October 16, 2023
By Dwight Akerman, OD, MBA, FAAO, FBCLA, FIACLE
Logan and Bullimore, in their article “Optical Interventions for Myopia Control,” published in the journal Eye, discuss optical interventions for myopia control, focusing on mechanisms of action, evidence for their efficacy, and what we still need to learn. They summarize key studies and their outcomes, identifying randomized controlled clinical trials of at least 18 months duration. The authors identified 13 randomized clinical trials for spectacles, five for overnight orthokeratology, five for soft contact lenses, and three for OrthoK combined with low-concentration atropine.
The authors found that overnight OrthoK trials were the most consistent, with two-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 0.31D, respectively. In contrast, next-generation designs with peripheral lenslets slow two-year elongation and progression by up to 0.35 mm and 0.80D. Among soft contact lens interventions, medium add concentric bifocals slow three-year elongation and progression by only 0.07 mm and 0.16D, while a dual-focus design slows three-year elongation and progression by 0.28 mm and 0.67D.
All three optical interventions have the potential to slow myopia progression significantly. 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.
The authors also discuss the mechanisms and theories of action behind optical interventions to slow myopia progression. An early prevailing theory was that excessive or prolonged accommodation was responsible for myopia progression. However, this theory has been largely discredited. More recent theories suggest that peripheral defocus, the difference in focus between the central and peripheral retina, may be responsible for myopia progression. Optical interventions that alter the peripheral defocus may, therefore, be effective in slowing myopia progression.
The authors conclude that optical interventions are a promising approach to myopia control. They are non-invasive, have few side effects, and are relatively inexpensive. However, more research is needed to determine the optimal optical design and treatment regimen. The authors suggest that future research should focus on identifying the most effective optical designs, determining the optimal age of intervention, and investigating the potential for combining optical interventions with other treatments, such as topical low-dose atropine.
Abstract
Optical Interventions for Myopia Control
Nicola S. Logan, Mark A. Bullimore
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 were identified. Randomized clinical trials were identified and summarized: 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.
Logan, N. S., & Bullimore, M. A. (2023). Optical interventions for myopia control. Eye, 1-9. DOI: https://doi.org/10.1038/s41433-023-02723-5
