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Leighton RE, Breslin KM, Richardson P, Doyle L, McCullough SJ, Saunders KJ. Relative peripheral hyperopia leads to greater short-term axial length growth in White children with myopia. Ophthalmic Physiol Opt 2023; 43:985-996. [PMID: 37340533 DOI: 10.1111/opo.13185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 05/18/2023] [Accepted: 06/01/2023] [Indexed: 06/22/2023]
Abstract
PURPOSE Controversy exists regarding the influence of peripheral visual experience on the onset and progression of childhood myopia. This longitudinal, observational study evaluated the relationship between relative peripheral refraction (RPR) and changes in refractive error and axial length (AL) over 12 months in White children aged 6-7 and 12-13 years with a range of baseline refractive errors. METHODS Cycloplegic baseline autorefraction at horizontal retinal eccentricities of 0° and ±30° were recorded with the Shin-Nippon NVision-K 5001 while AL was measured using the Zeiss IOLMaster 700. Measurements were repeated after 12 months on a subgroup. Refractive data were transposed into power vectors as mean spherical equivalent (M), J0 and J45 . RPR was calculated by subtracting central from peripheral measurements. Participants were defined as myopic (M ≤ -0.50 D), premyopic (-0.50 D < M ≤ +0.75 D), emmetropic (+0.75 D < M < +2.00 D) or hyperopic (M ≥ +2.00 D). RESULTS Data were collected from 222 and 245 participants aged 6-7 and 12-13 years, respectively. Myopic eyes demonstrated, on average, more hyperopic RPR. Emmetropes and premyopes displayed emmetropic RPR, and hyperopes showed a myopic RPR. Fifty-six 6- to 7-year-olds and seventy 12- to 13-year-olds contributed 12-month repeated measures. Longitudinal data demonstrated a significant relationship between a more hyperopic RPR in the nasal retina and greater short-term axial elongation in teens with myopia at baseline (β = 0.69; p = 0.04). Each dioptre of relative peripheral hyperopia in the nasal retina was associated with an additional 0.10 mm (95% CI: 0.02-0.18 mm) annual increase in AL. CONCLUSIONS Hyperopic RPR in the nasal retina of myopic children is indicative of increased risk for rapid axial elongation and may be a useful metric to support decision-making in myopia management.
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Affiliation(s)
- Rebecca E Leighton
- Centre for Optometry and Vision Science Research, School of Biomedical Sciences, Ulster University, Coleraine, UK
| | - Karen M Breslin
- Centre for Optometry and Vision Science Research, School of Biomedical Sciences, Ulster University, Coleraine, UK
| | - Patrick Richardson
- Centre for Optometry and Vision Science Research, School of Biomedical Sciences, Ulster University, Coleraine, UK
| | - Lesley Doyle
- Centre for Optometry and Vision Science Research, School of Biomedical Sciences, Ulster University, Coleraine, UK
| | - Sara J McCullough
- Centre for Optometry and Vision Science Research, School of Biomedical Sciences, Ulster University, Coleraine, UK
| | - Kathryn J Saunders
- Centre for Optometry and Vision Science Research, School of Biomedical Sciences, Ulster University, Coleraine, UK
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McCrann S, Flitcroft I, Loughman J. Is optometry ready for myopia control? Education and other barriers to the treatment of myopia. HRB Open Res 2020; 2:30. [PMID: 33083690 PMCID: PMC7542256 DOI: 10.12688/hrbopenres.12954.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2020] [Indexed: 11/23/2022] Open
Abstract
Background: With the increasing prevalence of myopia there is growing interest in active myopia control. However, the majority of progressive myopes are still prescribed single vision spectacles. This prospective study aims to elucidate the knowledge and attitudes of optometrists toward myopia control, and thereby identify perceived barriers to the implementation of a risk focussed model of myopia management. Methods: A series of four focus group discussions were conducted involving optometrists in different settings and career stages. Results: The key finding to emerge is a disconnect in myopia control knowledge and practices between academic optometrists, final year optometry students and clinicians in practice. Academic faculty believe the optometry curriculum should provide undergraduates with the clinical skills to practise myopia control, however, although students were knowledgeable in relation to myopia associated risk factors, some students had not yet undertaken any practical form of myopia control in their undergraduate degree. Furthermore, students may not receive hands-on myopia control experience during their supervised practice placement, as the majority of clinicians do not offer myopia control treatments, other than to communicate lifestyle advice to modify risk of myopia progression. Clinicians alluded to a lack of availability of myopia control interventions and identified a range of barriers relating to their training, clinical practice and public health challenges, financial, technological and other constraints that affect the implementation of such interventions. Conclusion: It appears optometrists have to yet embrace myopia control as a core element of the clinical eye care service they provide. Education, training, finance, and time restrictions, as well as limited availability of myopia control therapies were among the main perceived barriers to myopia control. This study revealed a distinct need for alignment between optometric training and the public health need for effective myopia control.
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Affiliation(s)
- Saoirse McCrann
- Centre for Eye Research Ireland, School of Physics and Clinical and Optometric Sciences, Technological University Dublin, Dublin, Ireland
| | - Ian Flitcroft
- Centre for Eye Research Ireland, School of Physics and Clinical and Optometric Sciences, Technological University Dublin, Dublin, Ireland.,Children's University Hospital, Dublin, Ireland
| | - James Loughman
- Centre for Eye Research Ireland, School of Physics and Clinical and Optometric Sciences, Technological University Dublin, Dublin, Ireland.,African Vision Research Institute, University of KwaZulu Natal, Durban, South Africa
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3
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McCrann S, Flitcroft I, Loughman J. Is optometry ready for myopia control? Education and other barriers to the treatment of myopia. HRB Open Res 2020; 2:30. [PMID: 33083690 PMCID: PMC7542256 DOI: 10.12688/hrbopenres.12954.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2020] [Indexed: 03/18/2024] Open
Abstract
Background: With the increasing prevalence of myopia there is growing interest in active myopia control. However, the majority of progressive myopes are still prescribed single vision spectacles. This prospective study aims to elucidate the knowledge and attitudes of optometrists toward myopia control, and thereby identify perceived barriers to the implementation of a risk focussed model of myopia management. Methods: A series of four focus group discussions were conducted involving optometrists in different settings and career stages. Results: The key finding to emerge is a disconnect in myopia control knowledge and practices between academic optometrists, final year optometry students and clinicians in practice. Academic faculty believe the optometry curriculum should provide undergraduates with the clinical skills to practise myopia control, however, although students were knowledgeable in relation to myopia associated risk factors, some students had not yet undertaken any practical form of myopia control in their undergraduate degree. Furthermore, students may not receive hands-on myopia control experience during their supervised practice placement, as the majority of clinicians do not offer myopia control treatments, other than to communicate lifestyle advice to modify risk of myopia progression. Clinicians alluded to a lack of availability of myopia control interventions and identified a range of barriers relating to their training, clinical practice and public health challenges, financial, technological and other constraints that affect the implementation of such interventions. Conclusion: It appears optometrists have to yet embrace myopia control as a core element of the clinical eye care service they provide. Education, training, finance, and time restrictions, as well as limited availability of myopia control therapies were among the main perceived barriers to myopia control. This study revealed a distinct need for alignment between optometric training and the public health need for effective myopia control.
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Affiliation(s)
- Saoirse McCrann
- Centre for Eye Research Ireland, School of Physics and Clinical and Optometric Sciences, Technological University Dublin, Dublin, Ireland
| | - Ian Flitcroft
- Centre for Eye Research Ireland, School of Physics and Clinical and Optometric Sciences, Technological University Dublin, Dublin, Ireland
- Children’s University Hospital, Dublin, Ireland
| | - James Loughman
- Centre for Eye Research Ireland, School of Physics and Clinical and Optometric Sciences, Technological University Dublin, Dublin, Ireland
- African Vision Research Institute, University of KwaZulu Natal, Durban, South Africa
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Wolffsohn JS, Calossi A, Cho P, Gifford K, Jones L, Jones D, Guthrie S, Li M, Lipener C, Logan NS, Malet F, Peixoto-de-Matos SC, González-Méijome JM, Nichols JJ, Orr JB, Santodomingo-Rubido J, Schaefer T, Thite N, van der Worp E, Tarutta E, Iomdina E, Ali BM, Villa-Collar C, Abesamis-Dichoso C, Chen C, Pult H, Blaser P, Parra Sandra Johanna G, Iqbal F, Ramos R, Carrillo Orihuela G, Boychev N. Global trends in myopia management attitudes and strategies in clinical practice - 2019 Update. Cont Lens Anterior Eye 2019; 43:9-17. [PMID: 31761738 DOI: 10.1016/j.clae.2019.11.002] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 11/01/2019] [Indexed: 12/13/2022]
Abstract
PURPOSE A survey in 2015 identified a high level of eye care practitioner concern about myopia with a reported moderately high level of activity, but the vast majority still prescribed single vision interventions to young myopes. This research aimed to update these findings 4 years later. METHODS A self-administrated, internet-based questionnaire was distributed in eight languages, through professional bodies to eye care practitioners globally. The questions examined: awareness of increasing myopia prevalence, perceived efficacy of available strategies and adoption levels of such strategies, and reasons for not adopting specific strategies. RESULTS Of the 1336 respondents, concern was highest (9.0 ± 1.6; p < 0.001) in Asia and lowest (7.6 ± 2.2; p < 0.001) in Australasia. Practitioners from Asia also considered their clinical practice of myopia control to be the most active (7.7 ± 2.3; p < 0.001), the North American practitioners being the least active (6.3 ± 2.9; p < 0.001). Orthokeratology was perceived to be the most effective method of myopia control, followed by pharmaceutical approaches and approved myopia control soft contact lenses (p < 0.001). Although significant intra-regional differences existed, overall, most practitioners did not consider single-vision distance under-correction to be an effective strategy for attenuating myopia progression (79.6 %), but prescribed single vision spectacles or contact lenses as the primary mode of correction for myopic patients (63.6 ± 21.8 %). The main justifications for their reluctance to prescribe alternatives to single vision refractive corrections were increased cost (20.6 %) and inadequate information (17.6 %). CONCLUSIONS While practitioner concern about myopia and the reported level of activity have increased over the last 4 years, the vast majority of eye care clinicians still prescribe single vision interventions to young myopes. With recent global consensus evidence-based guidelines having been published, it is hoped that this will inform the practice of myopia management in future.
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Affiliation(s)
| | - Antonio Calossi
- Department of Physics (Optics and Optometry), University of Florence, Italy
| | - Pauline Cho
- School of Optometry, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region
| | - Kate Gifford
- School of Optometry and Vision Science, Queensland University of Technology, Brisbane, Australia
| | - Lyndon Jones
- Centre for Ocular Research & Education (CORE), University of Waterloo, Waterloo, Ontario, Canada
| | - Deborah Jones
- Centre for Ocular Research & Education (CORE), University of Waterloo, Waterloo, Ontario, Canada
| | - Sarah Guthrie
- Centre for Ocular Research & Education (CORE), University of Waterloo, Waterloo, Ontario, Canada
| | - Ming Li
- Eye Hospital of Wenzhou Medical University, China
| | - Cesar Lipener
- Contact Lens Section, Federal University of São Paulo/Paulista School of Medicine, São Paulo, Brazil
| | - Nicola S Logan
- School of Health & Life Sciences, Aston University, Birmingham, UK
| | - Florence Malet
- Point Vision Bordeaux, Ophthalmologic Center, Bordeaux, France
| | - Sofia C Peixoto-de-Matos
- Clinical and Experimental Optometry Research Lab (CEORLab) - Center of Physics, University of Minho, Portugal
| | - José M González-Méijome
- Clinical and Experimental Optometry Research Lab (CEORLab) - Center of Physics, University of Minho, Portugal
| | - Jason J Nichols
- University of Alabama at Birmingham School of Optometry, Birmingham, AL, USA
| | - Janis B Orr
- School of Health & Life Sciences, Aston University, Birmingham, UK
| | | | | | - Nilesh Thite
- International Association of Contact Lens Educators, Pune, India
| | - Eef van der Worp
- Eye-Contact-Lens Research & Education, Amsterdam, The Netherlands
| | - Elena Tarutta
- Department of Refraction Pathology, Binocular Vision and Ophthalmoergonomics, Helmholtz National Medical Research Centre of Eye Diseases, Moscow, Russia
| | - Elena Iomdina
- Department of Refraction Pathology, Binocular Vision and Ophthalmoergonomics, Helmholtz National Medical Research Centre of Eye Diseases, Moscow, Russia
| | - Bariah Mohd Ali
- Optometry and Vision Science Program, Faculty of Health Sciences, Universiti Kebangsaan, Malaysia
| | - César Villa-Collar
- Department of Pharmacy, Biotechnology, Optics and Optometry, European University of Madrid, Villaviciosa de Odón, Spain
| | | | - Connie Chen
- Department of Optometry, Chung Shan Medical University, Taichung, Taiwan
| | - Heiko Pult
- School of Health & Life Sciences, Aston University, Birmingham, UK; Optometry & Vision Research, Weinheim, Germany; School of Biomedical & Life Sciences, Cardiff University, Cardiff, UK
| | | | | | - Fatima Iqbal
- School of Optometry, The University of Faisalabad, Pakistan
| | - Raul Ramos
- Alcon Latin America, LACAR Vision Care, Barrio Loreto, Alcaldia Álvaro Obregón; Ciudad de México
| | | | - Nikolay Boychev
- School of Health & Life Sciences, Aston University, Birmingham, UK
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Zloto O, Wygnanski-Jaffe T, Farzavandi SK, Gomez-de-Liaño R, Sprunger DT, Mezer E. Current trends among pediatric ophthalmologists to decrease myopia progression-an international perspective. Graefes Arch Clin Exp Ophthalmol 2018; 256:2457-2466. [PMID: 30074069 DOI: 10.1007/s00417-018-4078-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 06/20/2018] [Accepted: 07/23/2018] [Indexed: 12/27/2022] Open
Abstract
PURPOSE To explore what the current worldwide preferred practice patterns of pediatric ophthalmologists are to decrease myopia progression among their patients. METHODS A questionnaire was sent to all members of supranational and national pediatric ophthalmology and strabismus societies. RESULTS The questionnaire was fully completed by most respondents 90.10% (847 of 940 responses). Fifty-seven percent (457) routinely treat to decrease myopia progression. The most common parameter to initiate treatment was a myopic increase of 1 diopter/year or more (74.8%, 246). Seventy percent (345) prescribed eye drops. Atropine 0.01% was the most popular (63.4%, 277) followed by atropine 1% (10.9%, 48) and atropine 0.5% (8.9%, 39). Eighty-six percent (394) of the respondents advised to spend more time outdoors, to reduce the amount of time viewing screens (60.2%, 277), and cutback the use of smart phones (63.9%, 294). CONCLUSIONS Most pediatric ophthalmologists treat to decrease myopia. They employ a wide variety of means to decrease myopia progression. Atropine 0.01% is the most popular and safe modality used similarly to recent reports. However, there is no consensus when treatment should be initiated. Further prospective studies are needed to elucidate the best timing to start treatment and the applicability of recent studies in the Asian population to other ethnic groups. This will improve the ability to update pediatric ophthalmologist with evidenced-based treatment options to counter the myopia epidemic.
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Affiliation(s)
- Ofira Zloto
- Goldschleger Eye Institute, Sheba Medical Center, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tamara Wygnanski-Jaffe
- Goldschleger Eye Institute, Sheba Medical Center, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sonal K Farzavandi
- Singapore National Eye Centre, Singapore, Singapore.,Duke-National University of Singapore Graduate Medical School, Singapore, Singapore
| | | | - Derek T Sprunger
- Department of Ophthalmology, Pediatric and Strabismus Section, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Eedy Mezer
- Department of Ophthalmology, Ruth Rappaport Children's Hospital, Rambam Health Care campus, POB 9907, 3109901, Haifa, Israel. .,Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, I.I.T, Haifa, Israel.
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Li X, Friedman IB, Medow NB, Zhang C. Update on Orthokeratology in Managing Progressive Myopia in Children: Efficacy, Mechanisms, and Concerns. J Pediatr Ophthalmol Strabismus 2017; 54:142-148. [PMID: 28092397 DOI: 10.3928/01913913-20170106-01] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 10/19/2016] [Indexed: 02/06/2023]
Abstract
Myopia is an important public health issue, and high myopia may lead to severe complications if left untreated. Orthokeratology lenses, worn overnight to reshape the cornea, are one of many recent modalities used to slow down the progression of myopia in children. This treatment has been proven successful, as evidenced by decreased spherical refractive error and axial length relative to the control at interval follow-up ranging from 6 months to 5 years. In this systematic review, the authors collected published controlled studies that analyzed the efficacy of orthokeratology lens wear and calculated longitudinal relative changes in axial length, revealing a weighted average of -45.1% change in axial length at the 2-year follow-up. The exact mechanism by which orthokeratology lenses reduce myopia progression is unknown, but research shows that the corneal reshaping decreases peripheral hyperopic defocus and therefore increases peripheral myopic defocus to likely reduce stimuli for axial elongation and subsequent development of myopia. Use of orthokeratology lenses is generally safe, but cases of associated infectious keratitis may have a higher incidence of virulent organisms such as Pseudomonas, Acanthamoeba, and antibacterial-resistant strains of Staphylococcus, partially due to the required overnight use of these lenses. Orthokeratology is regarded as one of the most effective non-pharmacologic measures to slow progression of myopia in children and, with regular follow-up to ensure safety, continues to be one of the most effective treatments for myopia management around the world. [J Pediatr Ophthalmol Strabismus. 2017;54(3):142-148.].
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