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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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Chun RKM, Hon Y, Law TK, Wong KYQ, To CH, Shih KC, Leung CKS, Tse DYY. Combination effect of optical defocus and low dose atropine in myopia control: Study protocol for a randomized clinical trial. PLoS One 2024; 19:e0306050. [PMID: 38923965 PMCID: PMC11206955 DOI: 10.1371/journal.pone.0306050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2024] [Accepted: 06/06/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Myopia, characterized by excessive axial elongation of the eyeball, increases risks of having sight-threatening diseases and impose a financial burden to healthcare system. Although myopic control interventions showed their effectiveness in slowing progression, the efficacy varies between individuals and does not completely halt progression. The study aims to investigate the efficacy of combining 0.01% atropine administered twice daily with optical defocus for myopia control in schoolchildren. METHODS AND DESIGN This is a prospective, parallel-group, single-blinded, randomized, active-control trial (ClinicalTrials.gov identifier: NCT06358755). Myopic schoolchildren with no previous myopic control interventions aged between 7 to 12 years will be recruited. They will be randomly allocated into two groups (n = 56 per group) after baseline measurement. Both groups will receive 0.01% atropine twice per day for 18 months (one drop in the morning and the other drop at night before bedtime). Defocus incorporated multiple segments (DIMS) spectacle lenses will be prescribed in atropine plus optical defocus (ATD) treatment group while single vision spectacle lenses will be given in atropine only (AT) group. Cycloplegic refraction and axial lengths will be monitored every 6 months over 18-month study period. The primary outcomes are changes in cycloplegic refraction and axial lengths relative to the baseline over the study period. DISCUSSION The result will examine the combination effect of low dose atropine and myopic defocus on myopia control in a randomized controlled study. The findings will also explore the potential benefits of applying 0.01% atropine twice per day on myopic control and its potential side effects.
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Affiliation(s)
- Rachel Ka Man Chun
- School of Optometry, The Hong Kong Polytechnic University, Kowloon, Hong Kong
- Centre for Eye and Vision Research (CEVR), Shatin, Hong Kong
- Research Centre for SHARP Vision (RCSV), The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Ying Hon
- School of Optometry, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Tsz Kin Law
- School of Optometry, The Hong Kong Polytechnic University, Kowloon, Hong Kong
- Centre for Eye and Vision Research (CEVR), Shatin, Hong Kong
| | - Kryshell Yu Qi Wong
- School of Optometry, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Chi Ho To
- School of Optometry, The Hong Kong Polytechnic University, Kowloon, Hong Kong
- Centre for Eye and Vision Research (CEVR), Shatin, Hong Kong
- Research Centre for SHARP Vision (RCSV), The Hong Kong Polytechnic University, Kowloon, Hong Kong
- School of Optometry & Vision Sciences, Cardiff University, Cardiff, United Kingdom
| | - Kendrick C. Shih
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Christopher Kai Shun Leung
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Dennis Yan Yin Tse
- School of Optometry, The Hong Kong Polytechnic University, Kowloon, Hong Kong
- Centre for Eye and Vision Research (CEVR), Shatin, Hong Kong
- Research Centre for SHARP Vision (RCSV), The Hong Kong Polytechnic University, Kowloon, Hong Kong
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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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Farassat N. Topical Atropine for Myopia Control: A Review. Klin Monbl Augenheilkd 2024. [PMID: 38802078 DOI: 10.1055/a-2307-0363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
Over the past decade, atropine has emerged as an effective intervention for preventing myopia in children. Multiple randomized controlled trials, mainly from Asia, have demonstrated the safety and efficacy of topical atropine for myopia control. Both efficacy and side effects exhibit a positive dose-response relationship. This review focuses on new data from studies with predominantly white populations, ethnicity-dependent differences in efficacy and side effects, and primary prevention of incident myopia with atropine.
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Affiliation(s)
- Navid Farassat
- Medical Center, Eye Center, University Freiburg, Germany
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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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Atchison DA, Charman WN. Optics of spectacle lenses intended to treat myopia progression. Optom Vis Sci 2024; 101:238-249. [PMID: 38857035 DOI: 10.1097/opx.0000000000002140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2024] Open
Abstract
SIGNIFICANCE This is a review of the optics of various spectacle lenses that have been used in myopia control over the last 60 years, with emphasis on approximately the last 15 years.Myopia has become an increasing health problem worldwide, particularly in some East Asian countries. This has led to many attempts to slow its progression in children and reduce its endpoint value. This review is concerned with the optics of spectacle lenses for use in myopia control, from bifocal lenses to multisegment and diffusion optics lenses. Treatments are based on theories of the onset or progression of myopia. These include the hypotheses that eye growth and myopia in susceptible children may be stimulated by (1) poor accommodation response and the consequent hyperopic defocus with near vision tasks, (2) relative hyperopic peripheral refraction, and (3) high retinal image contrast as occurs in urban environments. Using spectacle lenses to slow myopia progression has a history of about 60 years. The review is laid out in approximately the order in which different types of lenses have been introduced: bifocals, conventional progressive addition lenses, undercorrection with single-vision lenses, specialized progressive addition lenses, defocus-incorporated multiple segments, diffusion optics, and concentric bifocals. In the review, some of the lenses are combined with an eye model to determine refractive errors for peripheral vision for the stationary eye and for foveal vision for the rotating eye. Numbers are provided for the reported success of particular designs in retarding myopia progression, but this is not an epidemiological paper, and there is no critical review of the findings. Some of the recent treatments, such as multiple segments, appear to reduce the eye growth and myopia progression by better than 50% over periods of up to 2 years.
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Affiliation(s)
| | - W Neil Charman
- Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
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Lu W, Ji R, Jiang D, Shi L, Ding W, Tian Y, Zhao C, Leng L. Different efficacy in myopia control: Comparison between orthokeratology and defocus-incorporated multiple segment lenses. Cont Lens Anterior Eye 2024; 47:102122. [PMID: 38220497 DOI: 10.1016/j.clae.2024.102122] [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: 10/17/2023] [Revised: 12/31/2023] [Accepted: 01/09/2024] [Indexed: 01/16/2024]
Abstract
PURPOSE To compare the efficiency of orthokeratology (OK) and defocus-incorporated multiple segment (DIMS) lenses in myopia control in children. METHODS This prospective study involved 540 subjects (7-14 years) categorized into three groups: DIMS lenses (180 cases), OK lenses (180 cases), or single-vision spectacles (SVS) (180 cases). After a one-year follow-up, changes in axial length (AL) and differences among the groups were analyzed. The subjects were further divided into a low myopia degree subgroup (LM, -1.50 D ≤ SE ≤ -0.50 D), a moderate myopia degree subgroup (MM, -3.00 D ≤ SE < -1.50 D), and a high myopia degree subgroup (HM, -5.00 D ≤ SE < -3.00 D). A one-way ANOVA and multiple linear regression analysis were used to compare AL elongation and the factors influencing the different groups. RESULTS A total of 496 (92 %) subjects completed the study. The mean AL change in the OK lenses, DIMS lenses, and SVS were 0.20±0.18 mm, 0.30±0.22 mm, and 0.38±0.19 mm, respectively (P < 0.001). In the LM subgroup, the OK and DIMS groups showed similar AL changes, but both exhibited slower changes than the SVS group (P = 0.001). In the MM and HM subgroups, the OK lens performed the shortest AL elongation compared with the DIMS lenses and SVS (P < 0.001). Multiple regression analysis showed that the AL change was associated with age (β = -0.038 and P = 0.005), initial AL (β = -0.010 and P = 0.011), initial SE (β = 0.028 and P = 0.007), and interventions using OK lenses (β = -0.172 and P = 0.020) and DIMS lenses (β = -0.089 and P = 0.020). CONCLUSION Over a one-year treatment period, OK and DIMS lenses can significantly retard AL elongation compared with SVS. In addition, the OK lenses were more effective than the DIMS lenses in controlling AL in patients with higher degrees of myopia.
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Affiliation(s)
- Weicong Lu
- Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, China; State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, China; School of Ophthalmology, Shandong First Medical University, China
| | - Rongyuan Ji
- Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, China; State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, China; School of Ophthalmology, Shandong First Medical University, China
| | - Dongdong Jiang
- Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, China; State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, China; School of Ophthalmology, Shandong First Medical University, China
| | - Lin Shi
- Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, China; State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, China; School of Ophthalmology, Shandong First Medical University, China
| | - Wenzhi Ding
- Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, China; State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, China; School of Ophthalmology, Shandong First Medical University, China
| | - Yuyin Tian
- Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, China; State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, China; School of Ophthalmology, Shandong First Medical University, China
| | - Chenpei Zhao
- Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, China; State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, China; School of Ophthalmology, Shandong First Medical University, China
| | - Lin Leng
- Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, China; State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, China; School of Ophthalmology, Shandong First Medical University, China.
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Ma J, Yang X, Liu Z, Fu H, Fan S, Wang K, Li Y, Huang L, Zhao M. The Impact of Vergence Dysfunction on Myopia Control in Children Wearing Defocus Spectacle Lenses. Clin Ophthalmol 2024; 18:799-807. [PMID: 38495679 PMCID: PMC10944170 DOI: 10.2147/opth.s453731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 02/28/2024] [Indexed: 03/19/2024] Open
Abstract
Purpose To investigate the impact of vergence dysfunction on myopia progression in children with Defocus incorporated multiple segments (DIMS) spectacle lenses. Patients and Methods We retrospectively enrolled children prescribed DIMS spectacle lenses to slow myopic progression. Baseline vergence dysfunction was determined according to phoria at distance and near. Axial length (AL) measurement and cycloplegic subjective refraction were performed before fitting the lenses and at six-month and one-year follow-ups. The six-month and one-year AL and spherical equivalent (SE) change from baseline were calculated and compared in subgroups stratified with the type of vergence dysfunction. Results Two hundred and ninety-two myopic children were included. Significant AL elongation and SE progression were observed at six months and one year (P < 0.05 for all comparisons). Multiple regression demonstrated that AL elongation at six months (P < 0.001) and one year (P < 0.001) was negatively correlated with age, and SE progression at six months was associated with age (P = 0.002). The AL elongation at six months in children with convergence excess was significantly greater than in normal myopic subjects (P = 0.011) and subjects with convergence insufficiency (P = 0.008), divergence excess (P = 0.007), divergence insufficiency (P = 0.024) and basic esophoria (P = 0.048) at six months. Conclusion The present research demonstrated that vergence dysfunction influences myopia progression for myopic children with DIMS, and the children with convergence excess suffer from the greatest myopia progression among different types of vergence dysfunction.
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Affiliation(s)
- Jiahui Ma
- Department of Ophthalmology, Peking University People’s Hospital, Beijing, People’s Republic of China
- Eye Diseases and Optometry Institute, Peking University People’s Hospital, Beijing, People’s Republic of China
- Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, People’s Republic of China
- College of Optometry, Peking University Health Science Center, Beijing, People’s Republic of China
| | - Xue Yang
- Department of Ophthalmology, Peking University International Hospital, Beijing, People’s Republic of China
| | - Zhiming Liu
- Department of Ophthalmology, Peking University People’s Hospital, Beijing, People’s Republic of China
- Eye Diseases and Optometry Institute, Peking University People’s Hospital, Beijing, People’s Republic of China
- Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, People’s Republic of China
- College of Optometry, Peking University Health Science Center, Beijing, People’s Republic of China
| | - Hao Fu
- Department of Ophthalmology, Peking University People’s Hospital, Beijing, People’s Republic of China
- Eye Diseases and Optometry Institute, Peking University People’s Hospital, Beijing, People’s Republic of China
- Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, People’s Republic of China
- College of Optometry, Peking University Health Science Center, Beijing, People’s Republic of China
| | - Sizhou Fan
- Department of Ophthalmology, Peking University People’s Hospital, Beijing, People’s Republic of China
- Eye Diseases and Optometry Institute, Peking University People’s Hospital, Beijing, People’s Republic of China
- Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, People’s Republic of China
- College of Optometry, Peking University Health Science Center, Beijing, People’s Republic of China
| | - Kai Wang
- Department of Ophthalmology, Peking University People’s Hospital, Beijing, People’s Republic of China
- Eye Diseases and Optometry Institute, Peking University People’s Hospital, Beijing, People’s Republic of China
- Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, People’s Republic of China
- College of Optometry, Peking University Health Science Center, Beijing, People’s Republic of China
| | - Yan Li
- Department of Ophthalmology, Peking University People’s Hospital, Beijing, People’s Republic of China
- Eye Diseases and Optometry Institute, Peking University People’s Hospital, Beijing, People’s Republic of China
- Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, People’s Republic of China
- College of Optometry, Peking University Health Science Center, Beijing, People’s Republic of China
| | - Lvzhen Huang
- Department of Ophthalmology, Peking University People’s Hospital, Beijing, People’s Republic of China
- Eye Diseases and Optometry Institute, Peking University People’s Hospital, Beijing, People’s Republic of China
- Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, People’s Republic of China
- College of Optometry, Peking University Health Science Center, Beijing, People’s Republic of China
| | - Mingwei Zhao
- Department of Ophthalmology, Peking University People’s Hospital, Beijing, People’s Republic of China
- Eye Diseases and Optometry Institute, Peking University People’s Hospital, Beijing, People’s Republic of China
- Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, People’s Republic of China
- College of Optometry, Peking University Health Science Center, Beijing, People’s Republic of China
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9
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Domsa P, Bankó ÉM, Körtvélyes J, Meigen C, Széchey R, Lantos K, Nagy ZZ, Csutak A. Astigmatism and maternal myopia as important factors affecting success rate of DIMS lens treatment. BMJ Open Ophthalmol 2024; 9:e001499. [PMID: 38453262 PMCID: PMC10921505 DOI: 10.1136/bmjophth-2023-001499] [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: 09/17/2023] [Accepted: 01/28/2024] [Indexed: 03/09/2024] Open
Abstract
OBJECTIVE To assess the efficacy of myopia control spectacle lenses (defocus incorporated multiple segments/DIMS) in slowing myopia progression among a diverse Central European paediatric population and investigate the contribution of baseline parameters on treatment outcomes. METHODS AND ANALYSIS This retrospective observational study included 62 individuals aged 4-17 years (mean±SD: 10.21±2.70) with progressing myopia but without ocular pathology with a range of -0.88 to -8.25 D spherical equivalent refraction (SER) (-3.73±1.56), coupled with astigmatism up to -3.25 D cylindrical. All participants were prescribed DIMS (Hoya MiyoSmart) spectacles. Key outcome variables were cycloplegic SER, measured for all participants and axial length (AL), assessed in a subset of patients, recorded at baseline, 6 months and 12 months. Quality of life assessments were conducted at baseline, at 2 weeks, and 3, 6, 9 and 12 months. Additionally, parental myopic dioptre was recorded when applicable. RESULTS At the 12-month mark, myopia progression in patients (mean±SE: -0.40±0.05) mirrored findings from prior European DIMS studies, but with 50% of patients showing no progression. A multivariate analysis of covariance model revealed that baseline astigmatism and younger age adversely affected therapy outcomes in both SER and AL, while severe maternal myopia led to greater SER progression. In contrast, only young age but not astigmatism was associated with AL increase in a comparable group of children with myopia, part of the LIFE Child Study, wearing single-vision spectacles. Patients reported consistent satisfaction with treatment, with minimal side effects, which diminished over the year. CONCLUSION In the European population, astigmatism, young age and severe maternal myopia are risk factors for suboptimal outcomes following DIMS therapy. Further research is necessary to elucidate the impact of astigmatism on myopic defocus therapy.
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Affiliation(s)
- Patricia Domsa
- Non Plus Ultra Vision Centre, Budapest, Hungary
- Department of Ophthalmology, University of Pécs Medical School, Pecs, Hungary
| | - Éva M Bankó
- HUN-REN Research Centre for Natural Sciences, Budapest, Hungary
| | - Judit Körtvélyes
- Non Plus Ultra Vision Centre, Budapest, Hungary
- Heim Pál National Pediatric Institute, Budapest, Hungary
| | - Christof Meigen
- LIFE Leipzig Research Center for Civilization Diseases, Leipzig University, Leipzig, Germany
| | - Rita Széchey
- Non Plus Ultra Vision Centre, Budapest, Hungary
- Semmelweis University of Medicine, Budapest, Hungary
| | - Krisztina Lantos
- Department of Ophthalmology, University of Pécs Medical School, Pecs, Hungary
| | - Zoltán Zsolt Nagy
- Department of Ophthalmology, Semmelweis University of Medicine, Budapest, Hungary
| | - Adrienne Csutak
- Department of Ophthalmology, University of Pécs Medical School, Pecs, Hungary
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10
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Logan NS, Bullimore MA. Optical interventions for myopia control. Eye (Lond) 2024; 38:455-463. [PMID: 37740053 PMCID: PMC10858277 DOI: 10.1038/s41433-023-02723-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 07/26/2023] [Accepted: 08/25/2023] [Indexed: 09/24/2023] Open
Abstract
A range of optical interventions have been developed to slow the progression of myopia. This review summarizes key studies and their outcomes. Peer-reviewed, randomized controlled clinical trials of at least 18 months duration were identified. Randomized clinical trials were identified and summarised: 13 for spectacles, 5 for overnight orthokeratology, 5 for soft contact lenses, and 3 for orthokeratology combined with low concentration atropine. Overnight orthokeratology trials were the most consistent with 2-year slowing of axial elongation between 0.24 and 0.32 mm. Other modalities were more variable due to the wide range of optical designs. Among spectacle interventions, progressive addition lenses were the least effective, slowing axial elongation and myopia progression by no more than 0.11 mm and 0.31 D, respectively. In contrast, novel designs with peripheral lenslets slow 2-year elongation and progression by up to 0.35 mm and 0.80 D. Among soft contact lens interventions, medium add concentric bifocals slow 3-year elongation and progression by only 0.07 mm and 0.16 D, while a dual-focus design slows 3-year elongation and progression by 0.28 mm and 0.67 D. In summary, all three optical interventions have the potential to significantly slow myopia progression. Quality of vision is largely unaffected, and safety is satisfactory. Areas of uncertainty include the potential for post-treatment acceleration of progression and the benefit of adding atropine to optical interventions.
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11
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Sánchez-Tena MÁ, Cleva JM, Villa-Collar C, Álvarez M, Ruiz-Pomeda A, Martinez-Perez C, Andreu-Vazquez C, Chamorro E, Alvarez-Peregrina C. Effectiveness of a Spectacle Lens with a Specific Asymmetric Myopic Peripheral Defocus: 12-Month Results in a Spanish Population. CHILDREN (BASEL, SWITZERLAND) 2024; 11:177. [PMID: 38397289 PMCID: PMC10887607 DOI: 10.3390/children11020177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/10/2024] [Accepted: 01/26/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND Different designs of ophthalmic lenses have been studied to control the progression of myopia in children. This study aims to evaluate the short-term efficacy of a new design of ophthalmic lens with asymmetric myopic peripheral defocus (MPDL) on myopia progression in children compared to a control group wearing a single-vision lens (SVL). METHODS Children aged 5 to 12 with myopia up to -0.50 D, astigmatism and anisometropia under 1.50 D, and corrected visual acuity over 20/20 were randomized to either the study group (MPDL) or control group (SVL). The myopia progression was evaluated by measuring axial length (AL) growth (IOL Master; Zeiss) over a period of one year. RESULTS Ninety-two subjects were recruited. Forty-six children were randomly assigned to the control group, and 46 to the study group. In total, 83 children completed the clinical trial, with a mean age of 10.81 [9.53-11.92] years, among which 59.04% were female. After one year of treatment, there was less AL elongation in the study group compared to the control group (0.16 ± 0.16 mm vs. 0.24 ± 0.16 mm, p = 0.034). CONCLUSIONS The MPDL significantly reduced the absolute growth of AL by 39% (p = 0.014) and relative growth of AL by 37.3% (p = 0.012) after 12 months in comparison to the control group in a Spanish population.
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Affiliation(s)
- Miguel Ángel Sánchez-Tena
- Department of Optometry and Vision, Faculty of Optics and Optometry, Universidad Complutense de Madrid, 28037 Madrid, Spain; (M.Á.S.-T.); (A.R.-P.); (C.A.-P.)
- ISEC LISBOA-Instituto Superior de Educação e Ciências, 1750-179 Lisbon, Portugal;
| | - Jose Miguel Cleva
- Clinical Research Department, Indizen Optical Technologies, 28002 Madrid, Spain; (M.Á.); (E.C.)
| | - Cesar Villa-Collar
- Faculty of Biomedical and Health Science, Universidad Europea de Madrid, 28670 Madrid, Spain;
| | - Marta Álvarez
- Clinical Research Department, Indizen Optical Technologies, 28002 Madrid, Spain; (M.Á.); (E.C.)
| | - Alicia Ruiz-Pomeda
- Department of Optometry and Vision, Faculty of Optics and Optometry, Universidad Complutense de Madrid, 28037 Madrid, Spain; (M.Á.S.-T.); (A.R.-P.); (C.A.-P.)
| | - Clara Martinez-Perez
- ISEC LISBOA-Instituto Superior de Educação e Ciências, 1750-179 Lisbon, Portugal;
| | - Cristina Andreu-Vazquez
- Faculty of Biomedical and Health Science, Universidad Europea de Madrid, 28670 Madrid, Spain;
| | - Eva Chamorro
- Clinical Research Department, Indizen Optical Technologies, 28002 Madrid, Spain; (M.Á.); (E.C.)
| | - Cristina Alvarez-Peregrina
- Department of Optometry and Vision, Faculty of Optics and Optometry, Universidad Complutense de Madrid, 28037 Madrid, Spain; (M.Á.S.-T.); (A.R.-P.); (C.A.-P.)
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12
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Erdinest N, Atar-Vardi M, London N, Landau D, Smadja D, Pras E, Lavy I, Morad Y. Treatment of Rapid Progression of Myopia: Topical Atropine 0.05% and MF60 Contact Lenses. Vision (Basel) 2024; 8:3. [PMID: 38391084 PMCID: PMC10885127 DOI: 10.3390/vision8010003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 01/11/2024] [Accepted: 01/14/2024] [Indexed: 02/24/2024] Open
Abstract
This retrospective study evaluates the effectiveness of combining 0.05% atropine with MF60 contact lenses in managing rapid myopia progression in children over one year. The study involved three groups: the treatment group (TG) with 15 children (53% male, average age 12.9 ± 1.04), the MF group (MF) with 12 children (50% male, average age 12.8 ± 0.8) using only MF60 lenses, and the control group (CG) with 14 children (43% male, average age 12.1 ± 0.76). Baseline myopia and axial length (AL) were similar across groups, with the TG, MF, and CG showing -4.02 ± 0.70 D, -4.18 ± 0.89 D, -3.86 ± 0.99 D, and 24.72 ± 0.73 mm, 24.98 ± 0.70 mm, 24.59 ± 1.02 mm, respectively. Prior to the study, all groups exhibited significant myopia and AL progression, with no previous myopia control management. The treatment involved daily 0.05% atropine instillation, the use of MF60 lenses and increased outdoor activity. Biannual cycloplegic refraction and slit lamp evaluations confirmed no adverse reactions. After one year, the TG showed a significant reduction in myopia and AL progression (-0.43 ± 0.46 D, p < 0.01; 0.22 ± 0.23 mm, p < 0.01), whereas the CG showed minimal change (-1.30 ± 0.43 D, p = 0.36; 0.65 ± 0.35 mm, p = 0.533). The MF group also exhibited a notable decrease (-0.74 ± 0.45 D, p < 0.01; 0.36 ± 0.23 mm). Increased outdoor activity during the treatment year did not significantly impact myopia control, suggesting its limited additional effect in this cohort. The study concludes that the combination of 0.05% atropine and peripheral defocus soft contact lenses effectively controls myopia progression in children.
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Affiliation(s)
- Nir Erdinest
- Department of Ophthalmology, Hadassah-Hebrew University Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9190500, Israel
- The Myopia Center, Petach Tikva 4900519, Israel
| | - Maya Atar-Vardi
- Department of Ophthalmology, Assaf Harofeh Medical Center, Zerifin 7033001, Israel
| | - Naomi London
- Private Practice, 5 Even Israel, Jerusalem 9422805, Israel
| | - David Landau
- Department of Ophthalmology, Hadassah-Hebrew University Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9190500, Israel
| | - David Smadja
- Department of Ophthalmology, Hadassah-Hebrew University Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9190500, Israel
| | - Eran Pras
- Department of Ophthalmology, Assaf Harofeh Medical Center, Zerifin 7033001, Israel
| | - Itay Lavy
- Department of Ophthalmology, Hadassah-Hebrew University Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9190500, Israel
| | - Yair Morad
- The Myopia Center, Petach Tikva 4900519, Israel
- Department of Ophthalmology, Assaf Harofeh Medical Center, Zerifin 7033001, Israel
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13
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Guimarães S, Barros da Silva P, Oliveiros B, Silva E. Myopia control: short-term effect of 0.01% atropine vs. defocus incorporated multiple segment lenses-a retrospective study in European children. Int Ophthalmol 2023; 43:3777-3784. [PMID: 37420123 PMCID: PMC10504187 DOI: 10.1007/s10792-023-02788-x] [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: 03/28/2023] [Accepted: 06/22/2023] [Indexed: 07/09/2023]
Abstract
PURPOSE To compare 0.01% atropine with DIMS spectacle lenses in the prevention of myopia progression in European children. METHODS This was a retrospective study including data from pediatric European patients with myopia. From November 2021 to March 2022, only 0.01% atropine was prescribed because DIMS lenses were still not available in Portugal. From March to October 2022, only DIMS spectacle lenses were prescribed due to patients' parents' preference. Myopia progression endpoints were axial length (AL) and spherical equivalent (SE) differences between before and 6 months after treatment. AL and SE evolution were compared using a general linear model with repeated measures. RESULTS The study included 98 eyes from 50 patients: 47 in the atropine group and 51 in the DIMS group. There were no statistically significant differences between groups in terms of initial AL, initial SE, sex or age. The mean AL elongation at 6 months was 0.057 mm in the atropine group (SD = 0.118) and 0.002 mm (SD = 0.077) in the DIMS group. SE progression was - 0.098 (SD = 0.232) D in the atropine group and - 0.039 (SD = 0.105) D in the DIMS group. AL elongation was significantly lower in the DIMS lens group (p = 0.038, partial Eta2 = 0.045). There was no difference in SE progression between groups (p = 0.302, partial Eta2 = 0.011). CONCLUSION Comparison between 0.01% atropine eyedrops and DIMS spectacle lenses for slowing the progression of myopia favored DIMS lenses in terms of AL elongation in a short-term follow-up. There was no difference in terms of SE between groups.
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Affiliation(s)
- Sandra Guimarães
- Instituto de Investigação, Inovação e Desenvolvimento da Universidade Fernando Pessoa (FP-I3ID), Gondomar, Porto, Portugal
- Hospital-Escola da Universidade Fernando Pessoa (HE-UFP), Gondomar, Porto, Portugal
- Escola Superior de Saúde da Universidade Fernando Pessoa (ESS-UFP), Gondomar, Porto, Portugal
| | - Patrícia Barros da Silva
- CRI - OftaPed, Hospital Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal.
- Department of Ophthalmology, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal.
| | - Bárbara Oliveiros
- Coimbra Institute for Clinical and Biomedical Research, Faculty of Medicine (iCBR-FMUC), University of Coimbra, Coimbra, Portugal
- Laboratory of Biostatistics and Medical Informatics, Faculty of Medicine (LBIM, FMUC), University of Coimbra, Coimbra, Portugal
| | - Eduardo Silva
- CRI - OftaPed, Hospital Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
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14
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Hou P, Wu D, Nie Y, Wei H, Liu L, Yang G. Comparison of the efficacy and safety of different doses of atropine for myopic control in children: a meta-analysis. Front Pharmacol 2023; 14:1227787. [PMID: 37767401 PMCID: PMC10520549 DOI: 10.3389/fphar.2023.1227787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 08/29/2023] [Indexed: 09/29/2023] Open
Abstract
Purpose: To comprehensively reassess the efficacy and safety of different concentrations of atropine for retarding myopia progression and seek the most appropriate therapeutic concentration for clinical practice. Methods: We searched PubMed, Cochrane Library, Embase, Chinese Science and Technology Periodicals (VIP) and China National Knowledege Infrastructure (CNKI) from their inception to 23 March 2023, to obtain eligible randomized controlled trials (RCTs) and cohort studies that had atropine in at least one treatment arm and placebo/no intervention in another arm. We evaluated the risk of bias of the RCTs according to the recommendations of the Cochrane Collaboration for RCTs and quality of cohort studies by the Newcastle‒Ottawa Scale. Weighted mean difference (WMD), 95% confidence interval were calculated for meta-analysis. All data analyses were performed using Review Manager 5.3, STATA 12.0 and SPSS 26.0 software. Results: A total of 44 studies were included in the meta-analysis. Weighted mean difference (WMD) were 0.73 diopters (D), 0.65 D, 0.35 D per year in refraction progression (χ 2 = 14.63, I 2 = 86.3%; p < 0.001) and -0.26 mm, -0.37 mm, -0.11 mm per year in axial length progression (χ 2 = 5.80, I 2 = 65.5%; p = 0.06) for high (0.5%-1%), moderate (0.1%-0.25%), and low (0.005%-0.05%) dose atropine groups, respectively. Logarithmic dose‒response correlations were found between atropine and their effect on change of refraction, axial length, accommodation and photopic pupil diameter. Through these curves, we found that atropine with concentrations ≤0.05% atropine resulted in a residual value of accommodation of more than 5 D and an increase in pupil diameter no more than 3 mm. Higher doses of atropine resulted in a higher incidence of adverse effects, of which the incidence of photophobia was dose-dependent (r = 0.477, p = 0.029). Conclusion: Both the efficacy and risk of adverse events for atropine treatment of myopia were mostly dose dependent. Comprehensively considered the myopia control effect and safety of each dose, 0.05% may be the best concentration of atropine to control myopia progression at present, at which myopia is better controlled and the side effects are tolerable. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/#recordDetails, CRD42022377705.
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Affiliation(s)
- Peixian Hou
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Laboratory of Optometry and Vision Sciences, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Dawen Wu
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Laboratory of Optometry and Vision Sciences, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yan Nie
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Laboratory of Optometry and Vision Sciences, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Hong Wei
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Laboratory of Optometry and Vision Sciences, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Longqian Liu
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Laboratory of Optometry and Vision Sciences, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Guoyuan Yang
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Laboratory of Optometry and Vision Sciences, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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15
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Dahlmann-Noor A. Low-concentration atropine: Co-management of myopia in children and young people in the UK - prospective case series. Eur J Ophthalmol 2023; 33:NP140-NP141. [PMID: 37128630 DOI: 10.1177/11206721231172238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Affiliation(s)
- Annegret Dahlmann-Noor
- Moorfields Eye Hospital, Children's Service, London, UK
- NIHR Moorfields Biomedical Research Centre, London, UK
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16
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Tariq F, Mobeen R, Wang X, Lin X, Bao Q, Liu J, Gao H. Advances in myopia prevention strategies for school-aged children: a comprehensive review. Front Public Health 2023; 11:1226438. [PMID: 37655278 PMCID: PMC10466414 DOI: 10.3389/fpubh.2023.1226438] [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: 05/21/2023] [Accepted: 07/24/2023] [Indexed: 09/02/2023] Open
Abstract
Myopia has significantly risen in East and Southeast Asia, and the pathological outcomes of this condition, such as myopic maculopathy and optic neuropathy linked to high myopia, have emerged as leading causes of irreversible vision loss. Addressing this issue requires strategies to reduce myopia prevalence and prevent progression to high myopia. Encouraging outdoor activities for schoolchildren and reducing near-work and screen time can effectively prevent myopia development, offering a safe intervention that promotes healthier habits. Several clinical approaches can be employed to decelerate myopia progression, such as administering low-dose atropine eye drops (0.05%), utilizing orthokeratology lenses, implementing soft contact lenses equipped with myopia control features, and incorporating spectacle lenses with aspherical lenslets. When choosing an appropriate strategy, factors such as age, ethnicity, and the rate of myopia progression should be considered. However, some treatments may encounter obstacles such as adverse side effects, high costs, complex procedures, or limited effectiveness. Presently, low-dose atropine (0.05%), soft contact lenses with myopia control features, and orthokeratology lenses appear as promising options for managing myopia. The measures mentioned above are not necessarily mutually exclusive, and researchers are increasingly exploring their combined effects. By advocating for a personalized approach based on individual risk factors and the unique needs of each child, this review aims to contribute to the development of targeted and effective myopia prevention strategies, thereby minimizing the impact of myopia and its related complications among school-aged children in affected regions.
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Affiliation(s)
- Farheen Tariq
- Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
- Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), Jinan, China
- School of Ophthalmology, Shandong First Medical University, Jinan, China
| | - Rabia Mobeen
- School of Optometry and Vision Science, UNSW Sydney, Sydney, NSW, Australia
| | - Xinhai Wang
- Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), Jinan, China
- School of Ophthalmology, Shandong First Medical University, Jinan, China
| | - Xiao Lin
- Shandong University of Traditional Chinese Medicine, Affiliated Eye Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Qingdong Bao
- Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), Jinan, China
- School of Ophthalmology, Shandong First Medical University, Jinan, China
| | - Jinhui Liu
- Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), Jinan, China
- School of Ophthalmology, Shandong First Medical University, Jinan, China
| | - Hua Gao
- Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), Jinan, China
- School of Ophthalmology, Shandong First Medical University, Jinan, China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Eye Institute of Shandong First Medical University, Qingdao, China
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