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Brennan NA, Nixon AD, Cheng X, Bullimore MA. Can we really distinguish 'responders' from 'non-responders' to myopia control interventions? Ophthalmic Physiol Opt 2024. [PMID: 39229644 DOI: 10.1111/opo.13379] [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: 05/27/2024] [Revised: 07/31/2024] [Accepted: 08/04/2024] [Indexed: 09/05/2024]
Abstract
PURPOSE It is common to hear talk of 'responders' and 'non-responders' with respect to myopia control interventions. We consider the reality of distinguishing these sub-groups using data from the first year of the Low-concentration Atropine for Myopia Progression (LAMP) study. METHODS The first year of the LAMP study was a robustly designed, placebo-controlled trial of three different low concentrations of atropine using a large sample size (N > 100 randomised to each group). The authors subsequently published mean axial elongation and myopia progression rates by age group. We used these data to calculate efficacy in terms of both absolute reduction in myopic progression and absolute reduction in axial elongation for each of the different atropine concentrations at each age group. We then compared these efficacy data to the overall progression for each of the two progression metrics. RESULTS Plotting efficacy as a function of overall myopia progression and axial elongation for each of the different atropine concentrations demonstrates the invariant nature of efficacy, in terms of clinically meaningful reduction in progression, despite a substantial range of underlying overall progression. That is, faster progressors-the so-called non-responders-achieved similar reduction in axial elongation and myopia progression as the slower progressors-the so-called responders-within the various atropine treatment groups. CONCLUSION The use of the terms, responders and non-responders, during myopia progression interventions is not supported by evidence. Those designated as such may simply be slower or faster progressors, who, on average achieve the same benefit from treatment.
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Affiliation(s)
| | | | - Xu Cheng
- Johnson & Johnson, Jacksonville, Florida, USA
| | - Mark A Bullimore
- College of Optometry, University of Houston, Houston, Texas, USA
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Zhang XJ, Zhang Y, Yip BHK, Kam KW, Tang F, Ling X, Ng MPH, Young AL, Wu PC, Tham CC, Chen LJ, Pang CP, Yam JC. Five-Year Clinical Trial of the Low-Concentration Atropine for Myopia Progression (LAMP) Study: Phase 4 Report. Ophthalmology 2024; 131:1011-1020. [PMID: 38494130 DOI: 10.1016/j.ophtha.2024.03.013] [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: 12/06/2023] [Revised: 02/07/2024] [Accepted: 03/11/2024] [Indexed: 03/19/2024] Open
Abstract
PURPOSE To evaluate (1) the long-term efficacy of low-concentration atropine over 5 years, (2) the proportion of children requiring re-treatment and associated factors, and (3) the efficacy of pro re nata (PRN) re-treatment using 0.05% atropine from years 3 to 5. DESIGN Randomized, double-masked extended trial. PARTICIPANTS Children 4 to 12 years of age originally from the Low-Concentration Atropine for Myopia Progression (LAMP) study. METHODS Children 4 to 12 years of age originally from the LAMP study were followed up for 5 years. During the third year, children in each group originally receiving 0.05%, 0.025%, and 0.01% atropine were randomized to continued treatment and treatment cessation. During years 4 and 5, all continued treatment subgroups were switched to 0.05% atropine for continued treatment, whereas all treatment cessation subgroups followed a PRN re-treatment protocol to resume 0.05% atropine for children with myopic progressions of 0.5 diopter (D) or more over 1 year. Generalized estimating equations were used to compare the changes in spherical equivalent (SE) progression and axial length (AL) elongation among groups. MAIN OUTCOMES MEASURES (1) Changes in SE and AL in different groups over 5 years, (2) the proportion of children who needed re-treatment, and (3) changes in SE and AL in the continued treatment and PRN re-treatment groups from years 3 to 5. RESULTS Two hundred seventy (82.8%) of 326 children (82.5%) from the third year completed 5 years of follow-up. Over 5 years, the cumulative mean SE progressions were -1.34 ± 1.40 D, -1.97 ± 1.03 D, and -2.34 ± 1.71 D for the continued treatment groups with initial 0.05%, 0.025%, and 0.01% atropine, respectively (P = 0.02). Similar trends were observed in AL elongation (P = 0.01). Among the PRN re-treatment group, 87.9% of children (94/107) needed re-treatment. The proportion of re-treatment across all studied concentrations was similar (P = 0.76). The SE progressions for continued treatment and PRN re-treatment groups from years 3 to 5 were -0.97 ± 0.82 D and -1.00 ± 0.74 D (P = 0.55) and the AL elongations were 0.51 ± 0.34 mm and 0.49 ± 0.32 mm (P = 0.84), respectively. CONCLUSIONS Over 5 years, the continued 0.05% atropine treatment demonstrated good efficacy for myopia control. Most children needed to restart treatment after atropine cessation at year 3. Restarted treatment with 0.05% atropine achieved similar efficacy as continued treatment. Children should be considered for re-treatment if myopia progresses after treatment cessation. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Xiu Juan Zhang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong; Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, Shantou, China
| | - Yuzhou Zhang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
| | - Benjamin H K Yip
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
| | - Ka Wai Kam
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong; Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong
| | - Fangyao Tang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
| | - Xiangtian Ling
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
| | - Mandy P H Ng
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
| | - Alvin L Young
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong; Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong
| | - Pei-Chang Wu
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Clement C Tham
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong; Hong Kong Eye Hospital, Hong Kong; Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong; Department of Ophthalmology, Hong Kong Children's Hospital, Hong Kong; Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong
| | - Li Jia Chen
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong; Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong; Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong
| | - Chi Pui Pang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong; Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong; Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, Shantou, China
| | - Jason C Yam
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong; Hong Kong Eye Hospital, Hong Kong; Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong; Department of Ophthalmology, Hong Kong Children's Hospital, Hong Kong; Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong; Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, Shantou, China.
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Yu M, Tang X, Jiang J, Zhou F, Wang L, Xiang C, Hu Y, Yang X. Axial Length Shortening after Combined Repeated Low-Level Red-Light Therapy in Poor Responders of Orthokeratology in Myopic Children. J Ophthalmol 2024; 2024:4133686. [PMID: 39156880 PMCID: PMC11330329 DOI: 10.1155/2024/4133686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 05/03/2024] [Accepted: 07/27/2024] [Indexed: 08/20/2024] Open
Abstract
Purpose To investigate the efficacy and safety of orthokeratology (ortho-k) and repeated low-level red-light (RLRL) therapy in treating poor responders of ortho-k in myopic children. Methods Study participants were 100 myopic children who completed two years of ortho-k treatment in a retrospective study. In the first year of ortho-k treatment (phase one), they experienced axial elongation of 0.30 mm or greater (defined as poor responders to ortho-k). Children were divided into two groups: the orthokeratology group (OK, n = 45) continued to receive ortho-k monotherapy and the combination group (OK-RLRL, n = 55) received RLRL in addition to ortho-k for the next year (phase two). Axial elongation over time between the groups was compared. Results The mean age, male-to-female ratio, axial length (AL), and axial elongation in phase one were comparable between OK and OK-RLRL groups (all P > 0.05). During phase two, significant AL shortening was observed in the OK-RLRL group compared with children in the OK group (-0.10 ± 0.16 mm vs 0.30 ± 0.19 mm, P < 0.001). Among these 55 myopic children in the OK-RLRL group, 35 (63.6%), 25 (45.4%), 11 (20%), 6 (10.9%), and 3 (5.4%) of them had AL shortening over 0.05 mm/year, 0.10 mm/year, and 0.20 mm/year, 0.3 mm/year, and 0.4 mm/year, respectively. Older baseline age (β = -0.02), higher treatment compliance (β = -0.462), and AL change at 1 month (β = 1.263) were significantly associated with less AL elongation (all P < 0.05). Conclusions For poor responders of orthokeratology, RLRL could slow axial elongation in addition to the ortho-k treatment effect. Those who respond poorly to ortho-k with elder age might benefit more from combined therapy.
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Affiliation(s)
- Mengting Yu
- State Key Laboratory of OphthalmologyZhongshan Ophthalmic CenterSun Yat-sen University, Guangzhou, China
| | - Xianghua Tang
- State Key Laboratory of OphthalmologyZhongshan Ophthalmic CenterSun Yat-sen University, Guangzhou, China
| | - Jinyun Jiang
- State Key Laboratory of OphthalmologyZhongshan Ophthalmic CenterSun Yat-sen University, Guangzhou, China
| | - Fengqi Zhou
- Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
- Department of OphthalmologyMayo Clinic Health System, Eau Claire, Wisconsin, USA
| | - Lili Wang
- State Key Laboratory of OphthalmologyZhongshan Ophthalmic CenterSun Yat-sen University, Guangzhou, China
| | - Chuqi Xiang
- State Key Laboratory of OphthalmologyZhongshan Ophthalmic CenterSun Yat-sen University, Guangzhou, China
| | - Yin Hu
- State Key Laboratory of OphthalmologyZhongshan Ophthalmic CenterSun Yat-sen University, Guangzhou, China
| | - Xiao Yang
- State Key Laboratory of OphthalmologyZhongshan Ophthalmic CenterSun Yat-sen University, Guangzhou, China
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Du L, Ding L, Chen J, Wang J, Yang J, Liu S, Xu X, He X, Huang J, Zhu M. Efficacy of weekly dose of 1% atropine for myopia control in Chinese children. Br J Ophthalmol 2024:bjo-2023-324615. [PMID: 39122352 DOI: 10.1136/bjo-2023-324615] [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: 01/13/2024] [Accepted: 07/21/2024] [Indexed: 08/12/2024]
Abstract
PURPOSE To assess the effect of weekly 1% atropine use on children's myopia progression and whether the effect is sustainable. METHODS Medical records of myopic children aged 3-15 years receiving weekly 1% atropine for more than 1 year were retrospectively reviewed. Axial length (AL) and spherical equivalent refraction (SER) at every visit were collected. The changes in AL or SER over time were analysed using generalised estimating equation. The related factors of myopic progression were performed by multiple linear regression. The performance of short-term AL change to predict atropine-poor responders (AL change >0.2 mm/year) was assessed using receiver operating characteristic analysis. RESULTS A total of 694 participants with a mean age of 8.83 years were included. The participants with follow-up time reached 1, 2, 3 and 4 years were 256 (36.9%), 250 (36.0%), 143 (20.6%) and 45 (6.5%) separately. The cumulative change in AL was 0.05 mm, 0.24 mm, 0.47 mm, 0.56 mm separately for 1-year, 2-year, 3-year and 4- year treatment. Approximate 0.20 mm elongation per year was observed since the second-year of the treatment. Older age and lower initial myopic refraction were independently associated with less myopic progression. A decrease in AL of more than 0.04 mm during the initial 2 months could serve as an indicator for identifying fast progressors (AL change >0.2 mm/year) over a 2-year period, with sensitivity and specificity rates of 0.78 and 0.73, respectively. CONCLUSION Weekly 1% atropine may be a potentially effective treatment with longer lasting effects for children with myopia control especially in those with older age and lower myopia.
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Affiliation(s)
- Linlin Du
- Shanghai Eye Diseases Prevention and Treatment Center, Shanghai Eye Hospital, Tongji University, Shanghai, China
| | - Li Ding
- Shanghai Eye Diseases Prevention and Treatment Center, Shanghai Eye Hospital, Tongji University, Shanghai, China
| | - Jun Chen
- Shanghai Eye Diseases Prevention and Treatment Center, Shanghai Eye Hospital, Tongji University, Shanghai, China
| | - Jingjing Wang
- Shanghai Eye Diseases Prevention and Treatment Center, Shanghai Eye Hospital, Tongji University, Shanghai, China
| | - Jinliuxing Yang
- Shanghai Eye Diseases Prevention and Treatment Center, Shanghai Eye Hospital, Tongji University, Shanghai, China
| | - Sichen Liu
- Shanghai Eye Diseases Prevention and Treatment Center, Shanghai Eye Hospital, Tongji University, Shanghai, China
| | - Xun Xu
- Shanghai Eye Diseases Prevention and Treatment Center, Shanghai Eye Hospital, Tongji University, Shanghai, China
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Xiangui He
- Shanghai Eye Diseases Prevention and Treatment Center, Shanghai Eye Hospital, Tongji University, Shanghai, China
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jiannan Huang
- Shanghai Eye Diseases Prevention and Treatment Center, Shanghai Eye Hospital, Tongji University, Shanghai, China
| | - Mengjun Zhu
- Shanghai Eye Diseases Prevention and Treatment Center, Shanghai Eye Hospital, Tongji University, Shanghai, China
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Wang Z, Li T, Zuo X, Zhang T, Liu L, Zhou C, Leng Z, Chen X, Wang L, Wang X, Liu H. 0.01% Atropine Eye Drops in Children With Myopia and Intermittent Exotropia: The AMIXT Randomized Clinical Trial. JAMA Ophthalmol 2024; 142:722-730. [PMID: 38958962 PMCID: PMC11223046 DOI: 10.1001/jamaophthalmol.2024.2295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 04/30/2024] [Indexed: 07/04/2024]
Abstract
Importance Exotropia and myopia are commonly coexistent. However, evidence is limited regarding atropine interventions for myopia control in children with myopia and intermittent exotropia (IXT). Objective To evaluate the efficacy and safety of 0.01% atropine eye drops on myopia progression, exotropia conditions, and binocular vision in individuals with myopia and IXT. Design, Setting, and Participants This placebo-controlled, double-masked, randomized clinical trial was conducted from December 2020 to September 2023. Children aged 6 to 12 years with basic-type IXT and myopia of -0.50 to -6.00 diopters (D) after cycloplegic refraction in both eyes were enrolled. Intervention Participants were randomly assigned in a 2:1 ratio to 0.01% atropine or placebo eye drops administered in both eyes once at night for 12 months. Main Outcomes and Measures The primary outcome was change in cycloplegic spherical equivalent from baseline at 1 year. Secondary outcomes included change in axial length (AL), accommodative amplitude (AA), exotropia conditions, and binocular vision at 1 year. Results Among 323 screened participants, 300 children (mean [SD] age, 9.1 [1.6] years; 152 male [50.7%]) were included in this study. A total of 200 children (66.7%) were in the atropine group, and 100 (33.3%) were in the placebo group. At 1 year, the 0.01% atropine group had slower spherical equivalent progression (-0.51 D vs -0.75 D; difference = 0.24 D; 95% CI, 0.11-0.37 D; P < .001) and AL elongation (0.31 mm vs 0.42 mm; difference = -0.11 mm; 95% CI, -0.17 to -0.06 mm; P < .001) than the placebo group. The mean AA change was -3.06 D vs 0.12 D (difference = -3.18 D; 95% CI, -3.92 to -2.44 D; P < .001) in the atropine and placebo groups, respectively. The 0.01% atropine group had a decrease in near magnitude of exodeviation whereas the placebo group had an increase (-1.25 prism diopters [PD] vs 0.74 PD; difference = -1.99 PD; 95% CI, -3.79 to -0.19 PD; P = .03). In the atropine vs placebo group, respectively, the incidence of study drug-related photophobia was 6.0% (12 of 200 participants) vs 8.0% (8 of 100 participants; difference = -2.0%; 95% CI, -9.4% to 3.7%; P = .51) and for blurred near vision was 6.0% (12 of 200 participants) vs 7.0% (7 of 100 participants) (difference = -1.0%; 95% CI, -8.2% to 4.5%; P = .74). Conclusions and Relevance The findings of this randomized clinical trial support use of 0.01% atropine eye drops, although compromising AA to some extent, for slowing myopia progression without interfering with exotropia conditions or binocular vision in children with myopia and IXT. Trial Registration Chinese Clinical Trial Registry Identifier: ChiCTR2000039827.
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Affiliation(s)
- Zijin Wang
- Department of Ophthalmology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Tianxi Li
- Department of Ophthalmology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Xiaoxia Zuo
- Department of Ophthalmology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Tong Zhang
- Department of Ophthalmology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Lei Liu
- School of Medical Technology, Jiangsu College of Nursing, Huai’an, China
| | - Chenyu Zhou
- Department of Ophthalmology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Zhenhua Leng
- Department of Ophthalmology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Xuejuan Chen
- Department of Ophthalmology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Lingyan Wang
- Department of Ophthalmology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Xiaofeng Wang
- Department of Ophthalmology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Hu Liu
- Department of Ophthalmology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
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Wen L, Liu H, Xu Q, Pan W, Lin Z, Xiao Z, Yang Z, Lan W, Chen Z. Add-on effect of using 0.05% atropine in fast progressors of orthokeratology: A preliminary retrospective study. Cont Lens Anterior Eye 2024:102282. [PMID: 39069400 DOI: 10.1016/j.clae.2024.102282] [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: 01/04/2024] [Revised: 07/22/2024] [Accepted: 07/24/2024] [Indexed: 07/30/2024]
Abstract
PURPOSE To investigate the potential benefit of combining orthokeratology (OK) lenses with 0.05% atropine ophthalmic solution on the efficacy of myopia control in the fast progressors of OK. METHODS Average axial length (AL) elongation of both eyes in 70 participants using OK lenses alone or OK lenses combined with 0.05 % atropine ophthalmic solution was retrospectively reviewed. During the observation period (phase 1), all participants exhibited an AL elongation that exceeded 0.15 mm over a 6-month period or 0.3 mm over a 12-month period. Subsequently, the participants were divided into two groups: one group received nightly 0.05 % atropine ophthalmic solution in addition to OK lenses for another 1 year (OKA), while the other group continued using OK lenses alone (phase 2). The changes in AL elongation over time and the differences in AL elongation between the two groups were then compared. RESULTS The baseline and phase 1 demographics and characteristics of the participants was similar between the two groups (all p > 0.05). when considering a one-year timeframe, the OKA group displayed a significantly less AL elongation compared to the OK group (0.14 ± 0.13 mm vs 0.27 ± 0.12 mm, p < 0.001). Within the OKA group, the AL elongation in the second half of the year was significantly faster than in the first half (0.12 ± 0.11 mm vs 0.02 ± 0.14 mm, p = 0.01). Conversely, there was no significant difference in AL elongation between the OK group in the first and second half of the year (0.12 ± 0.07 mm vs 0.15 ± 0.08 mm, p = 0.71). The combination of 0.05 % atropine ophthalmic solution had a significant effect on 1-year AL elongation (p < 0.001). CONCLUSIONS This study provided preliminary evidence that the combination of OK lenses and 0.05% atropine ophthalmic solution can significantly enhance the effectiveness of myopia control.
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Affiliation(s)
- Longbo Wen
- Aier School of Ophthalmology, Central South University, Changsha Aier Eye Hospital, Aier Eye Hospital Group, Hunan, China; Hunan Province Optometry Engineering and Technology Research Center, Changsha, China; Hunan Province International Cooperation Base for Optometry Science and Technology, Changsha, China
| | - Hong Liu
- Aier School of Ophthalmology, Central South University, Changsha Aier Eye Hospital, Aier Eye Hospital Group, Hunan, China; Hunan Province Optometry Engineering and Technology Research Center, Changsha, China; Hunan Province International Cooperation Base for Optometry Science and Technology, Changsha, China
| | - Qinglin Xu
- Aier School of Ophthalmology, Central South University, Changsha Aier Eye Hospital, Aier Eye Hospital Group, Hunan, China; Hunan Province Optometry Engineering and Technology Research Center, Changsha, China; Hunan Province International Cooperation Base for Optometry Science and Technology, Changsha, China
| | - Wei Pan
- Aier School of Ophthalmology, Central South University, Changsha Aier Eye Hospital, Aier Eye Hospital Group, Hunan, China; Hunan Province Optometry Engineering and Technology Research Center, Changsha, China; Hunan Province International Cooperation Base for Optometry Science and Technology, Changsha, China
| | - Zhenghua Lin
- Aier School of Ophthalmology, Central South University, Changsha Aier Eye Hospital, Aier Eye Hospital Group, Hunan, China; Hunan Province Optometry Engineering and Technology Research Center, Changsha, China; Hunan Province International Cooperation Base for Optometry Science and Technology, Changsha, China
| | | | - Zhikuan Yang
- Aier School of Ophthalmology, Central South University, Changsha Aier Eye Hospital, Aier Eye Hospital Group, Hunan, China; Hunan Province Optometry Engineering and Technology Research Center, Changsha, China; Hunan Province International Cooperation Base for Optometry Science and Technology, Changsha, China
| | - Weizhong Lan
- Aier School of Ophthalmology, Central South University, Changsha Aier Eye Hospital, Aier Eye Hospital Group, Hunan, China; Hunan Province Optometry Engineering and Technology Research Center, Changsha, China; Hunan Province International Cooperation Base for Optometry Science and Technology, Changsha, China; Guangzhou Aier Eye Hospital, Jinan University, Guangdong, China.
| | - Zhao Chen
- Aier School of Ophthalmology, Central South University, Changsha Aier Eye Hospital, Aier Eye Hospital Group, Hunan, China; Hunan Province Optometry Engineering and Technology Research Center, Changsha, China; Hunan Province International Cooperation Base for Optometry Science and Technology, Changsha, China.
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7
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Tapasztó B, Flitcroft DI, Aclimandos WA, Jonas JB, De Faber JTHN, Nagy ZZ, Kestelyn PG, Januleviciene I, Grzybowski A, Vidinova CN, Guggenheim JA, Polling JR, Wolffsohn JS, Tideman JWL, Allen PM, Baraas RC, Saunders KJ, McCullough SJ, Gray LS, Wahl S, Smirnova IY, Formenti M, Radhakrishnan H, Resnikoff S, Németh J. Myopia management algorithm. Annexe to the article titled Update and guidance on management of myopia. European Society of Ophthalmology in cooperation with International Myopia Institute. Eur J Ophthalmol 2024; 34:952-966. [PMID: 38087768 PMCID: PMC11295429 DOI: 10.1177/11206721231219532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 11/23/2023] [Indexed: 02/06/2024]
Abstract
Myopia is becoming increasingly common in young generations all over the world, and it is predicted to become the most common cause of blindness and visual impairment in later life in the near future. Because myopia can cause serious complications and vision loss, it is critical to create and prescribe effective myopia treatment solutions that can help prevent or delay the onset and progression of myopia. The scientific understanding of myopia's causes, genetic background, environmental conditions, and various management techniques, including therapies to prevent or postpone its development and slow its progression, is rapidly expanding. However, some significant information gaps exist on this subject, making it difficult to develop an effective intervention plan. As with the creation of this present algorithm, a compromise is to work on best practices and reach consensus among a wide number of specialists. The quick rise in information regarding myopia management may be difficult for the busy eye care provider, but it necessitates a continuing need to evaluate new research and implement it into daily practice. To assist eye care providers in developing these strategies, an algorithm has been proposed that covers all aspects of myopia mitigation and management. The algorithm aims to provide practical assistance in choosing and developing an effective myopia management strategy tailored to the individual child. It incorporates the latest research findings and covers a wide range of modalities, from primary, secondary, and tertiary myopia prevention to interventions that reduce the progression of myopia.
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Affiliation(s)
- Beáta Tapasztó
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
- Faculty of Health Sciences, Semmelweis University, Budapest, Hungary
| | - Daniel Ian Flitcroft
- Temple Street Children's Hospital, Dublin, Ireland
- Centre for Eye Research Ireland (CERI) Technological University, Dublin, Ireland
| | | | - Jost B Jonas
- Department of Ophthalmology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | | | - Zoltán Zsolt Nagy
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | | | | | - Andrzej Grzybowski
- Institute for Research in Ophthalmology, Foundation for Ophthalmology Development, Poznan, Poland
| | - Christina Nicolaeva Vidinova
- Department of Ophthalmology, Military Medical Academy, Sofia, Bulgaria
- Department of Optometry, Sofia University “St. Kliment Ohridski“, Sofia, Bulgaria
| | | | - Jan Roelof Polling
- Department of Ophthalmology and Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Optometry and Orthoptics, University of Applied Science, Utrecht, The Netherlands
| | - James S Wolffsohn
- Optometry and Vision Science Research Group, College of Health and Life Sciences, Aston University, Birmingham, UK
| | - J Willem L Tideman
- Department of Ophthalmology and Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
- Department Ophthalmology, Martini Hospital, Groningen, The Netherlands
| | - Peter M Allen
- Vision and Hearing Sciences Research Centre, Anglia Ruskin University, Cambridge, UK
| | - Rigmor C Baraas
- National Centre for Optics, Vision and Eye Care, University of South-Eastern Norway, Kongsberg, Norway
| | - Kathryn J Saunders
- Centre for Optometry and Vision Science, Ulster University, Coleraine, UK
| | - Sara J McCullough
- Centre for Optometry and Vision Science, Ulster University, Coleraine, UK
| | | | - Siegfried Wahl
- Institute for Ophthalmic Research, University Tübingen, Tübingen, Germany
- Carl Zeiss Vision International GmbH, Tübingen, Germany
| | | | - Marino Formenti
- Department of Physics, School of Science, University of Padova, Padova, Italy
| | - Hema Radhakrishnan
- Division of Pharmacy and Optometry, University of Manchester, Manchester, UK
| | - Serge Resnikoff
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
- Brien Holden Vision Institute, Sydney, Australia
| | - János Németh
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
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Tang T, Lu Y, Li X, Zhao H, Wang K, Li Y, Zhao M. Comparison of the long-term effects of atropine in combination with Orthokeratology and defocus incorporated multiple segment lenses for myopia control in Chinese children and adolescents. Eye (Lond) 2024; 38:1660-1667. [PMID: 38418604 PMCID: PMC11156845 DOI: 10.1038/s41433-024-02987-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 01/13/2024] [Accepted: 02/05/2024] [Indexed: 03/01/2024] Open
Abstract
PURPOSE The aim of this study was to evaluate the efficacy of Orthokeratology (Ortho-K), defocus incorporated multiple segment (DIMS) lens, combined Ortho-K/atropine, and combined DIMS/atropine for myopia control in children. METHODS A retrospective study included 167 myopic children aged 6-14 years with a spherical equivalent refraction (SER) of -0.75 to -4.00 diopter treated with Ortho-K (OK, n = 41), combined Ortho-K/atropine (OKA, n = 43), DIMS (n = 41), or combined DIMS/atropine (DIMSA, n = 42). Axial length (AL) was measured at baseline and at 3, 6, 9 and 12 months. Axial elongation over time and between groups were analysed. RESULTS After 12 months, the AL change was 0.20 ± 0.12 mm, 0.12 ± 0.14 mm, 0.22 ± 0.14 mm, and 0.15 ± 0.15 mm in the OK, OKA, DIMS, and DIMSA, respectively. There was no significant difference in AL change between OK and DIMS. OKA and DIMSA significantly slowed axial elongation compared to OK and DIMS monotherapy. After stratification by age, in the subgroup aged 6-10 years, there was significant difference in AL change between OKA and DIMS (p = 0.013), and no difference between other groups, while in the subgroup aged 10-14 years, the difference between OKA and DIMS became insignificant (p = 0.237), and the difference between OK and OKA, OK and DIMSA, DIMS and DIMSA became significant. CONCLUSIONS Ortho-K and DIMS lenses show similar reductions in myopia progression among children with low initial myopia. Atropine can significantly improve the efficacy of myopia control of both Ortho-K and DIMS lenses, and this add-on effect is better in older children.
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Affiliation(s)
- Tao Tang
- Department of Ophthalmology & Clinical Centre of Optometry, Peking University People's Hospital, Beijing, China
- Institute of Medical Technology, Peking University Health Science Center, Beijing, China
- College of Optometry, Peking University Health Science Center, Beijing, China
- Eye Disease and Optometry Institute, Peking University People's Hospital, Beijing, China
- Beijing Key Laboratory of the Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, China
| | - Yuchang Lu
- Department of Ophthalmology & Clinical Centre of Optometry, Peking University People's Hospital, Beijing, China
- Institute of Medical Technology, Peking University Health Science Center, Beijing, China
- College of Optometry, Peking University Health Science Center, Beijing, China
- Eye Disease and Optometry Institute, Peking University People's Hospital, Beijing, China
- Beijing Key Laboratory of the Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, China
| | - Xuewei Li
- Department of Ophthalmology & Clinical Centre of Optometry, Peking University People's Hospital, Beijing, China
- Institute of Medical Technology, Peking University Health Science Center, Beijing, China
- College of Optometry, Peking University Health Science Center, Beijing, China
- Eye Disease and Optometry Institute, Peking University People's Hospital, Beijing, China
- Beijing Key Laboratory of the Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, China
| | - Heng Zhao
- Department of Ophthalmology & Clinical Centre of Optometry, Peking University People's Hospital, Beijing, China
- Institute of Medical Technology, Peking University Health Science Center, Beijing, China
- College of Optometry, Peking University Health Science Center, Beijing, China
- Eye Disease and Optometry Institute, Peking University People's Hospital, Beijing, China
- Beijing Key Laboratory of the Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, China
| | - Kai Wang
- Department of Ophthalmology & Clinical Centre of Optometry, Peking University People's Hospital, Beijing, China.
- Institute of Medical Technology, Peking University Health Science Center, Beijing, China.
- College of Optometry, Peking University Health Science Center, Beijing, China.
- Eye Disease and Optometry Institute, Peking University People's Hospital, Beijing, China.
- Beijing Key Laboratory of the Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, China.
| | - Yan Li
- Department of Ophthalmology & Clinical Centre of Optometry, Peking University People's Hospital, Beijing, China
- College of Optometry, Peking University Health Science Center, Beijing, China
- Eye Disease and Optometry Institute, Peking University People's Hospital, Beijing, China
- Beijing Key Laboratory of the Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, China
| | - Mingwei Zhao
- Department of Ophthalmology & Clinical Centre of Optometry, Peking University People's Hospital, Beijing, China
- Institute of Medical Technology, Peking University Health Science Center, Beijing, China
- College of Optometry, Peking University Health Science Center, Beijing, China
- Eye Disease and Optometry Institute, Peking University People's Hospital, Beijing, China
- Beijing Key Laboratory of the Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, China
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Zhang H, Cui M, Jie Y, Chen T, Kang M, Bai W, Wang B, Wang Y. Efficacy of repeated low-level red-light therapy in the prevention and control of myopia in children. Photodiagnosis Photodyn Ther 2024; 47:104216. [PMID: 38740318 DOI: 10.1016/j.pdpdt.2024.104216] [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: 03/21/2024] [Revised: 04/28/2024] [Accepted: 05/10/2024] [Indexed: 05/16/2024]
Abstract
OBJECTIVE In this study, we aimed to determine how different factors influence the effectiveness of repeated low-level red-light (RLRL) therapy in preventing and treating myopia in children. METHODS Between June 2022 and April 2023, 336 children who visited our hospital due to myopia or significant decreases in hyperopia reserve were enrolled. The children were treated twice daily for three minutes with a head-mounted low-level red-light (single wavelength of 650 nm) therapeutic device. Each of the two treatment sessions was separated by at least four hours. The axial lengths and diopters of the children's eyes were compared before and three months after treatment, and the effects of gender, age, and baseline diopter on the efficacy of RLRL therapy were analyzed. RESULTS Following three months of treatment, the average axial length of the eyes decreased by 0.031 mm. The condition was better for the boys than for girls, but the difference was not statistically significant. As age increased (F = 8.112, P = 0.000) or as the absolute value of baseline myopia degree increased (F = 10.51, P = 0.000), axial lengths of the eyes tended to decrease. The spherical equivalent refraction (SER) of children decreased by an average of 0.012 ± 0.355D. The condition was better for the boys than for girls, but the difference was not statistically significant. SER increased in the direction of hyperopic drift as age increased (F = 2.48, P = 0.031), or as the absolute value of baseline myopia degrees increased (F = 6.835, P = 0.000). There were no obvious side effects following the treatment. CONCLUSION This study showed that RLRL therapy is a potential efficient, easily operable, and practically feasible method for the prevention and control of myopia.
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Affiliation(s)
- Hao Zhang
- Department of Ophthalmology, Capital Institute of Pediatrics Affiliated Children's Hospital, Beijing 100020, China.
| | - Mingming Cui
- Child Health Centre, Capital Institute of Pediatrics, Beijing 100020, China
| | - Ying Jie
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Ting Chen
- Department of Ophthalmology, Capital Institute of Pediatrics Affiliated Children's Hospital, Beijing 100020, China
| | - Meixia Kang
- Department of Ophthalmology, Capital Institute of Pediatrics Affiliated Children's Hospital, Beijing 100020, China
| | - Wanbing Bai
- Department of Ophthalmology, Capital Institute of Pediatrics Affiliated Children's Hospital, Beijing 100020, China
| | - Baoshi Wang
- Department of Ophthalmology, Capital Institute of Pediatrics Affiliated Children's Hospital, Beijing 100020, China
| | - Yuan Wang
- Department of Ophthalmology, Capital Institute of Pediatrics Affiliated Children's Hospital, Beijing 100020, China
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10
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Zhang H, Yang P, Li Y, Zhang W, Li S. Effect of Low-Concentration Atropine Eye Drops in Controlling the Progression of Myopia in Children: A One- and Two-Year Follow-Up Study. Ophthalmic Epidemiol 2024; 31:240-248. [PMID: 37528608 DOI: 10.1080/09286586.2023.2232462] [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: 11/26/2022] [Revised: 05/14/2023] [Accepted: 06/25/2023] [Indexed: 08/03/2023]
Abstract
PURPOSE Atropine eye drops have been shown to slow the progression of myopia, but there has been limited research on the effectiveness of 0.05% atropine in treating myopia. This study aimed to investigate the safety and efficacy of 0.05% atropine eye drops in controlling myopia in children. METHODS The study included 424 participants aged 6 to 12 years between January 1, 2015, and January 1, 2021. Of these, 213 were randomly assigned to the 0.05% atropine group and 211 to the placebo group. The cycloplegic spherical equivalent (SE), axial length (AL), corneal curvature (K), and anterior chamber depth (ACD) were measured using IOLMaster. The lens power and corneal astigmatism were also determined. The changes in ocular biometric parameters were compared between the two groups, and the contributions of ocular characteristics to SE progression were calculated and compared. RESULTS Over a 12-month period, the changes in spherical equivalent were -0.03 ± 0.28 and -0.32 ± 0.14 in the atropine and placebo groups, respectively (P = .01). The changes in axial length were 0.06 ± 0.11 and 0.17 ± 0.12, respectively (P = .01). At 18 and 24 months, there were significant differences in axial length and spherical equivalent between the atropine and placebo groups. Multiple regression models accounting for changes in AL, K, and lens magnification explained 87.23% and 98.32% of SE changes in the atropine and placebo groups, respectively. At 1 year (p = .01) and 2 years (p = .03), there were significant differences in photophobia between the atropine and placebo groups. CONCLUSIONS This two-year follow-up study demonstrates that 0.05% atropine eye drops are safe and effective in preventing the development of myopia in school-aged children.
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Affiliation(s)
- Hongbo Zhang
- Tianjin International Joint Research and Development Centre of Ophthalmology and Vision Science, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Peihua Yang
- Tianjin Open University College of Social Education, Tianjin, China
| | - Yahong Li
- Yuanfang Ophthalmology Clinic, Chengde City, Hebei Province, China. Engineering Research Center for Prevention and Control of Youth Myopia and Treatment of Pediatric Strabismus and Amblyopia, Chengde City, Hebei Province, China
| | - Weixiao Zhang
- Tianjin International Joint Research and Development Centre of Ophthalmology and Vision Science, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Shumao Li
- Tianjin Eye Hospital Optometric Center, Tianjin, China
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11
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Zhang XJ, Zaabaar E, French AN, Tang FY, Kam KW, Tham CC, Chen LJ, Pang CP, Yam JC. Advances in myopia control strategies for children. Br J Ophthalmol 2024:bjo-2023-323887. [PMID: 38777389 DOI: 10.1136/bjo-2023-323887] [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: 05/05/2023] [Accepted: 03/19/2024] [Indexed: 05/25/2024]
Abstract
Myopia has long been a global threat to public health. Timely interventions are likely to reduce the risk of vision-threatening complications. There are both established and rapidly evolving therapeutic approaches to slow myopia progression and/or delay its onset. The effective methods for slowing myopia progression include atropine eye-drops, defocus incorporated multiple segments (DIMS) spectacle lenses, spectacle lenses with highly aspherical lenslets target (HALT), diffusion optics technology (DOT) spectacle lenses, red light therapy (RLT), multifocal soft contact lenses and orthokeratology. Among these, 0.05% atropine, HALT lenses, RLT and +3.00 peripheral addition soft contact lenses yield over 60% reduction in myopia progression, whereas DIMS, DOT and MiSight contact lenses demonstrate at least 50% myopia control efficacy. 0.05% atropine demonstrates a more optimal balance of efficacy and safety than 0.01%. The efficacy of 0.01% atropine has not been consistent and requires further validation across diverse ethnicities. Combining atropine 0.01% with orthokeratology or DIMS spectacles yields better outcomes than using these interventions as monotherapies. Increased outdoor time is an effective public health strategy for myopia prevention while recent studies suggest that 0.05% low-concentration atropine and RLT therapy have promising potential as clinical myopia prevention interventions for high-risk groups. Myopia control spectacle lenses, being the least invasive, are safe for long-term use. However, when considering other approaches, it is essential to ensure proper instruction and regular follow-ups to maintain safety and monitor any potential complications. Ultimately, significant advances have been made in myopia control strategies, many of which have shown meaningful clinical outcomes. However, regular use and adequate safety monitoring over extended durations are imperative to foster confidence that can only come from extensive clinical experience.
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Affiliation(s)
- Xiu Juan Zhang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Ebenezer Zaabaar
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Amanda Nicole French
- Discipline of Orthoptics, University of Sydney, Sydney, New South Wales, Australia
| | - Fang Yao Tang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Ka Wai Kam
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
- Department of Ophthalmology and Visual Sciences, The Prince of Wales Hospital, Hong Kong SAR, China
| | - Clement C Tham
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
- Department of Ophthalmology and Visual Sciences, The Prince of Wales Hospital, Hong Kong SAR, China
- Hong Kong Eye Hospital, Hong Kong SAR, China
- Lam Kin Chung. Jet King-Shing Ho Glaucoma Treatment and Research Centre, Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
- Department of Ophthalmology, Hong Kong Children Hospital, Hong Kong SAR, China
- Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Li Jia Chen
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
- Department of Ophthalmology and Visual Sciences, The Prince of Wales Hospital, Hong Kong SAR, China
- Hong Kong Eye Hospital, Hong Kong SAR, China
- Lam Kin Chung. Jet King-Shing Ho Glaucoma Treatment and Research Centre, Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
- Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Chi Pui Pang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
- Lam Kin Chung. Jet King-Shing Ho Glaucoma Treatment and Research Centre, Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
- Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Jason C Yam
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
- Department of Ophthalmology and Visual Sciences, The Prince of Wales Hospital, Hong Kong SAR, China
- Hong Kong Eye Hospital, Hong Kong SAR, China
- Department of Ophthalmology, Hong Kong Children Hospital, Hong Kong SAR, China
- Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong SAR, China
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12
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Shahsuvaryan ML. Atropine: Updates on myopia pharmacotherapy. Taiwan J Ophthalmol 2024; 14:225-229. [PMID: 39027061 PMCID: PMC11253994 DOI: 10.4103/tjo.tjo-d-22-00060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 07/02/2022] [Indexed: 07/20/2024] Open
Abstract
The prevalence of myopia has rapidly increased over the last 30 years, with the World Health Organization estimating a worldwide incidence of 23%, projected to increase to 50% by 2050. The myopia epidemic has prompted a reincarnation in efforts to overcome this challenge. The exploration of atropine use in myopia was a result due to a lack of treatment in effect. This study aimed at reviewing the role of atropine in the management of myopia worldwide based on currently available findings. A literature search was conducted using PubMed/MEDLINE and Google Scholar for studies published up to April 2022 inclusive. Articles with high or medium clinical relevance were selected for this review. Multiple studies have demonstrated the relevance and efficacy rates of different concentrations of atropine, despite still insufficiently explained the exact site and mechanism of action of atropine in slowing myopia progression. Currently available findings highlight that topical atropine opened a new page in pharmacotherapy of myopia and have shown a high therapeutic effect on myopia progression in Asian and European child population, irrespective of ethnicity. There is potential for myopia control with fewer side effects using lower concentrations but still exists a room for improvement, underscoring the requirement of modified atropine topical preparations with increased bioavailability, potentially with nanoparticle formulations, to enable the effective management of myopia.
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Saxena R, Gupta V, Dhiman R, Joseph E, Agarkar S, Neena R, Magdalene D, Jethani J, Ganesh SC, Patil M, Gogri P, Gadaginamath S, Sen P, Sukhija J, Mishra D, Matalia JH, Sahu A, Kapoor S, Nishanth S, Chaurasia S, Pawar N, Deori N, Sivaraman V, Bordoloi A, Tibrewal S, Singh D, Prasad P, Phuljhele S, Sharma N. Low-dose atropine 0.01% for the treatment of childhood myopia: a pan-India multicentric retrospective study. Br J Ophthalmol 2024; 108:588-592. [PMID: 38290805 DOI: 10.1136/bjo-2023-324450] [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: 08/24/2023] [Accepted: 12/17/2023] [Indexed: 02/01/2024]
Abstract
OBJECTIVE The objective of this study was to assess the efficacy of low-dose atropine 0.01% in controlling myopia progression among Indian children over a 2-year period. METHODS This retrospective study, conducted across 20 centres in India, monitored the progression of myopia over 2 years after initiating treatment with 0.01% atropine eye drops. This included children between 6 and 14 years with baseline myopia ranging from -0.5 D to -6 D, astigmatism≤-1.5 D, anisometropia ≤ -1 D and documented myopia progression of ≥0.5 D in the year prior to starting atropine. Subjects with any other ocular pathologies were excluded. RESULTS A total of 732 children were included in the data analysis. The mean age of the subjects was 9.3±2.7 years. The mean myopia progression at baseline (1 year before starting atropine) was -0.75±0.31 D. The rate of myopia progression was higher in younger subjects and those with higher baseline myopic error. After initiating atropine, myopia progression significantly decreased to -0.27±0.14 D at the end of the first year and -0.24±0.15 D at the end of the second year (p<0.001). Younger children (p<0.001) and higher baseline myopia (p<0.001) was associated with greater myopia progression and poor treatment response (p<0.001 for both). CONCLUSION Low-dose atropine (0.01%) effectively reduces myopia progression over 2 years in Indian children.
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Affiliation(s)
- Rohit Saxena
- Dr. R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Vinay Gupta
- Dr. R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Rebika Dhiman
- Dr. R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Elizabeth Joseph
- Ophthalmology, Little Flower Hospital, Angamaly, Ernakulam, Kerala, India
| | - Sumita Agarkar
- Department of Pediatric Ophthalmology and Strabismus, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - R Neena
- Giridhar Eye Institute, Kochi, Kerala, India
| | | | - Jitendra Jethani
- Pediatric Ophthalmology, Baroda Children Eyecare and Squint Clinic, Vadodara, Gujarat, India
| | - Sandra C Ganesh
- Paediatric Ophthalmology and Strabismus, Aravind Eye Care System, Coimbatore, Tamil Nadu, India
| | - Minal Patil
- Drishti Eye Institute, Dehardun, Uttrakahand, India
| | - Pooja Gogri
- Jyotirmay Eye Clinic, Thane, Maharashtra, India
| | | | - Pradhnya Sen
- Department of Paediatric Ophthalmology and Strabismus, Shri Sadguru Seva Sangh Trust Chitrakoot Centre, Chitrakoot, Madhya Pradesh, India
| | - Jaspreet Sukhija
- Department of Ophthalmology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Deepak Mishra
- Regional institute of Ophthalmology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Jyoti H Matalia
- Pediatric Ophthalmology and strabismus, Narayana Nethralaya, Bangalore, India
| | - Anupam Sahu
- Pediatric Ophthalmology, MGM Eye Institute, Raipur, Chhattisgarh, India
| | - Smita Kapoor
- Pediatric Ophthalmology and Strabismus, Sankara Eye Hospital Coimbatore, Coimbatore, India
| | | | - Shweta Chaurasia
- Department of Ophthalmology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Neelam Pawar
- Pediatric and Squint, Aravind Eye Hospital, Tirunelveli, Tamil Nadu, India
- Kellogg Eye Centre, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Viswanathan Sivaraman
- Department of Pediatric Ophthalmology and Strabismus, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | | | - Shailja Tibrewal
- Pediatric Ophthalmology and Strabismus, Shroff Charity Eye Hospital, New Delhi, Delhi, India
| | - Davinder Singh
- Dr. R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Priyanka Prasad
- Dr. R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Swati Phuljhele
- Dr. R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Namrata Sharma
- Dr. R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Yam JC, Zhang Y. Pan-Indian multicentre retrospective study of 0.01% atropine for myopia control. Br J Ophthalmol 2024; 108:493-494. [PMID: 38320846 DOI: 10.1136/bjo-2024-325182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 01/10/2024] [Indexed: 03/22/2024]
Affiliation(s)
- Jason C Yam
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - Yuzhou Zhang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, People's Republic of China
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15
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Liu L, Wang Y, Liu F, Yu X, Xie L, Tan S, Liu J, Liu Y, Huang J, Zhang S, Jiang Y. Effects of repeated low-level red-light therapy on macular retinal thickness and microvascular system in children with myopia. Photodiagnosis Photodyn Ther 2024; 45:103938. [PMID: 38244655 DOI: 10.1016/j.pdpdt.2023.103938] [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: 10/01/2023] [Revised: 12/03/2023] [Accepted: 12/15/2023] [Indexed: 01/22/2024]
Abstract
OBJECTIVE The objective of the study was to use optical coherence tomography angiography (OCTA) to analyze the effects of repeated low-level red-light (LLLT) therapy on macular retinal thickness and the microvascular system in children with myopia to evaluate the safety of this therapy. METHODS This prospective study included 40 school-age children with myopia (80 eyes), aged 7-14 years, who received therapy using a LLLT instrument. At baseline and therapy for 1 month, 3 months, 6 months, all children underwent comprehensive ophthalmological examinations, including slit-lamp examination, uncorrected visual acuity, best-corrected visual acuity, spherical equivalent degree, axial length, and OCTA. The vessel densities of the superficial retinal capillary plexus, macular inner retinal thickness, and full-layer retinal thickness were measured. RESULTS The macular inner retinal thickness increased at 1 month and remained unchanged thereafter, It differed significantly in nine areas at 1, 3, and 6 months compared to the thicknesses before therapy (P < 0.05); however, we observed no significant differences between the different time points (P > 0.05). The macular full-layer retinal thickness increased at 1 month and remained unchanged thereafter; the changes showed significant differences at 1 month and 3 months compared to before therapy, for the inner nasal region (P < 0.05). The other eight areas showed significant differences at 1, 3, and 6 months compared with before therapy (P < 0.05); however, no significant difference was observed between the different time points after therapy (P > 0.05). The vessel density of the superficial retinal capillary plexus did not differ significantly among the four groups (P > 0.05). CONCLUSIONS LLLT therapy was safe. The school-aged children exhibited macular thickening after LLLT therapy, which had no significant effect on macular microcirculation.
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Affiliation(s)
- Linlin Liu
- Department of Ophthalmology, the First Affiliated Hospital of Gannan Medical University, Ganzhou 341000, Jiangxi, China
| | - Yuchuan Wang
- Xixia County People's Hospital, Nanyang, Henan, China; The First Clinical Medical College of Gannan Medical University, Ganzhou 341000, Jiangxi, China
| | - Fang Liu
- The First Clinical Medical College of Gannan Medical University, Ganzhou 341000, Jiangxi, China
| | - Xinghui Yu
- The First Clinical Medical College of Gannan Medical University, Ganzhou 341000, Jiangxi, China
| | - Lianfeng Xie
- Department of Ophthalmology, the First Affiliated Hospital of Gannan Medical University, Ganzhou 341000, Jiangxi, China
| | - Shuxiang Tan
- Department of Ophthalmology, the First Affiliated Hospital of Gannan Medical University, Ganzhou 341000, Jiangxi, China
| | - Jing Liu
- Department of Ophthalmology, the First Affiliated Hospital of Gannan Medical University, Ganzhou 341000, Jiangxi, China
| | - Yanfang Liu
- Department of Ophthalmology, the First Affiliated Hospital of Gannan Medical University, Ganzhou 341000, Jiangxi, China
| | - Jiaxing Huang
- Department of Ophthalmology, the First Affiliated Hospital of Gannan Medical University, Ganzhou 341000, Jiangxi, China
| | - Shuang Zhang
- Department of Ophthalmology, the First Affiliated Hospital of Gannan Medical University, Ganzhou 341000, Jiangxi, China
| | - Yiping Jiang
- Department of Ophthalmology, the First Affiliated Hospital of Gannan Medical University, Ganzhou 341000, Jiangxi, China.
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Wang M, Ji N, Yu SA, Liang LL, Ma JX, Fu AC. Comparison of 0.02% atropine eye drops, peripheral myopia defocus design spectacle lenses, and orthokeratology for myopia control. Clin Exp Optom 2023:1-7. [PMID: 38043135 DOI: 10.1080/08164622.2023.2288180] [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: 11/30/2022] [Accepted: 09/22/2023] [Indexed: 12/05/2023] Open
Abstract
CLINICAL RELEVANCE There are many methods to control the progression of myopia. However, it is currently unknown which method could better control myopia progression: 0.02% atropine eye drops, peripheral myopic defocus design spectacle lenses (PMDSL), or orthokeratology (OK). BACKGROUND To compare the efficacy of 0.02% atropine, PMDSL, and OK to control axial length (AL) elongation in children with myopia. METHODS This study was analysed based on a previous cohort study (0.02% atropine group) and retrospective data (PMDSL and OK group). Overall, 387 children aged 6-14 years with myopia - 1.00D to - 6.00D in the three groups were divided into four subgroups according to age and spherical equivalent refraction (SER). The primary outcome was changed in AL over 1-year. RESULTS The mean axial elongation was 0.30 ± 0.21 mm, 0.23 ± 0.16 mm, and 0.17 ± 0.19 mm in the 0.02% atropine, PMDSL, and OK groups, respectively. Multivariate linear regression analyses showed significant differences in axial elongation among the three groups, especially in children aged 6-10, but not in children aged 10.1-14; the corresponding axial elongation was 0.35 ± 0.21 mm, 0.23 ± 0.17 mm, and 0.21 ± 0.20 mm (P < 0.05 between any two groups, except between PMDSL and OK groups at P > 0.05) and 0.22 ± 0.20 mm, 0.21 ± 0.13 mm, and 0.13 ± 0.18 mm (P < 0.05 between any two groups, except between 0.02% atropine and PMDSL groups at P > 0.05) in children with SER from - 1.00D to - 3.00D and from - 3.01D to - 6.00D, respectively. CONCLUSIONS Within the limits of this study design and using only the current brand of PMDSL, OK appeared to be the best method, followed by PMDSL and then 0.02% atropine, for controlling AL elongation over one year. However, different effects were found in the various age and SER subgroups.
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Affiliation(s)
- Ming Wang
- Department of Ophthalmology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Na Ji
- Department of Optometry, The Affiliated Eye Hospital of Suzhou Vocational Health College, Suzhou, China
| | - Shi-Ao Yu
- Department of Ophthalmology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ling-Ling Liang
- Department of Ophthalmology, Shi Jiazhuang Aier Eye Hospital, Shi Jiazhuang, China
| | - Jing-Xue Ma
- Department of Ophthalmology, Shi Jiazhuang Aier Eye Hospital, Shi Jiazhuang, China
| | - Ai-Cun Fu
- Department of Ophthalmology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Hu Y, Ding X, Jiang J, Yu M, Chen L, Zhai Z, Zhang H, Fang B, Wang H, Yu S, He M, Zeng J, Zeng Y, Yang X. Long-Term Axial Length Shortening in Myopic Orthokeratology: Incident Probability, Time Course, and Influencing Factors. Invest Ophthalmol Vis Sci 2023; 64:37. [PMID: 38149970 PMCID: PMC10755594 DOI: 10.1167/iovs.64.15.37] [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: 07/21/2023] [Accepted: 10/17/2023] [Indexed: 12/28/2023] Open
Abstract
Purpose Long-term axial length (AL) shortening in myopia is uncommon but noteworthy. Current understanding on the condition is limited due to difficulties in case collection. The study reported percentage, probability, and time course of long-term AL shortening in myopic orthokeratology based on a large database. Methods This study reviewed 142,091 medical records from 29,825 subjects in a single-hospital orthokeratology database that were collected over 10 years. Long-term AL shortening was defined as a change in AL of -0.1 mm or less at any follow-up beyond 1 year. Incident probability was calculated based on multivariate logistic regression. Time course was estimated using mixed-effect regression model. Results A total of 10,093 subjects (mean initial age, 11.70 ± 2.52 years; 58.8% female) with 80,778 visits were included. The number of subjects experienced long-term AL shortening was 1,662 (16.47%; 95% confidence interval, 15.75%-17.21%). Initial age showed significant impact on the incident occurrence (OR, 1.37; 95% confidence interval, 1.34-1.40; P < 0.001). The estimated probability of AL shortening was approximately 2% for subjects with initial age of 6 years and 50% for those aged 18. Among the 1662 AL shortening cases, the median magnitude of the maximum AL reduction was 0.19 mm. The shortening process mostly occurred within the initial 2 years. Subject characteristics had limited associations with the shortening rate. Conclusions Long-term AL shortening is possible in subjects receiving myopic orthokeratology. Although age notably affect the incident probability, the time course seems to not vary significantly.
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Affiliation(s)
- Yin Hu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Xiaohu Ding
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Jinyun Jiang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Mengting Yu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Linxing Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Zhou Zhai
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Hening Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Binglan Fang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Huarong Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Shuiming Yu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Mingguang He
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
- Centre for Eye and Vision Research (CEVR), School of Optometry, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Junwen Zeng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Yangfa Zeng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Xiao Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
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18
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Xu S, Li Z, Zhao W, Zheng B, Jiang J, Ye G, Feng Z, Long W, He L, He M, Hu Y, Yang X. Effect of atropine, orthokeratology and combined treatments for myopia control: a 2-year stratified randomised clinical trial. Br J Ophthalmol 2023; 107:1812-1817. [PMID: 36229177 DOI: 10.1136/bjo-2022-321272] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 09/26/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE To investigate the 2-year efficacy of atropine, orthokeratology (ortho-k) and combined treatment on myopia. To explore the factors influencing the efficacy. METHODS An age-stratified randomised controlled trial. Children (n=164) aged 8-12 years with spherical equivalent refraction of -1.00 to -6.00 D were stratified into two age subgroups and randomly assigned to receive placebo drops+spectacles (control), 0.01% atropine+spectacles (atropine), ortho-k+placebo (ortho-k) or combined treatment. Axial length was measured at baseline and visits at 6, 12, 18 and 24 months. The primary analysis was done following the criteria of intention to treat, which included all randomised subjects. RESULTS All interventions can significantly reduce axial elongation at all visits (all p<0.05). Overall, the 2-year axial elongation was significantly reduced in combined treatment than in monotherapies (all p<0.05). After stratification by age, in the subgroup aged 8-10, the difference between combined treatment and ortho-k became insignificant (p=0.106), while in the subgroup aged 10-12, the difference between combined treatment and atropine became insignificant (p=0.121). A significant age-dependent effect existed in the ortho-k group versus the control group (p for interaction=0.013), and a significant age-dependent effect existed in the ortho-k group versus the atropine group (p for interaction=0.035), which indicated that ortho-k can achieve better efficacy in younger children. CONCLUSIONS Atropine combined with ortho-k treatment can improve the efficacy of myopia control compared with monotherapy in children aged 8-12. Younger children might benefit more from ortho-k. TRIAL REGISTRATION NUMBER ChiCTR1800015541.
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Affiliation(s)
- Shengsong Xu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Zhouyue Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Wenchen Zhao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Bingru Zheng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Jinyun Jiang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Guitong Ye
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Zhibin Feng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Wen Long
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Liying He
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Mingguang He
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, Guangdong, China
- Department of Surgery, Centre for Eye Research Australia, University of Melbourne, Melbourne, Victoria, Australia
| | - Yin Hu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Xiao Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, Guangdong, China
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19
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Du L, Chen J, Ding L, Wang J, Yang J, Xie H, Xu X, He X, Zhu M. Add-On Effect of 0.01% Atropine in Orthokeratology Wearers for Myopia Control in Children: A 2-Year Retrospective Study. Ophthalmol Ther 2023; 12:2557-2568. [PMID: 37405578 PMCID: PMC10442030 DOI: 10.1007/s40123-023-00755-4] [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: 04/09/2023] [Accepted: 06/08/2023] [Indexed: 07/06/2023] Open
Abstract
INTRODUCTION Orthokeratology (OK) and low-concentration atropine are recommended approaches for controlling myopia. However, children with younger age and lower myopia are more likely to experience rapid axial progression during OK or atropine monotreatment. This study aimed to assess the efficacy of OK combined with low-concentration atropine for myopia control in children over 24 months and to determine whether the effect was sustainable. METHODS In this retrospective study, we reviewed medical records of baseline and follow-up visits from children (7-14 years) applying OK for myopia control. Sixty-eight children receiving monoorthokeratology treatment (OK group) and 68 children who received 0.01% atropine in combination with orthokeratology simultaneously (AOK group) were included. A series of ophthalmic tests at baseline were conducted, and axial length (AL) was measured every 6 months. The comparison of AL change at different visits between the two groups was performed by repeated measures multivariate analyses of variance (RM-MANOVA). RESULTS There were no significant differences in baseline characters between the two groups (p > 0.05). The AL significantly increased over time in both groups (all p < 0.05), and the 2-year change in AOK was 0.16 mm (36%) lower than in OK (0.28 ± 0.22 mm versus 0.44 ± 0.34 mm, p = 0.001). Compared with OK group, the significant suppression of AL elongation in the AOK group was observed in 0-6, 6-12, and 12-18 month periods (suppression rate: 62.5%, 33.3%, 38.5%, respectively, p < 0.05), while there was no significant difference in the 18-24 month period (p = 0.105). The multiple regression analysis showed an interaction between age and treatment effect (interaction coefficient = 0.06, p = 0.040), indicating one year age decrease approximately associated with 0.06 mm increased retardation in AL elongation in the AOK group. CONCLUSION The add-on effect of 0.01% atropine in OK wearers only occurred within 1.5 years, and younger children benefited more from the combination treatment.
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Affiliation(s)
- Linlin Du
- Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai Vision Health Center & Shanghai Children Myopia Institute, No. 1440 Hongqiao Road, Shanghai, 201103, China
| | - Jun Chen
- Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai Vision Health Center & Shanghai Children Myopia Institute, No. 1440 Hongqiao Road, Shanghai, 201103, China
| | - Li Ding
- Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai Vision Health Center & Shanghai Children Myopia Institute, No. 1440 Hongqiao Road, Shanghai, 201103, China
| | - Jingjing Wang
- Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai Vision Health Center & Shanghai Children Myopia Institute, No. 1440 Hongqiao Road, Shanghai, 201103, China
| | - Jinliuxing Yang
- Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai Vision Health Center & Shanghai Children Myopia Institute, No. 1440 Hongqiao Road, Shanghai, 201103, China
| | - Hui Xie
- Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai Vision Health Center & Shanghai Children Myopia Institute, No. 1440 Hongqiao Road, Shanghai, 201103, China
| | - Xun Xu
- Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai Vision Health Center & Shanghai Children Myopia Institute, No. 1440 Hongqiao Road, Shanghai, 201103, China
- National Clinical Research Center for Eye Diseases, Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai General Hospital, Shanghai Jiao Tong University, No. 85 Wujin Road, Shanghai, 200080, China
| | - Xiangui He
- Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai Vision Health Center & Shanghai Children Myopia Institute, No. 1440 Hongqiao Road, Shanghai, 201103, China.
- National Clinical Research Center for Eye Diseases, Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai General Hospital, Shanghai Jiao Tong University, No. 85 Wujin Road, Shanghai, 200080, China.
| | - Mengjun Zhu
- Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai Vision Health Center & Shanghai Children Myopia Institute, No. 1440 Hongqiao Road, Shanghai, 201103, China.
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20
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Pérez-Flores I, Macías-Murelaga B, Barrio-Barrio J. Age-related results over 2 years of the multicenter Spanish study of atropine 0.01% in childhood myopia progression. Sci Rep 2023; 13:16310. [PMID: 37770602 PMCID: PMC10539365 DOI: 10.1038/s41598-023-43569-x] [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: 01/29/2023] [Accepted: 09/26/2023] [Indexed: 09/30/2023] Open
Abstract
To evaluate the age-related efficacy and safety of atropine 0.01% eye drops over 2 years for myopia control in a multicentric pediatric Spanish cohort. A non-controlled, interventional, prospective multicenter study was conducted as an extension of the Spanish Group of Atropine Treatment for Myopia Control Study (GTAM 1). Children aged 6-14 years with myopia from - 2.00 to - 6.00 D, astigmatism < 1.50 D and documented annual myopic progression of at least - 0.50 D under cycloplegic examination were recruited. From the original cohort of 105 participants, 92 children who had been receiving atropine 0.01% eye drops once nightly in each eye for 1 year continued their participation in this extended study (GTAM 2). All the patients underwent a standardized quarterly follow-up protocol, which included measurements of best-corrected visual acuity (BCVA), cycloplegic autorefraction, axial length (AL), anterior chamber depth (ACD), and pupil diameter. The study sample was divided into three age groups: 6-8, 9-11, and 12-14 years old. The mean change in cycloplegic spherical equivalent (SE) and axial length (AL) during the 24 months of follow-up was analyzed. Correlations between SE and AL, as well as the distribution of annual progression, were evaluated. Adverse effects were recorded using a specific questionnaire. Finally, 81 children completed the follow-up and were included in the analysis. Over the 2-year period, the mean changes in SE and AL were - 0.88 ± 0.60 D and 0.49 ± 0.25 mm, respectively. Additionally, 51 patients (63%) experienced SE annual progression lower than - 0.50 D. The correlation between the progression of SE and AL during the total period of treatment was mild (r = - 0.36; p < 0.001). There were no differences between the first and the second year of treatment in the progression of SE (- 0.42 ± 0.41 D versus - 0.45 ± 0.39 D; p = 0.69) or AL (0.25 ± 0.16 mm versus 0.23 ± 0.14 mm; p = 0.43). Older patients (12-14 years old) showed less AL progression than younger children (6-8 years old): 0.36 ± 0.18 mm versus 0.59 ± 0.30 mm; p = 0.01. Adverse effects were mild, infrequent, and decreased over time. On average, the myopia progression in control groups from other published biannual studies exceeded that observed in our study. Over 2 years, atropine 0.01% demonstrated a safe treatment for controlling myopia progression in a multicentric cohort of Spanish children. The effect remained stable during this period. Older patients exhibited a more favorable response in terms of AL enlargement. However, further studies are needed to investigate the age-related effect of low-dose atropine in the Caucasian population.
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Affiliation(s)
| | | | - Jesús Barrio-Barrio
- Department of Ophthalmology, Navarra University Clinic Hospital, Navarra Institute for Health Research, IdiSNA, Pio XII, 36. Pamplona, 31008, Navarra, Spain.
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21
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Kong X, Yang G, Chen Z, Han R, Zhao Y, Zeng L, Guo X, Shi Z, Zhang D, Yang Y, Liu J, Zhou X, Ma X. Addition of Auricular Acupoint Stimulation to 0.01% Atropine for Myopia: 12-Month Results from a Randomized Trial. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2023; 29:574-583. [PMID: 36971804 DOI: 10.1089/jicm.2022.0769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Introduction: A previous 6-month report showed that adjunctive auricular acupoint stimulation (AAS) slowed myopia progression compared with 0.01% atropine (0.01% A) alone. This 12-month report was to determine whether the antimyopic effect of AAS, when added to 0.01% A, continued beyond treatment cessation, and explore the mode of action of AAS from the accommodative response. Design and Interventions: One hundred four children were randomly assigned to either a 0.01% A group or a 0.01% A + AAS group. Participants in the 0.01% A + AAS group received AAS in addition to 0.01% A for 6 months, and then kept using 0.01% A for the following 6 months. Participants in the 0.01% A group only used 0.01% A. The primary outcome was the difference in the mean cycloplegic spherical equivalent refraction (SER) from the baseline to the 12-month visit. Secondary outcomes included axial length (AL) and accommodative lag assessments. Results: The adjusted mean change from baseline to month 12 in the SER was -0.62 D for 0.01% A and -0.46 D for 0.01% A + AAS (difference, 0.16 D; p = 0.01), with a respective mean increase of 0.37 and 0.31 mm in AL (difference, -0.05 mm; p = 0.05). For the 5D near target, there was a reduction in the accommodative lag in children receiving add-on AAS relative to 0.01% A alone at 1 and 6 months (both p = 0.002). Conclusions: AAS treatment produced additional benefits >0.01% A in slowing myopia progression over the 12-month period, where the efficacy was sustained after the cessation of AAS. An effect of add-on AAS on reducing accommodative lag in response to 5D stimulus was found, but its role in mediating therapeutic response remained unclear. Chinese Clinical Trial Registry number: ChiCTR1900021316.
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Affiliation(s)
- Xiehe Kong
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Shanghai Research Institute of Acupuncture and Meridian, Shanghai, China
| | - Guang Yang
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Shanghai Research Institute of Acupuncture and Meridian, Shanghai, China
| | - Zhi Chen
- Department of Ophthalmology and Visual Science, Eye and ENT Hospital of Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
- Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Rong Han
- Shanghai Qigong Research Institute, Shanghai, China
| | - Yue Zhao
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Shanghai Research Institute of Acupuncture and Meridian, Shanghai, China
| | - Li Zeng
- Department of Ophthalmology and Visual Science, Eye and ENT Hospital of Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
- Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Xiaocong Guo
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Zheng Shi
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Shanghai Research Institute of Acupuncture and Meridian, Shanghai, China
| | - Dan Zhang
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Shanghai Research Institute of Acupuncture and Meridian, Shanghai, China
| | - Yanting Yang
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Shanghai Research Institute of Acupuncture and Meridian, Shanghai, China
| | - Jie Liu
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Shanghai Research Institute of Acupuncture and Meridian, Shanghai, China
| | - Xingtao Zhou
- Department of Ophthalmology and Visual Science, Eye and ENT Hospital of Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
- Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Xiaopeng Ma
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Shanghai Research Institute of Acupuncture and Meridian, Shanghai, China
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22
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Zhang P, Zhang X, Zhu H. Photobiomodulation at 660 nm promotes collagen synthesis via downregulation of HIF-1α expression without photodamage in human scleral fibroblasts in vitro in a hypoxic environment. Graefes Arch Clin Exp Ophthalmol 2023; 261:2535-2545. [PMID: 37074407 DOI: 10.1007/s00417-023-06066-5] [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: 02/06/2023] [Revised: 03/29/2023] [Accepted: 04/10/2023] [Indexed: 04/20/2023] Open
Abstract
PURPOSE The increasing prevalence of myopia is a global public health issue. Because of the complexity of myopia pathogenesis, current control methods for myopia have great limitations. The aim of this study was to explore the effect of photobiomodulation (PBM) on human sclera fibroblasts (HSFs) under hypoxia, in the hope of providing new ideas for myopia prevention and control. METHODS Hypoxic cell model was established at 0, 6, 12, and 24 h time points to simulate myopia microenvironment and explore the optimal time point. Control, hypoxia, hypoxia plus light, and normal plus light cell models were set up for the experiments, and cells were incubated for 24 or 48 h after PBM (660 nm, 5 J/cm2), followed by evaluation of hypoxia-inducible factor 1α (HIF-1α) and collagen I a1 (COL1A1) proteins using Western blotting and immunofluorescence, and photo damage was detected by CCK-8, scratch test, and flow cytometry assays. We also used transfection technology to further elucidate the regulatory mechanism. RESULTS The change of target proteins is most obvious when hypoxia lasts for 24 h (p < 0.01). PBM at 660 nm increased extracellular collagen content (p < 0.001) and downregulated expression of HIF-1α (p < 0.05). This treatment did not affect the migration and proliferation of cells (p > 0.05), and effectively inhibited apoptosis under hypoxia (p < 0.0001). After overexpression of HIF-1α, the effect of PBM was attenuated (p > 0.05). CONCLUSIONS Photobiomodulation at 660 nm promotes collagen synthesis via downregulation of HIF-1α expression without photodamage.
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Affiliation(s)
- Pengbo Zhang
- Department of Ophthalmology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China
| | - Xibo Zhang
- Department of Ophthalmology, Affiliated Hospital of Southwest Medical University, Luzhou, 646000, Sichuan, China.
| | - Huang Zhu
- Department of Ophthalmology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China.
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23
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Zhu X, Wang Y, Liu Y, Ye C, Zhou X, Qu X. Effects of atropine 0.01% on refractive errors in children with myopia. Heliyon 2023; 9:e18743. [PMID: 37576220 PMCID: PMC10415657 DOI: 10.1016/j.heliyon.2023.e18743] [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: 03/04/2023] [Revised: 07/11/2023] [Accepted: 07/26/2023] [Indexed: 08/15/2023] Open
Abstract
Background Little is known about changes in astigmatism during atropine treatment. We aimed to explore the effects of atropine 0.01% eye drops on both spherical and cylindrical refractive errors in myopic children. Methods Children aged 6-14 years with myopia ≥ -6.00 D and < -0.50 D, and total astigmatism > -2.00 D in at least one eye were enrolled. Subjects were randomised either to receive atropine 0.01% once nightly with single-vision lenses or simply to wear single-vision lenses and were followed up at 3-month intervals. Cycloplegic refraction and axial length were measured. The magnitude and direction of total astigmatism (TA), corneal astigmatism (CA), and residual astigmatism (RA) were evaluated. Results Overall, 119 eyes (69 eyes in the atropine group and 50 eyes in the control group) were included in the final analyses after 9 months. Atropine-treated eyes showed significantly less progression of myopia than did control eyes (spherical equivalent: -0.35 ± 0.33 vs. -0.56 ± 0.49 D, p = 0.001; axial length: 0.20 ± 0.19 vs. 0.33 ± 0.19 mm, p < 0.001). Compared with control eyes (-0.04 ± 0.23 D), a significant increase in TA was observed in the atropine-treated eyes (-0.14 ± 0.29 D); this was mainly attributed to the increase in CA (-0.17 ± 0.26 D) rather than the minor decrease in RA (0.02 ± 0.32 D). Conclusions Atropine 0.01% was effective in preventing myopia progression, whereas 9 months of atropine treatment resulted in a clinically small, but statistically significant increase in TA in myopic Chinese children.
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Affiliation(s)
- Xingxue Zhu
- Department of Ophthalmology and Vision Science, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
- Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
| | - Yuliang Wang
- Department of Ophthalmology and Vision Science, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
- Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
| | - Yujia Liu
- Department of Ophthalmology and Vision Science, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
- Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
| | - Chaoying Ye
- Department of Ophthalmology and Vision Science, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
- Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
| | - Xingtao Zhou
- Department of Ophthalmology and Vision Science, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
- Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
| | - Xiaomei Qu
- Department of Ophthalmology and Vision Science, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
- Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
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24
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Yam JC, Jonas JB, Lam DSC. Low-Concentration Atropine Eye Drops for Myopia Progression. Asia Pac J Ophthalmol (Phila) 2023; 12:345-346. [PMID: 37523423 DOI: 10.1097/apo.0000000000000617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 05/16/2023] [Indexed: 08/02/2023] Open
Affiliation(s)
- Jason C Yam
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Shantou, China
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, China
- Hong Kong Eye Hospital, Kowloon, Hong Kong, China
- Department of Ophthalmology, Hong Kong Children's Hospital, Hong Kong, China
- Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong, China
| | - Jost B Jonas
- Department of Ophthalmology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland
- Privatpraxis Prof Jonas und Dr Panda-Jonas, Heidelberg, Germany
| | - Dennis S C Lam
- The International Eye Research Institute of The Chinese University of Hong Kong (Shenzhen), Shenzhen, China
- The C-MER Dennis Lam & Partners Eye Center, C-MER International Eye Care Group, Hong Kong, China
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25
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Yang Y, Chen M, Yao X, Wang J, Shi J, Wang Y, Tian J, Zhou X, Qu J, Zhang S. Choroidal blood perfusion could predict the sensitivity of myopia formation in Guinea pigs. Exp Eye Res 2023; 232:109509. [PMID: 37247833 DOI: 10.1016/j.exer.2023.109509] [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: 02/05/2023] [Revised: 04/25/2023] [Accepted: 05/15/2023] [Indexed: 05/31/2023]
Abstract
In this study, we explored the predictive role of choroidal blood perfusion (ChBP) and choroidal thickness (ChT) on the development of myopia in guinea pigs. Optical Coherence Tomography Angiography (OCTA) was used to assess the baseline choroidal blood perfusion (ChBP) and choroidal thickness (ChT) in 4-week-old guinea pigs. Refraction and axial length (AL) were measured at baseline. Myopia was induced for one week using form-deprivation (FD) or negative lenses followed by measurements of refraction, axial length and choroidal parameters (ChT and ChBP). The correlations were evaluated between the baseline choroidal values and the magnitude of myopia induced, along with the magnitude of changes in ChT and ChBP after myopia induction. There was a significant correlation between the baseline choroidal parameters and ocular refraction. Myopia induction led to choroidal thinning and less ChBP as well as longer eyes. On the other hand, following exposure to the same non-obstructed visual induction period, the myopic shift was less, and it was associated with thicker choroids and more ChBP at baseline. One week of myopia induction also resulted in thinner choroids and less ChBP, and these declines also correlated with their baseline values. In conclusion, the present study shows that the changes in the baseline choroidal ChT and ChBP parameters are proportional to the magnitude of myopia development and axial elongation in guinea pigs. These significant correlations between baseline ChBP and ChT and myopia development suggest that they may be a viable predictor of this process in guinea pigs.
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Affiliation(s)
- Yaozhen Yang
- State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China; Research Unit of Myopia Basic Research and Clinical Prevention and Control, Chinese Academy of Medical Sciences, 2019RU025, China.
| | - Mengxi Chen
- State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China; Research Unit of Myopia Basic Research and Clinical Prevention and Control, Chinese Academy of Medical Sciences, 2019RU025, China.
| | - Xinyuan Yao
- State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China; Research Unit of Myopia Basic Research and Clinical Prevention and Control, Chinese Academy of Medical Sciences, 2019RU025, China.
| | - Jiao Wang
- State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China; Research Unit of Myopia Basic Research and Clinical Prevention and Control, Chinese Academy of Medical Sciences, 2019RU025, China.
| | - Jiajia Shi
- State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China; Research Unit of Myopia Basic Research and Clinical Prevention and Control, Chinese Academy of Medical Sciences, 2019RU025, China.
| | - Yuanyuan Wang
- State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China; Research Unit of Myopia Basic Research and Clinical Prevention and Control, Chinese Academy of Medical Sciences, 2019RU025, China.
| | - Jinmin Tian
- State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China; Research Unit of Myopia Basic Research and Clinical Prevention and Control, Chinese Academy of Medical Sciences, 2019RU025, China.
| | - Xiangtian Zhou
- State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China; Research Unit of Myopia Basic Research and Clinical Prevention and Control, Chinese Academy of Medical Sciences, 2019RU025, China.
| | - Jia Qu
- State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China; Research Unit of Myopia Basic Research and Clinical Prevention and Control, Chinese Academy of Medical Sciences, 2019RU025, China.
| | - Sen Zhang
- State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China; Research Unit of Myopia Basic Research and Clinical Prevention and Control, Chinese Academy of Medical Sciences, 2019RU025, China.
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Chia A, Ngo C, Choudry N, Yamakawa Y, Tan D. Atropine Ophthalmic Solution to Reduce Myopia Progression in Pediatric Subjects: The Randomized, Double-Blind Multicenter Phase II APPLE Study. Asia Pac J Ophthalmol (Phila) 2023; 12:370-376. [PMID: 37523428 DOI: 10.1097/apo.0000000000000609] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 02/24/2023] [Indexed: 05/20/2023] Open
Abstract
PURPOSE The purpose of this study was to assess the dose-response effects of low-dose atropine on myopia progression and safety in pediatric subjects with mild-to-moderate myopia. METHODS This phase II, randomized, double-masked, placebo-controlled study compared the efficacy and safety of atropine 0.0025%, 0.005%, and 0.01% with placebo in 99 children, aged 6-11 years, with mild-to-moderate myopia. Subjects received 1 drop in each eye at bedtime. The primary efficacy endpoint was change in spherical equivalent (SE), while secondary endpoints included changes in axial length (AL) and near logMAR (logarithm of the minimum angle of resolution) visual acuity and adverse effects. RESULTS The mean±SD changes in SE from baseline to 12 months in the placebo and atropine 0.0025%, 0.005%, and 0.01% groups were -0.55±0.471, -0.55±0.337, -0.33±0.473, and -0.39±0.519 D, respectively. The least squares mean differences (atropine-placebo) in the atropine 0.0025%, 0.005%, and 0.01% groups were 0.11 D ( P =0.246), 0.23 D ( P =0.009), and 0.25 D ( P =0.006), respectively. Compared with placebo, the mean change in AL was significantly greater for atropine 0.005% (-0.09 mm, P =0.012) and 0.01% (-0.10 mm, P =0.003). There were no significant changes in near visual acuity in any of the treatment groups. The most common ocular adverse events were pruritus and blurred vision, each occurring in 4 (5.5%) atropine-treated children. Changes in mean pupil size and amplitude of accommodation were minimal. CONCLUSIONS Atropine doses of 0.005% and 0.01% effectively reduced myopia progression in children but no effect was noted with 0.0025%. All doses of atropine were safe and well tolerated.
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Affiliation(s)
- Audrey Chia
- Singapore National Eye Centre, Singapore, Singapore
| | - Cheryl Ngo
- Department of Ophthalmology, National University Hospital, Singapore, Singapore
| | | | | | - Donald Tan
- Singapore National Eye Centre, Singapore, Singapore
- Department of Ophthalmology, National University Hospital, Singapore, Singapore
- Eye and Retina Surgeons, Camden Medical Center, Singapore, Singapore
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27
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Sankaridurg P, Berntsen DA, Bullimore MA, Cho P, Flitcroft I, Gawne TJ, Gifford KL, Jong M, Kang P, Ostrin LA, Santodomingo-Rubido J, Wildsoet C, Wolffsohn JS. IMI 2023 Digest. Invest Ophthalmol Vis Sci 2023; 64:7. [PMID: 37126356 PMCID: PMC10155872 DOI: 10.1167/iovs.64.6.7] [Citation(s) in RCA: 28] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
Abstract
Myopia is a dynamic and rapidly moving field, with ongoing research providing a better understanding of the etiology leading to novel myopia control strategies. In 2019, the International Myopia Institute (IMI) assembled and published a series of white papers across relevant topics and updated the evidence with a digest in 2021. Here, we summarize findings across key topics from the previous 2 years. Studies in animal models have continued to explore how wavelength and intensity of light influence eye growth and have examined new pharmacologic agents and scleral cross-linking as potential strategies for slowing myopia. In children, the term premyopia is gaining interest with increased attention to early implementation of myopia control. Most studies use the IMI definitions of ≤-0.5 diopters (D) for myopia and ≤-6.0 D for high myopia, although categorization and definitions for structural consequences of high myopia remain an issue. Clinical trials have demonstrated that newer spectacle lens designs incorporating multiple segments, lenslets, or diffusion optics exhibit good efficacy. Clinical considerations and factors influencing efficacy for soft multifocal contact lenses and orthokeratology are discussed. Topical atropine remains the only widely accessible pharmacologic treatment. Rebound observed with higher concentration of atropine is not evident with lower concentrations or optical interventions. Overall, myopia control treatments show little adverse effect on visual function and appear generally safe, with longer wear times and combination therapies maximizing outcomes. An emerging category of light-based therapies for children requires comprehensive safety data to enable risk versus benefit analysis. Given the success of myopia control strategies, the ethics of including a control arm in clinical trials is heavily debated. IMI recommendations for clinical trial protocols are discussed.
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Affiliation(s)
- Padmaja Sankaridurg
- Brien Holden Vision Institute, Sydney, Australia
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - David A Berntsen
- University of Houston, College of Optometry, Houston, Texas, United States
| | - Mark A Bullimore
- University of Houston, College of Optometry, Houston, Texas, United States
| | - Pauline Cho
- West China Hospital, Sichuan University, Sichuan, China
- Eye & ENT Hospital of Fudan University, Shanghai, China
- Affiliated Eye Hospital of Wenzhou Medical University, Wenzhou, China
| | - 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
| | - Timothy J Gawne
- Department of Optometry and Vision Science, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Kate L Gifford
- Queensland University of Technology, Brisbane, Australia
| | - Monica Jong
- Johnson & Johnson Vision, Jacksonville, Florida, United States
| | - Pauline Kang
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - 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
| | - James S Wolffsohn
- College of Health & Life Sciences, Aston University, Birmingham, United Kingdom
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28
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Axial Shortening in Myopic Children after Repeated Low-Level Red-Light Therapy: Post Hoc Analysis of a Randomized Trial. Ophthalmol Ther 2023; 12:1223-1237. [PMID: 36790672 PMCID: PMC10011250 DOI: 10.1007/s40123-023-00671-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Accepted: 01/31/2023] [Indexed: 02/16/2023] Open
Abstract
INTRODUCTION Axial length (AL) elongation in myopia is considered irreversible. We aimed to systemically report unexpected AL shortening observed in a randomized clinical trial (RCT) after repeated low-level red-light (RLRL) therapy. METHODS This is a post hoc analysis of a multicenter, single-masked RCT. Two hundred sixty-four myopic children aged 8-13 years allocated to RLRL treatment (intervention group) or a single vision spectacle (SVS, control group) were included. AL was measured using an IOL-master 500 at baseline, 1-, 3-, 6-, and 12-month follow-up visits. AL shortening was defined as AL reduction from baseline to follow-up visits at three cutoffs: > 0.05 mm, > 0.10 mm, and > 0.20 mm. Frequency of AL shortening at different cutoffs was calculated. Analysis was done with intent to treat (ITT). RESULTS At 12-months follow up, frequency of AL shortening > 0.05 mm was 26/119 (21.85%) and 2/145 (1.38%) for the RLRL group versus the control group, respectively. The frequency was 18/119 (15.13%) versus 0/145 (0%) for AL shortening > 0.10 mm, and 7/119 (5.88%) versus 0/145 (0%), for AL shortening > 0.20 mm, respectively (p < 0.001). Mean AL shortening after 12 months (SD) was -0.156 (0.086) mm in the RLRL group and -0.06 mm in the control group. Age was significantly associated with AL shortening in the multivariable analysis. For the RLRL group that exhibited AL shortening (n = 56), choroidal thickness (ChT) thickening (0.056 mm) could only explain 28.3% of AL shortening (-0.20 mm). CONCLUSION Nearly a quarter of children had > 0.05 mm AL shortening following 12 months of RLRL therapy, whereas AL shortening rarely occurred among controls. TRIAL REGISTRATION ClinicalTrials.gov (NCT04073238).
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29
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Lanca C, Pang CP, Grzybowski A. Effectiveness of myopia control interventions: A systematic review of 12 randomized control trials published between 2019 and 2021. Front Public Health 2023; 11:1125000. [PMID: 37033047 PMCID: PMC10076805 DOI: 10.3389/fpubh.2023.1125000] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 03/07/2023] [Indexed: 04/11/2023] Open
Abstract
Purpose This study aims to investigate the effectiveness of interventions to control myopia progression. In this systematic review, the primary outcomes were mean differences (MD) between treatment and control groups in myopia progression (D) and axial length (AL) elongation (mm). Results The following interventions were found to be effective (p < 0.001): highly aspherical lenslets (HAL, 0.80 D, 95% CI, 0.77-0.83; -0.35 mm, 95% CI -0.36 to -0.34), MiSight contact lenses (0.66 D, 95% CI, 0.63-0.69; -0.28 mm, 95% CI -0.29 to -0.27), low dose atropine 0.05% (0.54 D, 95% CI, 0.38-0.70; -0.21 mm, 95% CI-0.28 to -0.14), Biofinity +2.50 D (0.45 D, 95% CI, 0.29, 0.61; -0.24 mm, 95% CI -0.33 to -0.15), defocus incorporated multiple segments [DIMS] (0.44 D, 95% CI, 0.42-0.46; -0.34 mm, 95% CI -0.35 to -0.33) and ortho-k lenses (-0.24 mm, 95% CI -0.33 to -01.5). Conclusion Low-dose atropine 0.01% was not effective in reducing AL progression in two studies. Treatment efficacy with low-dose atropine of 0.05% showed good efficacy. Spectacles (HAL and DIMS) and contact lenses (MiSight and Biofinity) may confer a comparable treatment benefit compared to atropine, to slow myopia progression.
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Affiliation(s)
- Carla Lanca
- Escola Superior de Tecnologia da Saúde de Lisboa (ESTeSL), Instituto Politécnico de Lisboa, Lisboa, Portugal
- Comprehensive Health Research Center (CHRC), Escola Nacional de Saúde Pública, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Chi Pui Pang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
- Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong, China
- Joint Shantou International Eye Center, Shantou University/The Chinese University of Hong Kong, Shantou, China
| | - Andrzej Grzybowski
- Department of Ophthalmology, University of Warmia and Mazury, Olsztyn, Poland
- Institute for Research in Ophthalmology, Foundation for Ophthalmology Development, Poznan, Poland
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30
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Yam JC, Zhang XJ, Kam KW, Chen LJ, Tham CC, Pang CP. Myopia control and prevention: From lifestyle to low-concentration atropine. The 2022 Josh Wallman Memorial Lecture. Ophthalmic Physiol Opt 2023; 43:299-310. [PMID: 36857025 DOI: 10.1111/opo.13118] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 02/09/2023] [Accepted: 02/09/2023] [Indexed: 03/02/2023]
Abstract
The purpose of this study was to explore the findings from the Hong Kong Children Eye Study and the Low Concentration Atropine for Myopia Progression (LAMP-1) Study. The incidence of myopia among schoolchildren in Hong Kong more than doubled during the COVID-19 pandemic, with outdoor time decreased significantly and screen time increased. The change in lifestyle during the COVID-19 pandemic aggravated myopia development. Low-concentration atropine (0.05%, 0.025% and 0.01%) is effective in reducing myopia progression with a concentration-related response. This concentration-dependent response was maintained throughout a 3-year follow-up period, and all low concentrations were well tolerated. An age-dependent effect was observed in each treatment group with 0.05%, 0.025% and 0.01% atropine. Younger age was associated with a poor treatment response to low-concentration atropine. Additionally, low-concentration atropine induced choroidal thickening along a concentration-dependent response throughout the treatment period. During the third year, continued atropine treatment achieved a better effect across all concentrations compared with the washout regimen. Stopping treatment at an older age and receiving lower concentration were associated with a smaller rebound effect. However, differences in the rebound effect were clinically small across all the three concentrations studied.
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Affiliation(s)
- Jason C Yam
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China.,Hong Kong Eye Hospital, Hong Kong, China.,Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, China.,Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong, China.,Department of Ophthalmology, Hong Kong Children's Hospital, Hong Kong, China.,Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, Shantou, China
| | - Xiu Juan Zhang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Ka Wai Kam
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China.,Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, China
| | - Li Jia Chen
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China.,Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, China.,Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong, China.,Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, Shantou, China
| | - Clement C Tham
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China.,Hong Kong Eye Hospital, Hong Kong, China.,Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, China.,Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong, China.,Department of Ophthalmology, Hong Kong Children's Hospital, Hong Kong, China.,Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, Shantou, China
| | - Chi Pui Pang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China.,Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong, China.,Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, Shantou, China
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31
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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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Yam JC, Zhang XJ, Zhang Y, Yip BHK, Tang F, Wong ES, Bui CHT, Kam KW, Ng MPH, Ko ST, Yip WW, Young AL, Tham CC, Chen LJ, Pang CP. Effect of Low-Concentration Atropine Eyedrops vs Placebo on Myopia Incidence in Children: The LAMP2 Randomized Clinical Trial. JAMA 2023; 329:472-481. [PMID: 36786791 PMCID: PMC9929700 DOI: 10.1001/jama.2022.24162] [Citation(s) in RCA: 39] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 12/13/2022] [Indexed: 02/15/2023]
Abstract
Importance Early onset of myopia is associated with high myopia later in life, and myopia is irreversible once developed. Objective To evaluate the efficacy of low-concentration atropine eyedrops at 0.05% and 0.01% concentration for delaying the onset of myopia. Design, Setting, and Participants This randomized, placebo-controlled, double-masked trial conducted at the Chinese University of Hong Kong Eye Centre enrolled 474 nonmyopic children aged 4 through 9 years with cycloplegic spherical equivalent between +1.00 D to 0.00 D and astigmatism less than -1.00 D. The first recruited participant started treatment on July 11, 2017, and the last participant was enrolled on June 4, 2020; the date of the final follow-up session was June 4, 2022. Interventions Participants were assigned at random to the 0.05% atropine (n = 160), 0.01% atropine (n = 159), and placebo (n = 155) groups and had eyedrops applied once nightly in both eyes over 2 years. Main Outcomes and Measures The primary outcomes were the 2-year cumulative incidence rate of myopia (cycloplegic spherical equivalent of at least -0.50 D in either eye) and the percentage of participants with fast myopic shift (spherical equivalent myopic shift of at least 1.00 D). Results Of the 474 randomized patients (mean age, 6.8 years; 50% female), 353 (74.5%) completed the trial. The 2-year cumulative incidence of myopia in the 0.05% atropine, 0.01% atropine, and placebo groups were 28.4% (33/116), 45.9% (56/122), and 53.0% (61/115), respectively, and the percentages of participants with fast myopic shift at 2 years were 25.0%, 45.1%, and 53.9%. Compared with the placebo group, the 0.05% atropine group had significantly lower 2-year cumulative myopia incidence (difference, 24.6% [95% CI, 12.0%-36.4%]) and percentage of patients with fast myopic shift (difference, 28.9% [95% CI, 16.5%-40.5%]). Compared with the 0.01% atropine group, the 0.05% atropine group had significantly lower 2-year cumulative myopia incidence (difference, 17.5% [95% CI, 5.2%-29.2%]) and percentage of patients with fast myopic shift (difference, 20.1% [95% CI, 8.0%-31.6%]). The 0.01% atropine and placebo groups were not significantly different in 2-year cumulative myopia incidence or percentage of patients with fast myopic shift. Photophobia was the most common adverse event and was reported by 12.9% of participants in the 0.05% atropine group, 18.9% in the 0.01% atropine group, and 12.2% in the placebo group in the second year. Conclusions and Relevance Among children aged 4 to 9 years without myopia, nightly use of 0.05% atropine eyedrops compared with placebo resulted in a significantly lower incidence of myopia and lower percentage of participants with fast myopic shift at 2 years. There was no significant difference between 0.01% atropine and placebo. Further research is needed to replicate the findings, to understand whether this represents a delay or prevention of myopia, and to assess longer-term safety. Trial Registration Chinese Clinical Trial Registry: ChiCTR-IPR-15006883.
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Affiliation(s)
- Jason C. Yam
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
- Hong Kong Eye Hospital, Hong Kong
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong
- Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong, Hong Kong
- Department of Ophthalmology, Hong Kong Children’s Hospital, Hong Kong
| | - Xiu Juan Zhang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
| | - Yuzhou Zhang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
| | - Benjamin H. K. Yip
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
| | - Fangyao Tang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
| | - Emily S. Wong
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
- Hong Kong Eye Hospital, Hong Kong
- Department of Ophthalmology, Hong Kong Children’s Hospital, Hong Kong
| | - Christine H. T. Bui
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
| | - Ka Wai Kam
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong
| | - Mandy P. H. Ng
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
| | - Simon T. Ko
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
- Department of Ophthalmology, Hong Kong Children’s Hospital, Hong Kong
| | - Wilson W.K. Yip
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong
| | - Alvin L. Young
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong
| | - Clement C. Tham
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
- Hong Kong Eye Hospital, Hong Kong
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong
- Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong, Hong Kong
- Department of Ophthalmology, Hong Kong Children’s Hospital, Hong Kong
| | - Li Jia Chen
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong
- Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Chi Pui Pang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
- Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong, Hong Kong
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Combined 0.01% atropine with orthokeratology in childhood myopia control (AOK) study: A 2-year randomized clinical trial. Cont Lens Anterior Eye 2023; 46:101723. [PMID: 35654683 DOI: 10.1016/j.clae.2022.101723] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 05/24/2022] [Accepted: 05/26/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND To investigate whether combining 0.01% atropine with orthokeratology (AOK) has a better effect in retarding axial elongation, compared with orthokeratology alone (OK) over two years. METHODS A total of 96 Chinese children aged six to < 11 years with myopia (1.00 - 4.00 D, inclusive) were randomized into either the AOK or OK group in a 1:1 ratio. Axial length (the primary outcome), and secondary outcomes (e.g. pupil size and choroidal thickness) were measured at 1-month and at 6-monthly intervals after commencement of treatment. RESULTS Both intention-to-treat and per-protocol analyses showed significantly slower axial elongation in the AOK group than OK group over two years (P = 0.008, P < 0.001, respectively). AOK subjects had statistically slower axial elongation (adjusted mean [standard error], 0.17 [0.03] mm vs 0.34 [0.03] mm, P < 0.001), larger increase in mesopic (0.70 [0.09] mm vs 0.31 [0.09] mm, P = 0.003) and photopic pupil size (0.78 [0.07] mm vs 0.23 [0.07] mm, P < 0.001), and greater thickening of the choroid (22.6 [3.5] µm vs -9.0 [3.5] µm, P < 0.001) than OK subjects over two years. Except for a higher incidence of photophobia in the AOK group (P = 0.006), there were no differences in the incidence of any other symptom or adverse events between the two groups. Slower axial elongation was associated with a larger increase in the photopic pupil size and a greater thickening in the choroid in the AOK group. CONCLUSIONS Slower axial elongation following 2-year AOK treatment may result from increased pupil dilation and a thickening in the choroid observed in the AOK group.
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Liu J, Lu Y, Huang D, Yang J, Fan C, Chen C, Li J, Wang Q, Li S, Jiang B, Jiang H, Li X, Yang Z, Lan W. The Efficacy of Defocus Incorporated Multiple Segments Lenses in Slowing Myopia Progression: Results from Diverse Clinical Circumstances. Ophthalmology 2023; 130:542-550. [PMID: 36642334 DOI: 10.1016/j.ophtha.2023.01.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 12/30/2022] [Accepted: 01/09/2023] [Indexed: 01/15/2023] Open
Abstract
PURPOSE Defocus incorporated multiple segments (DIMS) spectacle lenses were reported to slow myopia progression significantly in a randomized controlled trial (RCT). The study evaluated their effectiveness in clinical settings. DESIGN Retrospective study. PARTICIPANTS Patient records involving use of DIMS and single-vision (SV) spectacle lenses were collected from subsidiary hospitals of Aier Eye Hospital Group. METHODS The spherical equivalent (SE), determined by subjective refraction, was adopted to assess the myopia progression. The strategy of propensity score matching (PSM) was applied to match the confounding baseline characteristics between the 2 groups. The effectiveness was calculated based on the difference of myopia progression of these 2 approaches. MAIN OUTCOME MEASURES Change in SE. RESULTS Three thousand six hundred thirty-nine patients with DIMS and 6838 patients with SV spectacles were included. The age of the patients was 6 to 16 years (mean ± standard deviation: 11.02 ± 2.53 years). The baseline SE was between 0.00 and -10.00 diopters (D) (mean ± standard deviation: -2.78 ± 1.74 D). After the PSM, data on 2240 pairs with 1-year follow-up and on 735 pairs with 2-year follow-up were obtained. Significantly slower progression was seen in the DIMS group at both the 1-year (DIMS, -0.50 ± 0.43 D; SV, -0.77 ± 0.58 D; P < 0.001) and 2-year (DIMS, -0.88 ± 0.62 D; SV, -1.23 ± 0.76 D; P < 0.001) subdataset. In the 1-year subdataset, 40% and 19% showed myopia progression of no more than 0.25 D for the DIMS and SV groups, respectively (chi-square, 223.43; P < 0.001), whereas 9% and 22% showed myopia progression of more than 1.00 D for the DIMS and SV groups, respectively (chi-square, 163.38; P < 0.001). In the 2-year subdataset, 33% and 20% showed myopia progression of no more than 0.50 D for the DIMS and SV groups, respectively (chi-square, 31.15; P < 0.001), whereas 12% and 29% showed myopia progression of more than 1.50 D for the DIMS and SV groups (chi-square, 65.60; P < 0.001). CONCLUSIONS Although the magnitude was lower than that reported in the previous RCT, this large-scale study with diversity of the data sources confirmed the effectiveness of DIMS spectacles to slow myopia progression in clinical practice. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found after the references.
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Affiliation(s)
- Jiaxin Liu
- Aier School of Ophthalmology, Central South University, Changsha, China
| | - Yiqiu Lu
- Aier School of Ophthalmology, Central South University, Changsha, China
| | - Dan Huang
- Changsha Aier Eye Hospital, Beijing, China
| | - Jiwen Yang
- Shenyang Aier Eye Hospital, Shenyang, China
| | - Chunlei Fan
- Beijing Aier Intech Eye Hospital, Beijing, China
| | - Chunmei Chen
- Chongqing Aier-Mega Eye Hospital, Chongqing, China
| | - Jianhua Li
- Guangzhou Aier Eye Hospital, Jinan University, Guangzhou, China
| | | | - Shan Li
- Shenzhen Aier Eye Hospital, Huzhou, China
| | | | | | - Xiaoning Li
- Aier School of Ophthalmology, Central South University, Changsha, China; School of Stomatology and Ophthalmology, Xianning Medical College, Hubei University of Science and Technology, Xianning, China; Hunan Province Optometry Engineering and Technology Research Center, Changsha, China; Hunan Province International Cooperation Base for Optometry Science and Technology, Changsha, China
| | - Zhikuan Yang
- Aier School of Ophthalmology, Central South University, Changsha, China; School of Stomatology and Ophthalmology, Xianning Medical College, Hubei University of Science and Technology, Xianning, China; Hunan Province Optometry Engineering and Technology Research Center, Changsha, China; Hunan Province International Cooperation Base for Optometry Science and Technology, Changsha, China
| | - Weizhong Lan
- Aier School of Ophthalmology, Central South University, Changsha, China; Guangzhou Aier Eye Hospital, Jinan University, Guangzhou, China; School of Stomatology and Ophthalmology, Xianning Medical College, Hubei University of Science and Technology, Xianning, China; Hunan Province Optometry Engineering and Technology Research Center, Changsha, China; Hunan Province International Cooperation Base for Optometry Science and Technology, Changsha, China.
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Lanca C, Repka MX, Grzybowski A. Topical Review: Studies on Management of Myopia Progression from 2019 to 2021. Optom Vis Sci 2023; 100:23-30. [PMID: 36705712 DOI: 10.1097/opx.0000000000001947] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
SIGNIFICANCE Myopia is a common eye condition that increases the risk of sight-threatening complications. Each additional diopter increases the chance of complications. The purpose of this review was to make an overview of myopia control treatment options for children with myopia progression.In this nonsystematic review, we searched PubMed and Cochrane databases for English-language studies published from 2019 to September 2021. Emphasis was given to selection of randomized controlled trials. Nineteen randomized controlled trials and two retrospective studies were included. Topical atropine and orthokeratology remain the most used treatments, whereas lenses with novel designs are emerging treatments. Overall myopia progression in the treatment groups for low-dose atropine and orthokeratology was lower than in the control groups, and their efficacy was reported in several randomized controlled trials and confirmed by various systematic reviews and meta-analysis. The findings of myopia progression and axial elongation for the MiSight, defocus incorporated multiple segment spectacle lens, highly aspherical lenslets, and diffusion optics technology spectacle lens were comparable. Public health interventions to optimize environmental influences may also be important strategies to control myopia. Optimal choice of management of myopia depends on treatment availability, acceptability to child and parents, and specific patient features such as age, baseline myopia, and lifestyle. Eye care providers need to understand the advantages and disadvantages of each therapy to best counsel parents of children with myopia.
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Affiliation(s)
| | - Michael X Repka
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Low-Concentration Atropine Monotherapy vs. Combined with MiSight 1 Day Contact Lenses for Myopia Management. Vision (Basel) 2022; 6:vision6040073. [PMID: 36548935 PMCID: PMC9781043 DOI: 10.3390/vision6040073] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 12/02/2022] [Accepted: 12/06/2022] [Indexed: 12/14/2022] Open
Abstract
Objectives: To assess the decrease in myopia progression and rebound effect using topical low-dose atropine compared to a combined treatment with contact lenses for myopic control. Methods: This retrospective review study included 85 children aged 10.34 ± 2.27 (range 6 to 15.5) who were followed over three years. All had a minimum myopia increase of 1.00 D the year prior to treatment. The children were divided into two treatment groups and a control group. One treatment group included 29 children with an average prescription of 4.81 ± 2.12 D (sphere equivalent (SE) range of 1.25−10.87 D), treated with 0.01% atropine for two years (A0.01%). The second group included 26 children with an average prescription of 4.14 ± 1.35 D (SE range of 1.625−6.00 D), treated with MiSight 1 day dual focus contact lenses (DFCL) and 0.01% atropine (A0.01% + DFCL) for two years. The control group included 30 children wearing single-vision spectacles (SV), averaging −5.06 ± 1.77 D (SE) range 2.37−8.87 D). Results: There was an increase in the SE myopia progression in the SV group of 1.19 ± 0.43 D, 1.25 ± 0.52 D, and 1.13 ± 0.36 D in the first, second, and third years, respectively. Myopia progression in the A0.01% group was 0.44 ± 0.21 D (p < 0.01) and 0.51 ± 0.39 D (p < 0.01) in the first and second years, respectively. In the A0.01% + DFCL group, myopia progression was 0.35 ± 0.26 D and 0.44 ± 0.40 D in the first and second years, respectively (p < 0.01). Half a year after the cessation of the atropine treatment, myopia progression (rebound effect) was measured at −0.241 ± 0.35 D and −0.178 ± 0.34 D in the A0.01% and A0.01% + DFCL groups, respectively. Conclusions: Monotherapy low-dose atropine, combined with peripheral blur contact lenses, was clinically effective in decreasing myopia progression. A low rebound effect was found after the therapy cessation. In this retrospective study, combination therapy did not present an advantage over monotherapy.
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Cho H, Seo Y, Han SH, Han J. Factors Related to Axial Length Elongation in Myopic Children Who Received 0.05% Atropine Treatment. J Ocul Pharmacol Ther 2022; 38:703-708. [PMID: 36269657 DOI: 10.1089/jop.2022.0036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Purpose: To evaluate the longitudinal changes of axial length (AL) and factors associated with AL growth in myopic children receiving 0.05% atropine. Methods: This single-center retrospective study included children aged 4-13 years with myopia of at least -0.5 diopters (D) treated with 0.05% atropine eye drops from November 2016 to May 2021. Predictive factors for AL change were evaluated using linear mixed models. Results: Among 109 patients (218 eyes), 58 (53.2%) were male and the mean age at treatment was 8.5 ± 2.0 years. At baseline measurement, the mean spherical equivalent was -4.05 ± 2.34 diopters (D), and AL was 25.00 ± 0.97 mm. The mean follow-up duration was 25.4 (12-58) months, and the mean AL elongation was 0.23 ± 0.17 mm/year during the follow-up periods. AL shortening of ≥0.05 mm at subsequent visit occurred in 18 patients (26 eyes). The mean AL change in the group without initial AL shortening was statistically larger than that in the group with initial AL shortening (0.26 ± 0.16 mm/year vs. 0.02 ± 0.17 mm/year, P < 0.001). In linear mixed model, the age at atropine treatment and initial AL shortening were significantly associated with respect to AL growth (beta coefficient: -0.032 and -0.122, respectively, P < 0.001 for both). Conclusions: Our study found that older age and initial AL shortening are predictors of favorable response after 0.05% atropine treatment. Children with AL shortening at initial subsequent visit may be associated with good long-term response, and younger children may require higher concentration of atropine for optimal response.
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Affiliation(s)
- Hyuna Cho
- Institute of Vision Research, Department of Ophthalmology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Yuri Seo
- Institute of Vision Research, Department of Ophthalmology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, South Korea
| | - Sueng-Han Han
- Institute of Vision Research, Department of Ophthalmology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Jinu Han
- Institute of Vision Research, Department of Ophthalmology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
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Németh J, Aclimandos WA, Tapasztó B, Jonas JB, Grzybowski A, Nagy ZZ. The impact of the pandemic highlights the urgent need for myopia guidelines: The clinicians' role. Eur J Ophthalmol 2022; 33:11206721221143008. [PMID: 36448253 PMCID: PMC9713518 DOI: 10.1177/11206721221143008] [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: 05/12/2022] [Accepted: 10/30/2022] [Indexed: 12/05/2022]
Abstract
Myopia is already one of the leading causes of permanent vision impairment, including blindness, and the COVID-19 pandemic has exacerbated the global myopia-related burden among children owing to home confinement, increased screen time (e-learning), and decreased outside activities. To reverse the rising trend of myopia and myopia-related blindness, collaborative efforts are required. There is a wealth of evidence-based medicine (EBM) data on the epidemiology of myopia and effective interventions, but very little has been published on the clinicians' roles and responsibilities. However, this aspect is critical because preventing the onset and progression of myopia necessitates extensive health promotion and advocacy efforts among decision-makers. Only broad medical expert collaboration can bring about the necessary changes in children's lifestyle and education. This article discusses clinicians' critical roles in preventing the onset and progression of myopia.
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Affiliation(s)
- János Németh
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Wagih A Aclimandos
- King's College Hospital, London,
UK
- European Society of Ophthalmology,
Rotterdam, The Netherlands
| | - Beáta Tapasztó
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Jost B Jonas
- Department of Ophthalmology, Heidelberg University, Mannheim, Germany
- Institute of Molecular and Clinical
Ophthalmology Basel, Basel, Switzerland
| | - Andrzej Grzybowski
- Department of Ophthalmology, University of Warmia and
Mazury, Olsztyn, Poland
- Institute for Research in
Ophthalmology, Foundation for Ophthalmology Development, Poznan, Poland
| | - Zoltán Zsolt Nagy
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
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39
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Zhao C, Cai C, Dai H, Zhang J. Effect of the combined application of orthokeratology and single-vision spectacles on slowing the progression of high myopia: A systematic review and meta-analysis. Medicine (Baltimore) 2022; 101:e30178. [PMID: 35984116 PMCID: PMC9388007 DOI: 10.1097/md.0000000000030178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
PURPOSE The purpose of the study was to conduct a meta-analysis about the effect of the combined application of orthokeratology and single-vision spectacles on slowing the progression of high myopia. METHODS The literature was searched in PubMed, EMBASE, the Cochrane Library, Wang Fang Data, CNKI and sinoMed. The Cochrane Handbook was used to evaluate the quality of the included randomized clinical trials, and the Newcastle-Ottawa Scale was used to evaluate the included case-control or cohort studies. The results were analyzed by Revman 5.3. RESULTS Five studies (2 randomized clinical trials, 2 case-controls, and 1 cohort study) with a total of 360 patients were included in this meta-analysis. The follow-up time was at least 1 year. Combined application of orthokeratology and single-vision spectacles were used in the experimental group. The control group used single-vision spectacles only. The pooled estimates indicated that the standardized mean difference between the 2 groups was -1.46 mm (95% confidence interval: -1.88 to -1.05; P < .05) for axial length elongation and -1.85D (95% confidence interval: -2.40 to -1.31; P < .05) for change in spherical equivalent refraction. No serious adverse events were reported in all studies. CONCLUSION The combined application of orthokeratology and single-vision spectacles is more effective than single-vision spectacles only on slowing the progression of high myopia.
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Affiliation(s)
| | - Chunyan Cai
- Aier Eye Hospital of Wuhan University, Wuhan, China
| | - Hongbin Dai
- Aier Eye Hospital of Wuhan University, Wuhan, China
| | - Jun Zhang
- Aier Eye Hospital of Wuhan University, Wuhan, China
- *Correspondence: Jun Zhang, Aier Eye Hospital of Wuhan University, Wuhan, Hubei Province, China (e-mail: )
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Efficacy of 0.01% atropine for myopia control in a randomized, placebo-controlled trial depends on baseline electroretinal response. Sci Rep 2022; 12:11588. [PMID: 35804049 PMCID: PMC9270320 DOI: 10.1038/s41598-022-15686-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 06/28/2022] [Indexed: 11/30/2022] Open
Abstract
This study aimed to evaluate the efficacy of 18-month 0.01% atropine in 61 myopic children (aged 7–10) and the relationship with central retinal response (by multifocal electroretinogram [mfERG]) in a double-masked randomized placebo-controlled clinical trial. Global-flash mfERG was measured at baseline, while cycloplegic spherical equivalent refraction (SER) and axial length (AL) were measured at baseline and at 6-month intervals. Annualized change in SER and AL were compared between atropine and control groups, and the relationships with baseline mfERG were evaluated. Changes in SER (−0.70 ± 0.39D vs. −0.66 ± 0.41D, p = 0.63) and AL (0.32 ± 0.16 mm vs. 0.30 ± 0.22 mm, p = 0.52) were similar in atropine and control groups. Interestingly, in the placebo group, mfERG amplitude was negatively correlated with axial elongation (Rp = −0.44, p = 0.03) as in our previous study. However, in the atropine group, an opposite trend was observed that axial elongation was positively correlated with mfERG amplitude (Ra = 0.37, p = 0.04). Annualized myopia progression demonstrated similar opposite effect between atropine and placebo groups but did not reach statistical significance. An ERG screening protocol may be warranted to identify suitable candidates to reduce the likelihood of an unfavorable treatment response by 0.01% atropine.
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Lee LC, Hsieh MW, Chen YH, Chen PL, Chien KH. Characteristics of responders to atropine 0.01% as treatment in Asian myopic children. Sci Rep 2022; 12:7380. [PMID: 35513480 PMCID: PMC9072680 DOI: 10.1038/s41598-022-10978-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 04/15/2022] [Indexed: 01/04/2023] Open
Abstract
Recently, low-concentration atropine (0.01%) has gained increased attention in controlling myopia progression with satisfying effects and minimal side effects. However, studies concerning responders to 0.01% atropine are limited. This retrospective observational cohort study aimed to determine the responder characteristics of 0.01% atropine in Asian children. One hundred forty children (aged between 3 and 15 years) receiving 0.01% atropine were analyzed for the factors influencing annual spherical equivalent changes (SE). The mean age was 9.13 (2.6) years, the mean baseline SE was - 1.56 (1.52) diopters (D), and the mean annual SE change was - 0.52 (0.49) D. A 58.63% responder rate (146/249) of myopic control was achieved with 0.01% atropine in our entire cohort under the criteria of less than 0.5 D of myopic progression annually. The subjects were stratified into 4 subgroups based on a cut-off point of baseline SE of - 1.5 D and baseline age of 9 years. The responder rate differed significantly with the highest being the youngest with the lowest myopia subgroups. Our results demonstrated that children with myopia better than - 1.5 D and younger than 9 years had the highest potential to achieve successful myopic control under 0.01% atropine therapy.
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Affiliation(s)
- Lung-Chi Lee
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, No. 325, Sec. 2, Cheng-gong Rd., Neihu Dist., Taipei, 114, Taiwan, ROC
| | - Meng-Wei Hsieh
- Department of Ophthalmology, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan, ROC
- National Defense Medical Center, Taipei, Taiwan, ROC
| | - Yi-Hao Chen
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, No. 325, Sec. 2, Cheng-gong Rd., Neihu Dist., Taipei, 114, Taiwan, ROC
| | - Po-Liang Chen
- Hau-Ming Eye Clinic Center, No. 199, Zhongxing Rd., Xizhi Dist., New Taipei City, 221, Taiwan, ROC.
| | - Ke-Hung Chien
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, No. 325, Sec. 2, Cheng-gong Rd., Neihu Dist., Taipei, 114, Taiwan, ROC.
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42
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Yam JC, Jiang Y, Lee J, Li S, Zhang Y, Sun W, Yuan N, Wang YM, Yip BHK, Kam KW, Chan HN, Zhang XJ, Young AL, Tham CC, Cheung CY, Chu WK, Pang CP, Chen LJ. The Association of Choroidal Thickening by Atropine With Treatment Effects for Myopia: Two-Year Clinical Trial of the Low-concentration Atropine for Myopia Progression (LAMP) Study. Am J Ophthalmol 2022; 237:130-138. [PMID: 34942105 DOI: 10.1016/j.ajo.2021.12.014] [Citation(s) in RCA: 42] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 11/30/2021] [Accepted: 12/03/2021] [Indexed: 11/17/2022]
Abstract
PURPOSE To evaluate longitudinal changes in subfoveal choroidal thickness (SFChT) among children receiving atropine 0.05%, 0.025%, or 0.01% over 2 years and their associations with treatment outcomes in myopia control. DESIGN Double-blinded randomized controlled trial. METHODS SFChT was measured at 4-month intervals using spectral domain optical coherence tomography. Cycloplegic spherical equivalent (SE), axial length (AL), best-corrected visual acuity, parental SE, outdoor time, near work diopter hours, and treatment compliance were also measured. RESULTS 314 children were included with qualified choroidal data. The 2-year changes in SFChT from baseline were 21.15 ± 32.99 µm, 3.34 ± 25.30 µm, and -0.30 ± 27.15 µm for the atropine 0.05%, 0.025%, and 0.01% groups, respectively (P < .001). A concentration-dependent response was observed, with thicker choroids at higher atropine concentrations (β = 0.89, P < .001). Mean SFChT thickness significantly increased at 4 months in the atropine 0.025% (P = .001) and 0.05% groups (P < .001) and then remained stable until the end of the second year (P > .05 for all groups). Over 2 years, an increase in SFChT was associated with slower SE progression (β = 0.074, P < .001) and reduced AL elongation (β = -0.045, P < .001). In the mediation analysis, 18.45% of the effect on SE progression from atropine 0.05% was mediated via its choroidal thickening. CONCLUSIONS Low concentration atropine induced a choroidal thickening effect along a concentration-dependent response throughout the treatment period. The choroidal thickening was associated with a slower SE progression and AL elongation among all the treatment groups. Choroidal response can be used for assessment of long-term treatment outcomes and as a guide for concentration titrations of atropine.
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Affiliation(s)
- Jason C Yam
- From the Department of Ophthalmology and Visual Sciences (J.C.Y., Y.J., J.L., S.L., Y.Z., N.Y., Y.M.W., K.W.K., H.-N.C., X.J.Z., A.L.Y., C.C.T., C.Y.C., W.K.C., C.P.P., L.J.C.), The Chinese University of Hong Kong, Hong Kong;; Hong Kong Eye Hospital, (J.C.Y., C.C.T.), Hong Kong; Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, (J.C.Y., K.W.K., A.L.Y.,C.C.T., L.J.C.), Hong Kong; Hong Kong Hub of Paediatric Excellence (J.C.Y., C.C.T., W.K.C., C.P.P., L.J.C.), The Chinese University of Hong Kong; Department of Ophthalmology, Hong Kong Children's Hospital (J.C.Y.), Hong Kong.
| | - Yuning Jiang
- From the Department of Ophthalmology and Visual Sciences (J.C.Y., Y.J., J.L., S.L., Y.Z., N.Y., Y.M.W., K.W.K., H.-N.C., X.J.Z., A.L.Y., C.C.T., C.Y.C., W.K.C., C.P.P., L.J.C.), The Chinese University of Hong Kong, Hong Kong
| | - Jackie Lee
- From the Department of Ophthalmology and Visual Sciences (J.C.Y., Y.J., J.L., S.L., Y.Z., N.Y., Y.M.W., K.W.K., H.-N.C., X.J.Z., A.L.Y., C.C.T., C.Y.C., W.K.C., C.P.P., L.J.C.), The Chinese University of Hong Kong, Hong Kong
| | - Sherie Li
- From the Department of Ophthalmology and Visual Sciences (J.C.Y., Y.J., J.L., S.L., Y.Z., N.Y., Y.M.W., K.W.K., H.-N.C., X.J.Z., A.L.Y., C.C.T., C.Y.C., W.K.C., C.P.P., L.J.C.), The Chinese University of Hong Kong, Hong Kong
| | - Yuzhou Zhang
- From the Department of Ophthalmology and Visual Sciences (J.C.Y., Y.J., J.L., S.L., Y.Z., N.Y., Y.M.W., K.W.K., H.-N.C., X.J.Z., A.L.Y., C.C.T., C.Y.C., W.K.C., C.P.P., L.J.C.), The Chinese University of Hong Kong, Hong Kong
| | - Wen Sun
- Jockey Club School of Public Health and Primary Care (W.S., B.H.K.Y.), The Chinese University of Hong Kong, Hong Kong, China
| | - Nan Yuan
- From the Department of Ophthalmology and Visual Sciences (J.C.Y., Y.J., J.L., S.L., Y.Z., N.Y., Y.M.W., K.W.K., H.-N.C., X.J.Z., A.L.Y., C.C.T., C.Y.C., W.K.C., C.P.P., L.J.C.), The Chinese University of Hong Kong, Hong Kong
| | - Yu Meng Wang
- From the Department of Ophthalmology and Visual Sciences (J.C.Y., Y.J., J.L., S.L., Y.Z., N.Y., Y.M.W., K.W.K., H.-N.C., X.J.Z., A.L.Y., C.C.T., C.Y.C., W.K.C., C.P.P., L.J.C.), The Chinese University of Hong Kong, Hong Kong
| | - Benjamin Hon Kei Yip
- Jockey Club School of Public Health and Primary Care (W.S., B.H.K.Y.), The Chinese University of Hong Kong, Hong Kong, China
| | - Ka Wai Kam
- From the Department of Ophthalmology and Visual Sciences (J.C.Y., Y.J., J.L., S.L., Y.Z., N.Y., Y.M.W., K.W.K., H.-N.C., X.J.Z., A.L.Y., C.C.T., C.Y.C., W.K.C., C.P.P., L.J.C.), The Chinese University of Hong Kong, Hong Kong;; Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, (J.C.Y., K.W.K., A.L.Y.,C.C.T., L.J.C.), Hong Kong
| | - Hei-Nga Chan
- From the Department of Ophthalmology and Visual Sciences (J.C.Y., Y.J., J.L., S.L., Y.Z., N.Y., Y.M.W., K.W.K., H.-N.C., X.J.Z., A.L.Y., C.C.T., C.Y.C., W.K.C., C.P.P., L.J.C.), The Chinese University of Hong Kong, Hong Kong
| | - Xiu Juan Zhang
- From the Department of Ophthalmology and Visual Sciences (J.C.Y., Y.J., J.L., S.L., Y.Z., N.Y., Y.M.W., K.W.K., H.-N.C., X.J.Z., A.L.Y., C.C.T., C.Y.C., W.K.C., C.P.P., L.J.C.), The Chinese University of Hong Kong, Hong Kong
| | - Alvin L Young
- From the Department of Ophthalmology and Visual Sciences (J.C.Y., Y.J., J.L., S.L., Y.Z., N.Y., Y.M.W., K.W.K., H.-N.C., X.J.Z., A.L.Y., C.C.T., C.Y.C., W.K.C., C.P.P., L.J.C.), The Chinese University of Hong Kong, Hong Kong;; Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, (J.C.Y., K.W.K., A.L.Y.,C.C.T., L.J.C.), Hong Kong
| | - Clement C Tham
- From the Department of Ophthalmology and Visual Sciences (J.C.Y., Y.J., J.L., S.L., Y.Z., N.Y., Y.M.W., K.W.K., H.-N.C., X.J.Z., A.L.Y., C.C.T., C.Y.C., W.K.C., C.P.P., L.J.C.), The Chinese University of Hong Kong, Hong Kong;; Hong Kong Eye Hospital, (J.C.Y., C.C.T.), Hong Kong; Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, (J.C.Y., K.W.K., A.L.Y.,C.C.T., L.J.C.), Hong Kong; Hong Kong Hub of Paediatric Excellence (J.C.Y., C.C.T., W.K.C., C.P.P., L.J.C.), The Chinese University of Hong Kong
| | - Carol Y Cheung
- From the Department of Ophthalmology and Visual Sciences (J.C.Y., Y.J., J.L., S.L., Y.Z., N.Y., Y.M.W., K.W.K., H.-N.C., X.J.Z., A.L.Y., C.C.T., C.Y.C., W.K.C., C.P.P., L.J.C.), The Chinese University of Hong Kong, Hong Kong
| | - Wai Kit Chu
- From the Department of Ophthalmology and Visual Sciences (J.C.Y., Y.J., J.L., S.L., Y.Z., N.Y., Y.M.W., K.W.K., H.-N.C., X.J.Z., A.L.Y., C.C.T., C.Y.C., W.K.C., C.P.P., L.J.C.), The Chinese University of Hong Kong, Hong Kong;; Hong Kong Hub of Paediatric Excellence (J.C.Y., C.C.T., W.K.C., C.P.P., L.J.C.), The Chinese University of Hong Kong
| | - Chi Pui Pang
- From the Department of Ophthalmology and Visual Sciences (J.C.Y., Y.J., J.L., S.L., Y.Z., N.Y., Y.M.W., K.W.K., H.-N.C., X.J.Z., A.L.Y., C.C.T., C.Y.C., W.K.C., C.P.P., L.J.C.), The Chinese University of Hong Kong, Hong Kong;; Hong Kong Hub of Paediatric Excellence (J.C.Y., C.C.T., W.K.C., C.P.P., L.J.C.), The Chinese University of Hong Kong
| | - Li Jia Chen
- From the Department of Ophthalmology and Visual Sciences (J.C.Y., Y.J., J.L., S.L., Y.Z., N.Y., Y.M.W., K.W.K., H.-N.C., X.J.Z., A.L.Y., C.C.T., C.Y.C., W.K.C., C.P.P., L.J.C.), The Chinese University of Hong Kong, Hong Kong;; Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, (J.C.Y., K.W.K., A.L.Y.,C.C.T., L.J.C.), Hong Kong; Hong Kong Hub of Paediatric Excellence (J.C.Y., C.C.T., W.K.C., C.P.P., L.J.C.), The Chinese University of Hong Kong
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Erdinest N, London N, Levinger N, Lavy I, Pras E, Morad Y. Treatment of Rapid Progression of Myopia: Case Series and Literature Review. Case Rep Ophthalmol 2021; 12:875-881. [PMID: 34950014 PMCID: PMC8647107 DOI: 10.1159/000519629] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 09/09/2021] [Indexed: 11/24/2022] Open
Abstract
This retrospective case series demonstrates the combination of 0.05% atropine with MiSight<sup>®</sup> 1 day (Cooper vision, Sar Ramon, CA, USA) in rapid progression of myopia of 4 children. MiSight<sup>®</sup> 1 day is a peripheral defocus, center-distance soft contact lens and is effective at controlling moderate progression of myopia during the course of 1 year. The current case series included 2 females and 2 males with an average age of 9.68 ± 0.26 years and an average axial length of 24.81 ± 0.92 mm. Their myopic progression during the previous year was −1.45 ± 0.27 D. The children had not attempted any myopia control thus far. This relatively high increase prompted a combination treatment of daily instillation of 0.05% atropine and MiSight, a daily replacement soft contact lens. Cycloplegic refraction and a slit-lamp evaluation were performed every 6 months to confirm no adverse reactions or staining was present. The 8-item contact lens dry eye questionnaire (CLDEQ-8) score of these children was 10.66 ± 1.52. The average myopia progression at the end of 1 year decreased to −0.41 ± 0.11 D, and the average axial length increase was 0.28 ± 0.08 mm. To the best of the authors' knowledge, this is the first published study showing a combination of 0.05% atropine and peripheral defocus soft contact lenses indicating efficacy at controlling moderate myopia progression.
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Affiliation(s)
- Nir Erdinest
- Department of Ophthalmology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.,The Myopia Center, Rishon LeZion, Israel
| | | | - Nadav Levinger
- Department of Ophthalmology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.,Department of Opthalmology, Enaim Refractive Surgery Center, Jerusalem, Israel
| | - Itay Lavy
- Department of Ophthalmology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Eran Pras
- Department of Ophthalmology, Assaf Harofeh Medical Center, Zerifin, Israel
| | - Yair Morad
- The Myopia Center, Rishon LeZion, Israel.,Department of Ophthalmology, Assaf Harofeh Medical Center, Zerifin, Israel
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Three-Year Clinical Trial of Low-Concentration Atropine for Myopia Progression Study: Continued Versus Washout: Phase 3 Report. Ophthalmology 2021; 129:308-321. [PMID: 34627809 DOI: 10.1016/j.ophtha.2021.10.002] [Citation(s) in RCA: 86] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 09/29/2021] [Accepted: 10/01/2021] [Indexed: 12/16/2022] Open
Abstract
PURPOSE (1) To compare the efficacy of continued and stopping treatment for 0.05%, 0.025%, and 0.01% atropine during the third year. (2) To evaluate the efficacy of continued treatment over 3 years. (3) To investigate the rebound phenomenon and its determinants after cessation of treatment. DESIGN A randomized, double-masked extended trial. PARTICIPANTS A total of 350 of 438 children aged 4 to 12 years originally recruited into the Low-Concentration Atropine for Myopia Progression (LAMP) study. METHODS At the beginning of the third year, children in each group were randomized at a 1:1 ratio to continued treatment and washout subgroups. Cycloplegic spherical equivalent (SE) refraction and axial length (AL) were measured at 4-month intervals. MAIN OUTCOME MEASURES Changes in SE and AL between groups. RESULTS A total of 326 children completed 3 years of follow-up. During the third year, SE progression and AL elongation were faster in the washout subgroups than in the continued treatment groups across all concentrations: -0.68 ± 0.49 diopters (D) versus -0.28 ± 0.42 D (P < 0.001) and 0.33 ± 0.17 mm versus 0.17 ± 0.14 mm (P < 0.001) for the 0.05%; -0.57 ± 0.38 D versus -0.35 ± 0.37 D (P = 0.004) and 0.29 ± 0.14 mm versus 0.20 ± 0.15 mm (P = 0.001) for the 0.025%; -0.56 ± 0.40 D versus -0.38 ± 0.49 D (P = 0.04) and 0.29 ± 0.15 mm versus 0.24 ± 0.18 mm (P = 0.13) for the 0.01%. Over the 3-year period, SE progressions were -0.73 ± 1.04 D, -1.31 ± 0.92 D, and -1.60 ± 1.32 D (P = 0.001) for the 0.05%, 0.025%, and 0.01% groups in the continued treatment subgroups, respectively, and -1.15 ± 1.13 D, -1.47 ± 0.77 D, and -1.81 ± 1.10 D (P = 0.03), respectively, in the washout subgroup. The respective AL elongations were 0.50 ± 0.40 mm, 0.74 ± 0.41 mm, and 0.89 ± 0.53 mm (P < 0.001) for the continued treatment subgroups and 0.70 ± 0.47 mm, 0.82 ± 0.37 mm, and 0.98 ± 0.48 mm (P = 0.04) for the washout subgroup. The rebound SE progressions during washout were concentration dependent, but their differences were clinically small (P = 0.15). Older age and lower concentration were associated with smaller rebound effects in both SE progression (P < 0.001) and AL elongation (P < 0.001). CONCLUSIONS During the third year, continued atropine treatment achieved a better effect across all concentrations compared with the washout regimen. 0.05% atropine remained the optimal concentration over 3 years in Chinese children. The differences in rebound effects were clinically small across all 3 studied atropine concentrations. Stopping treatment at an older age and lower concentration are associated with a smaller rebound.
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Stepwise low concentration atropine for myopic control: a 10-year cohort study. Sci Rep 2021; 11:17344. [PMID: 34462467 PMCID: PMC8405709 DOI: 10.1038/s41598-021-96698-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 06/14/2021] [Indexed: 01/03/2023] Open
Abstract
The aim of this study was to analyze changes in refraction and evaluate the variables in school children who received atropine as myopic control for 10 years. Low-concentration atropine (0.05%) was prescribed initially, and the dose was increased in a stepwise manner if rapid myopic progression (≥ 0.5D per half year) was noted during the regular follow-up visit. 23 children with a mean age of 6.96 ± 1.07 years were included. The initial spherical equivalent was − 1.25 ± 0.84 D. The overall mean myopic progression was − 0.30 ± 0.27 D/year. Younger initial age, female, higher initial spherical equivalent and the need of higher concentration of atropine were found to be risk factors for myopic progression in multivariate mixed-effect analysis (p = 0.013, 0.017, 0.024 and 0.014). Children who kept using a lower concentration of atropine (≤ 0.1%) tended to have slower myopic progression throughout the 10-year course than those who shifted to higher concentrations (> 0.1%) (p ≤ 0.001). Stepwise low concentration of atropine might be effective for long-term myopic control in school students. Those who had poor response to lower concentration of atropine may have the risk of faster progression, even with high concentration of atropine. Additional or alternative treatment might be considered.
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Zhang XJ, Wang YM, Pang CP, Yam JC. Re: Saxena et al.: Atropine for treatment of childhood myopia in India: multicentric randomized trial (Ophthalmology. 2021;128:1367-1369). Ophthalmology 2021; 128:e214-e215. [PMID: 34452762 DOI: 10.1016/j.ophtha.2021.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 08/03/2021] [Indexed: 11/18/2022] Open
Affiliation(s)
- Xiu Juan Zhang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yu Meng Wang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Chi Pui Pang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Jason C Yam
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China.
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Saxena R, Dhiman R, Gupta V, Phuljhele S. Reply. Ophthalmology 2021; 128:e215-e217. [PMID: 34446302 DOI: 10.1016/j.ophtha.2021.07.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 07/09/2021] [Indexed: 12/30/2022] Open
Affiliation(s)
- Rohit Saxena
- Pediatric Ophthalmology and Strabismus Services, Dr. R. P. Centre for Ophthalmic Sciences, AIIMS, New Delhi, India.
| | - Rebika Dhiman
- Pediatric Ophthalmology and Strabismus Services, Dr. R. P. Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Vinay Gupta
- Pediatric Ophthalmology and Strabismus Services, Dr. R. P. Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Swati Phuljhele
- Pediatric Ophthalmology and Strabismus Services, Dr. R. P. Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
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Rose LVT, Schulz AM, Graham SL. Use baseline axial length measurements in myopic patients to predict the control of myopia with and without atropine 0.01. PLoS One 2021; 16:e0254061. [PMID: 34264970 PMCID: PMC8282033 DOI: 10.1371/journal.pone.0254061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 06/20/2021] [Indexed: 12/15/2022] Open
Abstract
PURPOSE Identifying axial length growth rate as an indicator of fast progression before initiating atropine 0.01% for myopia progression in children. METHOD From baseline, axial length growth over six months was measured prospectively. Subjects were then initiated on atropine 0.01% if axial length growth was greater than 0.1mm per 6 months (fast progressors), axial length and spherical equivalent change measurements recorded every six months. The rate of change was compared to the baseline pre-treatment rate. If axial length change was below the threshold, subjects received monitoring only. RESULTS 73 subjects were identified as fast progressors and commenced atropine 0.01%, (mean baseline refraction of OD -2.9±1.6, OS -2.9±1.8 and a mean baseline axial length OD 24.62 ± 1.00 mm, OS 24.53 ± 0.99 mm). At six months, the mean paired difference of axial length growth rate was significantly reduced by 50% of baseline (all 73 subjects, p<0.05). 53 subjects followed to 12 months, and 12 to 24 months maintained a reduced growth rate. Change in mean spherical equivalent was significantly reduced compared to pre-treatment refractive error (mean paired difference p<0.05) and at each subsequent visit. 91 children were slow progressors and remained untreated. Their axial length growth rate did not change significantly out to 24 months. Spherical equivalent changed less than -0.5D annually in this group. CONCLUSION Identifying fast progressors before treatment initiation demonstrated a strong treatment effect with atropine 0.01% reducing their individual rate of myopia progression by 50%. Another large group of myopic children, slow progressors, continued without medical intervention. A baseline axial length growth rate is proposed as a guideline to identify fast progressors who are more likely to benefit from atropine 0.01%.
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Affiliation(s)
- Loreto V. T. Rose
- Faculty of Medicine and Health Sciences, Macquarie University, Macquarie Park NSW, Australia
| | - Angela M. Schulz
- Faculty of Medicine and Health Sciences, Macquarie University, Macquarie Park NSW, Australia
| | - Stuart L. Graham
- Faculty of Medicine and Health Sciences, Macquarie University, Macquarie Park NSW, Australia
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Kaymak H, Graff B, Schaeffel F, Langenbucher A, Seitz B, Schwahn H. A retrospective analysis of the therapeutic effects of 0.01% atropine on axial length growth in children in a real-life clinical setting. Graefes Arch Clin Exp Ophthalmol 2021; 259:3083-3092. [PMID: 34142186 PMCID: PMC8478763 DOI: 10.1007/s00417-021-05254-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 05/06/2021] [Accepted: 05/22/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Several randomized controlled studies have demonstrated the beneficial effects of 0.01% atropine eye drops on myopia progression in children. However, treatment effects may be different in a routine clinical setting. We performed a retrospective analysis of our clinical data from children to investigate the effect of 0.01% atropine eye drops on myopia progression in a routine clinical setting. METHODS Atropine-treated children were asked to instill one drop of 0.01% atropine in each eye every evening at 5 days a week. Myopic children who did not undergo atropine treatment served as controls. Objective refraction and ocular biometry of 80 atropine-treated and 103 untreated children at initial visit and 1 year later were retrospectively analyzed. RESULTS Myopic refractions in the treated and untreated children at initial visit ranged from -0.625 to -15.25 D (-4.21 ± 2.90 D) and from -0.125 to -9.375 D (-2.92 ± 1.77 D), respectively. Ages at initial visit ranged from 3.2 to 15.5 years (10.1 ± 2.7 years) in the treated and from 3.4 to 15.5 years (11.2 ± 3.0 years) in untreated children. Two-factor ANOVA for age and atropine effects on axial length growth confirmed that axial length growth rates declined with age (p<0.0001) and revealed a significant inhibitory effect of atropine on axial length growth (p<0.0015). The atropine effect on axial length growth averaged to 0.08 mm (28%) inhibition per year. Effects on refraction were not statistically significant. CONCLUSION The observed atropine effects were not very distinctive: Statistical analysis confirmed that atropine reduced axial length growth, but to an extent of minor clinical relevance. It was also shown that beneficial effects of 0.01% atropine may not be obvious in each single case, which should be communicated with parents and resident ophthalmologists.
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Affiliation(s)
- Hakan Kaymak
- Internationale Innovative Ophthalmochirurgie GbR c/o Breyer Kaymak and Klabe Augenchirurgie, Duesseldorf, Germany. .,Institute of Experimental Ophthalmology, Saarland University, Homburg, Germany.
| | - Birte Graff
- Internationale Innovative Ophthalmochirurgie GbR c/o Breyer Kaymak and Klabe Augenchirurgie, Duesseldorf, Germany.,Institute of Experimental Ophthalmology, Saarland University, Homburg, Germany
| | - Frank Schaeffel
- Section of Neurobiology of the Eye, Ophthalmic Research Institute, University of Tuebingen, Tuebingen, Germany
| | - Achim Langenbucher
- Institute of Experimental Ophthalmology, Saarland University, Homburg, Germany
| | - Berthold Seitz
- Department of Ophthalmology, Saarland University Medical Center UKS, Homburg, Germany
| | - Hartmut Schwahn
- Internationale Innovative Ophthalmochirurgie GbR c/o Breyer Kaymak and Klabe Augenchirurgie, Duesseldorf, Germany
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Zhang XJ, Zhang Y, Yip BHK, Yam JC. Reply. Ophthalmology 2021; 128:e72. [PMID: 34148679 DOI: 10.1016/j.ophtha.2021.05.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 05/21/2021] [Accepted: 05/21/2021] [Indexed: 11/16/2022] Open
Affiliation(s)
- Xiu Juan Zhang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yuzhou Zhang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Benjamin Hon Kei Yip
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong
| | - Jason C Yam
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China.
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