October 10, 2024
Researchers in the field of myopia management from across the globe gathered in Hainan Island, China, for the International Myopia Conference from September 24 to September 28. Over the course of the conference, Review of Myopia Management highlighted many of the most important abstracts and posters that were presented at the event. See the full list of research highlights below:
- Predictive Factors Associated with Incident Myopia in Childhood
Nina Tahhan, Xiangui He, Kathryn Saunders, Pelsin Demir, Antonio F. Macedo, Rebecca Leighton, Karthikeyan Baskaran, Sara J. McCullough, Karen Breslin, Thomas Naduvilath
Purpose: Prevention and early intervention of myopia can reduce the risk of sight threatening complications later in life. The goals were: 1) to investigate differences in ocular parameters between children who become myopic (incident myopes) to those who remained non-myopic over one year from multiple regions and 2) to identify and quantify predictive risk factors for incident myopia.
Conclusions: The regional risk of myopia onset within one year can be modeled based on age, gender, spherical equivalent, and axial length/corneal radius. The risk of incident myopia is higher in China compared to Sweden and Northern Ireland. - Axial Length Growth Patterns from 6 to 18 Years of Age: The Generation R Study
J W L Tideman, SC M Kneepkens, DJ van Hemert, JR Polling, C C W Klaver
Purpose: Axial length (AL) is increasingly used to monitor myopia progression in children. The assessment of excessive eye growth in childhood has proven to be challenging as eye growth varies with age. The aim of this study is to investigate the association between AL eye growth from age 6-9, from 9-13, and 13 – 18 years, and to relate eye growth during these periods with myopia onset < 6 years, at 9 years, or at 13 years of age.
Conclusions: In this European study, yearly growth of the AL approximately halves every four years in emmetropic as well as myopic children. Myopic children have on average double the amount of growth than non-myopic children. Age of onset has no large effect on AL growth in myopic children, whereas pre-myopic children already have an accelerated growth, but not as fast as myopic children. These growth data will help clinicians diagnose excessive eye growth at an early age and substantiate the instigation of intervention for progressive myopia. - Myopia Control Prescribing Patterns Identified From a Large U.S. Registry Study
Kathryn Richdale, Cameron Postnikoff, Kenneth Tran, Sanjeev Kasthurirangan
Purpose: MiSight 1 day is the only United States (U.S.) Food and Drug Administration
(FDA)-approved option to slow myopia progression in children, aged 8 to 12 years who are -0.75 to -4.00D at initiation of treatment. The purpose of this analysis was to describe the U.S. MiSight 1 day wearer population based on screening and enrollment in a large multi-center study.
Conclusions: In this observational registry study, it was observed that practitioners routinely fit MiSight 1 day beyond the approved indication in the U.S.; primarily prescribing over a wider age or refractive error range. This indicates strong practitioner willingness to adopt off-label prescribing practices to manage their myopic patients. - CURB (CUmulative Refractive Benefit), CALM (Cumulative Axial Length Modification), and Treatment Efficacy Index (TEI): Three New Metrics for Monitoring Myopia Progression and Treatment
Corrina McElduff, Kate Loskutova, James Loughman, Gareth Lingham, Ian Flitcroft
Purpose: To review the limitations of current metrics for monitoring myopia treatments and provide new centile-based metrics for refractive and axial changes optimized for application in clinical practice, not just clinical trials.
Conclusions: Existing metrics for monitoring myopia progression and treatment are mostly designed to describe clinical trials or fail to address individual patient factors known to influence myopia progression (such as baseline refraction, age, and race). CURB, CALM, and TEI provide a novel, validated method of benchmarking an individual’s response to a myopia intervention for both spherical equivalent refraction and axial length. - Can Axial Length Centiles Be Used to Predict Eye Growth? Comparison of Placebo and Centile-Matched Virtual Control Group Progressions
Gareth Lingham, James Loughman, David A. Mackey, Samantha Sze-Yee Lee, Emmanuel Kobia-Acquah, Ian Flitcroft
Purpose: With acceptance of myopia control interventions into standard of care for
myopia progression, placebo control groups in randomized controlled trials are being phased out. We aimed to evaluate the performance of a centile-based method for creating a matched, virtual control group in the evaluation of myopia control interventions.
Conclusions: Reference axial length centile databases can be used to predict 24-month axial length growth in untreated myopic children and adolescents. Adjusting for participant ethnicity improved the prediction. Adding systematic corrections for sex and baseline axial length or centile may further improve projections. - Initial Clinical Management of Myopic and Pre-Myopic Patients in Ontario, Canada: How Has This Changed Over Time?
Deborah Jones, Sarah Guthrie, Mira Acs, Barbara Caffery, Angela DiMarco, Stephanie Fromstein, Shalu Pal, Stephanie Ramdass, Vishakha Thakrar, Matthew Zeidenberg, Amy Chow
Purpose: To determine how optometrists in Ontario, Canada, are changing their management of myopic and pre-myopic pediatric patients at their initial visit over time.
Conclusions: While optometrists in Ontario, Canada, are increasingly integrating evidence-based practices in the clinical management in myopic children and children at risk of myopia, this study reveals knowledge gaps that should be the focus of continuing education programs. Recommendations include initiating myopia control earlier instead of waiting for further progression of myopic refractive error and discussing lifestyle changes with pre-myopic children for optimal efficacy in delaying the onset of myopia. - Longitudinal Analysis of Axial Elongation Rates: Comparison Between Persistent Emmetropic and Pre- and Post-Myopic Eye Growth in ChildhoodTsz Wing Leung, Wai Cheung Liu, Siu Yin, Carly Lam, Jane, Fulton, Sara McCullough, Kathryn Saunders
Purpose: Myopia is characterized by excessive elongation of the eyeball. This study investigates the rate of axial elongation among children transitioning from hyperopic or emmetropic states to myopia. Specifically, it aims to identify at which developmental stage — pre-myopic or post-myopic — axial elongation occurs most rapidly, compared to children who remain non-myopic.
Conclusions: This study demonstrates that axial elongation occurs at a faster rate during the pre-myopic stage compared to the non-myopic group and accelerates further upon transitioning to myopia. These findings underscore the progressive nature of myopia and the importance of early detection and intervention. Early identification of changes in axial elongation facilitates the implementation of preventive strategies, such as lifestyle adjustments or myopia control treatments, potentially preventing the progression to more advanced stages of myopia. - Real-World Effectiveness of Diffusion Optics Technology (DOT) Spectacle Lenses for Myopia Control in Chinese Children
Dechen Wang, Marcella McParland, Sylvie Franz
Purpose: Diffusion Optics Technology (DOT) spectacle lenses are designed to slow myopia progression by modulating retinal contrast. The purpose of this study was to evaluate myopia progression observed in Chinese children wearing Diffusion Optics Technology (DOT) spectacle lenses in a real-world clinical population for 12 months.
Conclusions: Real-world use of DOT spectacle lenses demonstrate that contrast modulation spectacles successfully slowed the progression of myopia compared to modeled untreated myopic children. These real-world results demonstrate DOT spectacle lenses effectively slow myopia progression in clinical practice. - Correlation Between Tear Film Stability and Myopia in Young Chinese Adults: A Retrospective Cross-Sectional StudyXiyang Yang, Yan Zhang, Junyu Lin, Cheng Yang, Kiwako Mori, Kazuno Negishi, Kazuo Tsubota, Jin Zeng, Toshihide Kurihara
Purpose: The prevalence of both myopia and dry eye disease is increasing among young Asian adults. This study aimed to investigate the correlation between tear film instability and the degree of myopia.
Conclusions: The study found that tear film instability correlates with higher degrees of myopia. The role of the parasympathetic nervous system in myopia progression is highlighted, as increased parasympathetic activity and subsequent changes in choroidal blood flow may influence these changes in choroidal thickness. Additionally, dysfunction in the parasympathetic innervation of the lacrimal glands can lead to dry eye conditions, further contributing to tear film instability. Together, these findings underscore the potential contributions of autonomic nervous system balance and ocular surface health to myopia pathogenesis. Addressing these factors may be crucial in developing effective myopia management strategies. - Variations in Physiological and Myopic Eye Growth Among Children From Different Populations
Yee Ling Wong, Yimin Yuan, Yingying Ye, Bjorn Drobe, Hao Chen, Jinhua Bao
Purpose: In comparison to other populations, this study aims to evaluate physiological and myopic eye growth among children in Wenzhou, China.
Conclusions: Physiological and myopic eye growth differs between populations of varying ethnicities and countries. Therefore, it is important to apply physiological eye growth rates from a similar source population in interpretation of myopia control efficacy outcomes related to axial elongation. - A Preliminary Study of the Differences in the Effects of Monochromatic Light of Different Wavelengths on the Orthokeratization of Guinea Pig Eyes and the Biological Mechanisms Involved
Jiawei Zhang, Rui Liu
Purpose: Light plays an important role in regulating the process of ocular orthokeratology, and the dopamine, melatonin, cAMP, and cGMP pathways are signaling pathways associated with refractive development. In this study, we investigated the effects of different wavelengths of monochromatic light (430 nm blue light and 530 nm green light) on the process of orthokeratology in guinea pigs and the changes of dopamine and melatonin in peripheral serum in order to explore the possible mechanisms of monochromatic light regulation of orthokeratology.
Conclusions: Monochromatic light of different wavelengths can induce the orthokeratization process of guinea pig eyes to shift towards myopia or hyperopia, respectively. Blue light induced an increase in dopamine in vivo and inhibited the elongation of the eye axis. This process was negatively regulated by the melatonin and cAMP pathways and was dependent on the cGMP pathway. - Which is the Most Critical for Myopia Development: Reading Modality, Text Size, or Illumination?
Dr. Sayantan Biswas, Ms. Umaymah Jagot, Ms. Amisha Johal, Ms. Kymran Hairan, Ms. Esha Ali, Prof. Leon N. Davies, Prof. Nicola Logan
Purpose: To evaluate the interaction between near-work parameters (reading modality, text size) and illumination (indoor lighting) on axial length (AL) and choroidal thinning in young adults.
Conclusions: Exposure to mild or moderate intensity illumination can differentially induce a significant reduction in AL elongation and choroidal thinning in young emmetropic adults compared to myopes, suggesting differences in light responses between emmetropic and myopic eyes. The findings support the hypothesis that light exposure is a non-invasive method to prevent myopia development but might not effectively reduce progression in myopic eyes. This underscores the importance of considering factors such as refractive status when designing interventions to mitigate the effects of near work using light exposure. - Why Does Near Work Cause Myopia and How Might We Intervene Optically?
Rachel Langan, James A. Kuchenbecker, Dragos Rezeanu, Maureen Neitz, Jay Neitz
Purpose: Although controversial, it seems clear that near work is a causal factor for myopia. Diffusion Optics Technology (DOT) lenses are a myopia control design based on contrast theory shown to be effective in clinical trials. DOT lenses are proposed to mitigate the myopiagenic effects of near work by mimicking natural contrast. This study aims to test the hypothesis that near work causes myopia because high-contrast images from screens and reading drive the activity of peripheral midget bipolar cells excessively, signaling eye growth. In turn, the activity is proposed to be reduced by DOT lenses to levels like those produced by natural stimuli.
Conclusions: The results are consistent with the hypothesis that near work causes myopia because high contrast images from screens and reading excessively drive the activity of peripheral midget bipolar cells, which signal axial elongation. - Optimizing Early Detection of Pre-Myopia and Myopia in Young Children: Effective Non-Cycloplegic Screening Methods
Dr. Siofra Harrington, Dr. Michael Moore, Professor James Loughman, Professor Ian Flitcroft, Dr. Veronica O ‘Dwyer
Purpose: Pre-myopia, characterized by less hyperopic refraction than typical for 6 – 7-year-olds, significantly increases the risk of developing myopia by age 10. This condition is becoming more prevalent in younger Asian and Caucasian children. While myopia management technologies exist, early identification of children at risk for myopia or premyopia is crucial. However, there is limited research on effective screening methods for premyopia. This study aimed to establish effective non-cycloplegic screening methods for premyopia in 6 – 7-year olds.
Conclusions: While uncorrected distance vision acuity (UDVA) alone provides acceptable discrimination for myopia, it is insufficient for screening pre-myopia. Non-cycloplegic spherical equivalent (SE) alone has relatively poor discrimination for pre-myopia, but its accuracy improves when combined with ocular biometry. The best results for myopia discrimination are achieved by combining non-cycloplegic SE, biometry, and UDVA measures. - Myopia: Causes, Prevention, and Treatment of an Increasingly Common Disease
Machelle Pardue, Jeremy Guggenheim
Purpose: The United States National Academies of Sciences, Engineering, and Medicine will release a consensus study report in September 2024 that will consider various aspects related to the global increase in myopia. The goals of the study are to assess the current mechanistic understanding of myopia pathogenesis and causes of its increased prevalence, to identify knowledge gaps and barriers to progress, and to develop a research agenda aimed at better understanding the biological and environmental factors that could explain its increasing incidence. - Prevalence and Temporal Trends of Childhood Myopia and High Myopia in China: A Systematic Review and Meta-Analysis with Projects From 2020 to 2050
Wei Pan, Zhikuan Yang, Seang-mei Saw, Tien-yin Wong, Ian Morgan, Weizhong Lan
Purpose: Previous research by Holden et al. tried to address prevalence and temporal trends globally, however, there are some doubts about the methodology of this paper, and there are also doubts about the accuracy of their baseline prevalence estimates. The aim of this study is to set the baseline for childhood myopia and high myopia prevalence, determined with cycloplegia in China for the period 2010-2019, and assess the temporal trends of myopia from 2020 to 2050, and the potential impact of myopia prevention and control.
Conclusions: This study suggested an increasing burden for individuals and society if current trends of myopia prevalence continue, and the burden is even greater with maximal near-work intensity. Optimistically, the minimum growth model based on the experience of myopia prevention in Taiwan, suggests that substantial reductions in the prevalence of myopia and high myopia can be achieved by increasing time outdoors, one of the initiatives in China’ s Myopia Prevention policy, and reductions in education loads of the kind expected from China’ s Double Reductions policy could add significantly to these reductions. Monitoring future changes could provide valuable information for other countries faced with an epidemic of myopia. - Peripheral Retina Controls Emmetropization in Human Subjects
Barbara Swiatczak, Frank Schaeffel
Purpose: To investigate which retinal areas are necessary for the detection of optical defocus for emmetropization in young human subjects by real-time visual field patching via gaze tracking.
Conclusions: Foveal input is not needed for the retina to detect the imposed defocus, while an area between 6 and 12 degrees seems to be necessary for emmetropization. Since the patch covering the area between 12 and 18 degrees canceled the effect, it suggests that probably further peripheral areas also need to be exposed to the defocus. - Axial Length Estimates Derived With and Without Demographic Data: Are They Useful for Monitoring Axial Growth with Myopia Management?
Patrick Richardson, Lesley Doyle, Jane Fulton, Sara McCullough, Philip Morgan, Kathryn Saunders
Purpose: Many eye care practitioners aiming to slow axial elongation through myopia management do not have biometric devices for measuring axial length (AL), creating difficulties in establishing the level of risk associated with myopia, effectively monitoring myopia progression and identifying treatment success. Several AL “calculators” have been published to support clinical practice where biometry measurements are unavailable. Morgan et al.’s (2020) original AL estimation formula (M1) utilized only refractive error and corneal curvature to estimate AL. The equation has subsequently been updated to incorporate age and sex variables (M2). The present study used a prospective dataset to compare estimates of AL and axial elongation derived using original (M1) and updated (M2) formulae with measured values to investigate their utility in monitoring treatment success in pediatric myopia management.
Conclusions: Addition of age and sex improved limits of agreement for baseline AL by approximately 19%. Limits of agreement for estimating annual AL change were 2.5-4x narrower than for AL at a single timepoint. Nonetheless, elongation estimates’ limits of agreement significantly exceed repeatability values reported for biometers (IOL Master700 limits of agreement for repeatability + 0.014 mm), a limitation to consider when using AL estimates in decision-making. - Daily Disposable Hydrogel Soft Contact Lenses Do Not Adversely Affect Corneal Endothelium in Children
Hiu Yan Lam, Susie Jones, Nicola S. Logan
Purpose: Randomized controlled trials have demonstrated that specially designed, daily disposable soft contact lenses (SCLs) can slow myopia progression in children. Limited data exist on impact of SCLs on the anterior eye in a pediatric population. This study evaluates the long-term effect of wearing SCLs from a young age over a 10-year period to confirm their impact on corneal health following a non-inferiority approach.
Conclusions: This study showed wearing daily disposable, hydrogel SCL is not significantly worse (inferior) than wearing spectacles in terms of central corneal endothelium integrity in children who wore SCLs from 8 years of age for 10 years, who had good contact lens habits and regular contact lens aftercare. - Myopia Progression After Cessation of Diffusion Optics Technology (DOT) Spectacle Lenses
Jennifer S. Hill, Deborah Laughton, Marcella McParland, Graeme Young, Chris Hunt
Purpose: To investigate myopic progression in children following the cessation of Diffusion Optics Technology (DOT) spectacle lenses after wearing for at least four years.
Conclusions: The interim results from this ongoing study suggest that neither myopia progression nor axial growth was faster for the subjects who discontinued DOT spectacle lens wear compared to those who continued to wear single-vision spectacles. These findings indicate DOT spectacle lens treatment benefit is retained after cessation of treatment. - An Evaluation of Repeated Low-Level Red-Light Therapy Compliance and Use in the U.K.
Neema Ghorbani Mojarrad
Purpose: The Eyerising Ltd Myopia Management Device, which uses Repeated Low-Level Red-Light (RLRL) therapy for controlling the progression of myopia, has been licensed in the United Kingdom (U.K.) since 2023. An audit of the release of RLRL in U.K. practices was performed to explore the experiences of practitioners and patients over the first six months of use of RLRL in the U.K.
Conclusions: Interim analysis shows reasonable compliance and no adverse effects for those in the U.K. pilot thus far, with the majority of patients using RLRL successfully as a combination therapy, or as an alternative intervention where prior optical approaches have not been efficacious. Interestingly, compliance appears to vary monthly, which may be related to differences in routines and vacations away from home and needs to be considered for prescribing home-based treatments. Future work will involve evaluating the complete six-month dataset of ophthalmic outcomes once available, as well as better understanding the experiences of parents and children with RLRL. - Safety Profile of a Widely Used Red Light Laser Instrument for Myopia
Lisa Ostrin, Alexander Schill, Zhou Chen
Purpose: Low-Level Red-Light (LLRL) therapy has recently emerged as a treatment for myopia in children. Published results using LLRL show promising results for slowing the progression of myopia. However, the output and safety of all the commercially available devices for LLRL have not been thoroughly investigated. The goal of the current study was to characterize the output and determine the safety of the Eyerising instrument for LLRL, which is being increasingly utilized in China and recently approved in several other countries.
Conclusions: The Eyerising LLRL instrument evaluated here exceeds ANSI classification for a Class 1 laser and does not meet criteria for Group 1 or 2 instrument classification, depending on viewing time and pupil size. Caution is warranted in using LLRL instruments for myopia management until commercially available instruments are shown to be within established safety limits for repeated episodes of three minutes of continuous viewing. - Is Physiological Axial Length Growth Achieved with DIMS Spectacle Lenses in Myopic Children? A Retrospective Analysis of Real-Life Results in a German Clinical Setting
Hakan Kaymak, Birte Neller, Kai Neller, Ann-Isabel Mattern, Machteld Devenijn, Achim Langenbucher, Berthold Seitz, Hartmut Schwahn
Purpose: Defocus Incorporated Multiple Segments (DIMS) lenses have been proven to effectively inhibit children’s myopia progression in randomized controlled trials. We
performed a retrospective analysis of real-life data to evaluate the effect of DIMS lenses on axial length (AL) growth.
Conclusions: Older children and those with moderate baseline axial lengths showed treatment success after 12 months of wearing DIMS lenses. Younger children and those with a higher baseline AL showed lower treatment success. In such cases, combination treatment (DIMS lenses and low-dose atropine) should be considered from the outset. - MyopiaX-1 6-Month Safety and Effect Outcomes on the Reduction of Myopia Progression: A Randomized, Controlled, Multicenter Trial
Ian Flitcroft, Gareth Lingham, Ida Z. Undorf, Nikita Wong, Gabriela Burian, MyopiaX- 1 Investigator Group
Purpose: Light plays a significant role in myopia onset and progression, and light-based interventions are an emerging therapeutic category for myopia control. Dopamine is known to mediate the effects of light exposure on eye growth regulation and refractive error development. There is promising pre-clinical and translational evidence supporting the potential of blue light stimulation of the blind spot to control myopia via dopamine modulation. The Myopia X-1 proof-of-concept trial is a randomized, controlled, multicenter clinical investigation evaluating the safety, tolerability, and signals of effect of blue light stimulation of the blind spot, on myopia progression in children in Europe.
Conclusions: The six-month outcomes of the Myopia X-1 trial provide the first clinical evidence to support the safety and tolerability of a blue light intervention for myopia control in this pediatric population. Ongoing analyses will provide further insight into the outcomes of effect and potential clinical application of MyopiaX to control myopia in children. The 12-month MyopiaX-1 trial is scheduled to complete in September 2024. - Hyperopic Reserve as a Treatment Indicator for Low-Concentration Atropine to Delay Myopia Onset in Children (LAMP2 Study)
Xiu Juan Zhang, Yuzhou Zhang, Benjamin H. K. Yip, Ka Wai Kam, Alvin L. Young, Clement C. Tham, Li Jia Chen, Chi Pui Pang, Jason C. Yam
Purpose: The Low-concentration Atropine for Myopia Prevention (LAMP2) study showed that atropine eye drops can delay the myopia onset. A pivotal question remains unanswered: Who should receive atropine drops to prevent myopia onset? The current study aims to evaluate factors associated with the efficacy of low-concentration atropine eye drops in delaying myopia onset.
Conclusions: Low baseline hyperopic reserve and high level of parental myopia were two significant risk factors for both myopia onset and spherical equivalent progression in non-myopic children. They should therefore be considered for preventive treatment. Hyperopic reserve could be an indicator for atropine treatment since children may have greater benefits from early intervention with 0.05 % atropine when their hyperopic reserve remains preserved. - Deep MM: A Deep-Learning System for the Detection and Prediction of Myopic Maculopathy from Retinal Fundus Images in Children
Ziyi Qi, Jun Chen, Tingyao Li, Gengyou Huang, Bin Sheng, Xiangui He, Xun Xu
Purpose: The increasing prevalence of myopia worldwide presents a significant public health challenge. Myopic maculopathy (MM) is a growing concern due to its increasing prevalence and potential for vision loss. This study aims to develop an artificial intelligence (A.I.)-enabled decision support system to detect and predict MM in at-risk children using routine retinal fundus images.
Conclusions: Deep MM is a reliable and efficient A.I.-based decision support system for children, demonstrating potential for integration into large-scale screening programs, enhancement of diagnostic efficiency and accuracy, and prediction of tessellated fundus onset risk. - Stepwise Increase in Concentrations of Atropine Treatment for Myopia Control: The SICAT Study
Shifei Wei, Shiming Li, Ningli Wang
Purpose: To explore a stepwise atropine treatment strategy for myopic control: beginning with 0.01% atropine for six months, followed by adjustment to higher concentrations based on treatment response.
Conclusions: This study demonstrates that a stepwise atropine treatment regimen, starting with 0.01% atropine for six months and then increasing to 0.02% or 0.04% based on myopia progression, is an effective strategy for managing pediatric myopia. - Six-Month Analysis of the MAD Study: A Multicenter Randomized Trial High- and Low-Dose Atropine for Progressive Myopia in European Children
Jan Roelof Polling, Dirk van Hemert, Caroline Klaver
Purpose: Atropine shows dose-dependent efficacy in clinical trials, but comparative trials using low and high doses are rare. The MAD (Myopia Atropine Dose) study aims to compare the efficacy of atropine 0.05% and 0.5% in European children with progressive myopia. This double-masked, multicenter, randomized clinical trial targets children aged 6 to 11 years. The first interim analysis presents baseline characteristics and six-month follow-up data.
Conclusions: The six-month interim analysis shows that atropine therapy, does not significantly impact visual acuity for either near or distance vision. There was a notable hyperopic shift in refractive error and a significant reduction in axial length elongation in the atropine group compared to the reference group. These findings confirm the short-term effectiveness of atropine in slowing myopic progression. This trial is the first to compare different doses of atropine in white children. Final results will reveal which atropine dose is optimal for stabilizing myopia in children at high risk of severe myopia. - A Real-World Study Comparing Atropine Monotherapy to the Synergistic Effects of Combination Treatment: Defocus Incorporated Multiple Segments Spectacle Lenses and Low-Dose Atropine
Celso Marcelo Cunha, Jessica Teixeira Cunha, Giovanna Marchezine, Mariana Madrona Ribeiro, Matheus Bittencourt Novaes, Vinicius dal Ponte Carvalho, Jose Eduardo Cesario Lindote
Purpose: The effectiveness of Defocus Incorporated Multiple Segments (DIMS) spectacle lenses have been demonstrated both as a stand-alone treatment and when combined in diverse populations. There is limited literature on the effectiveness of combination treatment using DIMS spectacle lenses and low-dose atropine in the South American population. The objective of this study was to evaluate whether the combination of low-dose atropine and DIMS was beneficial in children undergoing myopia control treatment.
Conclusions: The combination of DIMS spectacle lenses and 0.025% atropine resulted in the most significant reductions in myopia progression based on axial length elongation when compared to the use of 0.025% atropine monotherapy or environmental control in a Brazilian population. Further randomized, double-blind clinical trials with longer follow-up may elucidate the true impact of this combination therapy on myopia progression. - Efficacy and Safety of 0.05% Atropine Eye Drops with Varying Frequencies for Myopia Control in Chinese Children
Haoran Wu, Yao Tang, Wei Pan, Yuanfang Yang, Qinglin Xu, Zhiwei Luo, Ziqi Hu, Wenyu Gao, Lijun Hou, Xiaoning Li, Zhikuan Yang
Purpose: This study evaluates the efficacy and safety of 0.05% atropine eye drops
administered at various dosing frequencies (daily, twice weekly, and weekly) over one year to determine the optimal dosing frequency for myopia control in Chinese children.
Conclusions: Administration of 0.05% atropine eye drops at different dosing frequencies effectively reduced myopia progression in a frequency-dependent manner. All dosing frequencies were well tolerated without adverse effects, with daily application being the most effective in controlling spherical equivalent progression and axial length elongation over the study period. - Add-On Effect of Using 0.05% Atropine in Fast Progressors of Orthokeratology: A Preliminary Retrospective Study
Longbo Wen, Weizhong Lan, Zhikuan Yang
Purpose: To investigate the potential benefit of combining orthokeratology (OK) lenses with 0.05% atropine ophthalmic solution on the efficacy of myopia control in the fast progressors of OK.
Conclusions: This study provided preliminary evidence that the combination of OK lenses and 0.05% atropine ophthalmic solution can significantly enhance the effectiveness of myopia control. - Interactions Between Dose and Eye Color in Low-Concentration Atropine Treatment for Myopia
Eoin Kerin, Gareth Lingham, Ian Flitcroft, Ernest Kyei Nkansah, Samantha Sze-Yee Lee, David A. Mackey, James Loughman
Purpose: Low-concentration atropine is frequently used to treat myopia progression in children and adolescents. However, the interaction between atropine and iris color remains under explored. This study investigates the impact of 0.01% and 0.05% atropine on pupil diameter and accommodative outcomes, while considering iris color, utilizing data from Myopia Outcome Study of Atropine in Children (MOSAIC; n=250, 11.8+ 2.37 years) and Treatment Optimization of Atropine Study (T0AST; n=56, 21. 4 + 1.88 years) in Ireland, Western Australian Atropine Treatment of Myopia (WA-ATOM ; n=153, 11.51+ 2.69 years) study, and Pediatric Eye Disease Investigators Group’s (PEDIG) Myopia Treatment Study (MTSl; n=186, 10.00 + 1.78 years).
Conclusions: Low-concentration atropine (0.01% and 0.05% ) generally exhibits similar effects on pupil diameter and accommodative outcomes across iris colors. Atropine 0.01% had greater treatment effect among participants with lighter irises, compared to brown. These findings support the tolerability of low-concentration atropine in diverse populations, but higher concentration atropine may be needed among participants with brown iris color to achieve adequate efficacy. - Eleven Years of Orthokeratology Contact Lens Wear for Slowing Myopia Progression in Children
Jacinto Santodomingo-Rubido, Cesar Villa-Collar, Ramon Gutierrez-Ortega, Keiji Sugimoto, Sachiko Nishimura, Steve Newman
Purpose: To compare axial length growth between a group of orthokeratology (OK) contact lens wearers and a control group of distance single-vision lens wearers over an 11-year period.
Conclusions: OK lens wear provided a substantial slowing in the axial elongation of the eye, with a treatment effect of up to -0.693 m m (-38%) following 11 years of lens wear in comparison with single-vision lens wear. These results provide further support towards the longer-term efficacy of OK in slowing myopia progression in children. - Effectiveness of 5.5 mm Back Zone Diameter Orthokeratology Lenses on Axial Length Control
Hui Guo, Xianfang Li, Jianhua Li
Purpose: To compare the efficacy of orthokeratology lenses with a 5.5 mm back zone diameter to those with a diameter of 6.0 mm or greater in axial length retardation.
Conclusions: The findings suggest that the orthokeratology lens with a 5.5 mm back zone diameter demonstrates superior efficacy in controlling axial length compared to those with a diameter of 1.0 mm or greater. Additionally, a higher degree of myopic sphere may indicate a more favorable effect for orthokeratology in controlling axial length. - Myopia Control Efficacy of Novel Lenslet-Array-Integrated Spectacle Lenses with Positive and Negative Power Lenslets: A One-Year Randomized Clinical Trial
Jiang Jun, Su Binbin, Zheng Jingwei
Purpose: Previous research has demonstrated significant myopia control effects using positive power lenslets, Cylindrical Annular Refractive Element lenses, and diffusion optical technology. These findings suggest other potential mechanisms in addition to the peripheral myopic defocus theory may contribute to myopia control. This study aimed to compare the myopia control effects of Lenslet-Array-Integrated (LARI) spectacle lenses with positive (PLARI) and negative (NLARI) power lenslets over a one-year clinical trial.
Conclusions: Both PLARI and NLARI lenses significantly controlled myopia, as evidenced by smaller increases in spherical equivalent refraction and axial length elongation compared to single-vision lenses. In the single vision and PLARI groups, younger age was associated with faster myopia progression, an association not observed in the NLAR I group. - Personalized Myopia Care Demonstrates Comparable Efficacy Across Myopia Control Options: Insights From Real-World Clinical Setting
Pavan Verkicharla, Nikesh Kangane, Sukhil D., Swapnil Thakur
Purpose: The effectiveness of various myopia control strategies has primarily been
documented through randomized clinical trials. In real-world clinical practice, treatment decisions are tailored to each individual’s myopia-related risk factors. This study investigated the effectiveness of various myopia control strategies using real-world data from a clinical setting that prioritizes personalized management approaches.
Conclusions: In our real-world clinical setting, all myopia control strategies including lifestyle modifications prescribed through personalized myopia management demonstrated a similar beneficial positive effect in controlling axial elongation and myopia progression. - Assessing the Two-Year Efficacy of Atropine, Orthokeratology, and Combined Therapies: Myopia Control and Choroidal Change — Insights From an Age-Stratified Randomized Controlled Trial
Shengsong Xu, Xiao Wang, Xiao Yang
Purpose: Orthokeratology and 0.01% atropine drops are proven effective, but lack long-term RCTs comparing their efficacy, meanwhile few studies examine long-term choroidal changes under these treatments. Hence, this study assesses their two-year comparative efficacy in myopia control and investigates choroidal changes during treatment.
Conclusions: Combining atropine and orthokeratology can boost myopia control compared to monotherapy. Orthokeratology benefits younger children more and improves choroidal thickness and contour, though this effect lessens in the long term. - Impact of Myopia Management Lenses with Highly Aspherical Lenslets on Visual Field Sensitivity in Myopic Children
Zaifeng Cui, Yingying Huang, Bjorn Drobe, Jinhua Bao, Xue Li
Purpose: This study investigated the impact of short-term and long-term use of myopia management lenses with highly aspherical lenslets (HAL) on visual field sensitivity in myopic children.
Conclusions: Short-term and long-term wearing of HAL did not significantly affect full-field static sensitivity within the 30° visual field in myopic children aged 13-18. - One-Year Results of the CEME Study: Efficacy of MyoCare for Myopia Control in a European Population
Cristina Alvarez-Peregrina, Miguel Angel Sanchez-Tena, Cesar V ilia-Collar, Clara Martinez-Perez, Padmaja Sankaridurg, Arne Ohlendorf
Purpose: Optical interventions are crucial in controlling myopia to prevent the
development of high myopia. MyoCare is one of the ophthalmic solutions for managing myopia, but its effectiveness has not been evaluated in the European population. This study aims to assess the efficacy of MyoCare in a European population after a year of follow-up.
Conclusions: The interim analysis conducted over one year has shown that MyoCare is effective in managing myopia. The children participating in the CEME study will be
monitored for an additional two years to provide a more comprehensive evaluation of MyoCare’s long-term effectiveness in slowing down the progression of myopia. - A Multi-Site Observational Study of Defocus Incorporated Multiple Segments (DIMS) Spectacle Lenses in U.K. Children: 2-Year Results
J. M. Fulton, S.J. McCullough, K.J. Saunders, P. Richardson, N.S. Logan, Y. Whayeb, P. Williamson, H. Barr, M. Nagra, S. Pardhan, R. Shah, N. Vlasak
Purpose: Defocus Incorporated Multiple Segments (DIMS) spectacles lenses are well tolerated and effective in slowing myopia in Chinese children compared to single vision (SV) spectacle lenses. This observational study explored the efficacy of DIMS lenses in controlling myopia over two years in U.K. children. To evaluate efficacy across ethnicities, the results were compared to published findings in Chinese children (Lam et al, 2020).
Conclusions: Compared with the expected age-normative myopic eye growth, the study found that DIMS spectacle lenses effectively slowed eye growth in most wearers in both year one and two of wear. The average reduction in axial elongation was sustained over two years. DIMS spectacle lenses performed equally well among U.K. and Chinese children. - Myopia Control Efficacy of Spectacle Lenses with Highly Aspherical Lenslets: A Retrospective Real-World Study
Hao Chen, Chenyao Liu, Xue Li, Yingying Huang, Jinhua Bao
Purpose: To investigate myopia control efficacy in children who wore spectacle lenses with highly aspherical lenslets (HAL) in clinical practice.
Conclusions: This real-world retrospective study found that HAL had a significant myopia control efficacy in children with low to moderate myopia, especially for children aged 14 years old or younger. - Evaluation of Fitting Success and Vision with Euclid Orthokeratology Lenses in Young Myopic New Lens Wearers
Sally Dillehay, OD, EdD, Jane Beeman, Brett O’ Connor, OD
Purpose: Euclid orthokeratology lenses are the most widely studied orthokeratology lenses worldwide, employing a streamlined, empirical fitting approach requiring manifest refraction, keratometry, and HVID. This study assessed the “first fit success” rate of the Euclid lens design with parameters optimized for myopia progression control.
Conclusions: These results demonstrate that the Euclid orthokeratology lenses provide excellent objective and subjective vision and comfort in new wearers who are young myopic children, with a high first fit success rate among practitioners including first time fitters of the lenses. - Influence of Frame Size in the Efficacy of a Spectacle Lens with Asymmetric Myopic Peripheral Defocus
Eva Chamorro, Miguel Angel Sanchez-Tena, Jose Miguel Cleva, Clara Martinez-Perez, Marta Alvarez, Cristina Alvarez-Peregrina, Cesar Villa-Collar
Purpose: Spectacle lenses with asymmetric myopic peripheral defocus (MPDL) consists of a central blur-free small area surrounded by a progressive power distribution whose defocus level varies bet ween the diff rent regions of the lens. A recent randomized clinical trial (RCT) has demonstrated that the lens MPDL significantly reduced the absolute growth of axial length (AL) by 39 % after 12 months of treatment in comparison to the control group in a Spanish population. However, until now, it has not been analyzed if the efficacy of the lens is influenced by the characteristics of the spectacle frame. The aim of this study is to investigate if the frame size and, in consequence, treatment size of the spectacle glasses influences the myopia control effects in myopic children wearing MPDL lenses.
Conclusions: Frame size does not affect to the efficacy of the myopia management treatment in the analyzed sample of children wearing MPDL lenses. This suggests that during prescription and dispensing of this lenses, it is more important to select a spectacle frame that correctly fits to the children physiognomy maintaining a correct position of the lenses in front of the eye, instead of forcing to select bigger frames with bigger treatment areas that can produce an inadequate fitting of the lenses, reduce comfort and decrease the compliance of treatment. - Efficacy in Myopia Control: The Impact of Rebound
Mark Bullimore, Noel Brennan
Purpose: A legitimate concern is the extent to which the slowing of myopia progression is retained once treatment is ceased. While post-treatment progression will likely exceed that observed during treatment, does it revert to expected values based on the age and race of the child, or does it accelerate further?
Conclusions: An FDA workshop concluded that there was “no evidence for a rebound effect with respect to optical myopia control treatments.” Likewise, a recent International Myopia Institute report concluded that “rebound effects as observed with higher concentration of atropine appear to be avoided with lower concentrations and optical strategies.” The results presented herein support these statements. Future research should further explore the relation bet ween the magnitude of treatment efficacy and rebound. - Efficacy in Myopia Control: An Omnibus Model
Noel A. Brennan, Xu Cheng, Monica Jong, Mark A. Bullimore
Purpose: Accurate prediction and monitoring of axial elongation and refractive progression is important for myopia management. Here, we provide an update on our progress in evidence-based interpretation of these features.
Conclusions: This omnibus model provides projections, and gives reference data, for efficacy of myopia control interventions based on one-year data. The challenges in following untreated control groups for long periods is a likely impediment to further refinement of this model. - A Comparison of Clinical Trials Investigating the Efficacy of Myopia Control with An Age-Matched Normal Axial Growth Analysis
Ann-Isabel Mattern, Birte Graff, Machteld Devenijn, Hakan Kaymak
Purpose: Myopia control strategies such as low-dose atropine, orthokeratology, multifocal contact lenses, and specially designed spectacle lenses are well evidenced for their use myopia management. Through evidence-based practice, practitioners can offer objective and unbiased myopia management advice to their patients. Treatment efficacy of the myopia control method is commonly calculated based on a non-age matched control group. The Age Matched Myopia Control (AMMC) model, developed by the present authors, classifies axial length growth as highly excessive, moderately excessive, and physiological growth whilst controlling for age. Aim of this study is to give an overview of results from recent clinical trials of myopia
management strategies that slow axial length growth and to categorize these results using the AMMC model. (Graff et al., 2023)
Conclusions: As children’s physiological axial length growth declines with age, the evaluation of reported clinical trial results need to be interpreted with respect to the cohort’s age and baseline axial length, and therefore the underlying age matched physiological axial growth. Only defocus incorporated multiple segments and dual-focus contact lenses resulted in physiological axial length growth over the treatment period. Practitioners should be aware of this finding when considering a long-term treatment for myopia. - A Review of Myopia Control for High Myopia
Rakhee Shah, Bruce J.W. Evans, Natalia Vlasak
Purpose: Myopia and especially high myopia are recognized as major public health concerns. Although the prevalence of high myopia in young children is low, 10-20 % of high school children in Asia have high myopia, with many still progressing, and one in three patients with high myopia develop visual impairment with age. Most participants in myopia control studies have low and moderate myopia; relatively little is known about myopia control in high myopia The primary aim is to comprehensively review the efficacy of current myopia control strategies for high myopia. A secondary aim of the review is to report on the structural and pathological complications of eyes as a result of high myopia.
Conclusions: High myopia has significant effects on quality of life and risk of pathological complications and vision impairment. Young children, excluding those with some syndromic associations, who are fast progressing moderate and high myopes require early intervention and close monitoring. From the limited available research, a significant reduction in progression of refractive error in high myopia is likely when using 0. 5% atropine and orthokeratology lenses were equally effective in reducing myopia progression in low, moderate, and high myopia. Further research investigating the efficacy of myopia control strategies in highly myopic patients, both independently and through combination treatments, are necessary. - Effects of Light Filters on Axial Length Change Following Short-Term Myopic Defocus Exposure
Xiao Nicole Liu, Thomas John Naduvilath, Padmaja R. Sankaridurg
Purpose: Myopic defocus is employed in a wide range of optical designs for myopia control. In this study we explored potential effects of different light filters on axial length changes in response to short-term myopic defocus.
Conclusions: In this adult population, red-only filters showed detrimental effects on axial length changes in response to one-hour myopic defocus compared to blue-only and ND16 filters. - Optical Defocus to Influence the Progression of Myopia and Eye Growth Shows Dosage-Dependency in Children
Kuang-mon Ashley Tuan, Sally M. Dillehay, The PROTECT Study Group
Purpose: A contact lens optical design with an extremely aspheric (catenary curve) power profile that rapidly transitions to 80 relative plus power from the center of the optic to 6 mm diameter is being evaluated for its effectiveness in myopia progression control (MPC). Optical designs for MPC typically provide around 2D of relative plus; we hypothesize that the catenary lens will be effective, and a higher magnitude of relative plus will result in a stronger response.
Conclusions: The catenary power profile lenses at one-year demonstrated slowing in myopia progression and axial elongation with a large range of normal pupil sizes. There is more relative plus/myopic defocus away from optical center with catenary contact lenses, while single vision contact lenses are not able to address periphery hyperopic defocus, when a prolate cornea with larger pupil may allow more hyperopic defocus to enter through the eye. The linear relationship between pupil size and progression rate indicated a dosage-dependent relationship between the magnitude of myopic defocus or hyperopic defocus and the speed of myopia progression and axial length elongation. Increasing magnitude of myopic defocus slows down the myopia and axial length progression and increasing hyperopic defocus increases the progression. - Trends in Vision Impairment Associated with Refractive Error in Ireland
Michael Moore, Siofra Harrington, Ian Flitcroft, James Loughman
Purpose: The combination of increasing refractive error, particularly myopic refractive error, and age has been associated with higher rates of vision impairment. A limited number of studies have assessed this relationship, which is critical in understanding the potential public health implications of increasing myopia prevalence and the benefits of myopia control treatments.
Conclusions: Increasing age and increasing refractive error were associated with worse visual acuity and higher rates of visual impairment. Myopes had the worst outcomes in terms of visual impairment and progressed to visual impairment at the fastest rate.
