Progressive anisometropia and orthokeratology: a case report

Retinoscopes: Past and present

BACKGROUND

Retinoscopy is arguably the most important method in the eye clinic for diagnosing and managing refractive errors. Advantages of retinoscopy include its non-invasive nature, ability to assess patients of all ages, and usefulness in patients with limited cooperation or communication skills.

AIM

To discuss the history of retinoscopes and examine current literature on the subject.

METHODS

A search was conducted on the PubMed and with the reference citation analysis (https://www.referencecitationanalysis.com) database using the term "Retinoscopy," with a range restricted to the last 10 years (2013-2023). The search string algorithm was: "Retinoscopy" (MeSH Terms) OR "Retinoscopy" (All Fields) OR "Retinoscopes" (All Fields) AND [(All Fields) AND 2013: 2023 (pdat)].

RESULTS

This systematic review included a total of 286 records. Publications reviewed iterations of the retinoscope into autorefractors, infrared photo retinoscope, television retinoscopy, and the Wifi enabled digital retinoscope.

CONCLUSION

The retinoscope has evolved significantly since its discovery, with a significant improvement in its diagnostic capabilities. While it has advantages such as non-invasiveness and broad applicability, limitations exist, and the need for skilled interpretation remains. With ongoing research, including the integration of artificial intelligence, retinoscopy is expected to continue advancing and playing a vital role in eye care.

Efficacy of long-term orthokeratology treatment in children with anisometropic myopia

AIM

To explore the efficacy of the orthokeratology lens for anisometropic myopia progression.

METHODS

A retrospective study was performed. Cycloplegic refraction and axial length (AL) were collected from 50 children (10.52±1.72y) who visited Peking University Third Hospital from July 2015 to August 2020. These children's one eyes (Group A) received monocular orthokeratology lenses at first, after different durations (12.20±6.94mo), their contralateral eyes (Group B) developed myopia and receive orthokeratology as well. The data in 1-year of binocular period were recorded. AL growth rate (difference of follow-up and baseline per month) were compared between two groups by paired t test. Interocular differences of AL were compared by Wilcoxon test.

RESULTS

During monocular period, the AL growth rate of the Group A (0.008±0.022 mm/mo) was significantly slower than that of the Group B (0.038±0.018 mm/mo; P<0.0001). However, during binocular period, the AL growth rate of the Group A (0.026±0.014 mm/mo) was significantly faster than that of the Group B (0.016±0.015 mm/mo; P<0.0001). The AL difference between both eyes was 0.6 (0.46) mm, then significantly decreased to 0.22 (0.39) mm when started binocular treatment (P<0.0001). However, it was significantly increased to 0.30 (0.32) mm after a year (P<0.0001), but still significantly lower than baseline (P<0.0001).

CONCLUSION

The orthokeratology lens is efficient for control the AL elongation of monocular myopia eyes and reduce anisometropia. For the condition that the contralateral eyes develop myopia and receive orthokeratology lens later, there is no efficiency observed on control interocular difference of AL during binocular treatment.

Effect of orthokeratology on anisometropia control: A meta-analysis

BACKGROUND

The effectiveness of orthokeratology in retarding anisometropic progression has been investigated in several small-sample studies. This quantitative analysis aimed to elucidate the efficacy of orthokeratology for anisometropia control.

METHODS

We searched PubMed, Embase, and Cochrane databases for relevant studies through September 2020. Axial length (AL) data at baseline and final follow-up were extracted, and AL elongation and difference were calculated. Methodological quality was evaluated using the risk of bias in non-randomized studies of interventions (ROBINS-I) tool. Meta-analyses were performed using a fixed-effect model based on the heterogeneity.

RESULTS

A total of 10 cohort studies (nine retrospective studies; one prospective study) were included. The pooled results for the unilateral myopia group showed that the mean AL elongation difference between myopic and emmetropic eyes was -0.27 mm (95% CI, -0.31 to -0.22; p < 0.01) at the one-year follow-up (four studies) and -0.17 mm (95% CI, -0.33 to -0.02; p = 0.03) at the two-year follow-up (two studies). In the bilateral anisomyopic group, mean AL elongation difference between high and low myopic eyes was -0.06 mm (95% CI, -0.09 to -0.04; p < 0.01) at the one-year follow-up (seven studies) and -0.13 mm (95% CI, -0.21 to -0.06; p < 0.01) at the two-year followup (three studies).

CONCLUSION

This study demonstrated that orthokeratology can effectively retard myopic progression and reduce anisomyopic values. However, additional wellstructured randomized controlled trials or prospective studies with longer follow-up periods are warranted to address this topic in more detail.

Axial length shortening in a myopic child with anisometropic amblyopia after wearing violet light-transmitting eyeglasses for 2 years

PURPOSE

To report a case in which the axial length (AL) shortened and the choroid thickened due to the use of violet light-transmitting eyeglasses.

OBSERVATIONS

A 4-year-old boy with high myopia was referred to Keio University Hospital. He was prescribed standard eyeglasses. Six months after the first visit, his best-corrected visual acuities were 1.2 and 0.4 in the right and left eyes, respectively, with the standard eyeglasses, and he was diagnosed with anisometropic amblyopia. The right eye then was patched for 6 hours daily during the daytime. Because of the availability of violet light-transmitting eyeglasses, we changed the eyeglasses and instructed his parents to have him engage in outdoor activities for over 2 hours daily to be exposed to sufficient violet light. As a result, the violet light entered his left eye and minimal violet light entered his right eye. The changes in the ALs, choroidal thicknesses, and cycloplegic objective refractions in the right and left eyes during 2 years of wearing violet light-transmitting eyeglasses were +0.85 and -0.20 mm, +4.9 and + 115.7 μm, and -1.02 and + 1.88 D, respectively.

CONCLUSIONS AND IMPORTANCE

We successfully described a case in which the myopia improved, the AL shortened, and the choroid thickened after using violet light-transmitting eyeglasses.

A comparative study of orthokeratology and low-dose atropine for the treatment of anisomyopia in children

Myopic anisometropia (anisomyopia) is a specific type of refractive error that may cause fusion impairment, asthenopia, and aniseikonia. It is sometimes severe enough to reduce the quality of life. Several studies have investigated the treatment effects of orthokeratology (Ortho-K) and topical atropine on anisomyopia control. However, no study has compared these two interventions simultaneously until now. The cohort of this retrospective study included 124 children with anisomyopia who were treated with binocular Ortho-K lenses, 0.01% atropine, or 0.05% atropine. After a 2-year follow-up, the inter-eye difference in axial length (AL) significantly decreased in the Ortho-K group (P = 0.015) and remained stable in the two atropine groups. When comparing the myopia control effect, the use of Ortho-K lenses resulted in an obviously smaller change in AL than the use of 0.01% and 0.05% atropine (P < 0.01). Ortho-K treatment may reduce the degree of anisomyopia and stabilise the progression of myopia. Hence, Ortho-K might be a better choice for anisomyopic children.

Effect of Orthokeratology on Axial Length Elongation in Anisomyopic Children

SIGNIFICANCE

Anisomyopia is a natural experimental paradigm that compares dose response between fellow eyes. This study is the first to explore whether orthokeratology (ortho-k) has a dose-response effect on axial length growth and reduces the interocular difference in axial length in anisomyopic children.

PURPOSE

The purpose of this study was to compare the effect of ortho-k on axial length elongation between the fellow eyes of anisomyopic children.

METHODS

In this retrospective study, 49 anisomyopic children who wore ortho-k lenses were assigned to the anisomyopic ortho-k group. Based on the one-to-one match principle (same age and proximate spherical equivalent), high-isomyopic and low-isomyopic groups each enrolled 49 isomyopic children who wore ortho-k lenses with spherical equivalent similar to that of the more myopic eye and the less myopic eye in the anisomyopic ortho-k group, respectively. Forty-nine anisomyopic children who wore spectacles were enrolled in the anisomyopic spectacle group. At baseline and at 1- and 2-year visits, axial length was measured. Axial length elongation and interocular difference in axial length were compared.

RESULTS

In the anisomyopic ortho-k group, the less myopic eyes exhibited more axial length elongation than did the more myopic eyes during 1- and 2-year treatment periods (P < .01). However, there was no significant difference in axial length elongation between the fellow eyes in the isomyopic groups and anisomyopic spectacle group. At the 2-year visit, the interocular difference in axial length of children in the anisomyopic ortho-k group significantly decreased from 0.72 ± 0.34 to 0.56 ± 0.38 mm (P < .05). In contrast, ortho-k lens-wearing isomyopic children or spectacle-wearing anisomyopic children did not show a significant change in interocular difference in axial length.

CONCLUSIONS

Orthokeratology could reduce the amount of anisomyopia in children primarily through stronger myopia control in the more myopic eye.

Effects of orthokeratology lens on axial length elongation in unilateral myopia and bilateral myopia with anisometropia children

PURPOSE

To investigate the effect of orthokeratology (OK) lens on axial length (AL) elongation in unilateral myopia and bilateral myopia with anisometropia children.

METHODS

Twenty-seven unilateral myopia (group 1) and 25 bilateral myopia with anisometropia children (group 2) were involved in this 1-year retrospective study. The eyes with higher spherical equivalent refractive error (SER) were assigned to the H eyes subgroup and the fellow eyes with lower SER to the L eyes subgroup in the two groups.

RESULTS

The mean change in AL of H eyes and L eyes were 0.11 ± 0.19 mm, 0.30 ± 0.28 mm in group 1 (P = 0.04) and 0.09± 0.14mm, 0.13± 0.16mm in group 2 (P = 0.36), respectively. Multivariate regression analyses showed that significant difference of change in AL was found between H eyes and L eyes in group1 (β=0.25, P = 0.03), but no difference in group 2 (β=0.09, P = 0.12). The AL of H eyes in group 1 and group 2, H eyes in group 1 and L eyes in group 2 had the same increased rate (β= -0.04, P = 0.43; β = 0.02, P = 0.56).

CONCLUSIONS

Monocular OK lens is effective on suppression AL elongation of the myopic eyes and reduce anisometropia value in unilateral myopic children. The OK lens can control the AL elongation in both eyes at the same rate, but it cannot reduce anisometropia value in bilateral myopia with anisometropia children after 1-year follow-up.