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Santodomingo-Rubido J, Cheung SW, Villa-Collar C. A new look at the myopia control efficacy of orthokeratology. Cont Lens Anterior Eye 2024:102251. [PMID: 38906728 DOI: 10.1016/j.clae.2024.102251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 04/26/2024] [Accepted: 06/11/2024] [Indexed: 06/23/2024]
Abstract
PURPOSE To evaluate the efficacy of orthokeratology contact lens wear in slowing the axial elongation of the eye in myopic children. METHODS Data from three prospective studies, which evaluated the use of orthokeratology for slowing myopia progression in children in comparison to a parallel control group of distance, single-vision spectacle lens wearers over a 2-year period, were pooled together for analysis. RESULTS Collectively, data from 125 orthokeratology and 118 control subjects were analyzed in this study. Of these, 101 (81 %) and 88 (75 %) orthokeratology and control subjects completed the 2-year follow-up period, respectively. Statistically significant differences in the change in axial length from baseline were found over time, between groups and for the time*group interaction (all p < 0.001), indicating that the rate of increase in axial length over time was significantly lower in the orthokeratology versus the control group. The lower axial elongation of the orthokeratology versus the control group was statistically significant at all time points (all p < 0.001), with significant differences being also present between each of the different pairs of time points (all p < 0.001). The interactions of group with age, gender, mean spherical refractive error and ethnicity at baseline were not significant (p > 0.05). The change in axial length at the 2-year visit in comparison to baseline for the orthokeratology and control groups were 0.41 ± 0.25 and 0.65 ± 0.30 mm, respectively, thus providing a treatment effect following 2-years of lens wear of 0.24 mm (95 % confidence intervals: 0.15 to 0.34 mm). About 40 % and 25 % of the orthokeratology subjects experienced remarkably low and high levels of myopia progression, respectively (2-years axial elongation: ≤0.30 mm and >0.59 mm, respectively). CONCLUSIONS Orthokeratology lens wear slows the axial elongation of the eye in comparison to spectacle lens wear in myopic children. The use of these lenses for slowing myopia progression appears to be very effective and not effective at all in 40% and 25% of orthokeratology lens wearers, respectively.
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Affiliation(s)
| | - Sin-Wan Cheung
- School of Optometry, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, China
| | - César Villa-Collar
- Faculty of Biomedical and Health Sciences, Universidad Europea, Madrid, Spain
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Bullimore MA, Jong M, Brennan NA. Myopia control: Seeing beyond efficacy. Optom Vis Sci 2024; 101:134-142. [PMID: 38546754 DOI: 10.1097/opx.0000000000002119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024] Open
Abstract
SIGNIFICANCE The availability of a range of effective myopia control modalities enables the clinician to exercise judgment when discussing the treatment plan with the patient and their parents. This article outlines important considerations beyond efficacy.Clinically meaningful myopia control may be attained with some spectacle lenses, select soft contact lenses, some concentrations of atropine, and overnight orthokeratology. Given that satisfactory efficacy can be achieved with a range of modalities, other factors should be considered when deciding upon the best intervention for a given child. Four key factors-compliance, quality of vision, quality of life, and safety-are discussed in this review. Compliance directly impacts efficacy regardless of the modality and is the most important consideration, as it is influenced by quality of vision and comfort. Daily disposal myopia control contact lenses and overnight orthokeratology are generally associated with high compliance, provide better vision-related quality of life than spectacles, and carry a very low risk when used appropriately. A further benefit of overnight orthokeratology is the elimination of a need for optical correction during the day.
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Wolffsohn JS. 2022 Glenn A. Fry Award lecture: Enhancing clinical assessment for improved ophthalmic management. Optom Vis Sci 2024; 101:12-24. [PMID: 38350054 DOI: 10.1097/opx.0000000000002102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024] Open
Abstract
ABSTRACT Detailed clinical assessment is critical to allow sensitive evaluation of the eye and its management. As technology advances, these assessment techniques can be adapted and refined to improve the detection of pathological changes of ocular tissue and their impact on visual function. Enhancements in optical medical devices including spectacle, contact, and intraocular lenses have allowed for a better understanding of the mechanism and amelioration of presbyopia and myopia control. Advancements in imaging technology have enabled improved quantification of the tear film and ocular surface, informing diagnosis and treatment strategies. Miniaturized electronics, large processing power, and in-built sensors in smartphones and tablets capacitate more portable assessment tools for clinicians, facilitate self-monitoring and treatment compliance, and aid communication with patients. This article gives an overview of how technology has been used in many areas of eye care to improve assessments and treatment and provides a snapshot of some of my studies validating and using technology to inform better evidence-based patient management.
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Martínez-Pérez C, Villa-Collar C, Santodomingo-Rubido J, Wolffsohn JS. Strategies and attitudes on the management of myopia in clinical practice in Spain - 2022 update. JOURNAL OF OPTOMETRY 2024; 17:100496. [PMID: 37879183 PMCID: PMC10618824 DOI: 10.1016/j.optom.2023.100496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/25/2023] [Accepted: 09/19/2023] [Indexed: 10/27/2023]
Abstract
OBJECTIVE This study analyses strategies and attitudes on myopia management reported by eye care practitioners (ECP) from Spain in 2022. METHODS A questionnaire was distributed to ECPs worldwide via the internet through professional associations. The questionnaire was distributed by email to all registered Spanish optician-optometrists. Questions examined awareness of increasing myopia prevalence; perceived efficacy; uptake of available approaches; and reasons preventing further uptake of specific approaches. RESULTS Of 3,107 practitioners who participated in the study, 380 were Spanish ECPs. Using a 10-point scale, Spanish practitioners reported less concern about increasing pediatric myopia (8.3 ± 1.6) compared to ECP's worldwide (8.5 ± 1.9) (p < 0.001), but similar level of clinical activity in myopia control (7.8 ± 2.3 vs. 7.5 ± 2.5, respectively) (p > 0.05); however, around half of all prescribed treatments were single-vision distance spectacles/contact lenses both in Spain and in most regions, with Spanish practitioners prescribing less single-vision spectacles than African and Asian (p < 0.001), but more than Australasian practitioners (p = 0.04). No significant differences were found between Spain and the other regions in the perceived efficacy of combined therapy, orthokeratology, and outdoor time (p > 0.05), with the former being perceived as the most effective myopia control method followed by orthokeratology. No significant differences were found between Spain and the world's average in factors preventing the prescription of myopia control approaches (p > 0.05). Spanish practitioners reported that embracing myopia management has a positive, but lower impact on customer loyalty, practice revenue and job satisfaction compared with the other regions (all p < 0.001). CONCLUSIONS Myopia control is increasing, although around half of practitioners still prescribe single-vision distance spectacles/contact lenses to young/progressive myopes. Combined therapy followed by orthokeratology were perceived as the most effective treatments. Embracing myopia management improved patient loyalty and job satisfaction.
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Affiliation(s)
- Clara Martínez-Pérez
- ISEC Lisboa-Instituto de Educação e Ciência de Lisboa, 1750-179 Lisboa, Portugal
| | - César Villa-Collar
- Optics & Optometry Department, Faculty of Health Sciences, Universidad Europea, Madrid, Spain
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Huang Y, Chen Z, Wang B, Zhao J, Zhou X, Qu X, Wang X, Zhou X. Chinese Parents' Perspective on Myopia: A Cross-Sectional Survey Study. Ophthalmol Ther 2023; 12:2409-2425. [PMID: 37314644 PMCID: PMC10265565 DOI: 10.1007/s40123-023-00743-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 05/23/2023] [Indexed: 06/15/2023] Open
Abstract
INTRODUCTION The prevalence of myopia in young generations has dramatically increased over the years, especially in China. This study aims to understand Chinese parents' perspectives on myopia for further improvement of treatment compliance and informing future health planning and policy. METHODS This was a prospective cross-sectional survey study. A self-administrated, internet-based questionnaire was distributed to 2545 parents in China. Detailed information about the demographics, the awareness of myopia, related complications, and practices of myopia prevention and control of the respondents were collected. The distribution of answers was compared among different groups of children's age, children's refractions, and parents' residential locations. Relationships between parental cognition and behavior were also analyzed. RESULTS Eligible responses were returned by 2500 parents. A total of 55.1% of the respondents considered myopia as a disease and more than 70% of respondents did not realize pathological changes related to myopia. Most parents thought myopia could be prevented (82.0%) and controlled (75.2%), and these parents were more likely to take measures than the parents who did not think so (P < 0.001). The most common myopia control modality was spectacles (87.0%), among which single-vision spectacles are the most used (63.7%). CONCLUSIONS Knowledge about health risks related to myopia was lacking in Chinese parents and their practices of myopia control mainly involved single-vision glasses. Nationwide education for parents about myopia is needed to further advance outcomes of myopia prevention and control.
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Affiliation(s)
- Yangyi Huang
- Eye Institute and Department of Ophthalmology and Vision Science, Eye & ENT Hospital, Fudan University, No.19 Baoqing Road, Xuhui District, Shanghai, 200031, China
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, China
- Shanghai Research Center of Ophthalmology and Optometry, Changning, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care, Shanghai, China
| | - Zhi Chen
- Eye Institute and Department of Ophthalmology and Vision Science, Eye & ENT Hospital, Fudan University, No.19 Baoqing Road, Xuhui District, Shanghai, 200031, China
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, China
- Shanghai Research Center of Ophthalmology and Optometry, Changning, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care, Shanghai, China
| | - Bingjie Wang
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Jing Zhao
- Eye Institute and Department of Ophthalmology and Vision Science, Eye & ENT Hospital, Fudan University, No.19 Baoqing Road, Xuhui District, Shanghai, 200031, China
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, China
- Shanghai Research Center of Ophthalmology and Optometry, Changning, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care, Shanghai, China
| | - Xueyi Zhou
- Eye Institute and Department of Ophthalmology and Vision Science, Eye & ENT Hospital, Fudan University, No.19 Baoqing Road, Xuhui District, Shanghai, 200031, China
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, China
- Shanghai Research Center of Ophthalmology and Optometry, Changning, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care, Shanghai, China
| | - Xiaomei Qu
- Eye Institute and Department of Ophthalmology and Vision Science, Eye & ENT Hospital, Fudan University, No.19 Baoqing Road, Xuhui District, Shanghai, 200031, China
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, China
- Shanghai Research Center of Ophthalmology and Optometry, Changning, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care, Shanghai, China
| | - Xiaoying Wang
- Eye Institute and Department of Ophthalmology and Vision Science, Eye & ENT Hospital, Fudan University, No.19 Baoqing Road, Xuhui District, Shanghai, 200031, China
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, China
- Shanghai Research Center of Ophthalmology and Optometry, Changning, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care, Shanghai, China
| | - Xingtao Zhou
- Eye Institute and Department of Ophthalmology and Vision Science, Eye & ENT Hospital, Fudan University, No.19 Baoqing Road, Xuhui District, Shanghai, 200031, China.
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, China.
- Shanghai Research Center of Ophthalmology and Optometry, Changning, China.
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care, Shanghai, China.
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Leighton RE, Breslin KM, Richardson P, Doyle L, McCullough SJ, Saunders KJ. Relative peripheral hyperopia leads to greater short-term axial length growth in White children with myopia. Ophthalmic Physiol Opt 2023; 43:985-996. [PMID: 37340533 DOI: 10.1111/opo.13185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 05/18/2023] [Accepted: 06/01/2023] [Indexed: 06/22/2023]
Abstract
PURPOSE Controversy exists regarding the influence of peripheral visual experience on the onset and progression of childhood myopia. This longitudinal, observational study evaluated the relationship between relative peripheral refraction (RPR) and changes in refractive error and axial length (AL) over 12 months in White children aged 6-7 and 12-13 years with a range of baseline refractive errors. METHODS Cycloplegic baseline autorefraction at horizontal retinal eccentricities of 0° and ±30° were recorded with the Shin-Nippon NVision-K 5001 while AL was measured using the Zeiss IOLMaster 700. Measurements were repeated after 12 months on a subgroup. Refractive data were transposed into power vectors as mean spherical equivalent (M), J0 and J45 . RPR was calculated by subtracting central from peripheral measurements. Participants were defined as myopic (M ≤ -0.50 D), premyopic (-0.50 D < M ≤ +0.75 D), emmetropic (+0.75 D < M < +2.00 D) or hyperopic (M ≥ +2.00 D). RESULTS Data were collected from 222 and 245 participants aged 6-7 and 12-13 years, respectively. Myopic eyes demonstrated, on average, more hyperopic RPR. Emmetropes and premyopes displayed emmetropic RPR, and hyperopes showed a myopic RPR. Fifty-six 6- to 7-year-olds and seventy 12- to 13-year-olds contributed 12-month repeated measures. Longitudinal data demonstrated a significant relationship between a more hyperopic RPR in the nasal retina and greater short-term axial elongation in teens with myopia at baseline (β = 0.69; p = 0.04). Each dioptre of relative peripheral hyperopia in the nasal retina was associated with an additional 0.10 mm (95% CI: 0.02-0.18 mm) annual increase in AL. CONCLUSIONS Hyperopic RPR in the nasal retina of myopic children is indicative of increased risk for rapid axial elongation and may be a useful metric to support decision-making in myopia management.
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Affiliation(s)
- Rebecca E Leighton
- Centre for Optometry and Vision Science Research, School of Biomedical Sciences, Ulster University, Coleraine, UK
| | - Karen M Breslin
- Centre for Optometry and Vision Science Research, School of Biomedical Sciences, Ulster University, Coleraine, UK
| | - Patrick Richardson
- Centre for Optometry and Vision Science Research, School of Biomedical Sciences, Ulster University, Coleraine, UK
| | - Lesley Doyle
- Centre for Optometry and Vision Science Research, School of Biomedical Sciences, Ulster University, Coleraine, UK
| | - Sara J McCullough
- Centre for Optometry and Vision Science Research, School of Biomedical Sciences, Ulster University, Coleraine, UK
| | - Kathryn J Saunders
- Centre for Optometry and Vision Science Research, School of Biomedical Sciences, Ulster University, Coleraine, UK
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Manoharan MK, Thakur S, Dhakal R, Gupta SK, Priscilla JJ, Bhandary SK, Srivastava A, Marmamula S, Poigal N, Verkicharla PK. Myopia progression risk assessment score (MPRAS): a promising new tool for risk stratification. Sci Rep 2023; 13:8858. [PMID: 37258536 DOI: 10.1038/s41598-023-35696-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 05/22/2023] [Indexed: 06/02/2023] Open
Abstract
Timely identification of individuals "at-risk" for myopia progression is the leading requisite for myopia practice as it aids in the decision of appropriate management. This study aimed to develop 'myopia progression risk assessment score' (MPRAS) based on multiple risk factors (10) to determine whether a myope is "at-risk" or "low-risk" for myopia progression. Two risk-score models (model-1: non-weightage, model-2: weightage) were developed. Ability of MPRAS to diagnose individual "at-risk" for myopia progression was compared against decision of five clinicians in 149 myopes, aged 6-29 years. Using model-1 (no-weightage), further 7 sub-models were created with varying number of risk factors in decreasing step-wise manner (1a: 10 factors to 1g: 4 factors). In random eye analysis for model-1, the highest Youden's J-index (0.63-0.65) led to the MPRAS cut-off score of 41.50-43.50 for 5 clinicians with a sensitivity ranging from 78 to 85% and specificity ranging from 79 to 87%. For this cut-off score, the mean area under the curve (AUC) between clinicians and the MPRAS model ranged from 0.89 to 0.90. Model-2 (weighted for few risk-factors) provided similar sensitivity, specificity, and AUC. Sub-model analysis revealed greater AUC with high sensitivity (89%) and specificity (94%) in model-1g that has 4 risk factors compared to other sub-models (1a-1f). All the MPRAS models showed good agreement with the clinician's decision in identifying individuals "at-risk" for myopia progression.
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Affiliation(s)
- Manoj K Manoharan
- Myopia Research Lab, Prof. Brien Holden Eye Research Centre, Brien Holden Institute of Optometry and Vision Sciences, L V Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, Telangana, 500034, India
- Infor Myopia Centre, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Swapnil Thakur
- Myopia Research Lab, Prof. Brien Holden Eye Research Centre, Brien Holden Institute of Optometry and Vision Sciences, L V Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, Telangana, 500034, India
| | - Rohit Dhakal
- Myopia Research Lab, Prof. Brien Holden Eye Research Centre, Brien Holden Institute of Optometry and Vision Sciences, L V Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, Telangana, 500034, India
- Infor Myopia Centre, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Satish K Gupta
- Myopia Research Lab, Prof. Brien Holden Eye Research Centre, Brien Holden Institute of Optometry and Vision Sciences, L V Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, Telangana, 500034, India
| | - Jacinth J Priscilla
- Myopia Research Lab, Prof. Brien Holden Eye Research Centre, Brien Holden Institute of Optometry and Vision Sciences, L V Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, Telangana, 500034, India
| | - Shashank K Bhandary
- Myopia Research Lab, Prof. Brien Holden Eye Research Centre, Brien Holden Institute of Optometry and Vision Sciences, L V Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, Telangana, 500034, India
| | - Alok Srivastava
- L V Prasad Eye Institute, Hyderabad, Telangana, India
- Sri Innovation and Research Foundation, Ghaziabad, Uttar Pradesh, India
| | - Srinivas Marmamula
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Nitish Poigal
- L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Pavan K Verkicharla
- Myopia Research Lab, Prof. Brien Holden Eye Research Centre, Brien Holden Institute of Optometry and Vision Sciences, L V Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, Telangana, 500034, India.
- Infor Myopia Centre, L V Prasad Eye Institute, Hyderabad, Telangana, India.
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Wolffsohn JS, Whayeb Y, Logan NS, Weng R. IMI-Global Trends in Myopia Management Attitudes and Strategies in Clinical Practice-2022 Update. Invest Ophthalmol Vis Sci 2023; 64:6. [PMID: 37126357 PMCID: PMC10155870 DOI: 10.1167/iovs.64.6.6] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 02/07/2023] [Indexed: 05/02/2023] Open
Abstract
Purpose Surveys in 2015 and 2019 identified a high level of eye care practitioner concern/activity about myopia, but the majority still prescribed single vision interventions to young myopes. This research aimed to provide updated information. Methods A self-administered, internet-based questionnaire was distributed in 13 languages, through professional bodies to eye care practitioners globally. The questions examined awareness of increasing myopia prevalence, perceived efficacy and adoption of available strategies, and reasons for not adopting specific strategies. Results Of the 3195 respondents, practitioners' concern about the increasing frequency of pediatric myopia in their practices differed between continents (P < 0.001), being significantly higher in Asia (9.0 ± 1.5 of 10) than other continents (range 7.7-8.2; P ≤ 0.001). Overall, combination therapy was perceived by practitioners to be the most effective method of myopia control, followed by orthokeratology and pharmaceutical approaches. The least effective perceived methods were single vision distance undercorrection, spectacles and contact lenses, as well as bifocal spectacles. Practitioners rated their activity in myopia control between (6.6 ± 2.9 in South America to 7.9 ± 1.2/2.2 in Australasia and Asia). Single-vision spectacles are still the most prescribed option for progressing young myopia (32.2%), but this has decreased since 2019, and myopia control spectacles (15.2%), myopia control contact lenses (8.7%) and combination therapy (4.0%) are growing in popularity. Conclusions More practitioners across the globe are practicing myopia control, but there are still significant differences between and within continents. Practitioners reported that embracing myopia control enhanced patient loyalty, increasing practice revenue and improving job satisfaction.
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Affiliation(s)
- James S. Wolffsohn
- College of Health & Life Sciences, Aston University, Birmingham, United Kingdom
| | - Yasmin Whayeb
- College of Health & Life Sciences, Aston University, Birmingham, United Kingdom
| | - Nicola S. Logan
- College of Health & Life Sciences, Aston University, Birmingham, United Kingdom
| | - Rebecca Weng
- Brien Holden Vision Institute, Sydney, NSW, Australia
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Tahhan N, Wolffsohn JS, Sankaridurg P, Jonas JB, Bullimore MA, Flitcroft I, Ostrin LA, Wildsoet C, Resnikoff S. Editorial: International Myopia Institute White Paper Series 2023. Invest Ophthalmol Vis Sci 2023; 64:1. [PMID: 37126361 PMCID: PMC10153580 DOI: 10.1167/iovs.64.6.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
Affiliation(s)
- Nina Tahhan
- Brien Holden Vision Institute, Sydney Australia
- School of Optometry and Vision Science, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - James S Wolffsohn
- College of Health & Life Sciences, Aston University, Birmingham, United Kingdom
| | - Padmaja Sankaridurg
- Brien Holden Vision Institute, Sydney Australia
- School of Optometry and Vision Science, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Jost B Jonas
- Department of Ophthalmology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Institute of Molecular and Clinical Ophthalmology Basel, Basel, Switzerland
| | - Mark A Bullimore
- University of Houston, College of Optometry, Houston, Texas, United States
| | - Ian Flitcroft
- Centre for Eye Research Ireland, School of Physics and Clinical and Optometric Sciences, Technological University Dublin, Dublin, Ireland
- Department of Ophthalmology, Children's Health Ireland at Temple Street Hospital, Dublin, Ireland
| | - Lisa A Ostrin
- University of Houston, College of Optometry, Houston, Texas, United States
| | - Christine Wildsoet
- UC Berkeley Wertheim School Optometry & Vision Science, Berkeley, California, United States
| | - Serge Resnikoff
- Brien Holden Vision Institute, Sydney Australia
- School of Optometry and Vision Science, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
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Eppenberger LS, Sturm V. Myopia Management in Daily Routine - A Survey of European Pediatric Ophthalmologists. Klin Monbl Augenheilkd 2023; 240:581-586. [PMID: 37164443 PMCID: PMC10129410 DOI: 10.1055/a-2013-2713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
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%).
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Affiliation(s)
- Leila Sara Eppenberger
- Eye Clinic, Cantonal Hospital of Lucerne, Lucerne, Switzerland
- Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Veit Sturm
- Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
- Eye Clinic, Saint Gallen Cantonal Hospital, Saint Gallen, Switzerland
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Assessment of the Clinical Effectiveness of DRL Orthokeratology Lenses vs. Single-Vision Spectacles in Controlling the Progression of Myopia in Children and Teenagers: 2 Year Retrospective Study. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020402. [PMID: 36832531 PMCID: PMC9955086 DOI: 10.3390/children10020402] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 02/15/2023] [Accepted: 02/17/2023] [Indexed: 02/22/2023]
Abstract
The purpose of this study was to assess the effect of orthokeratology treatment with DRL lenses on the control of myopia progression compared with single vision glasses users (monofocal glasses). It was also possible to analyze the clinical efficacy of orthokeratology treatment with DRL lenses for myopia correction in children and adolescents in a 2 year retrospective, multicenter study, performed in eight different ophthalmology centers in France. A total of 360 data records of children and adolescents with myopia between -0.50 D and -7.00 D at baseline visit, who completed treatment and had a centered outcome, were selected for the study from a database of 1271. The final sample included subjects undergoing orthokeratology treatment with DRL lenses (n = 211 eyes) and spectacle wearers (n = 149 eyes). After one year of treatment, the data analysis shows that the DRL lens has a refractive myopia progression control rate of 78.5% compared with the spectacle wearers (DRL M change = -0.10 ± 0.25 D, p < 0.001 Wilcoxon test and Glasses M change = -0.44 ± 0.38 D, p < 0.001 Wilcoxon test). Similar results were found after 2 years of treatment (80% with 310 eyes). This study showed the clinical efficacy of orthokeratology DRL lenses compared to monofocal spectacle wearers in controlling myopia progression in children and adolescents in a 2 year retrospective study.
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Lawrenson JG, Shah R, Huntjens B, Downie LE, Virgili G, Dhakal R, Verkicharla PK, Li D, Mavi S, Kernohan A, Li T, Walline JJ. Interventions for myopia control in children: a living systematic review and network meta-analysis. Cochrane Database Syst Rev 2023; 2:CD014758. [PMID: 36809645 PMCID: PMC9933422 DOI: 10.1002/14651858.cd014758.pub2] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
BACKGROUND Myopia is a common refractive error, where elongation of the eyeball causes distant objects to appear blurred. The increasing prevalence of myopia is a growing global public health problem, in terms of rates of uncorrected refractive error and significantly, an increased risk of visual impairment due to myopia-related ocular morbidity. Since myopia is usually detected in children before 10 years of age and can progress rapidly, interventions to slow its progression need to be delivered in childhood. OBJECTIVES To assess the comparative efficacy of optical, pharmacological and environmental interventions for slowing myopia progression in children using network meta-analysis (NMA). To generate a relative ranking of myopia control interventions according to their efficacy. To produce a brief economic commentary, summarising the economic evaluations assessing myopia control interventions in children. To maintain the currency of the evidence using a living systematic review approach. SEARCH METHODS: We searched CENTRAL (which contains the Cochrane Eyes and Vision Trials Register), MEDLINE; Embase; and three trials registers. The search date was 26 February 2022. SELECTION CRITERIA: We included randomised controlled trials (RCTs) of optical, pharmacological and environmental interventions for slowing myopia progression in children aged 18 years or younger. Critical outcomes were progression of myopia (defined as the difference in the change in spherical equivalent refraction (SER, dioptres (D)) and axial length (mm) in the intervention and control groups at one year or longer) and difference in the change in SER and axial length following cessation of treatment ('rebound'). DATA COLLECTION AND ANALYSIS: We followed standard Cochrane methods. We assessed bias using RoB 2 for parallel RCTs. We rated the certainty of evidence using the GRADE approach for the outcomes: change in SER and axial length at one and two years. Most comparisons were with inactive controls. MAIN RESULTS We included 64 studies that randomised 11,617 children, aged 4 to 18 years. Studies were mostly conducted in China or other Asian countries (39 studies, 60.9%) and North America (13 studies, 20.3%). Fifty-seven studies (89%) compared myopia control interventions (multifocal spectacles, peripheral plus spectacles (PPSL), undercorrected single vision spectacles (SVLs), multifocal soft contact lenses (MFSCL), orthokeratology, rigid gas-permeable contact lenses (RGP); or pharmacological interventions (including high- (HDA), moderate- (MDA) and low-dose (LDA) atropine, pirenzipine or 7-methylxanthine) against an inactive control. Study duration was 12 to 36 months. The overall certainty of the evidence ranged from very low to moderate. Since the networks in the NMA were poorly connected, most estimates versus control were as, or more, imprecise than the corresponding direct estimates. Consequently, we mostly report estimates based on direct (pairwise) comparisons below. At one year, in 38 studies (6525 participants analysed), the median change in SER for controls was -0.65 D. The following interventions may reduce SER progression compared to controls: HDA (mean difference (MD) 0.90 D, 95% confidence interval (CI) 0.62 to 1.18), MDA (MD 0.65 D, 95% CI 0.27 to 1.03), LDA (MD 0.38 D, 95% CI 0.10 to 0.66), pirenzipine (MD 0.32 D, 95% CI 0.15 to 0.49), MFSCL (MD 0.26 D, 95% CI 0.17 to 0.35), PPSLs (MD 0.51 D, 95% CI 0.19 to 0.82), and multifocal spectacles (MD 0.14 D, 95% CI 0.08 to 0.21). By contrast, there was little or no evidence that RGP (MD 0.02 D, 95% CI -0.05 to 0.10), 7-methylxanthine (MD 0.07 D, 95% CI -0.09 to 0.24) or undercorrected SVLs (MD -0.15 D, 95% CI -0.29 to 0.00) reduce progression. At two years, in 26 studies (4949 participants), the median change in SER for controls was -1.02 D. The following interventions may reduce SER progression compared to controls: HDA (MD 1.26 D, 95% CI 1.17 to 1.36), MDA (MD 0.45 D, 95% CI 0.08 to 0.83), LDA (MD 0.24 D, 95% CI 0.17 to 0.31), pirenzipine (MD 0.41 D, 95% CI 0.13 to 0.69), MFSCL (MD 0.30 D, 95% CI 0.19 to 0.41), and multifocal spectacles (MD 0.19 D, 95% CI 0.08 to 0.30). PPSLs (MD 0.34 D, 95% CI -0.08 to 0.76) may also reduce progression, but the results were inconsistent. For RGP, one study found a benefit and another found no difference with control. We found no difference in SER change for undercorrected SVLs (MD 0.02 D, 95% CI -0.05 to 0.09). At one year, in 36 studies (6263 participants), the median change in axial length for controls was 0.31 mm. The following interventions may reduce axial elongation compared to controls: HDA (MD -0.33 mm, 95% CI -0.35 to 0.30), MDA (MD -0.28 mm, 95% CI -0.38 to -0.17), LDA (MD -0.13 mm, 95% CI -0.21 to -0.05), orthokeratology (MD -0.19 mm, 95% CI -0.23 to -0.15), MFSCL (MD -0.11 mm, 95% CI -0.13 to -0.09), pirenzipine (MD -0.10 mm, 95% CI -0.18 to -0.02), PPSLs (MD -0.13 mm, 95% CI -0.24 to -0.03), and multifocal spectacles (MD -0.06 mm, 95% CI -0.09 to -0.04). We found little or no evidence that RGP (MD 0.02 mm, 95% CI -0.05 to 0.10), 7-methylxanthine (MD 0.03 mm, 95% CI -0.10 to 0.03) or undercorrected SVLs (MD 0.05 mm, 95% CI -0.01 to 0.11) reduce axial length. At two years, in 21 studies (4169 participants), the median change in axial length for controls was 0.56 mm. The following interventions may reduce axial elongation compared to controls: HDA (MD -0.47mm, 95% CI -0.61 to -0.34), MDA (MD -0.33 mm, 95% CI -0.46 to -0.20), orthokeratology (MD -0.28 mm, (95% CI -0.38 to -0.19), LDA (MD -0.16 mm, 95% CI -0.20 to -0.12), MFSCL (MD -0.15 mm, 95% CI -0.19 to -0.12), and multifocal spectacles (MD -0.07 mm, 95% CI -0.12 to -0.03). PPSL may reduce progression (MD -0.20 mm, 95% CI -0.45 to 0.05) but results were inconsistent. We found little or no evidence that undercorrected SVLs (MD -0.01 mm, 95% CI -0.06 to 0.03) or RGP (MD 0.03 mm, 95% CI -0.05 to 0.12) reduce axial length. There was inconclusive evidence on whether treatment cessation increases myopia progression. Adverse events and treatment adherence were not consistently reported, and only one study reported quality of life. No studies reported environmental interventions reporting progression in children with myopia, and no economic evaluations assessed interventions for myopia control in children. AUTHORS' CONCLUSIONS Studies mostly compared pharmacological and optical treatments to slow the progression of myopia with an inactive comparator. Effects at one year provided evidence that these interventions may slow refractive change and reduce axial elongation, although results were often heterogeneous. A smaller body of evidence is available at two or three years, and uncertainty remains about the sustained effect of these interventions. Longer-term and better-quality studies comparing myopia control interventions used alone or in combination are needed, and improved methods for monitoring and reporting adverse effects.
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Affiliation(s)
- John G Lawrenson
- Centre for Applied Vision Research, School of Health & Psychological Sciences , City, University of London, London, UK
| | - Rakhee Shah
- Centre for Applied Vision Research, School of Health & Psychological Sciences , City, University of London, London, UK
| | - Byki Huntjens
- Centre for Applied Vision Research, School of Health & Psychological Sciences , City, University of London, London, UK
| | - Laura E Downie
- Department of Optometry and Vision Sciences, The University of Melbourne, Melbourne, Australia
| | - Gianni Virgili
- Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Rohit Dhakal
- Myopia Research Lab, Prof. Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, India
| | - Pavan K Verkicharla
- Myopia Research Lab, Prof. Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, India
| | - Dongfeng Li
- Centre for Public Health, Queen's University Belfast, Belfast, UK
- Department of Ophthalmology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Sonia Mavi
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Ashleigh Kernohan
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Tianjing Li
- Department of Ophthalmology, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA
| | - Jeffrey J Walline
- College of Optometry, The Ohio State University, Columbus, Ohio, USA
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Nti AN, Owusu-Afriyie B, Osuagwu UL, Kyei S, Ovenseri-Ogbomo G, Ogbuehi KC, Ouzzani M, Agho KE, Mashige KP, Ekure E, Ekpenyong BN, Ocansey S, Ndep AO, Obinwanne CJ, Berntsen DA, Wolffsohn JS, Naidoo KS. Trends in myopia management attitudes and strategies in clinical practice: Survey of eye care practitioners in Africa. Cont Lens Anterior Eye 2023; 46:101597. [PMID: 35428590 DOI: 10.1016/j.clae.2022.101597] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 04/04/2022] [Accepted: 04/08/2022] [Indexed: 01/18/2023]
Abstract
PURPOSE There remains a lack of information on the perception and adoption of myopia control strategies among African eye care practitioners (ECPs). This study provides an African perspective to similar previous studies conducted in other parts of the world. METHODS A self-administered survey in English and French was distributed to ECPs across Africa. The items on the questionnaire assessed their level of concern about the increasing prevalence of paediatric myopia, perceived efficacy, opinions on, and adoption of various myopia management modalities. RESULTS Responses were obtained from 330 ECPs working in 23 African countries. Respondents were highly concerned about the increasing prevalence of paediatric myopia in their clinic (median 8/10) and perceived approved myopia control soft contact lenses as the most effective at slowing myopia progression (mean perceived reduction in myopia progression ± SD; 53.9 ± 27.1%), followed by single vision spectacles (53.1 ± 30.9%), and orthokeratology (52.8 ± 28.0%). Multifocal soft contact lenses (40.4 ± 25.8%) and pharmaceutical agents such as topical atropine drops (39.5 ± 27.1%) were perceived as least effective in slowing myopia progression. Although ECPs reported being aware of various myopia control strategies, they still mainly prescribed single vision spectacles to a large proportion (64.3 ± 29.9%) of young progressing myopes. Nearly one-third (27%) of ECPs who prescribed single vision lenses stated they were concerned about the cost implications to patients. Other reported concerns included safety of, and inadequate information about myopia control options. CONCLUSIONS African ECPs continue to prescribe single vision lenses for progressing myopes despite being aware of the various myopia control options. Practitioners' perceptions of the efficacy of several modalities to slow myopia progression do not align with the current best evidence. Clear practice guidelines and continuing education on myopia control are warranted to inform and guide the management of myopic patients in Africa.
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Affiliation(s)
- Augustine N Nti
- The Ocular Surface Institute, University of Houston College of Optometry, Houston, TX, United States of America
| | - Bismark Owusu-Afriyie
- Clinical Optometry Programme, School of Optometry and Vision Sciences, Cardiff University, United Kingdom
| | - Uchechukwu Levi Osuagwu
- Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia; African Vision Research Institute, Discipline of Optometry, University of KwaZulu-Natal, Westville Campus, Durban 3629, South Africa
| | - Samuel Kyei
- Department of Optometry and Vision Science, School of Allied Health Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Godwin Ovenseri-Ogbomo
- Department of Optometry, Centre for Health Sciences, University of the Highlands and Islands, Inverness IV2 3JH, UK
| | - Kelechi C Ogbuehi
- Department of Medicine, Dunedin School of Medicine, University of Otago, New Zealand
| | - Mhamed Ouzzani
- Optometry Research Group, LPCMME, Université Oran 1, B.P 1524, El M'Naouer 31000 Oran, Algeria; IRLCM: Innovation-Recherche en Lentille cornéenne de l'Université de Montréal, 3744 Rue Jean-Brillant Bureau 110, Montréal, QC H3T 1P1, Canada
| | - Kingsley E Agho
- Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia; School of Health Science, Western Sydney University, Campbelltown, NSW 2560, Australia
| | - Khathutshelo Percy Mashige
- African Vision Research Institute, Discipline of Optometry, University of KwaZulu-Natal, Westville Campus, Durban 3629, South Africa
| | | | - Bernadine N Ekpenyong
- Epidemiology & Medical Statistics Unit, Department of Public Health, University of Calabar, Calabar, Nigeria
| | - Stephen Ocansey
- Department of Optometry and Vision Science, School of Allied Health Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Antor O Ndep
- Health Education & Health Promotion Unit, Department of Public Health, University of Calabar, Calabar, Nigeria
| | - Chukwuemeka Junior Obinwanne
- Cornea, Contact Lens, and Myopia Control Unit, De Lens Ophthalmics Family Eye and Vision Care Center, Suite G14, Febson Mall, Plot 2425, Hebert Macaulay Way, Wuse Zone 4, Abuja, Nigeria
| | - David A Berntsen
- The Ocular Surface Institute, University of Houston College of Optometry, Houston, TX, United States of America
| | - James S Wolffsohn
- Optometry and Vision Science Research Group, College of Health and Life Sciences, Aston University, Birmingham, United Kingdom
| | - Kovin S Naidoo
- African Vision Research Institute, Discipline of Optometry, University of KwaZulu-Natal, Westville Campus, Durban 3629, South Africa; School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia.
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Rizzo GC, Di Vizio A, Versaci F, Przekoracka K, Tavazzi S, Zeri F. Centration assessment of an extended depth of focus contact lens for myopic progression control. Cont Lens Anterior Eye 2023; 46:101533. [PMID: 34753686 DOI: 10.1016/j.clae.2021.101533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 09/24/2021] [Accepted: 10/21/2021] [Indexed: 01/18/2023]
Abstract
PURPOSE To evaluate the accuracy and the inter and intra-observer reliability of the centration assessment of extended depth of focus (EDOF) contact lenses (CL) using corneal topography. METHOD EDOF soft CLs (Mylo, Mark'Ennovy) were fitted on thirty-three myopic students (25 females), aged 19-28 years (22.7 ± 2.0 years). For any EDOF CL, a topography over the CL and a slit lamp (SL) digital picture were taken in random order. For the topographic images, the position of the EDOF CL centre, with respect to the pupil centre, was detected by two different practitioners (one newly graduated and one with more than 20 years of clinical experience respectively) and repeated after 15 days. This measurement was compared to the one taken through the SL, considered as the gold standard, and assessed using the instrument software. RESULTS EDOF CLs resulted decentred inferiorly and temporally ranging, in the case of slit lamp assessment, between -0.27 ± 0.19 and 0.22 ± 0.23 mm horizontally and between -0.12 ± 0.31 and -0.17 ± 0.34 mm vertically, for the right and left eye respectively. The accuracy of the topographic assessment in determining EDOF CL centration was found to be very good compared to the SL assessment. No differences were found for the left eye, whereas in the right eye, a less temporally decentred position of the CL was detected by the topographical method (p < 0.05). However, this difference appeared clinically negligible (0.14 ± 0.22 mm). Inter-observer reliability (the differences between the two practitioners in assessing the EDOF centre) resulted significant only for the vertical coordinates of the centre position (p < 0.05). Concerning intra-observer reliability, better coefficient of precision and reliability between measurements within the same session were achieved by the more experienced practitioner, as well as a better level of the intraclass correlation coefficient in test-retest. CONCLUSION The centration of the EDOF CL investigated in this study can be accurately detected by a corneal topography performed over CLs. Inter-observer reliability resulted good whereas the intra-observer reliability resulted partially affected by the level of clinical experience of the practitioner.
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Affiliation(s)
- Giulia Carlotta Rizzo
- University of Milano-Bicocca, Department of Materials Science, Milan, Italy; University of Milano-Bicocca, COMiB Research Centre in Optics and Optometry, Milan, Italy
| | - Assunta Di Vizio
- Degree Course in Optics and Optometry, Department of Sciences. Roma TRE University, Rome, Italy
| | - Francesco Versaci
- R&D Department, Costruzione Strumenti Oftalmici (CSO), Florence, Italy
| | - Katarzyna Przekoracka
- Laboratory of Bionics and Experimental Medical Biology, Department of Bionics and Bioimpendance, University of Medical Sciences, Poznań, Poland; Laboratory of Vision Science and Optometry, Faculty of Physics, Adam Mickiewicz University, Poznań, Poland
| | - Silvia Tavazzi
- University of Milano-Bicocca, Department of Materials Science, Milan, Italy; University of Milano-Bicocca, COMiB Research Centre in Optics and Optometry, Milan, Italy
| | - Fabrizio Zeri
- University of Milano-Bicocca, Department of Materials Science, Milan, Italy; University of Milano-Bicocca, COMiB Research Centre in Optics and Optometry, Milan, Italy; College of Health and Life Sciences, Aston University, Birmingham, UK.
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Martínez-Pérez C, Villa-Collar C, Santodomingo-Rubido J, Wolffsohn JS. Strategies and attitudes on the management of myopia in clinical practice in Spain. JOURNAL OF OPTOMETRY 2023; 16:64-73. [PMID: 35365431 PMCID: PMC9811371 DOI: 10.1016/j.optom.2022.03.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 01/14/2022] [Accepted: 03/06/2022] [Indexed: 06/02/2023]
Abstract
OBJECTIVE In 2019, an international survey was conducted to evaluate strategies and attitudes in the management of myopia in clinical practice worldwide. This study reports on the results found in Spain and how these results compare with those from other regions of the world. METHODS A self-administrated, internet-based questionnaire was distributed to eye care professionals around the world through professional associations. The questions examined were based on the available strategies and their use. RESULTS A total of 173 Spanish optometrists, of the 1,336 practitioners from the five different continents who participated in the study, responded to the online survey. Spain, Asia and South America were found among the regions with the highest concern regarding the increased incidence of myopia (p ≤ 0.001). However, in these regions, the prescription of single-vision spectacles and single-vision contact lenses continues to be the main methods of visual correction prescribed to young myopic patients (p ≤ 0.001). Spanish practitioners, like those from other regions, considered orthokeratology to be the most effective treatment to control myopia progression (p ≤ 0.001). The major reasons why Spanish practitioners were not prescribing myopia control strategies were increased cost, inadequate information and unpredictable outcomes (p < 0.05). CONCLUSIONS The uptake of myopia control methods by Spanish practitioners is relatively low, despite the increase in the prevalence of paediatric myopia as well as increased concern and perceived clinical activity in the area in recent years.
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Affiliation(s)
- Clara Martínez-Pérez
- Optics & Optometry Department, Faculty of Health Sciences, Universidad Europea, Madrid, Spain
| | - César Villa-Collar
- Optics & Optometry Department, Faculty of Health Sciences, Universidad Europea, Madrid, Spain
| | | | - James S Wolffsohn
- College of Health & Life Sciences, Aston University, Birmingham, United Kingdom
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Queirós A, Amorim-de-Sousa A, Fernandes P, Ribeiro-Queirós MS, Villa-Collar C, González-Méijome JM. Mathematical Estimation of Axial Length Increment in the Control of Myopia Progression. J Clin Med 2022; 11:jcm11206200. [PMID: 36294521 PMCID: PMC9604591 DOI: 10.3390/jcm11206200] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 10/17/2022] [Accepted: 10/18/2022] [Indexed: 11/16/2022] Open
Abstract
This study aims to evaluate the existing mathematical approach for the theoretical estimation of axial length (AL) in a cross-sectional study, developing a new mathematical model and testing it in a longitudinal sample. Many professionals do not have a device to measure the AL due to clinic space and cost of equipment. However, this parameter plays an important role in the assessment of myopia progression to monitor treatment effects with myopia control strategies. First, a cross-sectional study based on the mathematical equation proposed by Morgan was performed. The AL was estimated based on the mean values of keratometry and spherical equivalent in 1783 subjects (52% female), aged 14.6 ± 4.6 years (6 to 25 years), of whom 738 were myopic, 770 emmetropic and 275 hyperopic. On average, the AL estimated with the Morgan formula was 0.25 ± 0.48 mm larger than the real AL value (95% limits of agreement: +0.70 to −1.20 mm). The study by gender, ametropia, type of astigmatism and age showed statistically significant differences between the real AL and predicted AL_Morgan (r > 0.750, spearman). Based on the previous sample, a multiple linear regression was applied, and a new mathematical model was proposed. The model was tested on a longitudinal sample of 152 subjects whose mean age was 13.3 ± 3.1 years (9 to 24 years) and of whom 96 were female (64%). The sample consisted of 46 myopes, 82 emmetropes and 24 hyperopes. The longitudinal study of the differences in axial length at one year between the models showed no statistically significant differences and that the mathematical equations are valid for estimating differences in axial increment for ages between 9 and 24 years, despite errors in the predicted value for axial length.
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Affiliation(s)
- António Queirós
- Clinical and Experimental Optometry Research Lab (CEORLab), School of Science, University of Minho, Gualtar, 4710-057 Braga, Portugal
- Physics Center of Minho and Porto Universities, (CF-UM-UP), Gualtar, 4710-057 Braga, Portugal
- Correspondence: ; Tel.: +351-253-60-40-67
| | - Ana Amorim-de-Sousa
- Clinical and Experimental Optometry Research Lab (CEORLab), School of Science, University of Minho, Gualtar, 4710-057 Braga, Portugal
- Physics Center of Minho and Porto Universities, (CF-UM-UP), Gualtar, 4710-057 Braga, Portugal
| | - Paulo Fernandes
- Clinical and Experimental Optometry Research Lab (CEORLab), School of Science, University of Minho, Gualtar, 4710-057 Braga, Portugal
- Physics Center of Minho and Porto Universities, (CF-UM-UP), Gualtar, 4710-057 Braga, Portugal
| | | | - César Villa-Collar
- Departamento de Farmacia, Biotecnología, Óptica y Optometría, Universidad Europea de Madrid, 28670 Madrid, Spain
| | - José M. González-Méijome
- Clinical and Experimental Optometry Research Lab (CEORLab), School of Science, University of Minho, Gualtar, 4710-057 Braga, Portugal
- Physics Center of Minho and Porto Universities, (CF-UM-UP), Gualtar, 4710-057 Braga, Portugal
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Ortiz-Peregrina S, Casares-López M, Castro-Torres JJ, Anera RG, Artal P. Effect of peripheral refractive errors on driving performance. BIOMEDICAL OPTICS EXPRESS 2022; 13:5533-5550. [PMID: 36425634 PMCID: PMC9664894 DOI: 10.1364/boe.468032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 09/13/2022] [Accepted: 09/15/2022] [Indexed: 05/30/2023]
Abstract
The effect of peripheral refractive errors on driving while performing secondary tasks at 40° of eccentricity was studied in thirty-one young drivers. They drove a driving simulator under 7 different induced peripheral refractive errors (baseline (0D), spherical lenses of +/- 2D, +/- 4D and cylindrical lenses of +2D and +4D). Peripheral visual acuity and contrast sensitivity were also evaluated at 40°. Driving performance was significantly impaired by the addition of myopic defocus (4D) and astigmatism (4D). Worse driving significantly correlated with worse contrast sensitivity for the route in general, but also with worse visual acuity when participants interacted with the secondary task. Induced peripheral refractive errors may negatively impact driving when performing secondary tasks.
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Affiliation(s)
- Sonia Ortiz-Peregrina
- Department of Optics, Laboratory of Vision Sciences and Applications, University of Granada, Granada 18071, Spain
| | - Miriam Casares-López
- Department of Optics, Laboratory of Vision Sciences and Applications, University of Granada, Granada 18071, Spain
| | - José J. Castro-Torres
- Department of Optics, Laboratory of Vision Sciences and Applications, University of Granada, Granada 18071, Spain
| | - Rosario G. Anera
- Department of Optics, Laboratory of Vision Sciences and Applications, University of Granada, Granada 18071, Spain
| | - Pablo Artal
- Laboratorio de Óptica, Universidad de Murcia, Campus de Espinardo, Murcia 30100, Spain
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Differences in Practitioner Experience, Practice Type, and Profession in Attitudes Toward Growing Contact Lens Practice. Eye Contact Lens 2022; 48:369-376. [PMID: 35971228 DOI: 10.1097/icl.0000000000000920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To investigate eye care practitioners' attitudes and perceptions toward potential interventions that can enhance contact lens (CL) practice across the world, and how this is influenced by their practice setting. METHODS A self-administered, anonymized survey was constructed in English and then forward and backward translated into six more languages. The survey was distributed online via social media platforms and mailing lists involving reputed international professional bodies. RESULTS In total, 2,222 responses from 27 countries with sufficient responses were analyzed (53% females, median age- 37 years). Most of the respondents were optometrists (81.9%) and 47.6% were from stand-alone/independent practices. Median working experience in CL prescribing was 11.0 years (IQR: 18.0, 4-22 years). Over two-third of them declared themselves to be very hopeful (22.9%) or hopeful (45.1%) about the future of their CL practice. Among the potential interventions proposed, continuous update of knowledge and skills and competently managing CL-related complications were rated the most important (median score: 9/10 for each). Practitioners working in national/regional retail chains expressed higher proactivity in recommending CLs (9/10) than those in local chains, hospitals, and universities (for all 8/10, P<0.05). National differences were also identified in eye care practitioner attitudes and perceptions (P<0.05). CONCLUSIONS The study provided important information to delineate a variety of elements characterizing CL practice across the world. These insights can serve as a basis to design strategies at national and international levels.
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Yang A, Pang BY, Vasudevan P, Drobe B. Eye Care Practitioners Are Key Influencer for the Use of Myopia Control Intervention. Front Public Health 2022; 10:854654. [PMID: 35425741 PMCID: PMC9002343 DOI: 10.3389/fpubh.2022.854654] [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: 01/14/2022] [Accepted: 03/08/2022] [Indexed: 12/03/2022] Open
Abstract
Background The study sought to investigate the self-reported practices of Singaporean eye care practitioners on myopia management and the interaction between eye care practitioners and parents. Methods Self-reported questionnaire (1) to eye care practitioners to understand their clinical practice behavior, their opinion in myopia management (2) to parents on their knowledge of myopia control products and interaction with eye care practitioners. Results 80.0% of eye care practitioners prescribe myopia control in their practice but only 33.1% of eye care practitioners prescribed myopia control interventions during the first visit, and only 41.4% of parents were recommended myopia control interventions by eye care practitioners, of which 75.6% followed the recommendations of eye care practitioners. Eye care practitioners (53.1%) prefer atropine the most and parents prefer controlling the amount of time doing near work (54.5%) and outdoor activities (52.5%). Eye care practitioners had the highest influence on the choice of vision correction with 78.8% of parents choosing to follow them. 66.9% of eye care practitioners did not prescribe myopia control interventions during the first visit as they lack myopia progression data from the patient. Eye care practitioners felt that more education on myopia control products (57.7%), hands-on workshops (47.7%) and management of children (44.6%) would encourage them to use myopia control interventions more frequently. 40.0% of the eye care practitioners were concerned about the cost of myopia control products. Conclusions Eye care practitioners strongly influence parents to uptake myopia control interventions. More education and hands-on workshops on myopia and children management can help encourage the use of myopia control interventions by eye care practitioners.
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Affiliation(s)
- Adeline Yang
- Essilor R&D, Essilor International, Singapore, Singapore
| | - Bao Y Pang
- Essilor R&D, Essilor International, Singapore, Singapore
| | | | - Björn Drobe
- Essilor R&D, Essilor International, Singapore, Singapore
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20
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Systematic review and meta-analysis of myopia prevalence in African school children. PLoS One 2022; 17:e0263335. [PMID: 35113922 PMCID: PMC8812871 DOI: 10.1371/journal.pone.0263335] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 01/15/2022] [Indexed: 12/19/2022] Open
Abstract
Purpose Increased prevalence of myopia is a major public health challenge worldwide, including in Africa. While previous studies have shown an increasing prevalence in Africa, there is no collective review of evidence on the magnitude of myopia in African school children. Hence, this study reviews the evidence and provides a meta-analysis of the prevalence of myopia in African school children. Methods This review was conducted using the 2020 Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Five computerized bibliographic databases, PUBMED, Scopus, Web of Science, ProQuest, and Africa Index Medicus were searched for published studies on the prevalence of myopia in Africa from 1 January 2000 to 18 August 2021. Studies were assessed for methodological quality. Data were gathered by gender, age and refraction technique and standardized to the definition of myopia as refractive error ≥ 0.50 diopter. A meta-analysis was conducted to estimate the prevalence. Significant heterogeneity was detected among the various studies (I2 >50%), hence a random effect model was used, and sensitivity analysis was performed to examine the effects of outliers. Results We included data from 24 quality assessed studies, covering 36,395 African children. The overall crude prevalence of myopia over the last two decades is 4.7% (95% CI, 3.9–5.7) in African children. Although the prevalence of myopia was slightly higher in females (5.3%, 95%CI: 4.1, 6.5) than in males (3.7%, 95% CI, 2.6–4.7; p = 0.297) and higher in older [12–18 years 5.1% (95% CI, 3.8–6.3) than younger children (aged 5–11 years, 3.4%, 95% CI, 2.5–4.4; p = 0.091), the differences were not significant. There was a significantly lower prevalence of myopia with cycloplegic compared with non-cycloplegic refraction [4.2%, 95%CI: 3.3, 5.1 versus 6.4%, 95%CI: 4.4, 8.4; p = 0.046]. Conclusions Our results showed that myopia affects about one in twenty African schoolchildren, and it is overestimated in non-cycloplegic refraction. Clinical interventions to reduce the prevalence of myopia in the region should target females, and school children who are aged 12–18 years.
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Walsh K, Jones L, Moody K. Addressing common myths and misconceptions in soft contact lens practice. Clin Exp Optom 2021; 105:459-473. [PMID: 34886744 DOI: 10.1080/08164622.2021.2003693] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Advances in contact lens technology over the past 50 years since the commercialisation of the first soft lenses in 1971 have been incredible, with significant changes in contact lens materials, frequency of replacement, care systems and lens designs occurring. However, despite the widespread availability of contact lenses, penetration rates for those who need vision correction remain in the low single digits and many practitioners seem to hold on to concepts around the potential value of contact lenses that appear based in the dim and distant past and are certainly no longer valid today. This review addresses 10 common 'myths and misconceptions' around soft contact lenses using an evidence-based approach that can hopefully dispel some of these incorrect assumptions.
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Affiliation(s)
- Karen Walsh
- Centre for Ocular Research & Education (CORE), School of Optometry and Vision Science, University of Waterloo, Waterloo, Canada
| | - Lyndon Jones
- Centre for Ocular Research & Education (CORE), School of Optometry and Vision Science, University of Waterloo, Waterloo, Canada.,Centre for Eye and Vision Research (CEVR), 17W Hong Kong Science Park, Shatin, Hong Kong
| | - Kurt Moody
- Johnson & Johnson Vision, Jacksonville, Florida, USA
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22
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Wu J, Fang W, Xu H, Liu X, Zhao D, Rong Q. The Biomechanical Response of the Cornea in Orthokeratology. Front Bioeng Biotechnol 2021; 9:743745. [PMID: 34708026 PMCID: PMC8542762 DOI: 10.3389/fbioe.2021.743745] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 09/06/2021] [Indexed: 11/13/2022] Open
Abstract
Orthokeratology has been widely used to control myopia, but the mechanism is still unknown. To further investigate the underlying mechanism of corneal reshaping using orthokeratology lenses via the finite element method, numerical models with different corneal curvatures, corneal thicknesses, and myopia reduction degrees had been developed and validated to simulate the corneal response and quantify the changes in maximum stress in the central and peripheral corneal areas during orthokeratology. The influence of the factors on corneal response had been analyzed by using median quantile regression. A partial eta squared value in analysis of variance models was established to compare the effect size of these factors. The results showed central and peripheral corneal stress responses changed significantly with increased myopia reduction, corneal curvature, and corneal thickness. The target myopia reduction had the greatest effect on the central corneal stress value (partial eta square = 0.9382), followed by corneal curvature (partial eta square = 0.5650) and corneal thickness (partial eta square = 0.1975). The corneal curvature had the greatest effect on the peripheral corneal stress value (partial eta square = 0.5220), followed by myopia reduction (partial eta square = 0.2375) and corneal thickness (partial eta square = 0.1972). In summary, the biomechanical response of the cornea varies significantly with the change in corneal conditions and lens designs. Therefore, the orthokeratology lens design and the lens fitting process should be taken into consideration in clinical practice, especially for patients with high myopia and steep corneas.
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Affiliation(s)
- Jinfang Wu
- Department of Mechanics and Engineering Science, College of Engineering, Peking University, Beijing, China
| | - Wenxuan Fang
- Department of Mechanics and Engineering Science, College of Engineering, Peking University, Beijing, China
| | - Huiwen Xu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
- Medical Informatics Center, Peking University, Beijing, China
| | - Xiaode Liu
- Department of Mechanics and Engineering Science, College of Engineering, Peking University, Beijing, China
- X Lab, the Second Academy of CASIC, Beijing, China
| | - Dongliang Zhao
- School of Chemical Biology and Biotechnology, Peking University Shenzhen Graduate School, Shenzhen, China
| | - Qiguo Rong
- Department of Mechanics and Engineering Science, College of Engineering, Peking University, Beijing, China
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Bullimore MA, Ritchey ER, Shah S, Leveziel N, Bourne RRA, Flitcroft DI. The Risks and Benefits of Myopia Control. Ophthalmology 2021; 128:1561-1579. [PMID: 33961969 DOI: 10.1016/j.ophtha.2021.04.032] [Citation(s) in RCA: 82] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 04/27/2021] [Accepted: 04/28/2021] [Indexed: 02/09/2023] Open
Abstract
PURPOSE The prevalence of myopia is increasing around the world, stimulating interest in methods to slow its progression. The primary justification for slowing myopia progression is to reduce the risk of vision loss through sight-threatening ocular pathologic features in later life. The article analyzes whether the potential benefits of slowing myopia progression by 1 diopter (D) justify the potential risks associated with treatments. METHODS First, the known risks associated with various methods of myopia control are summarized, with emphasis on contact lens wear. Based on available data, the risk of visual impairment and predicted years of visual impairment are estimated for a range of incidence levels. Next, the increased risk of potentially sight-threatening conditions associated with different levels of myopia are reviewed. Finally, a model of the risk of visual impairment as a function of myopia level is developed, and the years of visual impairment associated with various levels of myopia and the years of visual impairment that could be prevented with achievable levels of myopia control are estimated. RESULTS Assuming an incidence of microbial keratitis between 1 and 25 per 10 000 patient-years and that 15% of cases result in vision loss leads to the conclusion that between 38 and 945 patients need to be exposed to 5 years of wear to produce 5 years of vision loss. Each additional 1 D of myopia is associated with a 58%, 20%, 21%, and 30% increase in the risk of myopic maculopathy, open-angle glaucoma, posterior subcapsular cataract, and retinal detachment, respectively. The predicted mean years of visual impairment ranges from 4.42 in a person with myopia of -3 D to 9.56 in a person with myopia of -8 D, and a 1-D reduction would lower these by 0.74 and 1.21 years, respectively. CONCLUSIONS The potential benefits of myopia control outweigh the risks: the number needed to treat to prevent 5 years of visual impairment is between 4.1 and 6.8, whereas fewer than 1 in 38 will experience a loss of vision as a result of myopia control.
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Affiliation(s)
| | - Eric R Ritchey
- College of Optometry, University of Houston, Houston, Texas
| | - Sunil Shah
- Birmingham and Midland Eye Centre, Birmingham, United Kingdom; Ophthalmic and Vision Sciences Research Group, Life and Health Sciences, Aston University, Birmingham, United Kingdom
| | - Nicolas Leveziel
- Service d'ophtalmologie, Centre Hospitalier Universitaire (CHU) Poitiers, Poitiers, France; University of Poitiers, Poitiers, France; Centre d'Investigation Clinique (CIC 1402), Poitiers, France; Institut National de la Santé et de la Recherche Médicale (INSERM 1084), Poitiers, France; Vision & Eye Research Institute, School of Medicine, Anglia Ruskin University, Cambridge, United Kingdom
| | - Rupert R A Bourne
- Vision & Eye Research Institute, School of Medicine, Anglia Ruskin University, Cambridge, United Kingdom; Department of Ophthalmology, Cambridge University Hospital, Cambridge, United Kingdom
| | - D Ian Flitcroft
- Department of Ophthalmology, Children's University Hospital, Dublin, Ireland; Centre for Eye Research Ireland, School of Physics, Clinical and Optometric Sciences, Technological University Dublin, Dublin, Ireland
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Lawrenson JG, Dhakal R, Verkicharla PK, Shah R, Huntjens B, Downie LE, Kernohan A, Li T, Virgili G, Walline JJ. Interventions for myopia control in children: a living systematic review and network meta-analysis. Hippokratia 2021. [DOI: 10.1002/14651858.cd014758] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- John G Lawrenson
- Centre for Applied Vision Research, School of Health Sciences; City University of London; London UK
| | - Rohit Dhakal
- Myopia Research Lab, Prof. Brien Holden Eye Research Centre; L V Prasad Eye Institute; Hyderabad India
| | - Pavan K Verkicharla
- Myopia Research Lab, Prof. Brien Holden Eye Research Centre; L V Prasad Eye Institute; Hyderabad India
| | - Rakhee Shah
- Centre for Applied Vision Research, School of Health Sciences; City University of London; London UK
| | - Byki Huntjens
- Centre for Applied Vision Research, School of Health Sciences; City University of London; London UK
| | - Laura E Downie
- Department of Optometry and Vision Sciences; The University of Melbourne; Melbourne Australia
| | - Ashleigh Kernohan
- Population Health Sciences Institute; Newcastle University; Newcastle upon Tyne UK
| | - Tianjing Li
- Department of Ophthalmology; University of Colorado Denver Anschutz Medical Campus; Aurora CO USA
| | - Gianni Virgili
- Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA); University of Florence; Florence Italy
- Centre for Public Health; Queen's University Belfast; Belfast UK
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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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26
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Ouzzani M, Mekki MB, Chiali S, Kail F, Chahed L. Practice of orthokeratology in Algeria: a retrospective study. JOURNAL OF OPTOMETRY 2021; 14:176-182. [PMID: 32988782 PMCID: PMC8093529 DOI: 10.1016/j.optom.2020.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 05/21/2020] [Accepted: 05/25/2020] [Indexed: 06/11/2023]
Abstract
PURPOSE To report the practice of orthokeratology (OK) in Algeria and to investigate the visual outcomes, safety and subjective responses with this technique in myopes. METHODS A retrospective chart review of 48 participants using OK lenses since January 2010 were included in the study. Lenses were selected and fitted according to the manufacturer's recommendations using their respective software and the number of lenses required for a successful fit was recorded. Visual acuity (VA) in logMAR units and biomicroscopic findings were recorded for each visit. Subjective ratings was determined with analogue rating scale was filled in by the investigator, the participants were divided into Group 1 (> 4.00D) and Group 2 (< 3.75D) myopic groups for analysis. RESULTS First lens fitting success rate of 64.58%. There was also a significant difference between the BCVA at baseline and VA at Day 1 (P < 0.05), and no significant difference at Day 7, Day 30 and the final visit (P = 0.51, P = 0.93, P = 0.62, respectively), for Group 2. There was a significant difference between the BCVA at baseline and VA at Day 1, 7, 30 and the final visit (P < 0.05), for Group 1. the patients of the second group were happier but the results from the survey were not statistically significant (P = 0.10), no serious complication was reported. CONCLUSION the technique was efficient and safe as we didn't have any serious complication, with a high success rate for first lens fitting.
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Affiliation(s)
- Mhamed Ouzzani
- Optometry Research Group, LPCMME, University of Oran1, Oran, Algeria; Centre Ibn Al Haythem, Contactologie et chirurgie ophtalmologique, Algiers, Algeria.
| | - Moatez Billah Mekki
- Centre Ibn Al Haythem, Contactologie et chirurgie ophtalmologique, Algiers, Algeria
| | - Selma Chiali
- Optometry Research Group, LPCMME, University of Oran1, Oran, Algeria
| | - Fatiha Kail
- Optometry Research Group, LPCMME, University of Oran1, Oran, Algeria
| | - Larbi Chahed
- Optometry Research Group, LPCMME, University of Oran1, Oran, Algeria
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27
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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: 124] [Impact Index Per Article: 31.0] [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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Magakwe TS, Xulu-Kasaba ZN, Hansraj R. Visual impairment and refractive error amongst school-going children aged 6–18 years in Sekhukhune District (Limpopo, South Africa). AFRICAN VISION AND EYE HEALTH 2020. [DOI: 10.4102/aveh.v79i1.551] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Background: Refractive error (RE) and visual impairment (VI) remain major problems affecting school-going children worldwide.Aim: To determine the prevalence and distribution of VI and RE in school-going children aged 6–18 years.Setting: The study was conducted in Sekhukhune District, Limpopo, South Africa.Methods: A multistage random sampling method was used to select school-going children aged 6–18 years from Grades 1 to 12. A total of 326 learners went through eye examinations, which included visual acuity (VA) measurement using a logarithm of the minimum angle of resolution chart, autorefraction under cycloplegia and ocular health assessment.Results: The prevalence of uncorrected, presenting and best-corrected VA of 0.30 M or worse in the better eye was 12.3% (95% confidence interval [CI], 8.70–15.80), 12.3% (95% CI, 8.70–15.80) and 2.1% (95% CI, 0.60–3.70), respectively. Refractive error accounted for 80% (95% CI, 67.6–92.4) of all causes of VI. Myopia was the most prevalent RE (50.7%; 95% CI, 38.8–62.7), followed by astigmatism (36%; 95% CI, 24.3–47.3) and hypermetropia (13.6%; 95% CI, 5.30–21.6). There was no significant difference in the prevalence of RE and VI between males (50.7%; 95% CI, 38.8–62.7) and females (49.3%; 95% CI, 37.3–61.2). Refractive error and VI were higher amongst children aged 14–18 years: 56.7% (95% CI, 44.9–68.6) and 60% (95% CI, 44.8–75.20), respectively.Conclusion: The prevalence of RE and VI amongst school-going children in Sekhukhune District was high, highlighting the need for school visual screening and strategies to address these conditions in that area.
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Chen Z, Li T, Li M, Xu Y, Zhou X. Effect of Tropicamide on crystalline Lens rise in low-to-moderate myopic eyes. BMC Ophthalmol 2020; 20:327. [PMID: 32778077 PMCID: PMC7418382 DOI: 10.1186/s12886-020-01594-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 07/31/2020] [Indexed: 12/17/2022] Open
Abstract
Background Cycloplegics have been reported to induce changes in the lens thickness. However, the studies of correlation between cycloplegia and the lens position are limited. This study aims to investigate changes in crystalline lens rise (CLR) and other anterior segment parameters after inducing cycloplegia with tropicamide. Methods In this consecutive case study, 39 children (20 boys and 19 girls; mean age, 9.51 ± 1.75 years, mean spherical equivalence [SE], − 1.9 ± 1.5 D) with low-to moderate myopia were examined using CASIA 2 both before and after 30 min of administering 5-cycles (each 5 min apart) of 0.5% tropicamide. Measurements included CLR, crystalline lens thickness (CLT), mean radius of curvature of the anterior/posterior surface of the lens (Rf_ave/Rb_ave), anterior chamber depth (ACD), anterior chamber width (ACW), and central corneal thickness (CCT). Correlations of CLT and CLR with ACD, SE, and age were assessed respectively. Results CLT and CLR decreased significantly after cycloplegia (p < 0.001 and p < 0.001, respectively); whereas CCT, ACD, and Rf_ave increased (p = 0.008, p < 0.001, p < 0.001, respectively). A positive correlation was found between CLR and SE (r = 0.565, p < 0.001). However, a negative correlation between ACD and CLR was found before and after cycloplegia (r = − 0.430, p = 0.006; r = − 0.342, p = 0.035, respectively). Conclusions The crystalline lens appeared thinner and moved backward after cycloplegia. ACD increased mainly due to the backward movement of the crystalline lens. These results aid in elucidating the impact of crystalline lens changes during the process of accommodation.
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Affiliation(s)
- Zhuoyi Chen
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University); Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Tao Li
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University); Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Meiyan Li
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University); Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Ye Xu
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University); Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Xingtao Zhou
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China. .,NHC Key Laboratory of Myopia (Fudan University); Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China. .,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China.
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Ma S, Guan Y, Yuan Y, Tai Y, Wang T. A One-Step, Streamlined Children's Vision Screening Solution Based on Smartphone Imaging for Resource-Limited Areas: Design and Preliminary Field Evaluation. JMIR Mhealth Uhealth 2020; 8:e18226. [PMID: 32673243 PMCID: PMC7386401 DOI: 10.2196/18226] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 04/15/2020] [Accepted: 04/16/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Young children's vision screening, as part of a preventative health care service, produces great value for developing regions. Besides yielding a high return on investment from forestalling surgeries using a low-cost intervention at a young age, it improves school performance and thus boosts future labor force quality. Leveraging low-skilled health care workers with smartphones and automated diagnosis to offer such programs can be a scalable model in resource-limited areas. OBJECTIVE This study aimed to develop and evaluate an effective, efficient, and comprehensive vision screening solution for school children in resource-limited areas. First, such an exam would need to cover the major risk factors of amblyopia and myopia, 2 major sources of vision impairment effectively preventable at a young age. Second, the solution must be integrated with digital patient record-keeping for long-term monitoring and popular statistical analysis. Last, it should utilize low-skilled technicians and only low-cost tools that are available in a typical school in developing regions, without compromising quality or efficiency. METHODS A workflow for the screening program was designed and a smartphone app was developed to implement it. In the standardized screening procedure, a young child went through the smartphone-based photoscreening in a dark room. The child held a smartphone in front of their forehead, displaying pre-entered personal information as a quick response code that duplexed as a reference of scale. In one 10-second procedure, the child's personal information and interpupillary distance, relative visual axis alignment, and refractive error ranges were measured and analyzed automatically using image processing and artificial intelligence algorithms. The child's risk for strabismus, myopia, and anisometropia was then derived and consultation given. RESULTS A preliminary evaluation of the solution was conducted alongside yearly physical exams in Luoyang, Henan, People's Republic of China. It covered 20 students with suspected strabismus and 80 randomly selected students, aged evenly between 8 and 10. Each examinee took about 1 minute, and a streamlined workflow allowed 3 exams to run in parallel. The 1-shot and 2-shot measurement success rates were 87% and 100%, respectively. The sensitivity and specificity of strabismus detection were 0.80 and 0.98, respectively. The sensitivity and specificity of myopia detection were 0.83 and 1.00, respectively. The sensitivity and specificity of anisometropia detection were 0.80 and 1.00, respectively. CONCLUSIONS The proposed vision screening program is effective, efficient, and scalable. Compared with previously published studies on utilizing a smartphone for an automated Hirschberg test and photorefraction screening, this comprehensive solution is optimized for practicality and robustness, and is thus better ready-to-deploy. Our evaluation validated the achievement of the program's design specifications.
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Affiliation(s)
- Shuoxin Ma
- College of Software Engineering, Southeast University, Nanjing, China
- TerryDr Infomation Technology, Nanjing, China
| | - Yongqing Guan
- The Fourth Hospital of Hebei Medical University, ShiJiaZhuang, China
| | - Yazhen Yuan
- The Fourth Hospital of Hebei Medical University, ShiJiaZhuang, China
| | - Yuan Tai
- TerryDr Infomation Technology, Nanjing, China
| | - Tan Wang
- TerryDr Infomation Technology, Nanjing, China
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McCrann S, Flitcroft I, Loughman J. Is optometry ready for myopia control? Education and other barriers to the treatment of myopia. HRB Open Res 2020; 2:30. [PMID: 33083690 PMCID: PMC7542256 DOI: 10.12688/hrbopenres.12954.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2020] [Indexed: 11/23/2022] Open
Abstract
Background: With the increasing prevalence of myopia there is growing interest in active myopia control. However, the majority of progressive myopes are still prescribed single vision spectacles. This prospective study aims to elucidate the knowledge and attitudes of optometrists toward myopia control, and thereby identify perceived barriers to the implementation of a risk focussed model of myopia management. Methods: A series of four focus group discussions were conducted involving optometrists in different settings and career stages. Results: The key finding to emerge is a disconnect in myopia control knowledge and practices between academic optometrists, final year optometry students and clinicians in practice. Academic faculty believe the optometry curriculum should provide undergraduates with the clinical skills to practise myopia control, however, although students were knowledgeable in relation to myopia associated risk factors, some students had not yet undertaken any practical form of myopia control in their undergraduate degree. Furthermore, students may not receive hands-on myopia control experience during their supervised practice placement, as the majority of clinicians do not offer myopia control treatments, other than to communicate lifestyle advice to modify risk of myopia progression. Clinicians alluded to a lack of availability of myopia control interventions and identified a range of barriers relating to their training, clinical practice and public health challenges, financial, technological and other constraints that affect the implementation of such interventions. Conclusion: It appears optometrists have to yet embrace myopia control as a core element of the clinical eye care service they provide. Education, training, finance, and time restrictions, as well as limited availability of myopia control therapies were among the main perceived barriers to myopia control. This study revealed a distinct need for alignment between optometric training and the public health need for effective myopia control.
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Affiliation(s)
- Saoirse McCrann
- Centre for Eye Research Ireland, School of Physics and Clinical and Optometric Sciences, Technological University Dublin, Dublin, Ireland
| | - Ian Flitcroft
- Centre for Eye Research Ireland, School of Physics and Clinical and Optometric Sciences, Technological University Dublin, Dublin, Ireland.,Children's University Hospital, Dublin, Ireland
| | - James Loughman
- Centre for Eye Research Ireland, School of Physics and Clinical and Optometric Sciences, Technological University Dublin, Dublin, Ireland.,African Vision Research Institute, University of KwaZulu Natal, Durban, South Africa
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McCrann S, Flitcroft I, Loughman J. Is optometry ready for myopia control? Education and other barriers to the treatment of myopia. HRB Open Res 2020; 2:30. [PMID: 33083690 PMCID: PMC7542256 DOI: 10.12688/hrbopenres.12954.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2020] [Indexed: 03/18/2024] Open
Abstract
Background: With the increasing prevalence of myopia there is growing interest in active myopia control. However, the majority of progressive myopes are still prescribed single vision spectacles. This prospective study aims to elucidate the knowledge and attitudes of optometrists toward myopia control, and thereby identify perceived barriers to the implementation of a risk focussed model of myopia management. Methods: A series of four focus group discussions were conducted involving optometrists in different settings and career stages. Results: The key finding to emerge is a disconnect in myopia control knowledge and practices between academic optometrists, final year optometry students and clinicians in practice. Academic faculty believe the optometry curriculum should provide undergraduates with the clinical skills to practise myopia control, however, although students were knowledgeable in relation to myopia associated risk factors, some students had not yet undertaken any practical form of myopia control in their undergraduate degree. Furthermore, students may not receive hands-on myopia control experience during their supervised practice placement, as the majority of clinicians do not offer myopia control treatments, other than to communicate lifestyle advice to modify risk of myopia progression. Clinicians alluded to a lack of availability of myopia control interventions and identified a range of barriers relating to their training, clinical practice and public health challenges, financial, technological and other constraints that affect the implementation of such interventions. Conclusion: It appears optometrists have to yet embrace myopia control as a core element of the clinical eye care service they provide. Education, training, finance, and time restrictions, as well as limited availability of myopia control therapies were among the main perceived barriers to myopia control. This study revealed a distinct need for alignment between optometric training and the public health need for effective myopia control.
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Affiliation(s)
- Saoirse McCrann
- Centre for Eye Research Ireland, School of Physics and Clinical and Optometric Sciences, Technological University Dublin, Dublin, Ireland
| | - Ian Flitcroft
- Centre for Eye Research Ireland, School of Physics and Clinical and Optometric Sciences, Technological University Dublin, Dublin, Ireland
- Children’s University Hospital, Dublin, Ireland
| | - James Loughman
- Centre for Eye Research Ireland, School of Physics and Clinical and Optometric Sciences, Technological University Dublin, Dublin, Ireland
- African Vision Research Institute, University of KwaZulu Natal, Durban, South Africa
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Bullimore MA, Johnson LA. Overnight orthokeratology. Cont Lens Anterior Eye 2020; 43:322-332. [PMID: 32331970 DOI: 10.1016/j.clae.2020.03.018] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 03/19/2020] [Accepted: 03/27/2020] [Indexed: 12/27/2022]
Abstract
Overnight orthokeratology lenses are approved in countries all over the world for the temporary reduction in myopia, and recently, one lens design has received regulatory approval for myopia control in Europe. The modern orthokeratology lens has a substantial history from its origins of attempting to flatten the corneal curvature with a spherical rigid contact lens to sophisticated gas permeable lenses, designed to reshape the cornea. These lenses are predominantly prescribed for children to slow myopia progression and limit axial elongation of the eye. This article reviews the peer-reviewed literature on the efficacy of orthokeratology for myopia control, sustainability after treatment is discontinued, and the safety concerns of overnight contact lens wear. Future avenues of research are discussed.
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Affiliation(s)
- Mark A Bullimore
- University of Houston, College of Optometry, 4901 Calhoun Rd., Houston, TX, 77204, United States.
| | - Leah A Johnson
- University of Houston, College of Optometry, 4901 Calhoun Rd., Houston, TX, 77204, United States; Paragon Vision Sciences, 2120 West Guadalupe Road, Suite 112, Gilbert, AZ, 85233, United States.
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Recommendations for progressive myopia in childhood and adolescence. Ophthalmologe 2020; 117:11-15. [DOI: 10.1007/s00347-019-00953-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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2-D Peripheral image quality metrics with different types of multifocal contact lenses. Sci Rep 2019; 9:18487. [PMID: 31811185 PMCID: PMC6898319 DOI: 10.1038/s41598-019-54783-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 11/18/2019] [Indexed: 12/19/2022] Open
Abstract
To evaluate the impact of multifocal contact lens wear on the image quality metrics across the visual field in the context of eye growth and myopia control. Two-dimensional cross-correlation coefficients were estimated by comparing a reference image against the computed retinal images for every location. Retinal images were simulated based on the measured optical aberrations of the naked eye and a set of multifocal contact lenses (centre-near and centre-distance designs), and images were spatially filtered to match the resolution limit at each eccentricity. Value maps showing the reduction in the quality of the image through each optical condition were obtained by subtracting the optical image quality from the theoretical physiological limits. Results indicate that multifocal contact lenses degrade the image quality independently from their optical design, though this result depends on the type of analysis conducted. Analysis of the image quality across the visual field should not be oversimplified to a single number but split into regional and groups because it provides more insightful information and can avoid misinterpretation of the results. The decay of the image quality caused by the multifocal contacts alone, cannot explain the translation of peripheral defocus towards protection on myopia progression, and a different explanation needs to be found.
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36
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Estimation of ocular axial length from conventional optometric measures. Cont Lens Anterior Eye 2019; 43:18-20. [PMID: 31786071 DOI: 10.1016/j.clae.2019.11.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 11/11/2019] [Accepted: 11/11/2019] [Indexed: 11/21/2022]
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Wolffsohn JS, Calossi A, Cho P, Gifford K, Jones L, Jones D, Guthrie S, Li M, Lipener C, Logan NS, Malet F, Peixoto-de-Matos SC, González-Méijome JM, Nichols JJ, Orr JB, Santodomingo-Rubido J, Schaefer T, Thite N, van der Worp E, Tarutta E, Iomdina E, Ali BM, Villa-Collar C, Abesamis-Dichoso C, Chen C, Pult H, Blaser P, Parra Sandra Johanna G, Iqbal F, Ramos R, Carrillo Orihuela G, Boychev N. Global trends in myopia management attitudes and strategies in clinical practice - 2019 Update. Cont Lens Anterior Eye 2019; 43:9-17. [PMID: 31761738 DOI: 10.1016/j.clae.2019.11.002] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 11/01/2019] [Indexed: 12/13/2022]
Abstract
PURPOSE A survey in 2015 identified a high level of eye care practitioner concern about myopia with a reported moderately high level of activity, but the vast majority still prescribed single vision interventions to young myopes. This research aimed to update these findings 4 years later. METHODS A self-administrated, internet-based questionnaire was distributed in eight languages, through professional bodies to eye care practitioners globally. The questions examined: awareness of increasing myopia prevalence, perceived efficacy of available strategies and adoption levels of such strategies, and reasons for not adopting specific strategies. RESULTS Of the 1336 respondents, concern was highest (9.0 ± 1.6; p < 0.001) in Asia and lowest (7.6 ± 2.2; p < 0.001) in Australasia. Practitioners from Asia also considered their clinical practice of myopia control to be the most active (7.7 ± 2.3; p < 0.001), the North American practitioners being the least active (6.3 ± 2.9; p < 0.001). Orthokeratology was perceived to be the most effective method of myopia control, followed by pharmaceutical approaches and approved myopia control soft contact lenses (p < 0.001). Although significant intra-regional differences existed, overall, most practitioners did not consider single-vision distance under-correction to be an effective strategy for attenuating myopia progression (79.6 %), but prescribed single vision spectacles or contact lenses as the primary mode of correction for myopic patients (63.6 ± 21.8 %). The main justifications for their reluctance to prescribe alternatives to single vision refractive corrections were increased cost (20.6 %) and inadequate information (17.6 %). CONCLUSIONS While practitioner concern about myopia and the reported level of activity have increased over the last 4 years, the vast majority of eye care clinicians still prescribe single vision interventions to young myopes. With recent global consensus evidence-based guidelines having been published, it is hoped that this will inform the practice of myopia management in future.
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Affiliation(s)
| | - Antonio Calossi
- Department of Physics (Optics and Optometry), University of Florence, Italy
| | - Pauline Cho
- School of Optometry, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region
| | - Kate Gifford
- School of Optometry and Vision Science, Queensland University of Technology, Brisbane, Australia
| | - Lyndon Jones
- Centre for Ocular Research & Education (CORE), University of Waterloo, Waterloo, Ontario, Canada
| | - Deborah Jones
- Centre for Ocular Research & Education (CORE), University of Waterloo, Waterloo, Ontario, Canada
| | - Sarah Guthrie
- Centre for Ocular Research & Education (CORE), University of Waterloo, Waterloo, Ontario, Canada
| | - Ming Li
- Eye Hospital of Wenzhou Medical University, China
| | - Cesar Lipener
- Contact Lens Section, Federal University of São Paulo/Paulista School of Medicine, São Paulo, Brazil
| | - Nicola S Logan
- School of Health & Life Sciences, Aston University, Birmingham, UK
| | - Florence Malet
- Point Vision Bordeaux, Ophthalmologic Center, Bordeaux, France
| | - Sofia C Peixoto-de-Matos
- Clinical and Experimental Optometry Research Lab (CEORLab) - Center of Physics, University of Minho, Portugal
| | - José M González-Méijome
- Clinical and Experimental Optometry Research Lab (CEORLab) - Center of Physics, University of Minho, Portugal
| | - Jason J Nichols
- University of Alabama at Birmingham School of Optometry, Birmingham, AL, USA
| | - Janis B Orr
- School of Health & Life Sciences, Aston University, Birmingham, UK
| | | | | | - Nilesh Thite
- International Association of Contact Lens Educators, Pune, India
| | - Eef van der Worp
- Eye-Contact-Lens Research & Education, Amsterdam, The Netherlands
| | - Elena Tarutta
- Department of Refraction Pathology, Binocular Vision and Ophthalmoergonomics, Helmholtz National Medical Research Centre of Eye Diseases, Moscow, Russia
| | - Elena Iomdina
- Department of Refraction Pathology, Binocular Vision and Ophthalmoergonomics, Helmholtz National Medical Research Centre of Eye Diseases, Moscow, Russia
| | - Bariah Mohd Ali
- Optometry and Vision Science Program, Faculty of Health Sciences, Universiti Kebangsaan, Malaysia
| | - César Villa-Collar
- Department of Pharmacy, Biotechnology, Optics and Optometry, European University of Madrid, Villaviciosa de Odón, Spain
| | | | - Connie Chen
- Department of Optometry, Chung Shan Medical University, Taichung, Taiwan
| | - Heiko Pult
- School of Health & Life Sciences, Aston University, Birmingham, UK; Optometry & Vision Research, Weinheim, Germany; School of Biomedical & Life Sciences, Cardiff University, Cardiff, UK
| | | | | | - Fatima Iqbal
- School of Optometry, The University of Faisalabad, Pakistan
| | - Raul Ramos
- Alcon Latin America, LACAR Vision Care, Barrio Loreto, Alcaldia Álvaro Obregón; Ciudad de México
| | | | - Nikolay Boychev
- School of Health & Life Sciences, Aston University, Birmingham, UK
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Batres L, Peruzzo S, Serramito M, Carracedo G. Accommodation response and spherical aberration during orthokeratology. Graefes Arch Clin Exp Ophthalmol 2019; 258:117-127. [PMID: 31720836 DOI: 10.1007/s00417-019-04504-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 09/12/2019] [Accepted: 10/03/2019] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To evaluate the changes in the accommodative response and in the corneal and internal spherical aberration during 3 months of wear of orthokeratology lenses from the baseline. METHODS Fifty children aged 8 to 17 were recruited for a prospective study and were fitted with orthokeratology lenses. Refraction without cycloplegia, high and low uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), accommodation lag, horizontal near phoria without correction, corneal topography, corneal, and total wavefront aberration were performed at baseline, 1 day, 1 week, 1 month, and 3 months. Data were analyzed by Student's t test for related samples, repeated measures ANOVA test, and Pearson correlation test. RESULTS The spherical equivalent (SE) before and after 3 months was - 3.33 ± 1.60 D and - 0.30 ± 0.46 D, respectively. Accommodation lag was 0.53 ± 0.38 D and 0.20 ± 0.33 D at baseline and at 3 months, respectively. A moderate correlation between lag at the baseline and its change between baseline and the 3-month visit was found (P < 0.05; R = 0.748). The spherical aberration (SA) increased for anterior corneal and total measurement, being statistically significant for all visits (P < 0.05). The internal SA decreased: - 0.105 ± 0.006 at baseline and - 0.196 ± 0.203 at 1 week (P < 0.05). No difference between baseline and the follow-up visits in posterior corneal SA was found (P > 0.05) CONCLUSION: The negative SA of the lens increases during OK treatment compensated for the increase of the anterior corneal surface positive SA, in addition to increasing the accommodative response.
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Affiliation(s)
- L Batres
- Department of Optometry and Vision, Faculty of Optics and Optometry, Complutense University of Madrid, C/Arcos del Jalon 118, 28032, Madrid, Spain
- Ophthalmological Clinic Doctor Lens, Madrid, Spain
| | - S Peruzzo
- Department of Optometry and Vision, Faculty of Optics and Optometry, Complutense University of Madrid, C/Arcos del Jalon 118, 28032, Madrid, Spain
| | - M Serramito
- Department of Optometry and Vision, Faculty of Optics and Optometry, Complutense University of Madrid, C/Arcos del Jalon 118, 28032, Madrid, Spain
| | - G Carracedo
- Department of Optometry and Vision, Faculty of Optics and Optometry, Complutense University of Madrid, C/Arcos del Jalon 118, 28032, Madrid, Spain.
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Subudhi P, Patro S, Khan Z, Subudhi BNR, Sitaram S. Refractive outcomes of implantation of an implantable phakic copolymer lens with peripheral holes in the intraocular posterior chamber in moderate to high myopia patients: a single-surgeon series. Clin Ophthalmol 2019; 13:1887-1894. [PMID: 31576104 PMCID: PMC6765325 DOI: 10.2147/opth.s215821] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 08/26/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose To assess the safety and efficacy of implanting implantable phakic copolymer lenses (IPCLs) with peripheral optic holes in the intraocular posterior chamber in Indian patients with moderate to high myopia. Methods Seventy-five eyes of 50 patients who underwent IPCL implantation were retrospectively analyzed. Preoperative parameters, such as subjective refraction, anterior chamber depth (measured using a pentacam), and white-to-white diameter were measured. A custom-made IPCL using the aforementioned parameters was then implanted in the sulcus to correct moderate to high myopia. All patients had undergone neodymium-doped yttrium aluminum garnet peripheral iridotomy. Results Clinical outcome data were collated retrospectively from the medical case records of the patients. The mean age was 25.36 years (standard deviation [SD]: 3.60 years), and 55.55% of the patients were men. The mean preoperative best-corrected visual acuity (BCVA) was 0.367 logmar units (SD: 0.266, max: 0.0 and min: 1.2). The post-IPCL implantation mean uncorrected visual acuity was 0.225 logmar units (SD: 0.172, max: 0 and min: 0.7), which was significantly superior to the preoperative BCVA (P=<0.0001). Forty-three patients (86%; satisfaction scores of ≥4; scale 1-5) were "highly satisfied" to "extremely satisfied" with the outcome. The mean follow-up period was 1.8 years. Conclusion Implantation of the IPCL with peripheral holes in the intraocular posterior chamber resulted in a clinically significant improvement in unaided visual acuity. Long-term follow-up showed optimum stability of vision.
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Affiliation(s)
- Praveen Subudhi
- Department of Cornea and Refractive Surgery, Ruby Eye Hospital, Berhampur, Odisha, India.,Ophthalmology Department, Hitech Medical College, Bhubaneswar, India
| | - Sweta Patro
- Department of Cornea and Refractive Surgery, Ruby Eye Hospital, Berhampur, Odisha, India
| | - Zahiruddin Khan
- Ophthalmology Department, Hitech Medical College, Bhubaneswar, India
| | | | - Silla Sitaram
- Ophthalmology Department, SDH, Chatrapur, Odisha, India
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McCrann S, Flitcroft I, Strang NC, Saunders KJ, Logan NS, Lee SS, Mackey DA, Butler JS, Loughman J. Myopia Outcome Study of Atropine in Children (MOSAIC): an investigator-led, double-masked, placebo-controlled, randomised clinical trial protocol. HRB Open Res 2019. [DOI: 10.12688/hrbopenres.12914.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: The Myopia Outcome Study of Atropine in Children (MOSAIC) aims to explore the efficacy, safety, acceptability and mechanisms of action of 0.01% unpreserved atropine for myopia control in a European population. Methods: MOSAIC is an investigator-led, double-masked, placebo-controlled, randomised clinical trial (RCT) investigating the efficacy, safety and mechanisms of action of 0.01% atropine for managing progression of myopia. During Phase 1 of the trial, 250 children aged 6-16 years with progressive myopia instil eye drops once nightly in both eyes from randomisation to month 24. From month 24 to 36 participants are re-randomised in Phase 2 of the trial, into continued 0.01% atropine, and washout, at 1:1 ratio for those participants initially randomised to the intervention arm (n=167), during which any potential rebound effects on cessation of treatment will be monitored. All participants initially assigned to the placebo (n=83) crossover to the intervention arm of the study for Phase 2, and from month 24 to 36, instil 0.01% atropine eye drops in both eyes once nightly. Further treatment and monitoring beyond 36 months is planned (Phase 3) and will be designed dependent on the outcomes of Phase 1. Results: The primary outcome measure is cycloplegic spherical equivalent refractive error progression at 24 months. Secondary outcome measures include axial length change as well as the rebound, safety and acceptability profile of 0.01% atropine. Additional analyses will include the mechanisms of action of 0.01% atropine for myopia control. Conclusions: The generalisability of results from previous clinical trials investigating atropine for myopia control is limited by the predominantly Asian ethnicity of previous study populations. MOSAIC is the first RCT to explore the efficacy, safety and mechanisms of action of unpreserved 0.01% atropine in a predominantly White population.
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Wolffsohn JS, Flitcroft DI, Gifford KL, Jong M, Jones L, Klaver CCW, Logan NS, Naidoo K, Resnikoff S, Sankaridurg P, Smith EL, Troilo D, Wildsoet CF. IMI - Myopia Control Reports Overview and Introduction. Invest Ophthalmol Vis Sci 2019; 60:M1-M19. [PMID: 30817825 PMCID: PMC6735780 DOI: 10.1167/iovs.18-25980] [Citation(s) in RCA: 86] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
With the growing prevalence of myopia, already at epidemic levels in some countries, there is an urgent need for new management approaches. However, with the increasing number of research publications on the topic of myopia control, there is also a clear necessity for agreement and guidance on key issues, including on how myopia should be defined and how interventions, validated by well-conducted clinical trials, should be appropriately and ethically applied. The International Myopia Institute (IMI) reports the critical review and synthesis of the research evidence to date, from animal models, genetics, clinical studies, and randomized controlled trials, by more than 85 multidisciplinary experts in the field, as the basis for the recommendations contained therein. As background to the need for myopia control, the risk factors for myopia onset and progression are reviewed. The seven generated reports are summarized: (1) Defining and Classifying Myopia, (2) Experimental Models of Emmetropization and Myopia, (3) Myopia Genetics, (4) Interventions for Myopia Onset and Progression, (5) Clinical Myopia Control Trials and Instrumentation, (6) Industry Guidelines and Ethical Considerations for Myopia Control, and (7) Clinical Myopia Management Guidelines.
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Affiliation(s)
- James S Wolffsohn
- Ophthalmic Research Group, Aston University, Birmingham, United Kingdom
| | - Daniel Ian Flitcroft
- Children's University Hospital, University College Dublin and Dublin Institute of Technology, Dublin, Ireland
| | - Kate L Gifford
- Private Practice and Queensland University of Technology, Queensland, Australia
| | - Monica Jong
- Brien Holden Vision Institute and School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
| | - Lyndon Jones
- Centre for Ocular Research & Education (CORE), School of Optometry & Vision Science, University of Waterloo, Waterloo, Canada
| | - Caroline C W Klaver
- Department of Ophthalmology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Nicola S Logan
- Ophthalmic Research Group, Aston University, Birmingham, United Kingdom
| | - Kovin Naidoo
- African Vision Research Institute, University of KwaZulu-Natal, Durban, South Africa
| | - Serge Resnikoff
- Brien Holden Vision Institute and School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
| | - Padmaja Sankaridurg
- Brien Holden Vision Institute and School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
| | - Earl L Smith
- College of Optometry, University of Houston, Houston, Texas, United States
| | - David Troilo
- SUNY College of Optometry, State University of New York, New York, New York, United States
| | - Christine F Wildsoet
- Berkeley Myopia Research Group, School of Optometry & Vision Science Program, University of California Berkeley, Berkeley, California, United States
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Jones L, Drobe B, González-Méijome JM, Gray L, Kratzer T, Newman S, Nichols JJ, Ohlendorf A, Ramdass S, Santodomingo-Rubido J, Schmid KL, Tan D, Tan KO, Vera-Diaz FA, Wong YL, Gifford KL, Resnikoff S. IMI - Industry Guidelines and Ethical Considerations for Myopia Control Report. Invest Ophthalmol Vis Sci 2019; 60:M161-M183. [PMID: 30817831 DOI: 10.1167/iovs.18-25963] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To discuss guidelines and ethical considerations associated with the development and prescription of treatments intended for myopia control (MC). Methods Critical review of published papers and guidance documents was undertaken, with a view to carefully considering the ethical standards associated with the investigation, development, registration, marketing, prescription, and use of MC treatments. Results The roles and responsibilities of regulatory bodies, manufacturers, academics, eye care practitioners, and patients in the use of MC treatments are explored. Particular attention is given to the ethical considerations for deciding whether to implement a MC strategy and how to implement this within a clinical trial or practice setting. Finally, the responsibilities in marketing, support, and education required to transfer required knowledge and skills to eye care practitioners and academics are discussed. Conclusions Undertaking MC treatment in minors creates an ethical challenge for a wide variety of stakeholders. Regulatory bodies, manufacturers, academics, and clinicians all share an ethical responsibility to ensure that the products used for MC are safe and efficacious and that patients understand the benefits and potential risks of such products. This International Myopia Institute report highlights these ethical challenges and provides stakeholders with recommendations and guidelines in the development, financial support, prescribing, and advertising of such treatments.
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Affiliation(s)
- Lyndon Jones
- Centre for Ocular Research & Education, School of Optometry & Vision Science, University of Waterloo, Waterloo, Canada
| | - Björn Drobe
- Essilor Research and Development, Vision Sciences AMERA, Center of Innovation and Technology AMERA, Singapore, Singapore
| | - José Manuel González-Méijome
- Clinical & Experimental Optometry Research Lab, Center of Physics (Optometry), School of Science, University of Minho, Braga, Portugal
| | - Lyle Gray
- Department of Vision Sciences, Glasgow Caledonian University, Glasgow, United Kingdom
| | - Timo Kratzer
- Carl Zeiss Vision International GmbH, Aalen, Germany
| | | | - Jason J Nichols
- University of Alabama at Birmingham, School of Optometry, Birmingham, Alabama, United States
| | - Arne Ohlendorf
- Carl Zeiss Vision International GmbH, Aalen, Germany.,Institute for Ophthalmic Research, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Stephanie Ramdass
- Vision Research Institute, Michigan College of Optometry, Ferris State University, Big Rapids, Michigan, United States
| | | | - Katrina L Schmid
- School of Optometry and Vision Science, Institute of Health and Biomedical Innovation, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Donald Tan
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-National University of Singapore Medical School, Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Kah-Ooi Tan
- Brien Holden Vision Institute, and School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | | | - Yee-Ling Wong
- Essilor Research and Development, Vision Sciences AMERA, Center of Innovation and Technology AMERA, Singapore, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Kate L Gifford
- Private Practice and School of Optometry and Vision Science, Institute of Health and Biomedical Innovation, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Serge Resnikoff
- Brien Holden Vision Institute, and School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
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43
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Gifford KL, Richdale K, Kang P, Aller TA, Lam CS, Liu YM, Michaud L, Mulder J, Orr JB, Rose KA, Saunders KJ, Seidel D, Tideman JWL, Sankaridurg P. IMI - Clinical Management Guidelines Report. Invest Ophthalmol Vis Sci 2019; 60:M184-M203. [PMID: 30817832 DOI: 10.1167/iovs.18-25977] [Citation(s) in RCA: 98] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Best practice clinical guidelines for myopia control involve an understanding of the epidemiology of myopia, risk factors, visual environment interventions, and optical and pharmacologic treatments, as well as skills to translate the risks and benefits of a given myopia control treatment into lay language for both the patient and their parent or caregiver. This report details evidence-based best practice management of the pre-, stable, and the progressing myope, including risk factor identification, examination, selection of treatment strategies, and guidelines for ongoing management. Practitioner considerations such as informed consent, prescribing off-label treatment, and guides for patient and parent communication are detailed. The future research directions of myopia interventions and treatments are discussed, along with the provision of clinical references, resources, and recommendations for continuing professional education in this growing area of clinical practice.
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Affiliation(s)
- Kate L Gifford
- Private Practice and Queensland University of Technology, Brisbane, Queensland, Australia
| | | | - Pauline Kang
- University of New South Wales, Sydney, New South Wales, Australia
| | - Thomas A Aller
- Private Practice and University of California, Berkeley, United States
| | - Carly S Lam
- The Hong Kong Polytechnic University, Hong Kong
| | - Y Maria Liu
- University of California, Berkeley, California, United States
| | | | - Jeroen Mulder
- University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Janis B Orr
- Aston University, Birmingham, United Kingdom
| | - Kathryn A Rose
- University of Technology Sydney, New South Wales, Australia
| | | | - Dirk Seidel
- Glasgow Caledonian University, Glasgow, United Kingdom
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44
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Cheung SW, Boost MV, Cho P. Pre-treatment observation of axial elongation for evidence-based selection of children in Hong Kong for myopia control. Cont Lens Anterior Eye 2019; 42:392-398. [DOI: 10.1016/j.clae.2018.10.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 09/30/2018] [Accepted: 10/11/2018] [Indexed: 12/18/2022]
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45
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Morgan PB, Efron N, Woods CA, Santodomingo-Rubido J. International survey of orthokeratology contact lens fitting. Cont Lens Anterior Eye 2019; 42:450-454. [DOI: 10.1016/j.clae.2018.11.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Revised: 11/07/2018] [Accepted: 11/07/2018] [Indexed: 12/31/2022]
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46
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Effects of Optical Correction Method on the Magnitude and Variability of Accommodative Response: A Test-retest Study. Optom Vis Sci 2019; 96:568-578. [DOI: 10.1097/opx.0000000000001406] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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47
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McCrann S, Flitcroft I, Strang NC, Saunders KJ, Logan NS, Lee SS, Mackey DA, Butler JS, Loughman J. Myopia Outcome Study of Atropine in Children (MOSAIC): an investigator-led, double-masked, placebo-controlled, randomised clinical trial protocol. HRB Open Res 2019; 2:15. [PMID: 32002514 PMCID: PMC6973533 DOI: 10.12688/hrbopenres.12914.1] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2019] [Indexed: 12/16/2022] Open
Abstract
Background: The Myopia Outcome Study of Atropine in Children (MOSAIC) aims to explore the efficacy, safety, acceptability and mechanisms of action of 0.01% unpreserved atropine for myopia control in a European population. Methods: MOSAIC is an investigator-led, double-masked, placebo-controlled, randomised clinical trial (RCT) investigating the efficacy, safety and mechanisms of action of 0.01% atropine for managing progression of myopia. During Phase 1 of the trial, 250 children aged 6-16 years with progressive myopia instil eye drops once nightly in both eyes from randomisation to month 24. No treatment is given during Phase 2 from month 24 to 36 (washout period) for those participants initially randomised to the intervention arm (n=167), during which any potential rebound effects on cessation of treatment will be monitored. All participants initially assigned to the placebo (n=83) crossover to the intervention arm of the study for Phase 2, and from month 24 to 36, instil 0.01% atropine eye drops in both eyes once nightly. Further treatment and monitoring beyond 36 months is planned (Phase 3) and will be designed dependent on the outcomes of Phase 1. Results: The primary outcome measure is cycloplegic spherical equivalent refractive error progression at 24 months. Secondary outcome measures include axial length change as well as the rebound, safety and acceptability profile of 0.01% atropine. Additional analyses will include the mechanisms of action of 0.01% atropine for myopia control. Conclusions: The generalisability of results from previous clinical trials investigating atropine for myopia control is limited by the predominantly Asian ethnicity of previous study populations. MOSAIC is the first RCT to explore the efficacy, safety and mechanisms of action of unpreserved 0.01% atropine in a predominantly White population. Trial registration: ISRCTN:
ISRCTN36732601 (04/10/2017), EudraCTdatabase
2016-003340-37 (03/07/2018).
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Affiliation(s)
- Saoirse McCrann
- Centre for Eye Research Ireland, School of Physics, Clinical and Optometric Sciences, Technological University Dublin, Ireland, Dublin, Ireland
| | | | - Niall C Strang
- Department of Vision Sciences, Glasgow Caledonian University, Glasgow, UK
| | | | - Nicola S Logan
- Optometry & Vision Science Research Group, Aston Optometry School, Aston University, Birmingham, UK
| | - Samantha Szeyee Lee
- Centre for Ophthalmology and Visual Science (incorporating Lions Eye Institute), University of Western Australia, Perth, WA, Australia
| | - David A Mackey
- Centre for Ophthalmology and Visual Science (incorporating Lions Eye Institute), University of Western Australia, Perth, WA, Australia
| | - John S Butler
- School of Mathematical Sciences, Technological University Dublin, Dublin, Ireland
| | - James Loughman
- Centre for Eye Research Ireland, School of Physics, Clinical and Optometric Sciences, Technological University Dublin, Ireland, Dublin, Ireland
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48
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Lau JK, Wan K, Cheung SW, Vincent SJ, Cho P. Weekly Changes in Axial Length and Choroidal Thickness in Children During and Following Orthokeratology Treatment With Different Compression Factors. Transl Vis Sci Technol 2019; 8:9. [PMID: 31360614 PMCID: PMC6656409 DOI: 10.1167/tvst.8.4.9] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 05/13/2019] [Indexed: 12/13/2022] Open
Abstract
Purpose To determine the influence of compression factor upon changes in axial length and choroidal thickness during and following orthokeratology treatment. Methods Orthokeratology lenses of different compression factors (one eye with 0.75 D and the fellow eye with 1.75 D) were randomly assigned to 28 subjects (median [range] age: 9.3 [7.8–11.0] years). Ocular biometrics were measured weekly for 1 month of lens wear and after lens cessation until the refraction stabilized (mean duration: 2.8 ± 0.4 weeks). Changes between eyes, and the associations between axial shortening and choroidal thickening with other ocular biometrics were analyzed. Results There were no significant between-eye differences in the changes of ocular biometrics (all P > 0.05). After adjusting for paired-eye data, axial length initially decreased by 26 ± 41 μm (P = 0.03) at week 1, then gradually returned to its original length. An approximate antiphase relationship of choroidal thickness (mean change: 9 ± 12 μm, P < 0.001) with axial length was observed. A significant rebound in axial length, but not choroidal thickness, occurred during the cessation period. Central corneal thinning and choroidal thickening accounted for 70% of initial axial shortening. Conclusions Increasing the compression factor by 1.00 D did not affect changes in ocular biometrics in short-term orthokeratology. Significant axial shortening and choroidal thickening were observed during early treatment period. Axial shortening could not be entirely explained by central corneal thinning and choroidal thickening, which warrants further investigation. Translational Relevance Initial axial shortening in orthokeratology is transient and therefore axial length remains useful for long-term monitoring of axial elongation in children.
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Affiliation(s)
- Jason K Lau
- Centre for Myopia Research, School of Optometry, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR, China
| | - Kin Wan
- Centre for Myopia Research, School of Optometry, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR, China
| | - Sin-Wan Cheung
- Centre for Myopia Research, School of Optometry, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR, China
| | - Stephen J Vincent
- Contact Lens and Visual Optics Laboratory, School of Optometry and Vision Science, Queensland University of Technology, Brisbane, Australia
| | - Pauline Cho
- Centre for Myopia Research, School of Optometry, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR, China
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49
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International survey of contact lens fitting for myopia control in children. Cont Lens Anterior Eye 2019; 43:4-8. [PMID: 31279577 DOI: 10.1016/j.clae.2019.06.008] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 06/24/2019] [Accepted: 06/26/2019] [Indexed: 12/31/2022]
Abstract
PURPOSE To determine the extent of contact lens fitting for myopia control (MC) in children (defined as ≤ 17 years of age) worldwide and to characterize the associated demographics and fitting patterns. METHODS Survey forms were sent to contact lens fitters in 66 countries between January and March every year for eight consecutive years (2011-2018, inclusive). Practitioners were asked to record data relating to the first 10 contact lens fits performed after receiving the survey form. Data were analysed for those countries reporting ≥ 100 contact lens fits to children. RESULTS Data were analysed for 535 MC fits and 23,295 other (non-MC) lens fits undertaken in 31 countries reporting ≥ 100 contact lens fits to children, with 52.1% of MC fits and 12.0% of non-MC fits being with rigid lenses (p < 0.0001). Overall, MC lenses represented 2.3% of all contact lens fits to children, with significant differences between nations (p < 0.0001), ranging from no MC fits recorded in the Czech Republic, Greece, Japan, South Korea and Puerto Rico, to 24.9% in Austria. There has been an increase in contact lens fitting for MC over the survey period (p < 0.0001). MC contact lenses were fitted to younger children compared to non-MC lenses (MC, median 13 years vs. non-MC, median 15 years) (p < 0.0001). There was no sex bias in the fitting of MC lenses (p = 0.89). CONCLUSIONS MC lenses are currently being prescribed for younger children in equal measure in terms of soft vs. rigid lenses and males vs. females. The extent of MC fitting is low and varies between nations. The gradual increase in MC fitting throughout the survey period perhaps reflects growing concerns among practitioners over the myopia epidemic.
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50
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Lau JK, Vincent SJ, Cheung SW, Cho P. The influence of orthokeratology compression factor on ocular higher-order aberrations. Clin Exp Optom 2019; 103:123-128. [PMID: 31264269 DOI: 10.1111/cxo.12933] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Revised: 05/20/2019] [Accepted: 05/21/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND To investigate the influence of compression factor upon changes in ocular higher-order aberrations (HOAs) in young myopic children undergoing orthokeratology treatment. METHODS Subjects aged between six and < 11 years, with low myopia (0.50-4.00 D inclusive), low astigmatism (≤ 1.25 D), and anisometropia (≤ 1.00 D), were randomly assigned to wear orthokeratology lenses of different compression factors in each eye (one eye 0.75 D and the fellow eye 1.75 D). HOAs were measured weekly over one month of lens wear. Wavefront analysis was conducted over a 5-mm pupil using a sixth order Zernike polynomial expansion. Linear mixed models were used to examine the individual Zernike co-efficients and specific root-mean-square (RMS) error (spherical, comatic, total HOAs) metrics and their changes between the two eyes during the study period. RESULTS Twenty-eight myopic (mean manifest spherical equivalent refraction: -2.10 ± 0.58 D) children (median [range] age: 9.3 [7.8-11.0] years) were analysed. Significant interocular differences in HOAs at baseline were observed for Z 6 - 6 and Z 6 - 4 only (both p < 0.05). During the lens wear period, eyes fitted with the increased compression factor showed greater changes in primary spherical aberration ( Z 4 0 , p = 0.04) and RMS values for spherical and total HOAs (both p < 0.01). Considering data from both eyes together, after adjusting for the paired nature of the data, some other Zernike terms ( Z 3 1 and Z 6 0 , both p < 0.01) and the RMS value of comatic aberrations (p < 0.001) significantly increased after one month of orthokeratology treatment. The increase in primary spherical aberration ( Z 4 0 ) was positively correlated with the reduction in spherical equivalent refractive error, but only in eyes fitted with the increased compression factor (r = 0.69, p < 0.001). CONCLUSIONS Increasing the orthokeratology compression factor by 1.00 D significantly altered some HOAs, particularly spherical aberration. Given the association between positive spherical aberration and eye growth in children, further research investigating the influence of orthokeratology compression factor on axial eye growth is warranted.
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Affiliation(s)
- Jason K Lau
- Centre for Myopia Research, School of Optometry, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region, China
| | - Stephen J Vincent
- Contact Lens and Visual Optics Laboratory, School of Optometry and Visual Science, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Sin-Wan Cheung
- Centre for Myopia Research, School of Optometry, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region, China
| | - Pauline Cho
- Centre for Myopia Research, School of Optometry, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region, China
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