Spherical Soft Contact Lens Designs and Peripheral Defocus in Myopic Eyes

Impact of Peripheral Refractive Errors in Mobility Performance

Purpose

The purpose of this study was to investigate the functional effects of peripheral refractive errors on mobility performance through a stair negotiation task.

Methods

Twenty-one young, normal sighted subjects navigated through an obstacle with steps, wearing spectacles that altered only their peripheral refraction. Lenses were used to induce positive defocus (+2 diopters [D] and +4 D), negative defocus (-2 D and -4 D), or astigmatism (+1.75 D and -3.75 D, axis 45 degrees) in the periphery. Feet trajectories were analyzed, and several gait assessment parameters were obtained. Statistical tests were conducted to determine significant performance differences between the lenses. Peripheral refraction in each subject was measured using a scanning Hartmann-Shack wavefront sensor to assess the impact of intrinsic peripheral refraction on the experiment.

Results

Statistically significant differences in performance appeared when peripheral errors were superimposed. Crossing time with respect to plano lenses increased by 6.2%, 7.6%, 19.2%, and 29.6% for the -2 D, +2 D, -4 D, and +4 D lenses, respectively (P < 0.05 in the last 3 cases). Subjects exhibited slower walking speeds, increased step count, and adopted precautionary measures. High-power positive defocus lenses had the biggest impact on performance, and differences were observed in distance to steps between induced positive and negative defocus.

Conclusions

In this laboratory-based study without an adaptation period, peripheral refractive errors affected stair negotiation, causing cautious behavior in subjects. Performance differences among types of peripheral defocus may result from magnification effects and intrinsic peripheral refraction. These results highlight the importance of understanding the effects of induced peripheral errors by myopia control and intraocular lenses.

Binocular balance across spatial frequency in anisomyopia

Purpose

Anisomyopia is prevalent in myopia and studies have reported it exhibits impaired binocular function. We investigated the binocular balance across spatial frequency in adults with anisomyopia and compared it to in individuals with less differences in refractive error, and examined whether ocular characteristics can predict binocular balance in anisomyopia.

Methods

Fifteen anisomyopes, 15 isomyopes and 12 emmetropes were recruited. Binocular balance was quantitatively measured at 0.5, 1, 2 and 4 c/d. The first two groups of the observers were tested with and without optical correction with contact lenses. Emmetropes were tested without optical correction.

Results

Binocular balance across spatial frequency in optically corrected anisomyopes and isomyopes, as well as emmetropes were found to be similar. Their binocular balance nevertheless still got worse as a function of spatial frequency. However, before optical correction, anisomyopes but not isomyopes showed significant imbalance at higher spatial frequencies. There was a significant correlation between the dependence on spatial frequency of binocular imbalance in uncorrected anisomyopia and interocular difference in visual acuity, and between the dependence and interocular difference in spherical equivalent refraction.

Conclusion

Anisomyopes had intact binocular balance following correction across spatial frequency compared to those in isomyopes and emmetropes. Their balance was weakly correlated with their refractive status after optical correction. However, their binocular balance before correction and binocular improvement following optical correction were strongly correlated with differences in ocular characteristics between eyes.

Peripheral Defocus, Pupil Size, and Axial Eye Growth in Children Wearing Soft Multifocal Contact Lenses in the BLINK Study

Purpose

The purpose of this study was to evaluate the relationship between peripheral defocus and pupil size on axial growth in children randomly assigned to wear either single vision contact lenses, +1.50 diopter (D), or +2.50 D addition multifocal contact lenses (MFCLs).

Methods

Children 7 to 11 years old with myopia (-0.75 to -5.00 D; spherical component) and ≤1.00 D astigmatism were enrolled. Autorefraction (horizontal meridian; right eye) was measured annually wearing contact lenses centrally and ±20 degrees, ±30 degrees, and ±40 degrees from the line of sight at near and distance. Photopic and mesopic pupil size were measured. The effects of peripheral defocus, treatment group, and pupil size on the 3-year change in axial length were modeled using multiple variables that evaluated defocus across the retina.

Results

Although several peripheral defocus variables were associated with slower axial growth with MFCLs, they were either no longer significant or not meaningfully associated with eye growth after the treatment group was included in the model. The treatment group assignment better explained the slower eye growth with +2.50 MFCLs than peripheral defocus. Photopic and mesopic pupil size did not modify eye growth with the +2.50 MFCL (all P ≥ 0.37).

Conclusions

The optical signal causing slower axial elongation with +2.50 MFCLs is better explained by the lens type worn than by peripheral defocus. The signal might be something other than peripheral defocus, or there is not a linear dose-response relationship within treatment groups. We found no evidence to support pupil size as a criterion when deciding which myopic children to treat with MFCLs.

Quality of life after wearing multifocal contact lenses for myopia control for 2 weeks in the BLINK Study

PURPOSE

To validate Pediatric Refractive Error Profile 2 (PREP2) subscales that can be used to evaluate contact lens wearers and compare vision-specific quality of life measurements between children wearing multifocal and single vision contact lenses for 2 weeks.

METHODS

Two hundred and ninety-four myopic children aged 7-11 years (inclusive) were enrolled in the 3-year, double-masked Bifocal Lenses In Nearsighted Kids (BLINK) Study. Participants completed the PREP2 survey after having worn contact lenses for 2 weeks. The Vision, Symptoms, Activities and Overall PREP2 subscales were used to compare participants' subjective assessment while wearing +1.50 or +2.50 D add multifocal or single vision contact lenses. Rasch analysis was used to validate each subscale and to compare participants' subjective assessment of contact lens wear.

RESULTS

Item fit to the Rasch model was good for all scales, with no individual items having infit mean square statistics outside the recommended range (0.7-1.3). Response category function was acceptable for all subscales, with ordered category thresholds. Measurement precision, assessed by the Rasch person reliability statistic, was less than ideal (≥0.8) for three of the subscales, but met the minimum acceptable standard of 0.5. Scores for the Vision subscale differed by treatment assignment (p = 0.03), indicating that participants with the highest add power reported statistically worse quality of vision, although the difference was only 3.9 units on a scale of 1-100. Girls reported fewer symptoms than boys (p = 0.006), but there were no other differences between boys and girls.

CONCLUSIONS

Rasch analysis demonstrates that the PREP2 survey is a valid instrument for assessing refractive error-specific quality of life. These results suggest that vision-related quality of life is not meaningfully affected by 2 weeks of soft multifocal contact lens wear for myopia control.

Peripheral Defocus and Myopia Management: A Mini-Review

Myopia is the most common refractive error in the world, and its' prevalence continually increases. The potential pathological and visual complications of progressive myopia have inspired researchers to study the sources of myopia, axial elongation, and explore modalities to arrest progression. Considerable attention has been given over the past few years to the myopia risk factor known as hyperopic peripheral blur, the focus of this review. The primary theories currently believed to be the cause of myopia, the parameters considered to contribute and influence the effect of peripheral blur, such as the surface retinal area or depth of blur will be discussed. The currently available optical devices designed to provide peripheral myopic defocus will be discussed, including bifocal and progressive addition ophthalmic lenses, peripheral defocus single vision ophthalmic lenses, orthokeratology lenses, and bifocal or multifocal center distance soft lenses, as well as their effectivity as mentioned in the literature to date.

The role of peripheral ocular length and peripheral corneal radius of curvature in determining refractive error

PURPOSE

The purpose of this study was to extend the knowledge of peripheral biometric component and its relationship to refractive status in healthy individuals by determining the correlation between peripheral ocular length to peripheral corneal radius ratio and the refractive error.

METHODS

This prospective study was conducted on thirty-three healthy adult participants. Refractive error was assessed objectively and subjectively and recorded as the mean spherical equivalent. Central and peripheral ocular lengths at 30° were assessed using partial coherence interferometry under dilation with 1% tropicamide. Central and peripheral corneal radius of curvature was assessed using Scheimpflug topography. Peripheral ocular lengths at 30° were paired with peripheral corneal curvatures at the incident points of the IOLMaster beam (3.8mm away from corneal apex) superiorly, inferiorly, temporally and nasally to calculate the peripheral ocular length-peripheral corneal radius ratio. Descriptive statistics were used to describe the distribution and spread of the data. Pearson's correlation analysis was used to present the association between biometric and refractive variables.

RESULTS

Refractive error was negatively correlated with the axial length-central corneal radius ratio (r=-0.91; p<0.001) and with 30° peripheral ocular length-peripheral corneal radius ratio in all four meridians (r≤-0.76; p<0.001). The strength of the correlation was considerably lower when only axial length or peripheral ocular lengths were used.

CONCLUSION

Using the ratios of peripheral ocular length-peripheral corneal radius to predict refractive error is more effective than using peripheral corneal radius or peripheral ocular length alone.

A Clinical Study of the Impact of Soft Contact Lenses on the Progression of Myopia in Young Patients

PURPOSE

To assess the impact of soft contact lenses on the progression of myopia in young patients.

PATIENTS AND METHODS

The observational study included 102 patients divided into 3 groups: MFCL (multifocal contact lenses) group: 15 girls and 9 boys, aged 8-20 (= 14.12 ± 2.863) with soft multifocal contact lenses with myopia: = -3.12 D ± 1.776 D and mean myopia progression -0.23 ± 0.233D after 2 years; SVCL (single vision contact lenses) group: 30 girls and 5 boys, 11-20 years old (=15.5 ± 2.24) with myopia = -2.88 ± 2.122 D at admission and mean myopia progression -0.54 ± 0.464 D after 2 years; the spectacle (single vision glasses) group: 25 girls and 18 boys, aged 8-18 years ( = 13.65 ± 2.448) with single vision glasses with myopia: = -1.74 ± 1.412 D at admission and mean myopia progression -0.86 ± 0.489D after 2 years. Medical history and physical examination were performed every 6, 12, 18 and 24 months. Refractive error was examined using the autorefractometry after cycloplegia.

RESULTS

The analysis of myopia correction after 2 years showed differences between MFCL and spectacle correction. The change in myopia progression after 2 years was statistically significant for MFCL vs SVCL and MFCL vs spectacle correction when the myopia occured before the period of intensive growth. When myopia occurred during the period of intensive growth, difference was noted for MFCL vs spectacle correction and SVCL vs spectacle correction. When myopia occurred after a period of intensive growth, no significant differences between the groups were observed.

CONCLUSION

1) Multifocal contact lenses and some single vision contact lenses (Biofinity) may be useful in the control of myopia in younger patients, slowing the progression of nearsightedness; therefore, they can be a therapeutic option in inhibiting the progression of myopia. 2) The best effects of using multifocal contact lenses occur if myopia is diagnosed before the period of intensive growth.

Axial length growth difference between eyes after monocular laser refractive surgery: eight patients who underwent myopic laser ablation for both eyes at intervals of several years

Background

Myopia is a global public health issue. Controlling myopia progression is a primary focus of myopia studies today. Peripheral retinal myopic defocus is considered the mechanism for reduced myopia progression in orthokeratology studies. The topographic change in the front corneal surface after laser refractive surgery and orthokeratology procedures may appear similar. The purpose of this study was to explore the role of myopic laser ablation on axial length (AL) growth.

Methods

Myopic patients who underwent monocular excimer laser refractive surgery first in one eye and then in another eye several years later because of myopia occurrence or myopia progression were recruited. The axial length elongation and refraction (spherical equivalent) between the two eyes were observed and compared.

Results

A total of 8 myopic patients were enrolled in the study. The AL increased from 24.52 ± 0.96 mm to 24.68 ± 1.03 mm but without significance (T = 1.49, P > 0.05) in the ablated eyes. The AL increased significantly from 23.73 ± 0.91 mm to 24.26 ± 0.95 mm in the nonablated eyes (T = 6.76, P < 0.001). The AL elongation of the ablated eyes with 0.16 ± 0.30 mm growth was significantly lower than that of the nonablated eyes with 0.53 ± 0.32 mm growth (T = 8.98, P < 0.001). The spherical equivalent (SE) increased significantly in the ablated eyes (− 0.59 ± 0.21 (D), T = 6.36, P < 0.001) and in the nonablated eyes (− 0.97 ± 0.55 (D), T = 4.91, P < 0.01), and the difference between the two eyes was significant (T = 3.05, P < 0.05).

Conclusions

The inhibitory effect of myopic laser ablation on AL elongation reported in the limited case studies argues for animal research on its efficacy as a new intervention for myopia progression.

Novel application of multispectral refraction topography in the observation of myopic control effect by orthokeratology lens in adolescents

BACKGROUND

Myopia, as one of the common ocular diseases, often occurs in adolescence. In addition to the harm from itself, it may also lead to serious complications. Thus, prevention and control of myopia are attracting more and more attention. Previous research revealed that single-focal glasses and orthokeratology lenses (OK lenses) played an important part in slowing down myopia and preventing high myopia.

AIM

To compare the clinical effects of OK lenses and frame glasses against the increase of diopter in adolescent myopia and further explore the mechanism of the OK lens.

METHODS

Changes in diopter and axial length were collected among 70 adolescent myopia patients (124 eyes) wearing OK lenses for 1 year (group A) and 59 adolescent myopia patients (113 eyes) wearing frame glasses (group B). Refractive states of their retina were inspected through multispectral refraction topography. The obtained hyperopic defocus was analyzed for the mechanism of OK lenses on slowing down the increase of myopic diopter by delaying the increase of ocular axis length and reducing the near hyperopia defocus.

RESULTS

Teenagers in groups A and B were divided into low myopia (0D - -3.00 D) and moderate myopia (-3.25D - -6.00 D), without statistical differences among gender and age. After 1-year treatment, the increase of diopter and axis length and changes of retinal hyperopic defocus amount of group A were significantly less than those of group B. According to the multiple linear analysis, the retinal defocus in the upper, lower, nasal, and temporal directions had almost the same effect on the total defocus. The amount of peripheral retinal defocus (15°-53°) in group A was significantly lower than that in group B.

CONCLUSION

Multispectral refraction topography is progressive and instructive in clinical prevention and control of myopia.

Dietary ω-3 polyunsaturated fatty acids are protective for myopia

Myopia is a leading cause of visual impairment and blindness worldwide. However, a safe and accessible approach for myopia control and prevention is currently unavailable. Here, we investigated the therapeutic effect of dietary supplements of omega-3 polyunsaturated fatty acids (ω-3 PUFAs) on myopia progression in animal models and on decreases in choroidal blood perfusion (ChBP) caused by near work, a risk factor for myopia in young adults. We demonstrated that daily gavage of ω-3 PUFAs (300 mg docosahexaenoic acid [DHA] plus 60 mg eicosapentaenoic acid [EPA]) significantly attenuated the development of form deprivation myopia in guinea pigs and mice, as well as of lens-induced myopia in guinea pigs. Peribulbar injections of DHA also inhibited myopia progression in form-deprived guinea pigs. The suppression of myopia in guinea pigs was accompanied by inhibition of the "ChBP reduction-scleral hypoxia cascade." Additionally, treatment with DHA or EPA antagonized hypoxia-induced myofibroblast transdifferentiation in cultured human scleral fibroblasts. In human subjects, oral administration of ω-3 PUFAs partially alleviated the near-work-induced decreases in ChBP. Therefore, evidence from these animal and human studies suggests ω-3 PUFAs are potential and readily available candidates for myopia control.

Alterations in peripheral refraction with spectacles, soft contact lenses and orthokeratology during near viewing: implications for myopia control

CLINICAL RELEVANCE

The peripheral refraction profile in myopes with different corrective modalities varies significantly for both distance and near viewing and will have implications in managing myopia.

BACKGROUND

This study investigated how the magnitude of peripheral myopic defocus induced by Ortho-K varies with and without accommodation, and how this compares to single vision spectacles and soft-contact-lenses (SCL).

METHODS

Relative peripheral refraction (RPR) of 18 young adults (spherical equivalent -1.00 D to -4.50 D) was determined along the horizontal meridian (±10°, ±20°, ±25°) during distance (3-metres) and near viewing (0.2-metres), and along vertical meridian (±10°, ±15°) for distance viewing alone. Measurements were obtained in an uncorrected state and with single vision spectacles, soft contact lens and Ortho-K. Changes in RPR and astigmatic components were compared between distance and near viewing with all different modalities.

RESULTS

A significant interaction (p = 0.02) between relative peripheral refraction and the target distance (distance and near viewing) was found among different refractive modalities. Single overnight Ortho-K lens wear alone led to relative peripheral myopia for both distance (mean RPR ± SE: -0.92 ± 0.21D and -1.04 ± 0.22D) and near viewing (-0.71 ± 0.17D and -0.76 ± 0.20D). Comparisons of relative peripheral refraction between different corrective modalities at each eccentricity indicated statistical significance of RPR at extreme locations along both temporal and nasal meridian (±20 and ±25°, p < 0.05). RPR with soft contact lenses and spectacles were similar for both distance and near viewing (p > 0.05).

CONCLUSION

Single overnight Ortho-K lens wear alone shifted the RPR in the myopic direction for both distance and near viewing in comparison with single vision spectacles and soft contact lenses. The Ortho-K lens designs that offer a large amount of mid-peripheral corneal steeping, in-turn leading to high relative peripheral myopia for both distance and near viewing and might offer beneficial effects on myopia control.

The Effects of Center-near and Center-distance Multifocal Contact Lenses on Peripheral Defocus and Visual Acuity

SIGNIFICANCE

Multifocal contact lenses (MFCLs) are being used clinically for myopia control. Center-distance designs caused myopic changes in defocus across the retina that varied by lens design, whereas the center-near design caused peripheral hyperopic changes. Multifocal lenses caused reductions in low-contrast vision that varied by lens design, affecting visual performance.

PURPOSE

The purpose of this study was to compare changes in defocus with four MFCLs, three center-distance and one center-near.

METHODS

Two cohorts of 25 nonpresbyopic myopic adults were enrolled. The first cohort was fitted with Proclear D and Biofinity D MFCL (center-distance, +2.50 D add), and the second cohort was fitted with NaturalVue MFCL (center-distance) and Clariti 1-Day MFCL (center-near, high add), both in random order. Overrefraction was performed to maximize visual acuity. Cycloplegic autorefraction was performed with each lens and without a lens along the line of sight and at nasal and temporal retinal locations out to 40°. Data were analyzed with repeated-measures ANOVAs with post hoc t tests, when indicated.

RESULTS

Changes in defocus at each location differed between MFCL designs (lens by location; both, P < .001). Clariti 1-Day caused peripheral hyperopic retinal changes (40 and 30° nasal, and 20, 30, and 40° temporal; all, P < .05). NaturalVue MFCL caused myopic changes centrally and hyperopic changes at 40° nasal and 30° temporal (all, P < .05). The remaining center-distance designs caused myopic changes at multiple locations (all, P < .05).

CONCLUSIONS

After overrefraction, the center-near MFCL design caused hyperopic defocus at multiple peripheral locations, which is not hypothesized to slow myopia progression. NaturalVue MFCL caused myopic changes in defocus centrally but hyperopic changes in the far periphery. Biofinity D and Proclear D caused myopic changes in retinal defocus. Further work is warranted to determine whether defocus profile differences between the center-distance designs influence any slowing of myopia progression.

Is Peripheral Motion Detection Affected by Myopia?

Purpose

The current study was to investigate whether myopia affected peripheral motion detection and whether the potential effect interacted with spatial frequency, motion speed, or eccentricity.

Methods

Seventeen young adults aged 22–26 years participated in the study. They were six low to medium myopes [spherical equivalent refractions −1.0 to −5.0 D (diopter)], five high myopes (<-5.5 D) and six emmetropes (+0.5 to −0.5 D). All myopes were corrected by self-prepared, habitual soft contact lenses. A four-alternative forced-choice task in which the subject was to determine the location of the phase-shifting Gabor from the four quadrants (superior, inferior, nasal, and temporal) of the visual field, was employed. The experiment was blocked by eccentricity (20° and 27°), spatial frequency (0.6, 1.2, 2.4, and 4.0 cycles per degree (c/d) for 20° eccentricity, and 0.6, 1.2, 2.0, and 3.2 c/d for 27° eccentricity), as well as the motion speed [2 and 6 degree per second (d/s)].

Results

Mixed-model analysis of variances showed no significant difference in the thresholds of peripheral motion detection between three refractive groups at either 20° (F[2,14] = 0.145, p = 0.866) or 27° (F[2,14] = 0.475, p = 0.632). At 20°, lower motion detection thresholds were associated with higher myopia (p < 0.05) mostly for low spatial frequency and high-speed targets in the nasal and superior quadrants, and for high spatial frequency and high-speed targets in the temporal quadrant in myopic viewers. Whereas at 27°, no significant correlation was found between the spherical equivalent and the peripheral motion detection threshold under all conditions (all p > 0.1). Spatial frequency, speed, and quadrant of the visual field all showed significant effect on the peripheral motion detection threshold.

Conclusion

There was no significant difference between the three refractive groups in peripheral motion detection. However, lower motion detection thresholds were associated with higher myopia, mostly for low spatial frequency targets, at 20° in myopic viewers.

Review on the Myopia Pandemic: Epidemiology, Risk Factors, and Prevention

Nearsightedness, or myopia, is becoming more prevalent worldwide. The eye experiences dynamic growth throughout adolescence, but the etiopathogenesis of myopia progression is not fully understood. Myopia is associated with several pathologic eye conditions, leading to irreversible vision loss. Treatment for preventing myopia progression is reliant on effective screening and initiating treatment early in life. This article will review risk factors for myopia progression and discuss treatment strategies that are most effective in halting its spread.

Interventions to slow progression of myopia in children

BACKGROUND

Nearsightedness (myopia) causes blurry vision when one is looking at distant objects. Interventions to slow the progression of myopia in children include multifocal spectacles, contact lenses, and pharmaceutical agents.

OBJECTIVES

To assess the effects of interventions, including spectacles, contact lenses, and pharmaceutical agents in slowing myopia progression in children.

SEARCH METHODS

We searched CENTRAL; Ovid MEDLINE; Embase.com; PubMed; the LILACS Database; and two trial registrations up to February 2018. A top up search was done in February 2019.

SELECTION CRITERIA

We included randomized controlled trials (RCTs). We excluded studies when most participants were older than 18 years at baseline. We also excluded studies when participants had less than -0.25 diopters (D) spherical equivalent myopia.

DATA COLLECTION AND ANALYSIS

We followed standard Cochrane methods.

MAIN RESULTS

We included 41 studies (6772 participants). Twenty-one studies contributed data to at least one meta-analysis. Interventions included spectacles, contact lenses, pharmaceutical agents, and combination treatments. Most studies were conducted in Asia or in the United States. Except one, all studies included children 18 years or younger. Many studies were at high risk of performance and attrition bias. Spectacle lenses: undercorrection of myopia increased myopia progression slightly in two studies; children whose vision was undercorrected progressed on average -0.15 D (95% confidence interval [CI] -0.29 to 0.00; n = 142; low-certainty evidence) more than those wearing fully corrected single vision lenses (SVLs). In one study, axial length increased 0.05 mm (95% CI -0.01 to 0.11) more in the undercorrected group than in the fully corrected group (n = 94; low-certainty evidence). Multifocal lenses (bifocal spectacles or progressive addition lenses) yielded small effect in slowing myopia progression; children wearing multifocal lenses progressed on average 0.14 D (95% CI 0.08 to 0.21; n = 1463; moderate-certainty evidence) less than children wearing SVLs. In four studies, axial elongation was less for multifocal lens wearers than for SVL wearers (-0.06 mm, 95% CI -0.09 to -0.04; n = 896; moderate-certainty evidence). Three studies evaluating different peripheral plus spectacle lenses versus SVLs reported inconsistent results for refractive error and axial length outcomes (n = 597; low-certainty evidence). Contact lenses: there may be little or no difference between vision of children wearing bifocal soft contact lenses (SCLs) and children wearing single vision SCLs (mean difference (MD) 0.20D, 95% CI -0.06 to 0.47; n = 300; low-certainty evidence). Axial elongation was less for bifocal SCL wearers than for single vision SCL wearers (MD -0.11 mm, 95% CI -0.14 to -0.08; n = 300; low-certainty evidence). Two studies investigating rigid gas permeable contact lenses (RGPCLs) showed inconsistent results in myopia progression; these two studies also found no evidence of difference in axial elongation (MD 0.02mm, 95% CI -0.05 to 0.10; n = 415; very low-certainty evidence). Orthokeratology contact lenses were more effective than SVLs in slowing axial elongation (MD -0.28 mm, 95% CI -0.38 to -0.19; n = 106; moderate-certainty evidence). Two studies comparing spherical aberration SCLs with single vision SCLs reported no difference in myopia progression nor in axial length (n = 209; low-certainty evidence). Pharmaceutical agents: at one year, children receiving atropine eye drops (3 studies; n = 629), pirenzepine gel (2 studies; n = 326), or cyclopentolate eye drops (1 study; n = 64) showed significantly less myopic progression compared with children receiving placebo: MD 1.00 D (95% CI 0.93 to 1.07), 0.31 D (95% CI 0.17 to 0.44), and 0.34 (95% CI 0.08 to 0.60), respectively (moderate-certainty evidence). Axial elongation was less for children treated with atropine (MD -0.35 mm, 95% CI -0.38 to -0.31; n = 502) and pirenzepine (MD -0.13 mm, 95% CI -0.14 to -0.12; n = 326) than for those treated with placebo (moderate-certainty evidence) in two studies. Another study showed favorable results for three different doses of atropine eye drops compared with tropicamide eye drops (MD 0.78 D, 95% CI 0.49 to 1.07 for 0.1% atropine; MD 0.81 D, 95% CI 0.57 to 1.05 for 0.25% atropine; and MD 1.01 D, 95% CI 0.74 to 1.28 for 0.5% atropine; n = 196; low-certainty evidence) but did not report axial length. Systemic 7-methylxanthine had little to no effect on myopic progression (MD 0.07 D, 95% CI -0.09 to 0.24) nor on axial elongation (MD -0.03 mm, 95% CI -0.10 to 0.03) compared with placebo in one study (n = 77; moderate-certainty evidence). One study did not find slowed myopia progression when comparing timolol eye drops with no drops (MD -0.05 D, 95% CI -0.21 to 0.11; n = 95; low-certainty evidence). Combinations of interventions: two studies found that children treated with atropine plus multifocal spectacles progressed 0.78 D (95% CI 0.54 to 1.02) less than children treated with placebo plus SVLs (n = 191; moderate-certainty evidence). One study reported -0.37 mm (95% CI -0.47 to -0.27) axial elongation for atropine and multifocal spectacles when compared with placebo plus SVLs (n = 127; moderate-certainty evidence). Compared with children treated with cyclopentolate plus SVLs, those treated with atropine plus multifocal spectacles progressed 0.36 D less (95% CI 0.11 to 0.61; n = 64; moderate-certainty evidence). Bifocal spectacles showed small or negligible effect compared with SVLs plus timolol drops in one study (MD 0.19 D, 95% CI 0.06 to 0.32; n = 97; moderate-certainty evidence). One study comparing tropicamide plus bifocal spectacles versus SVLs reported no statistically significant differences between groups without quantitative results. No serious adverse events were reported across all interventions. Participants receiving antimuscarinic topical medications were more likely to experience accommodation difficulties (Risk Ratio [RR] 9.05, 95% CI 4.09 to 20.01) and papillae and follicles (RR 3.22, 95% CI 2.11 to 4.90) than participants receiving placebo (n=387; moderate-certainty evidence).

AUTHORS' CONCLUSIONS

Antimuscarinic topical medication is effective in slowing myopia progression in children. Multifocal lenses, either spectacles or contact lenses, may also confer a small benefit. Orthokeratology contact lenses, although not intended to modify refractive error, were more effective than SVLs in slowing axial elongation. We found only low or very low-certainty evidence to support RGPCLs and sperical aberration SCLs.

IMI - Clinical Myopia Control Trials and Instrumentation Report

The evidence-basis based on existing myopia control trials along with the supporting academic literature were reviewed; this informed recommendations on the outcomes suggested from clinical trials aimed at slowing myopia progression to show the effectiveness of treatments and the impact on patients. These outcomes were classified as primary (refractive error and/or axial length), secondary (patient reported outcomes and treatment compliance), and exploratory (peripheral refraction, accommodative changes, ocular alignment, pupil size, outdoor activity/lighting levels, anterior and posterior segment imaging, and tissue biomechanics). The currently available instrumentation, which the literature has shown to best achieve the primary and secondary outcomes, was reviewed and critiqued. Issues relating to study design and patient selection were also identified. These findings and consensus from the International Myopia Institute members led to final recommendations to inform future instrumentation development and to guide clinical trial protocols.