Clinical

New Technology Records Visual Behavior to Identify Risk Factors of Myopia Progression

April 15, 2021

By Andreas Kelch & Daniel Boss

Vivior can offer added value for myopia management by recording the objective visual behavior to determine myopia risk factors.

Usually, the first step in myopia management1 is identifying the risk factors that enhance the development of severe myopia. Apart from age, refraction, axial length, and genetic factors (myopia in the family, ethnic background), a child’s behavioral and environmental risks should also be investigated.2 At the same time, parents and children must be informed about the respective risks and possible measures to reduce the avoidable risk.

In practice today, the behavioral risks are usually identified through questionnaires or in a face-to-face conversation. In many cases, however, parents and children cannot provide accurate information about their personal behavioral risks, as these are not recorded consciously and therefore difficult to quantify. Consequently, it is difficult for the optometrist to give a clear and concise recommendation for behavioral changes that parents and children could follow.

Moreover, in the course of myopia management, the optometrist has no objective control over whether there has been any change in the child’s behavior that could significantly influence the further development of myopia. Now, Vivior can offer added value for myopia management by recording the objective visual behavior to determine myopia risk factors.

The Vivior Concept
Vivior is a technology startup company from Zürich, Switzerland, that aims to optimize vision performance based on innovative sensor technology in conjunction with cloud-based artificial intelligence (see image to the left). For the first time, specific visual behavior data can be obtained over a period of several days during which the Vivior Monitor is worn. On this basis, personalized solutions can be implemented to correct the patient’s vision.

Today, the Vivior Monitor is already used in ophthalmology to select an intraocular lens (IOL) and in optometry for determining patient needs when selecting single-vision and progressive lens designs. 

The Vivior Monitor can be attached easily to any spectacle frames and, because it weighs only 14 grams, the patient is not inconvenienced by the Monitor when wearing the glasses. During the period that it is worn (at least four days), the Monitor measures the following data using various sensors:

  • distances to objects in the visual field
  • light conditions in the visual field
  • ambient UV light
  • head movement and position

The Vivior data are stored anonymously in the cloud and processed using artificial intelligence to determine the type and duration of visual activities (such as reading, working on a computer, time outdoors, etc.).

Using a web application, the optometrist can analyze the results and discuss them with the patient.  The optometrist can also generate various patient reports that explain the results regarding the specific visual behavior and the customized solutions in a patient-friendly way.

Apart from patient reports for selecting single-vision and progressive glasses, Vivior is now also offering a Myopia Report to clarify the objective behavioral risk factors for children.

Vivior Myopia Report: Risk Factor Evaluation
The Vivior Myopia Report focuses on behavioral risk factors that have been associated with a higher risk for myopia onset and progression. These risk factors are visualized in the report in a spider chart and evaluated using a three-star scoring system (see Myopia Risk Factors diagram below). A risk factor scoring fewer stars and covering less area means that the visual behavior associated with it bears a higher risk for the development and/or progression of myopia. The risk factor charts are evaluated separately for weekdays and weekends to highlight potential differences in behavior.

Greater Patient Connectivity in Treatment
The Vivior Myopia Report is an addition to the conventional treatments in myopia management and should not be regarded as a substitute for them. The optometrist obtains a reliable determination of the behavioral risk factors from the objective data and can then give specific recommendations regarding changes in behavior with the help of artificial intelligence. Furthermore, the optometrist can use the report to evaluate the behavioral risks periodically as part of myopia management and map out the recommended treatment plan. 

The report helps parents and children assess personal risk and should simultaneously motivate them to implement the intended changes in behavior that have favorable effects on the further development of myopia. The objective measurement of visual behavior with the Vivior Monitor involves the child more firmly into myopia management. The new way of representing the risk factors and the algorithm-based evaluation should likewise positively affect compliance.

 

On the basis of the objective evaluation of the behavioral risks, a personal and algorithm-based recommendation for the child’s behavior is given in the myopia report.
A recommendation to spend more time outdoors is given if the average “time spent outdoors” per day (including weekdays and weekends) is less than one hour. 3,4,11
A recommendation to increase the reading distance is given if the measured “near-vision distance” is less than 30 cm. 5-8
The recommendation to take more breaks during near-vision activities is given if the measured “near-vision episode duration” is more than 30 min. 9,10

 

 

 

Andreas Kelch, MA, is a graduate engineer in optometry and business of the Ostfalia University of Applied Sciences in Wolfsburg (DE). Since 2019 he has been working for Vivior AG in Zurich as Head Marketing & Sales Manager Vision Care. Previously, he held several managing positions in the vision care industry.

 

 

 

 

 

Daniel Boss, PhD, is an optical scientist who has worked in the ophthalmic industries for several years. He received his PhD from Ecole Polytechnique Fédérale de Lausanne (EPFL), Switzerland.

 

 

 

 

References:

  1. Holden, B. A. et al. Global Prevalence of Myopia and High Myopia and Temporal Trends from 2000 through 2050. Ophthalmology 123, 1036–1042 (2016).
  2. Gifford, K. L. et al. IMI – Clinical Management Guidelines Report. Investig.Opthalmology Vis. Sci. 60, M184 (2019).
  3. Xiong, S. et al. Time spent in outdoor activities in relation to myopia prevention and control: a meta-analysis and systematic review. Acta Ophthalmol. 95, 551–566 (2017).
  4. Ho, C. L., Wu, W. F. & Liou, Y. M. Dose-response relationship of outdoor exposure and myopia indicators: A systematic review and meta-analysis of various research methods. Int. J. Environ. Res. Public Health 16, (2019).
  5. Lanca, C. & Saw, S. The association between digital screen time and myopia: A systematic review. Ophthalmic Physiol. Opt. 40, 216–229 (2020).
  6. Mutti, D. O., Mitchell, G. L., Moeschberger, M. L., Jones, L. A. & Zadnik, K. Children’s Refractive Error. Investig. Opthalmology Vis. Sci. 43, 3633–3640 (2002).
  7. Ip, J. M. et al. Role of Near Work in Myopia: Findings in a Sample of Australian School Children. Investig. Opthalmology Vis. Sci. 49, 2903 (2008).
  8. Huang, H., Chang, D. S. & Wu, P. The Association between Near Work Activities and Myopia in Children—A Systematic Review and Meta-Analysis. PLoS One 10, e0140419 (2015).
  9. Kee, C. S. et al. Temporal constraints on experimental emmetropization in infant monkeys. Investig. Ophthalmol. Vis. Sci. 48, 957– 962 (2007).
  10. Benavente-Perez, A., Nour, A. & Troilo, D. Short Interruptions of Imposed Hyperopic Defocus Earlier in Treatment are More Effective at Preventing Myopia Development. Sci. Rep. 9, 25–29 (2019).
  11. Read, S. A. et al. Patterns of daily outdoor light exposure in Australian and Singaporean children. Transl. Vis. Sci. Technol. 7, (2018).
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