[Current recommendations for deceleration of myopia progression]

Myopia Management in Daily Routine - A Survey of European Pediatric Ophthalmologists

PURPOSE

Assessment of diagnostic and therapeutic strategies currently used in routine practice for myopia management in Europe.

METHODS

Online survey study including 11 main questions. The questionnaire was sent to members of the European Paediatric Ophthalmology Society (EPOS). The following items and questions were surveyed: I. Profession and workplace of the survey participants. II. Preventive measures and recommendations for myopia management, a) regarding reading distance and near work, b) optical tools, i.e., application of Defocus Incorporated Multiple Segments (DIMS) glasses, near additions, or contact lenses, and c) the application of atropine eye drops. III. Application of additional diagnostic tools.

RESULTS

Forty-eight individuals completed the survey. Of the respondents, 88% (n = 42) affirmed that they generally gave advice on strategies for myopia prevention and management strategies. Almost all study participants (n = 41; 85%) recommend outdoor time as a preventive measure. The recommendation on near distance is given less frequently, with 28 (58%) participants confirming that they do recommend a "safe" reading distance, and 15 (31%) negating this. Eight (17%) survey participants recommend using near addition glasses, while 36 (75%) do not. Similarly, 35 (73%) respondents do not apply DIMS glasses and 8 (17%) apply them. Fourteen (29%) participants recommend myopia-reducing contact lenses while 30 (63%) do not, and 29 (60%) confirmed that they applied atropine eye drops to slow myopia progression while 14 (29%) do not prescribe these eye drops. The majority of respondents (n = 25; 86%) who prescribe atropine eye drops use atropine 0.01% eye drops.

CONCLUSIONS

Prevention and therapeutic management of childhood myopia is an essential part in the daily routine of pediatric ophthalmologists. Substantial agreement was found for the protective role of outdoor time (85%). The only common therapeutic approach is the administration of atropine eye drops (60%).

The Role of Time Exposed to Outdoor Light for Myopia Prevalence and Progression: A Literature Review

Purpose

The development of myopia as a refractive disorder seems to hold multifactorial causes. Among others, increased time exposed to natural light outdoors is regarded as possible effective preventive measure against myopia development. The objective of this review is to analyse and summarize the evidence investigating the association between time outdoors and myopia prevalence and progression.

Methods

A review, restricted to articles published in the last ten years, was conducted. The literature search for the included articles was performed in the following databases: PubMed, the Cochrane Library, Web of Science and Scopus. If predefined inclusion criteria were met, the studies were further categorized and data were summarized and individually evaluated.

Results

Two cross-sectional studies, 7 prospective cohort studies and 3 intervention studies were reported in this review, representing the data of a total of 32,381 participants. The majority of the studies found an inverse association between myopia incidence/prevalence and increased time outdoors. The association between time outdoors and myopia progression on the other hand remains debatable; one recent randomized controlled trial indicating a protective value of increased time outdoors for further progression in myopic children.

Conclusion

In summary, increasing time exposed to outdoor light seems to be a simple and effective preventive measure to decrease myopia prevalence. Also, contrasting previous review work, it may represent a potential strategy for myopia progression control. Future investigation is necessary to better define and quantify outdoor time and its effects on myopia.

Comparison of Solar Radiation and Myopia Occurrence in South Korean Children

PURPOSE

To investigate the association between regional solar radiation and myopia occurrence in South Korean children.

MATERIALS AND METHODS

A population-based cross-sectional study using data of 1218 children aged 7-9 years from the Korea National Health and Nutritional Examination Survey was conducted from January 1, 2008, to December 31, 2012. Myopia prevalence and the mean spherical equivalent were estimated; myopia was defined as spherical equivalent refraction <-1.5 D. Data regarding solar radiation and sunshine duration were collected from 21 national monitoring stations in South Korea. Multiple logistic regression analyses and multiple linear regression analyses were used to evaluate the associations. However, the most important covariate, the time spent outdoors, was not measured and could not be used.

RESULTS

In the entire cohort of 1218 participants, solar radiation and sunshine duration were significantly associated with the mean spherical equivalent (P=0.001 and P=0.014, B = 0.088 and B = 0.069, respectively) and solar radiation was significantly associated with myopia prevalence (P=0.008). And, a negative but not statistically significant association between sunshine duration and myopia prevalence was observed (P=0.064, respectively).

CONCLUSIONS

Solar radiation and sunshine duration are associated with the mean spherical equivalent and myopia prevalence in South Korean children.

Little effect of 0.01% atropine eye drops as used in myopia prevention on the pattern electroretinogram

PURPOSE

Daily administration of 0.01% atropine eye drops is a promising approach for myopia control. The mechanism of action is believed to involve the dopaminergic system of the retina, triggering an increased release of dopamine. Previous studies in psychiatric condition such as major depression suggest that pattern electroretinogram (PERG) amplitudes are modulated by changes in retinal dopamine. It is thus plausible that atropine eye drops could have an effect on PERG amplitudes. The present study was designed to test this, assessing the difference in amplitude between contrast levels and the ratio of amplitudes between check sizes as primary endpoints.

METHODS

We included 14 participants with no more than ± 2 diopters of ametropia and visual acuity of at least 1.0. One eye was chosen randomly in each participant for atropine application (14 days, one drop of 0.01% atropine solution once daily before bedtime). We recorded two sets of steady-state PERG recordings: one with different contrasts (25% and 98%) and one with different check sizes (0.8° and 17°). Near-point distance, near visual acuity, and pupil diameter were measured additionally.

RESULTS

The recordings to different contrasts did not show atropine-related changes of PERG amplitude. A small increase by 6% of the amplitude difference between contrast levels with atropine application was not significant (p = 0.08). Raw amplitudes in the check size condition increased with atropine by 17% (p < 0.01) and 10% (p < 0.03) for small and large checks, respectively, without a significant concomitant effect on the amplitude ratio. Pupil size was significantly affected (median increase 0.5 mm, p < 0.002). However, neither of the experimental conditions was associated with a significant correlation between pupil size and PERG effects.

CONCLUSION

The effects on PERG primary endpoints after the 14-day period of atropine administration were small, especially compared to effect sizes in major depression, and statistically insignificant. Effects on raw amplitude were inconsistent. The present results suggest that retinal processing as reflected by PERG does not sizably change following a treatment regimen with atropine that is typical for myopia control.

[Epidemiology of refractive errors]

Refractive errors are very common and can lead to severe pathological changes in the eye. This article analyzes the epidemiology of refractive errors in the general population in Germany and worldwide and describes common definitions for refractive errors and clinical characteristics for pathologicaal changes. Refractive errors differ between age groups due to refractive changes during the life time and also due to generation-specific factors. Current research about the etiology of refractive errors has strengthened the influence of environmental factors, which led to new strategies for the prevention of refractive pathologies.