning: Assessment by the DNA Dot Hybridization Assay. Eye Contact Lens 2017; 43:174-180. [PMID: 26859742 PMCID: PMC5405777 DOI: 10.1097/icl.0000000000000252] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background: The aim of this study was to measure the changes in the bacterial bioburden in orthokeratology (OK) lens storage cases using the DNA dot hybridization assay (DHA) after forewarning patients about their bacterial contamination severity. Methods: Thirty-one OK lens wearers were prospectively enrolled in this study. Dot hybridization assay was used for serial measurements of bacterial bioburden in OK storage cases after lenses had been soaked for approximately 6 hr. After the first assessment, the lens wearers were informed of the extent of case contamination and the possible risk of microbial keratitis (MK), and best practices for lens care and lens case hygiene were reviewed and reinforced. A second assessment by the same DHA method was performed after approximately 6 months. Results: Two universal bacterial probes confirmed a significant decrease in bacterial bioburden at the second assessment (P<0.01 and P<0.001). Genus-specific probes showed significant reductions in Acinetobacter and Klebsiella (P=0.02 and P=0.01), but not in Pseudomonas (P=0.42). Conclusions: Making OK lens wearers aware of the bacterial bioburden in their lens cases resulted in improved quality of case care and reduced bioburden. Our results suggest that a strategy of bioburden assessment with forewarning could be a useful method to decrease the incidence of OK-related MK.
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Li X, Friedman IB, Medow NB, Zhang C. Update on Orthokeratology in Managing Progressive Myopia in Children: Efficacy, Mechanisms, and Concerns. J Pediatr Ophthalmol Strabismus 2017; 54:142-148. [PMID: 28092397 DOI: 10.3928/01913913-20170106-01] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 10/19/2016] [Indexed: 02/06/2023]
Abstract
Myopia is an important public health issue, and high myopia may lead to severe complications if left untreated. Orthokeratology lenses, worn overnight to reshape the cornea, are one of many recent modalities used to slow down the progression of myopia in children. This treatment has been proven successful, as evidenced by decreased spherical refractive error and axial length relative to the control at interval follow-up ranging from 6 months to 5 years. In this systematic review, the authors collected published controlled studies that analyzed the efficacy of orthokeratology lens wear and calculated longitudinal relative changes in axial length, revealing a weighted average of -45.1% change in axial length at the 2-year follow-up. The exact mechanism by which orthokeratology lenses reduce myopia progression is unknown, but research shows that the corneal reshaping decreases peripheral hyperopic defocus and therefore increases peripheral myopic defocus to likely reduce stimuli for axial elongation and subsequent development of myopia. Use of orthokeratology lenses is generally safe, but cases of associated infectious keratitis may have a higher incidence of virulent organisms such as Pseudomonas, Acanthamoeba, and antibacterial-resistant strains of Staphylococcus, partially due to the required overnight use of these lenses. Orthokeratology is regarded as one of the most effective non-pharmacologic measures to slow progression of myopia in children and, with regular follow-up to ensure safety, continues to be one of the most effective treatments for myopia management around the world. [J Pediatr Ophthalmol Strabismus. 2017;54(3):142-148.].
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Abstract
Objectives: The aim of this review is to evaluate the ocular safety of orthokeratology (OrthoK) treatment of myopia correction and retardation. Data Sources: Clinical studies published in English and Chinese were identified from MEDLINE, EMBASE CNKI, CQVIP, and WANFANG DATA (all from 1980 to April 2015). The reference lists of the studies and the Science Citation Index were also searched. Selection Criteria: Relevant clinical studies including case series, case reports, patient/practitioner surveys, retrospective and prospective cohort studies, and clinical trials were all included in the review. The material of OrthoK lenses was limited to gas-permeable lens. Main Results: This review incorporated a total of 170 publications, including 58 English and 112 Chinese literature. The risk of microbial keratitis in overnight OrthoK was similar to that of other overnight modality. The most common complication was corneal staining. Other clinically insignificant side effects included epithelial iron deposit, prominent fribrillary lines, and transient changes of corneal biomechanical properties. There was no long-term effect of OrthoK on corneal endothelium. Conclusions: There is sufficient evidence to suggest that OrthoK is a safe option for myopia correction and retardation. Long-term success of OrthoK treatment requires a combination of proper lens fitting, rigorous compliance to lens care regimen, good adherence to routine follow-ups, and timely treatment of complications.
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He M, Du Y, Liu Q, Ren C, Liu J, Wang Q, Li L, Yu J. Effects of orthokeratology on the progression of low to moderate myopia in Chinese children. BMC Ophthalmol 2016; 16:126. [PMID: 27464993 PMCID: PMC4964026 DOI: 10.1186/s12886-016-0302-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 07/13/2016] [Indexed: 11/19/2022] Open
Abstract
Background To investigate the effectiveness of orthokeratology (ortho-k) in reducing the development of myopia in Chinese children with low to moderate myopia. Methods This was a retrospective study. In the ortho-k group, there were141 subjects, and the average age was (9.43 ± 1.10) years. The average spherical equivalent refractive error (SER) was (−2.74 ± 1.15)D, with examinations performed 1, 7, 30, and 90 days and 12 months after the patients started wearing ortho-k lenses. In the control group, there were 130 subjects, and the average age was (9.37 ± 1.00) years. The average SER was (−2.88 ± 1.39)D, with examinations performed every 6 months. Axial elongation, which is an important parameter reflecting the progression of myopia, was measured at baseline from the same IOLMaster each time by the same masked examiner and was compared between the groups after 1 year. The subjects were divided into two sub-groups according to age to further study the development of myopia at different ages. An unpaired t-test, paired t-test, Chi-square test and Spearman test were performed to analyze the data. Results After 1 year, the average axial elongation was (0.27 ± 0.17) mm in the ortho-k lens group and (0.38 ± 0.13) mm in the control group, with a significant difference between the groups (P < 0.001). Axial elongation was not correlated with SER but had a negative correlation with initial age (ortho-k group: rs = −0.309, p < 0.01; control group: rs = −0.472, p < 0.01). The percentages of individuals with fast myopic progression (axial elongation > 0.36 mm per year) were 38.0 % among younger children (7.00 to 9.40 years) and 24.3 % among older children (9.40 to 12.00 years), whereas the respective percentages were 76.5 and 12.9 % in the control group. When SER ranged from -5.0D to −6.0D, the axial elongation in the ortho-k group was 57.1 % slower than that in the control group. Conclusions Ortho-k lenses are effective in controlling myopic progression in Chinese children, particularly in younger children and in children with higher myopia.
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Affiliation(s)
- Mengmei He
- Department of Ophthalmology, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, No.301 Middle YanChang Road, ZhaBei District, Shanghai, 200072, China
| | - Yaru Du
- Department of Ophthalmology, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, No.301 Middle YanChang Road, ZhaBei District, Shanghai, 200072, China.,Department of First Clinical Medical College, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Qingyu Liu
- Department of Ophthalmology, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, No.301 Middle YanChang Road, ZhaBei District, Shanghai, 200072, China
| | - Chengda Ren
- Department of Ophthalmology, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, No.301 Middle YanChang Road, ZhaBei District, Shanghai, 200072, China
| | - Junling Liu
- Department of Ophthalmology, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, No.301 Middle YanChang Road, ZhaBei District, Shanghai, 200072, China
| | - Qianyi Wang
- Department of Ophthalmology, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, No.301 Middle YanChang Road, ZhaBei District, Shanghai, 200072, China
| | - Li Li
- Department of Ophthalmology, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, No.301 Middle YanChang Road, ZhaBei District, Shanghai, 200072, China.
| | - Jing Yu
- Department of Ophthalmology, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, No.301 Middle YanChang Road, ZhaBei District, Shanghai, 200072, China.
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Chen J, He JC, Chen Y, Xu J, Wu H, Wang F, Lu F, Jiang J. Interocular Difference of Peripheral Refraction in Anisomyopic Eyes of Schoolchildren. PLoS One 2016; 11:e0149110. [PMID: 26881745 PMCID: PMC4755577 DOI: 10.1371/journal.pone.0149110] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2015] [Accepted: 01/27/2016] [Indexed: 12/26/2022] Open
Abstract
Purpose Refraction in the peripheral visual field is believed to play an important role in the development of myopia. The purpose of this study was to investigate the differences in peripheral refraction among anisomyopia, isomyopia, and isoemmetropia for schoolchildren. Methods Thirty-eight anisomyopic children were recruited and divided into two groups: (1) both eyes were myopic (anisomyopic group, AM group) and (2) one eye was myopic and the contralateral eye was emmetropic (emmetropic anisomyopic group, EAM group). As controls, 45 isomyopic and isoemmetropic children were also recruited with age and central spherical equivalent (SE) matched to those of the AM and EAM groups. The controls were divided into three groups: (1) intermediate myopia group (SE matched to the more myopic eye of AM group), (2) low myopia group (SE matched to the less myopic eye of AM group and the more myopic eye of EAM group), and (3) emmetropia group (SE matched to the less myopic eye of EAM group). Peripheral refraction at 7 points across the central ±30° on the horizontal visual field with a 10° interval was measured with an autorefractor. Axial length (AL), corneal curvature (CC), and anterior chamber depth (ACD) were also determined by using the Zeiss IOL-Master. Results The relative peripheral spherical equivalent [RPR(M)] and relative peripheral spherical value [RPR(S)] of the more myopic eye was shifted more hyperopically than the contralateral eye in both the AM and the EAM groups (both p<0.0001). The RPR(M, S) of the less myopic eyes in the AM and EAM groups showed a relatively flat trend across the visual field and were not significantly different from the emmetropia group. The RPR(M, S) of less myopic eyes in the AM group were shifted less hyperopically than in the isomyopic low myopia group and the more myopic eye of the EAM group [RPR(M), p = 0.007; RPR(S), p = 0.001], although the central SEs of the three groups were not significantly different from each other. However, RPR(M, S) of the more myopic eyes were not different from the corresponding isomyopic groups. There was also no significant difference in the relative peripheral astigmatism [RPR(J0, J45)] between the more and the less myopic eyes in either the AM or the EAM group. Conclusion Refraction of anisomyopia differs between the two eyes not only at the central visual field but also at the off-axis periphery. The relative peripheral refraction of the more myopic eye of anisomyopia was shifted hyperopically, as occurs in isomyopia with similar central subjective SE values. Less myopic eyes were much less hyperopically shifted in relative peripheral refraction than the corresponding isomyopic eyes, but are comparable to emmetropic eyes. This emmetropia-like relative peripheral refraction in less myopic eyes might be a factor responsible for slowing down the progression of myopia.
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Affiliation(s)
- Junhong Chen
- School of Optometry & Ophthalmology, Wenzhou Medical College, Wenzhou, Zhejiang, China
| | - Ji C. He
- School of Optometry & Ophthalmology, Wenzhou Medical College, Wenzhou, Zhejiang, China
- New England College of Optometry, Boston, Massachusetts, United States of America
| | - Yunyun Chen
- School of Optometry & Ophthalmology, Wenzhou Medical College, Wenzhou, Zhejiang, China
| | - Jingjing Xu
- School of Optometry & Ophthalmology, Wenzhou Medical College, Wenzhou, Zhejiang, China
| | - Haoran Wu
- School of Optometry & Ophthalmology, Wenzhou Medical College, Wenzhou, Zhejiang, China
| | - Feifu Wang
- School of Optometry & Ophthalmology, Wenzhou Medical College, Wenzhou, Zhejiang, China
| | - Fan Lu
- School of Optometry & Ophthalmology, Wenzhou Medical College, Wenzhou, Zhejiang, China
- * E-mail: (JJ); (FL)
| | - Jun Jiang
- School of Optometry & Ophthalmology, Wenzhou Medical College, Wenzhou, Zhejiang, China
- * E-mail: (JJ); (FL)
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Cheng HC, Liang JB, Lin WP, Wu R. Effectiveness and safety of overnight orthokeratology with Boston XO2 high-permeability lens material: A 24 week follow-up study. Cont Lens Anterior Eye 2016; 39:67-71. [DOI: 10.1016/j.clae.2015.07.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 07/03/2015] [Accepted: 07/14/2015] [Indexed: 11/29/2022]
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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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Li SM, Kang MT, Wu SS, Liu LR, Li H, Chen Z, Wang N. Efficacy, Safety and Acceptability of Orthokeratology on Slowing Axial Elongation in Myopic Children by Meta-Analysis. Curr Eye Res 2015; 41:600-8. [PMID: 26237276 DOI: 10.3109/02713683.2015.1050743] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To compare the efficacy, safety and acceptability of a treatment group (Orthokeratology) to a control group (single vision Spectacles) on slowing axial elongation in children. METHODS We searched studies in MEDLINE, EMBASE and the Cochrane Library up to January 2015 for randomized controlled trials (RCTs) and observational studies. We pooled the mean differences between the Orthokeratology and Control groups for axial elongation and the OR for rates of adverse events and dropout. RESULTS Three RCTs and six cohort studies with 667 children aged 6-16 years old were included. Two years' mean differences in axial elongation were -0.27 mm (95% confidence intervals [CI], -0.32 to -0.23) in all studies, -0.28 mm (95% CI, -0.35 to -0.20) in RCTs and -0.27 mm (95% CI, -0.32 to -0.22) in cohort studies (p < 0.01). At 6 months, 1 year, 1.5 years and 2 years, mean differences in axial elongation were -0.13 mm, -0.19 mm, -0.23 mm, and -0.27 mm (p < 0.01), respectively. The effect was greater in Asian children than Caucasian (-0.28 mm versus -0.22 mm) and in children with moderate to high myopia when compared to children with low myopia (-0.35 mm versus -0.25 mm). Orthokeratology had more non-significant adverse events (odd ratio [OR], 8.87; 95% CI, 3.79-20.74; p < 0.01) but comparable dropout rates (OR = 0.84, 95% CI, 0.40-1.74, p = 0.64) than control. CONCLUSION Orthokeratology has significantly greater efficacy in controlling axial elongation in children compared to Spectacle correction. The safety and acceptability results are good, and there appears to be a greater myopia control effect in Chinese children compared to Caucasians, and in those with higher initial myopia.
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Affiliation(s)
- Shi-Ming Li
- a Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology & Visual Science Key Lab, Beijing Institute of Ophthalmology, Capital Medical University , Beijing , China
| | - Meng-Tian Kang
- a Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology & Visual Science Key Lab, Beijing Institute of Ophthalmology, Capital Medical University , Beijing , China
| | - Shan-Shan Wu
- b Department of Epidemiology and Health Statistics , Peking University School of Public Health , Beijing , China
| | - Luo-Ru Liu
- c Anyang Eye Hospital, Henan Province , China and
| | - He Li
- c Anyang Eye Hospital, Henan Province , China and
| | - Zhuo Chen
- d Lakewood Eye Care , Houston, TX , USA
| | - Ningli Wang
- a Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology & Visual Science Key Lab, Beijing Institute of Ophthalmology, Capital Medical University , Beijing , China
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