Myopia Control: Why Each Diopter Matters

Correlation between refractive error, muscle thickness, and bioelectrical activity of selected masticatory muscles

OBJECTIVE

The aim of this study was to analyze the correlation between the refractive error, muscle thickness, and the bioelectrical activity of selected masticatory and neck muscles in subjects with myopia.

METHODS

For bioelectrical activity analysis within the masticatory muscles, an 8-channel BioEMG III electromyograph was used. An M-Turbo ultrasound machine was used to analyze the masticatory and neck muscle thickness.

RESULTS

Statistical analysis showed significant positive correlations between masseter muscle thickness at rest on the right side. Statistical analysis showed negative correlations between the digastric muscle and Activity Index within masticatory muscles at rest on the left side when the eyes were closed.

CONCLUSIONS

As refractive error increases in myopic subjects, the resting tension on the temporal muscles increases, an increase in masseter muscle thickness is noted, and a decrease in bioelectrical activity on the digastric muscle at rest.

Association between Plasma Metabolite Levels and Myopia: A 2-Sample Mendelian Randomization Study

Purpose

The role of plasma metabolites in myopia is still unclear, and previous studies are limited by various factors and were mostly observational. This study aims to investigate the causal relationship between plasma metabolites and myopia using 2-sample Mendelian randomization (MR).

Design

A 2-sample MR study.

Subjects and Participants

This study analyzed plasma metabolites consisting of 1091 metabolites and 309 metabolite ratios in 8299 individuals from the Canadian Longitudinal Study on Aging cohort. Summary statistics for myopia were obtained from the UK Biobank, encompassing 37 362 cases and 460 536 controls.

Methods

Causal effect estimates were primarily derived using the inverse variance weighting (IVW) method and the constrained maximum likelihood and model averaging-based MR method. Statistical significance for the MR effect estimate was defined as a false discovery rate (FDR) of <0.05. Additionally, we used the MR Steiger directionality test to examine whether exposure was directionally causal for the outcome. Furthermore, 4 supplementary methods were used for analysis: weighted median, MR-Egger, simple mode, and weighted mode.

Main Outcome Measures

Genetic causal association between plasma metabolites and myopia.

Results

The IVW analysis results indicated that elevated levels of 1-arachidonoyl-GPE (20:4n6) (P_FDR = 5.80E-06), linoleoyl-arachidonoyl glycerol (18:2/20:4)[1] (P_FDR = 2.24E-06), and linoleoyl-arachidonoyl-glycerol (18:2/20:4) [2](P_FDR = 0.0242) have a protective effect on myopia. Elevated levels of 4 plasma metabolite ratios, including the phosphate to linoleoyl-arachidonoyl-glycerol (18:2/20:4) [2] ratio (P_FDR = 0.0029), citrulline to dimethylarginine (SDMA + ADMA) ratio (P_FDR = 0.0207), oleoyl-linoleoyl-glycerol (18:1/18:2) [2] to linoleoyl-arachidonoyl-glycerol (18:2/20:4) [1] ratio (P_FDR = 0.0230), and retinol (vitamin A) to linoleoyl-arachidonoyl-glycerol (18:2/20:4) [2] ratio (P_FDR = 0.0230), were significantly associated with a higher risk of myopia.

Conclusions

This study provides evidence of a causal relationship between specific plasma metabolites and myopia, highlighting potential therapeutic targets and contributing to the understanding of myopia's etiology. Future research should include diverse populations to enhance the generalizability of these findings.

Financial Disclosures

The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Myopia control efficacy of Asymmetric Multi-point Defocus Technique spectacle lenses: 1-year double-masked randomized controlled trial

PURPOSE

To evaluate the 12-month myopia control efficacy of an Asymmetric Multi-point Defocus Technique (AMDT) spectacle lens.

DESIGN

Double-masked randomized controlled trial.

PARTICIPANTS

140 participants completed all visits (mean age, 10.6 ± 1.5 years; 50% female), with SER between -5.00 and -0.75 diopter (D), astigmatism ≤ 1.50 D and anisometropia ≤ 1.50 D.

METHODS

144 children recruited from two ophthalmic centers aged 8-13 years with myopia of -0.75 D to -5.00 D were randomized (1:1) to wear AMDT or single vision (SVL) spectacle lenses. Cycloplegic spherical equivalent refraction (SER) and axial length (AL) were measured at the baseline, 6-month, and 12-month visits. Adaptation and visual performance questionnaires were administered during the intervention.

MAIN OUTCOME MEASURES

The SER change after one year was the primary outcome and the change in AL, visual performance, and ocular parameters after one year were defined as secondary outcomes.

RESULTS

After 12 months, the SVL group (n = 69) exhibited mean changes in SER and AL of -0.50 ± 0.06 D and 0.32 ± 0.02 mm, respectively, compared to -0.16 ± 0.06 D and 0.17 ± 0.02 mm (both p< 0.001) in the AMDT group (n = 71). Compared with the SVL group, participants in the AMDT group had significantly less myopia progression by 0.39 D in SER (74%) and 0.17mm in AL (51%) after adjustment for baseline age, baseline SER/AL and ophthalmic center. The correlation between younger age and more rapid AL elongation was more pronounced in the SVL group (r = -0.68, p <0.001), compared to the AMDT group (r = -0.37, p = 0.002). 30 (42.2%) participants in the AMDT group displayed no SER progression after 1-year. No serious adverse events or persistent visual discomfort were observed.

CONCLUSION

Compared with SVL, AMDT spectacle lenses significantly reduced SER and AL progression over 1 year, with a favorable safety profile and visual performance. The correlation between age and myopia progression was diminished after AMDT intervention, but not for SVL.

2024 Chew Sek Jin Memorial Lecture: "Are we there yet?"

The journey from myopia being an intriguing scientific puzzle to part of clinical practice has been a long and varied path. Chew Sek Jin was one of the pioneers on this journey and, as director of the Singapore Eye Research Institute, initiated an ambitious research program that has helped us get to where we are today. His work was data-driven, embracing the power of epidemiological and longitudinal studies. He emphasized both the public health aspects and clinical management of myopia, pioneering the use of atropine in Singapore. With his work with Josh Wallman, he recognized the importance of research into the biological mechanisms of myopia.

MultifocAL COntact Lenses for Myopia (MALCOLM) control in Australian children: a study protocol for a double-blind, contralateral eye, non-inferiority, randomised controlled clinical trial

INTRODUCTION

Myopia is the most common refractive error worldwide, but each dioptre increase in myopia leads to an increased risk of degenerative eye disease and permanent vision impairment. Soft contact lens (CL) designs have been developed to slow myopia and potentially reduce long-term risk, but there is still a need for additional designs of varied materials and parameters to cater for diverse patient needs. The MultifocAL COntact Lenses for Myopia control study aims to compare the efficacy of the Acuvue Oasys for Presbyopia (AOP) CL against the Food and Drug Administration approved MiSight 1-Day multifocal CL in controlling progressive myopia in children using a non-inferiority contralateral eye design.

METHODS AND ANALYSIS

A double-blind, contralateral eye, non-inferiority, randomised, controlled clinical trial will be conducted at University of New South Wales Sydney, Australia (UNSW). Children (6 to 12 years of age, inclusive) will be randomised to wear AOP in their right or left eye, with the MiSight 1-Day CL fitted to the contralateral eye. The primary outcome is the difference in axial length and cycloplegic objective refraction change between the two CLs over 12 months. Additional outcomes include quality of life, pupillometry and adherence to treatment. To achieve a statistical power of 80% to demonstrate non-inferiority of the AOP to the MiSight 1-Day and taking into consideration a 20% discontinuation rate, the calculated sample size is 72. This trial started recruitment during the recent COVID-19 pandemic in January 2021.

ETHICS AND DISSEMINATION

Ethics approval has been obtained from the UNSW Human Research Ethics Committee (HC200052), and the study complies with the Declaration of Helsinki and the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use Good Clinical Practice guidelines. The results of this trial will be disseminated in peer-reviewed publications and conference presentations.

TRIAL REGISTRATION NUMBER

ACTRN12620000159954, CTN-00 282-1 v2, NCT06887920.

Optical influence of myopia control spectacles at the retinal level: Effect of local light modulation

PURPOSE

To investigate the influence of light modulation conferred by current designs of myopia control spectacles on retinal sensitivity.

METHODS

Retinal sensitivity and scanning laser ophthalmoscopy (SLO) fundus images were obtained from nine healthy subjects using a Macular Integrity Assessment microperimeter with current myopia control spectacle lenses: MyoCare, Stellest, MiYOSMART and DOT. Respectively powered single vision lenses and a 0.8-grade Bangerter occlusion foil (BF) served as comparative controls.

RESULTS

Using the SLO image, one can visualise the areas of light modulation of the various myopia control lens designs at the level of the retina. Clear zone sizes differ between lens designs, with the DOT lens having the smallest area. Retinal sensitivity in areas of local light modulation was not reduced for the Stellest and MyoCare lenses, but declined with the MiYOSMART lens, suggesting a more prominent local light modulation. The DOT lenses produced a significant reduction in overall retinal sensitivity, although the reduction with the BF was greater. In all instances, retinal sensitivity remained well above the range considered normal for a healthy retina.

CONCLUSIONS

None of the lenses tested produced a clinically relevant reduction in retinal sensitivity and all scored significantly better than the lowest (that is, 0.8) grade BF. Given that current myopia control spectacles do not show consistent treatment effects as required to slow progression effectively over extended periods, there appears to be a subtle, yet crucial difference in spatial light modulation among these myopia control spectacle lenses. Seemingly similar lens designs cannot be assumed to have equivalent treatment effects; a thorough assessment of these nuances is essential to ensure accurate claims regarding their long-term efficacy.

Absolute Risks and Decision Tools for Communicating the Risks of Visual Impairment From Myopia-Related Diseases

Purpose

The risks of developing myopia complications are frequently reported in relative terms, which can be misleading. This study provides absolute risk estimates of visual impairment (VI) from myopia-related diseases.

Methods

A critical integrative review provided data on frequency of myopic macular degeneration (MMD), primary open-angle glaucoma (POAG), rhegmatogenous retinal detachment (RRD), and associated VI in predominantly White and East Asian populations. The absolute risks of persons over 40 years of age with no myopia, low myopia (-2.00 D), or high myopia (-6.00 D) developing VI from each myopia-related disease were calculated by multiplying the proportion of each refractive group with the disease by the rate of VI. The sum of the risks of VI from MMD, POAG, and RRD provided an estimate of VI risk from any of these three myopia-related diseases in adults over 40 years old.

Results

VI from MMD, POAG, or RRD combined is expected in 0.4 in 100, 1.4 in 100, and 6.8 in 100 of White persons with no myopia, low myopia, or high myopia, respectively. The same risks in an East Asian population are 0.5 in 100, 2.4 in 100 and 10.3 in 100 in persons with no myopia, low myopia, or high myopia, respectively.

Conclusions

Absolute risks are provided to enable balanced discussions of the future risk that a child may have in developing VI from myopia-related diseases when considering myopia management. These estimates should be put into context using decision tools and balanced statements providing information on the likelihood of both developing VI and not developing VI.

Topical review: Potential mechanisms of atropine for myopia control

SIGNIFICANCE

Atropine is effective at slowing myopia progression in children, but the mechanism of action by which it controls myopia remains unclear. This article is an evidenced-based review of potential receptor-based mechanisms by which atropine may act to slow the progression of myopia.The rising number of individuals with myopia worldwide and the association between myopia and vision-threatening ocular pathologies have made myopia control treatments one of the fastest growing areas of ophthalmic research. High-concentration atropine (1%) is the most effective treatment for slowing myopia progression to date; low concentrations of atropine (≤0.05%) appear partially effective and are currently being used to slow myopia progression in children. While significant progress has been made in the past few decades in understanding fundamental mechanisms by which atropine may control myopia, the precise characterization of how atropine works for myopia control remains incomplete. It is plausible that atropine slows myopia via its affinity to muscarinic receptors and influence on accommodation, but animal studies suggest that this is likely not the case. Other studies have shown that, in addition to muscarinic receptors, atropine can also bind, or affect the action of, dopamine, alpha-2-adrenergic, gamma-aminobutyric acid, and cytokine receptors in slowing myopia progression. This review summarizes atropine's effects on different receptor pathways of ocular tissues and discusses how these effects may or may not contribute to slowing myopia progression. Given the relatively broad array of receptor-based mechanisms implicated in atropine control of myopia, a single mode of action of atropine is unlikely; rather atropine may be exerting its myopia control effects directly or indirectly via several mechanisms at multiple levels of ocular tissues, all of which likely trigger the response in the same direction to inhibit eye growth and myopia progression.

Myopia progression in young adults: insights from real-world clinical data

CLINICAL RELEVANCE

Myopia may progress even during adulthood. Clinical trials are required to evaluate the effectiveness of myopia control interventions in adults.

PURPOSE

This study aimed to investigate what proportion of young adults undergo myopia progression of <-0.50 D and the factors associated with this progression based on data from real-world clinical settings.

METHODS

This retrospective study included 2,683 myopes with spherical equivalent (SE) ranging from -0.50D to -14.75D. The spherical and cylindrical components were separately categorised into mild, moderate, and high-magnitude groups. Myopia progression was calculated as the difference between the previous spectacle prescription (obtained from a 1-year-old spectacle) and the current refraction. A binary logistic regression model was used to obtain the odds ratio.

RESULTS

The mean ± standard deviation age of myopic individuals was 24.45 ± 2.74 years (range: 18-30) and annual myopia progression was -0.22 ± 0.38D. Out of 2,683 myopes, 2,341 (87.3%) had stable refraction (annual change: ≤0.25 to ≥-0.50 D), and 342 (12.7%) myopes had progression of <-0.50 D. Overall, 4.6% (n = 124/2,683) of myopes had a change in refraction of ≤-1.00 D. The younger age group (18-20 years, OR 1.63 [95% CI 1.03-2.57], p = 0.04), high-spherical equivalent (OR 2.37 [95% CI 1.28-4.38]), and high-cylinder (OR 6.60 [95% CI 3.40-12.81]) were found to be significantly (p < 0.05) associated with increased odds of myopia progression. Age of apparent myopia onset, gender, and spherical components were not associated with myopia progression (p > 0.05).

CONCLUSION

About 1 out 20 myopes in clinical settings tend to have progression of one dioptre even during adulthood. Regular monitoring of biometry in young adults with high-spherical equivalent and astigmatism could aid in the identification of those with myopia progression.

Application of 3D MRI and SS-OCT/OCTA in Assessment of Posterior Scleral Contraction for Myopic Traction Maculopathy

Purpose

To evaluate the clinical efficacy and safety of posterior scleral contraction (PSC) in the treatment of myopic traction maculopathy (MTM) by three-dimensional magnetic resonance imaging (3D MRI), swept-source optical coherence tomography (SS-OCT) and swept-source optical coherence tomography angiography (SS-OCTA).

Methods

In this prospective study, 30 eyes of 25 patients with MTM were treated with PSC. The ocular parameters of the patients were measured before surgery and at 1 month, 6 months, and 1 year after 3D MRI and SS-OCT/OCTA.

Results

The differences in preoperative and postoperative parameters, including axial length (AL), spherical equivalent (SE), best-corrected visual acuity (BCVA), retinoschisis area, total posterior staphyloma height (PSH), and vitreous volume were statistically significant (P < 0.001). The choroidal thickness (CT) in each sector, choroidal perfusion area (CPA) in subfoveal and temporal sectors, and choroidal vascularity index (CVI) in inferior and temporal sectors increased significantly after PSC surgery (P < 0.05). Additionally, 3D MRI showed that the surgical strips remained strong and stable during the follow-up period, without complications such as strip displacement, fracture, and loosening.

Conclusions

The application of 3D MRI and SS-OCT/OCTA in assessment of the treatment of MTM with PSC was comprehensive with multiple ocular parameters and could further guide the clinical diagnosis and treatment of MTM.

Translational Relevance

We combined SS-OCT/OCTA and 3D MRI to provide the basis of a theory for guiding the clinical diagnosis and treatment of MTM.

RNA methylation homeostasis in ocular diseases: All eyes on Me

RNA methylation is a pivotal epigenetic modification that adjusts various aspects of RNA biology, including nuclear transport, stability, and the efficiency of translation for specific RNA candidates. The methylation of RNA involves the addition of methyl groups to specific bases and can occur at different sites, resulting in distinct forms, such as N6-methyladenosine (m6A), N1-methyladenosine (m1A), 5-methylcytosine (m5C), and 7-methylguanosine (m7G). Maintaining an optimal equilibrium of RNA methylation is crucial for fundamental cellular activities such as cell survival, proliferation, and migration. The balance of RNA methylation is linked to various pathophysiological conditions, including senescence, cancer development, stress responses, and blood vessel formation, all of which are pivotal for comprehending a spectrum of eye diseases. Recent findings have highlighted the significant role of diverse RNA methylation patterns in ophthalmological conditions such as age-related macular degeneration, diabetic retinopathy, cataracts, glaucoma, uveitis, retinoblastoma, uveal melanoma, thyroid eye disease, and myopia, which are critical for vision health. This thorough review endeavors to dissect the influence of RNA methylation on common and vision-impairing ocular disorders. It explores the nuanced roles that RNA methylation plays in key pathophysiological mechanisms, such as oxidative stress and angiogenesis, which are integral to the onset and progression of these diseases. By synthesizing the latest research, this review offers valuable insights into how RNA methylation could be harnessed for therapeutic interventions in the field of ophthalmology.

Correlation of contrast sensitivity at low spatial frequencies with myopic shift in Chinese children

PURPOSE

To investigate the correlation of contrast sensitivity function (CSF) with myopic shift in Chinese children.

METHODS

This prospective case-series study included 62 eyes (31 children) who visited the Eye and ENT Hospital of Fudan University in January 2022 and were followed up for 6 months. Routine ophthalmic examinations and quantitative CSF (qCSF) tests without refractive correction were performed. Differences in CSF parameters, including the area under the log CSF (AULCSF), CSF acuity, and contrast sensitivity (CS) at 1.0-18.0 cpd, were compared between two groups stratified according to the myopic shift based on mydriatic spherical equivalent (<-0.50 D or ≥-0.50 D) during follow-up.

RESULTS

The myopia progressed by 0.13 ± 0.24 and 1.18 ± 0.75 D in the stabilized (28 eyes) and advanced (34 eyes) groups, respectively. Compared with the advanced group, the stabilized group showed significantly lower baseline qCSF test results for CSF acuity and CS at 1.0 and 1.5 cpd. The qCSF readings for CSF acuity and CS at 1.0, 1.5, and 3.0 cpd increased significantly during the 6-month follow-up in the stabilized group, while these values showed non-significant decreases in the advanced group. CS at 3.0 cpd was significantly correlated with myopic shift. Compared with the advanced group, participants in the stabilized group with higher myopia showed relatively significantly lower CS (baseline CSF acuity and CS at 1.0, 1.5, and 3.0 cpd).

CONCLUSIONS

Children with relatively slower myopic shift showed lower contrast sensitivity at low spatial frequencies, which might be an effective factor in myopia control.

Long-term effect of repeated low-level red light therapy on myopia control: A systematic review and meta-analysis

INTRODUCTION

Myopia is a refractive error where distant objects are not clearly seen and appear blurred. Goal of this study was to evaluate long-term effectiveness of Repeated Low-Level Red Light (RLRL) therapy for children with myopia, which primarily focused on Axial length (AL) and Spherical Equivalent Refraction (SER) as primary endpoints.

METHODS

The research compared outcomes between RLRL treatment with Single Vision Spectacles (SVS) for childhood myopia management. We performed a systematic literature search in the PubMed, Embase and Cochrane databases using "Myopia" and " Repeated Low-Level Red Light ". Mean differences (MD) were estimated and the effects of therapies measured. Publication bias and heterogeneity analysis were carried out by Inverted Precision Effect Test-Precision Effect Estimate Standard Error (PET-PEESE) (and subsequent Search Sequential Analysis) and Tau test. Bayesian meta-analysis was performed using Jaffrey Amazing Statistical Package (JASP).

RESULTS

This meta-analysis comprised 1,714 participants: 824 in RLRL and 890 in SVS group. Pooled effect size for AL reduction was 0.953 ± 0.294, (95% credible interval (CI) 0.775 to 0.980). Pooled effect size for SER reduction was 1.521 ± 0.662 (95% CI 0.102 to 2.736). PET-PEESE analysis revealed no significant publication bias (p-value 0.407). Random effects models were employed for presence of significant heterogeneity (3.9 and 5.7 for AL; 5.7 for SER), alongside degree of variation (0.828 & 1.665) for Tau (τ), which estimates the between-study variance.

CONCLUSION

Long-term observations indicate that RLRL treatment significantly influences myopia management, leading to considerable reductions in both AL and SER. Additional research is essential to investigate potential long-term rebound effects.

Exploring myopia management practices among eye care professionals in India: A knowledge, attitudes, practices, and barriers study

CLINICAL RELEVANCE

Rising myopia prevalence in Indian children necessitates an increase in the number of myopia practitioners across all states to effectively counteract its progression and prevent long-term visual impairment.

PURPOSE

There is limited information on how eye care practitioners perceive and practice myopia control treatments in India. This study aimed to assess the current knowledge, attitudes, practices, and barriers to initiating myopia management among eye care practitioners in India.

METHODS

A self-administered online questionnaire was distributed through social media platforms and emails to eye care practitioners from January 8 to 23, 2022. This survey comprised a total of 12 questions to seek information related to knowledge, attitudes, practices, and barriers associated with myopia management. Basic descriptive and percentage analyses were performed.

RESULTS

Among the 423 respondents, optometrists were 66% (n = 279/423), followed by ophthalmologists (16%, n = 68/423) and trainees involving optometrists and ophthalmologists (18%, n = 76/423). Of all, only 22% (n = 94/423) indicated practicing myopia management. They gained knowledge through scientific articles (71%, n = 300/423), conferences, and continuous professional education (62%, n = 231/423). Low-concentration atropine eye drops are widely considered for myopia control by both optometrists (57%, n = 28/49) and ophthalmologists (97%, n = 38/39), along with behavioural and lifestyle modifications (55%, n = 27/49; 74%, n = 29/39). A smaller proportion preferred to under-correct myopia (20%, n = 19/94) to counteract progression. Among myopia practitioners, combination therapy was recommended by 24% (n = 12/49) of optometrists and 23% (n = 9/39) of ophthalmologists to halt progression if a single modality was ineffective. The major barriers to initiating myopia management were lack of awareness among parents (73%, n = 68/94), lack of education (34%, n = 143/423) and training (26%, n = 112/423) among practitioners, and unavailability of treatment modalities in various regions of India (18%, n = 76/423).

CONCLUSION

Only 1 out of 5 practitioners was actively involved in practicing myopia management. Barriers must be minimised through various means to enable routine myopia practice in clinics.

Axial Growth and Myopia Progression After Discontinuing Soft Multifocal Contact Lens Wear

Importance

For myopia control to be beneficial, it would be important that the benefit of treatment (slowed eye growth) is not lost because of faster than normal growth (rebound) after discontinuing treatment.

Objective

To determine whether there is a loss of treatment effect (rebound) after discontinuing soft multifocal contact lenses in children with myopia.

Design, Setting, and Participants

The Bifocal Lenses in Nearsighted Kids 2 (BLINK2) cohort study involved children with myopia (aged 11-17 years at BLINK2 baseline) who completed the BLINK Study randomized clinical trial. Enrollment was from September 2019 through January 2021; follow-up was completed in January 2024. In the BLINK2 Study, all children wore high-add (+2.50 diopter [D]) multifocal soft contact lenses for 2 years and single-vision soft contact lenses during the third year to determine if rebound occurred.

Exposure

High-add multifocal soft contact lenses and single-vision soft contact lenses.

Main Outcomes and Measures

Eye length (optical biometry) and refractive error (cycloplegic autorefraction) were measured annually.

Results

Of 248 participants enrolled in BLINK2, 235 completed the study. The median age at the baseline visit was 15 years (range, 11-17 years); 146 participants (59%) were female, and 102 (41%) were male. At baseline for BLINK2, mean (SD) axial length and spherical equivalent refractive error were 25.2 (0.9) mm and -3.40 (1.40) D, respectively. After participants switched from multifocal to single-vision contact lenses, axial elongation increased by 0.03 mm per year (95% CI, 0.01 to 0.05) regardless of their original BLINK treatment assignment (P = .81). There was also an increase in myopia progression after switching to single-vision lenses of -0.17 D per year (95% CI, -0.22 to -0.12) that did not depend on the original BLINK treatment assignment (P = .57). There continued to be a difference in axial length and refractive error throughout BLINK2 based on the BLINK Study treatment assignment with the original high-add group having shorter eyes and less myopia than the original medium-add (+1.50 D) and single-vision groups.

Conclusions and Relevance

The BLINK2 Study found no evidence of a loss of treatment effect after discontinuing multifocal contact lenses in older teenagers. These data suggest eye growth and myopia progression returned to faster but age-expected rates and support continuing multifocal lenses until cessation of elongation and progression.

Axial Shortening Effects of Repeated Low-level Red-light Therapy in Children With High Myopia: A Multicenter Randomized Controlled Trial

PURPOSE

To evaluate the effectiveness and safety of repeated low-level red-light (RLRL) in delaying the progression of high myopes with -6.00 diopters (D) or worse.

DESIGN

Multicenter, randomized, parallel-group, single-blind clinical trial. A total of 202 high myopic children aged 7 to 12 years with cycloplegia spherical equivalent (SE) refraction ≤-6.00 D, astigmatism less than 2.50 D, and anisometropia of 1.50 D or less were enrolled from March 2022 to December 2022. Follow-up was completed in December 2023.

METHODS

Eligible participants were randomly allocated to the intervention (RLRL + single vision spectacle) or the control group (single vision spectacle). The RLRL treatment was administered every day for 3 minutes, twice a day, with an interval of at least 4 hours. The primary outcome was the change in axial length (AL) at 12 months compared with baseline. Secondary outcomes included changes in SE, changes in choroidal thickness (ChT), and changes in retinal thickness (RT) in different circle sectors. Outcomes were analyzed by means of intention-to-treat and per-protocol methods.

RESULTS

After 12 months of treatment, AL and SE changes were -0.11 ± 0.25 mm and 0.18 ± 0.63 D for the RLRL group and 0.32 ± 0.09 mm and -0.80 ± 0.42 D for the control group, respectively. Axial shortening >0.05 mm was 59% in the RLRL and 0% in the control group at 12 months. ChT and RT from a single center were analyzed. In the RLRL group, ChT was thickened in all sectors at 12 months. RT was increased in parafoveal and perifoveal circles. In the control group, all sectors of ChT and only perifoveal RT were significantly thinner at 12 months. The multivariate linear regression model revealed significant correlations between changes in the ChT central foveal circle and RT perifoveal circle at 1 month and AL changes at 12 months. No fundus structure changes, afterimage exceeding 6 minutes, or best-corrected visual acuity decrease were reported.

CONCLUSIONS

RLRL could effectively shorten the AL and inhibit the progression of myopia in high myopic patients with -6.00 D or worse. AL shortening is sustained over 12 months of treatment. These observed changes appeared to be associated with increases in ChT and RT.

Broadband Long Wavelength Light Promotes Myopic Eye Growth and Alters Retinal Responses to Light Offset in Chick

Purpose

Prolonged exposure to broadband light with a short-wavelength (blue) or long-wavelength (orange/red) bias is known to impact eye growth and refraction, but the mechanisms underlying this response are unknown. Thus, the present study investigated the effects of broadband blue and orange lights with well-differentiated spectrums on refractive development and global flash electroretinography (gfERG) measures of retinal function in the chick myopia model.

Methods

Chicks were raised for 4 days with monocular negative lenses, or no lens, under blue, orange, or white light. Chick weight, eye dimensions, and refraction were measured at the conclusion of rearing. In a separate cohort of chicks, the effect of 4 days of colored light rearing on retinal responses to orange, blue, or white light flashes was assessed using gfERG.

Results

Chicks reared under orange light for 4 days exhibited a significantly larger myopic shift in response to negative lenses compared to those reared under blue light. Orange light rearing for 4 days increased the gfERG d-wave amplitude and implicit time in response to orange light flashes but did not alter responses to white or blue flashes. Blue and white light rearing did not affect the retina's response to light flashes of any color.

Conclusions

Orange light rearing exacerbated defocus-induced myopia relative to blue light rearing. The gfERG recordings revealed that prolonged orange light exposure increased retinal responsivity to the offset of long wavelength light flashes, suggesting a potential role for ON/OFF pathway balance in generating the refractive response that requires further electrophysiological and molecular investigation.

Cross-population validation of the PreMO risk indicator for predicting myopia onset in children

PURPOSE

The Predicting Myopia Onset and progression (PreMO) risk indicator, developed using data generated from white children in the UK, incorporates age, spherical equivalent refraction (SER), axial length (AL) and parental myopia to stratify the likelihood of developing myopia. This study evaluated the PreMO's predictive accuracy using prospective datasets from independent samples of children in Hong Kong (HK) and an ethnically diverse cohort of children in the United Kingdom.

METHODS

Non-myopic children (SER > -0.50 D) aged 6-8 and 9-10 years were scored using the PreMO risk indicator framework, integrating baseline cycloplegic SER, AL and parental myopia data. Scores were assigned risk categories as follows: 0 = no risk, 1-3 = low risk, 4-6 = moderate risk and 7-9 = high risk. SER at ≥15 years of age was used to define refractive outcomes as 'myopic' or 'not myopic'. PreMO's predictive accuracy was analysed via Receiver Operator Characteristic curves, with Youden's J-Index identifying the optimal risk score threshold. Sensitivity, specificity and area under the curve were determined and compared with those of singular predictors, that is, SER < +0.75 D and AL ≥ 23.07 mm at 6-8 years.

RESULTS

In the cohort of children aged 6-8 years, a PreMO risk score ≥ 4 exhibited high sensitivity in predicting myopia onset in UK (0.97) and HK (0.94) children, with high specificity in UK (0.96) and moderate specificity in HK (0.64) children. In UK children aged 6-8 years, the PreMO outperformed singular predictors such as SER and AL. Among HK children aged 9-10 years, the PreMO score maintained high sensitivity (0.90) and moderate specificity (0.72).

CONCLUSIONS

A PreMO risk score ≥ 4 is a strong predictive indicator for future myopia onset, particularly in UK children. Despite high sensitivity in both UK and HK cohorts, specificity varied, indicating the need for contextual application of the tool, particularly in pre-myopic Asian children.

Natural Course of Refractive Error in Congenital Stationary Night Blindness: Implications for Myopia Treatment

Purpose

A range of pharmacological and optical therapies are being studied and implemented in children with myopia to reduce the progression of myopia. At present, the efficacy of these myopia reduction treatments in children with underlying inherited retinal disorders (IRDs) is largely unknown. To evaluate this efficacy, it is essential to first understand the natural progression of myopia within each distinct underlying IRD. We investigated the natural course of refractive error throughout childhood in patients with congenital stationary night blindness (CSNB) of the Schubert-Bornschein type.

Methods

We retrospectively assessed a total of 295 refraction measurements in 127 patients with CSNB (48 with "complete" CSNB [CSNB1] and 79 with "incomplete" CSNB [CSNB2]) at different ages between 0 and 21 years old. None had a history of myopia control treatment. A linear mixed effects model was fitted on the data to analyze the natural course of refraction in these patients.

Results

The fitted model showed that refractive error in patients with CSNB increases quickly toward myopia in the first years of life. After the age of 4 years, there was a minimal progression of only -0.12 diopters (D) per year up to 15 years, after which the refraction seemed stable. All (43/43) of the patients with CSNB1 aged > 4 years were myopic and 84% (62/74) of the patients with CSNB2 aged > 4 years were myopic at the last refraction measurement.

Conclusions

In general, the refractive error of children with CSNB changes minimally after the age of 4 years old. A critical approach to myopia control interventions in these children is warranted.

Gender issues in myopia: a changing paradigm in generations

Myopia is becoming an important cause of visual impairment. Determining risk profiles will help to develop targeted prevention strategies. This study aims to explore the difference in myopia development between genders in two cohorts representing different generations, and to assess whether hypothetical interventions targeting education or lifestyle factors would reduce a gender gap. This study included two Dutch population-based cohorts; 11,109 adults aged ≥ 45 years from the Rotterdam Study I-III born between 1887 and 1960, and 7229 children from the birth cohort Generation R study born between 2002 and 2006 at age 9-13 years. Sequential G-estimation was used to estimate changes in gender-specific myopia prevalence, incidence and spherical equivalent if hypothetical interventions such as education and lifestyle changes would have been implemented. Myopia prevalence was 32.3% in men and 29.3% in women in the generation born between 1887 and 1960 (0.23 dioptre difference in spherical equivalent; p < 0.001); while this prevalence was 20.2% in boys and 24.7% in girls born between 2002 and 2006 at age 13 (0.15 dioptre difference in spherical equivalent; p = 0.02). In the older generation, hypothetically intervening to lower education reduced the difference between genders by -52.4% (-108.0%; -13.2%) for spherical equivalent and - 53.0% (-112.0%; -11.6%) for myopia. In children, hypothetically intervening on reducing reading time (-50.0%, 95%CI=-267.5%; 33.8% for spherical equivalent) and number of books read/week (-76.8%, 95% CI=-349.9%; 20.2% for spherical equivalent) was most prominent, but not statistically significant. The results show that men had a higher prevalence of myopia in our study of older generations; while girls had a higher prevalence in the young generation. Our hypothetical interventions suggest that these generation-specific gender preponderances were largely due to education and, possibly, lifestyle factors in youth.

Novel Lenslet-ARray-Integrated Spectacle Lenses for Myopia Control: A 1-Year Randomized, Double-Masked, Controlled Trial

PURPOSE

To investigate the myopia control efficacy of novel Lenslet-ARray-Integrated (LARI) spectacle lenses with positive power lenslets (PLARI) and negative power lenslets (NLARI) worn for 1 year in myopic children.

DESIGN

Randomized, double-masked, controlled clinical trial.

PARTICIPANTS

A total of 240 children 6 to 12 years of age with spherical equivalent refraction (SER) between -4.00 and -1.00 diopters (D), astigmatism of ≤ 1.50 D, and anisometropia of ≤ 1.00 D.

METHODS

Participants were assigned randomly in a 1:1:1 ratio to PLARI, NLARI, and control (single-vision [SV]) groups. Cycloplegic autorefraction and axial length were measured at baseline and 6-month intervals after lens wear.

MAIN OUTCOME MEASURES

Changes in SER, axial elongation (AE), and differences between groups.

RESULTS

After 1 year, SER changes and AE in the PLARI and NLARI groups were significantly less than those in the SV group (SER: -0.30 ± 0.48 D, -0.21 ± 0.35 D, and -0.66 ± 0.40 D, respectively; AE: 0.19 ± 0.20 mm, 0.17 ± 0.14 mm, 0.34 ± 0.18 mm, respectively; all P < 0.001). No significant differences were found in SER changes and AE between PLARI and NLARI groups (P = 0.54 and P = 1.00, respectively). Younger age was associated with more rapid SER increase and larger AE in the SV group (r = 0.40 [P < 0.001] and r = -0.59 [P < 0.001], respectively) and PLARI group (r = 0.46 [P < 0.001] and r = -0.52 [P < 0.001], respectively), but not in the NLARI group (r = -0.002 [P = 0.98] and r = -0.08 [P = 0.48], respectively).

CONCLUSIONS

Compared with the SV group, both PLARI and NARI groups showed significantly slower myopia progression in terms of SER and AE. Faster myopia progression, in terms of both SER and AE, was associated with younger age in the SV and PLARI groups but not the NLARI group.

FINANCIAL DISCLOSURE(S)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Visual performance and quality of life in myopic adolescents with pupil-optimised multifocal versus single-vision contact lenses

CLINICAL RELEVANCE

Myopia control is a prominent area of global research, with multifocal contact lenses identified as an effective intervention for adolescents.

BACKGROUND

This study aims to evaluate the visual performance and vision-related quality of life (QoL) of myopic adolescents when corrected with pupil-optimised multifocal soft contact lenses (MFSCLs) versus single-vision contact lenses (SVCLs), with each participant serving as their own control.

METHODS

Thirty-five myopic adolescents, habitually wearing SVCLs and fitted with pupil-optimised MFSCL with mid-addition power, were recruited. The assessment included distance visual acuity (DVA), near visual acuity (NVA), maximum reading speed (MRS), reading acuity (RA), contrast sensitivity (CS), and stereoacuity (SA) in photopic conditions for both types of lenses. Vision-related QoL was quantified twice for both lens types using the National Eye Institute Visual Function Questionnaire (NEI VFQ-42), covering 13 vision-specific domains.

RESULTS

Comparisons of visual outcomes between MFSCLs and SVCLs for the same subjects revealed statistically significant differences in DVA (p = 0.010), NVA (p = 0.014), MRS (p = 0.044), and RA (p < 0.001), with SVCLs outperforming in DVA only. No significant difference in CS and SA was observed between the two lens types. According to the NEI VFQ-42, scores for clarity of vision, far vision, glare, and satisfaction with correction were higher with SVCLs, while the score for near vision was higher with MFSCLs. When fitted with MFSCLs, no significant correlations were found between pupil size and age of the patient with any visual examination parameters. However, there was a significant negative correlation between the DVA, NVA and the spherical equivalent of the lens.

CONCLUSION

MFSCLs with mid-add power significantly improve NVA, MRS, and RA, albeit with a reduction in DVA compared to SVCLs. While SVCLs were associated with better clarity of vision, far vision, and satisfaction with correction, MFSCLs offered superior performance in near vision tasks, according to the NEI VFQ-42 scores.

Adult Myopia Progression

Purpose

To explore evidence for myopic shift between the ages of 20 and 50 years.

Methods

Three usable sets of data with long-term adult refractive progression were identified: (1) US population-based prevalence data for those 18 to 24 years of age in 1971 and 1972 and 45 to 54 years of age from 1999 to 2004; a logit transformation of prevalence values at different refractive error thresholds allowed estimation of myopic progression in this group. (2) German clinical data describing 5- to 10-year progression for different refractive error groupings across 5-year age bands from 20 to 49 years; these were extracted, adjusted, and analyzed. (3) Five-year progression rates with similar breakdown of age and refractive error groups as the German data but in a Japanese clinical population.

Results

Estimates of progression between 20 and 50 years for the given studies were: (1) -1.1, -1.4, and -1.9 diopters (D) for baseline refractive errors of -1, -3, and -6 D, respectively; (2) a range from -1.0 to -2.9 D, increasing with degree of baseline myopia; (3) a weighted average of -1.0 D for males and -0.9 D for females but with decreasing progression with increasing myopia. In all studies, average progression rates fell with increasing age, with most progression occurring between 20 and 30 years.

Conclusions

All three studies provide evidence of around -1 D myopia progression between the ages of 20 and 50 years. This has implications for intervention to slow progression during adulthood, as well as projections of visual impairment associated with myopia.

2024 UK and Ireland modified Delphi consensus on myopia management in children and young people

INTRODUCTION

This work aimed to establish the largest UK and Ireland consensus on myopia management in children and young people (CYP).

METHODS

A modified Delphi consensus was conducted with a panel of 34 optometrists and ophthalmologists with expertise in myopia management.

RESULTS

Two rounds of voting took place and 131 statements were agreed, including that interventions should be discussed with parents/carers of all CYP who develop myopia before the age of 13 years, a recommendation for interventions to be publicly funded for those at risk of fast progression and high myopia, that intervention selection should take into account the CYP's hobbies and lifestyle and that additional training for eye care professionals should be available from non-commercial sources. Topics for which published evidence is limited or lacking were areas of weaker or no consensus. Modern myopia management contact and spectacles are suitable first-line treatments. The role and provision of low-concentration atropine needs to be reviewed once marketing authorisations and funding decisions are in place. There is some evidence that a combination of low-concentration atropine with an optical intervention can have an additive effect; further research is needed. Once an intervention is started, best practice is to monitor non-cycloplegic axial length 6 monthly.

CONCLUSION

Research is needed to identify those at risk of progression, the long-term effectiveness of individual and combined interventions, and when to discontinue treatment when myopia has stabilised. As further evidence continues to emerge, this consensus work will be repeated to ensure it remains relevant.

Control of myopia using diffusion optics spectacle lenses: 4-year results of a multicentre randomised controlled, efficacy and safety study (CYPRESS)

AIMS

To evaluate the myopia control efficacy of Diffusion Optics Technology (DOT) spectacle lenses in children over a 4-year treatment period.

METHODS

CYPRESS Part 1 (NCT03623074) was a 3-year multicentre, randomised, controlled, double-masked trial comparing two investigational spectacle lens DOT designs (Test 1, Test 2) and standard single vision Control lenses in 256 North American children aged 6-10 years. Children completing Part 1 (n=200) were invited to enrol in CYPRESS Part 2 (NCT04947735) for an additional 1-year period. In Part 2, Test 1 (n=35) and Control groups (n=42) continued with their original lens assignment and the Test 2 group (n=21) were crossed over to Test 1 (DOT 0.2) lenses. The co-primary endpoints were change from baseline in axial length (AL) and cycloplegic spherical equivalent refraction (cSER).

RESULTS

Test 1 spectacle lenses demonstrated superiority to the Control in both co-primary endpoints: with a difference between means (Test 1-Control) of -0.13 mm for AL (p=0.018) and 0.33 D for cSER (p=0.008) in Part 1 and -0.05 mm for AL (p=0.038) and 0.13 D for cSER (p=0.043) in Part 2. Comparing treatment effects in Part 1 and 2 suggests that COVID-19 public health restrictions negatively impacted treatment efficacy in study years 2 and 3.

CONCLUSION

DOT 0.2 spectacle lenses are safe and effective at reducing myopia progression, with additional benefit evident in year 4 of wear. These results support the hypothesis that a mild reduction in retinal contrast can slow myopia progression in young children. The unprecedented disruption in participant schooling and lifestyle during the COVID-19 pandemic may have depressed treatment efficacy in Part 1.

Epidemiology of Myopia: Prevalence, Risk Factors and Effects of Myopia

Myopia is the most common cause of visual impairment in children and young adults. In order to assess the consequences for society, it is necessary to know temporal trends in prevalence, incidence and associated factors in childhood and adolescence, as well as the rate of myopia progression, as based on epidemiological research. This paper presents a literature review of publications from 2020 up to March 2024, supplemented by other relevant publications. The prevalence of myopia in children and adolescents in Germany is almost stable and is significantly lower than in Asia. The development of myopia is influenced by outdoor activity, parental myopia, genetics and near work, while insufficient time spent outdoors in childhood is a significant and controllable risk factor for myopia-related complications such as myopic maculopathy, glaucoma, and retinal detachment.

The Onset and Progression of Myopia Slows in Chinese 15-Year-Old Adolescents Following Vocational Rather Than Academic School Pathways

Purpose

The purpose of this study was to investigate the changes in spherical equivalent (SE) and axial length (AL) and cumulative incidence of myopia and high myopia in Chinese 15-year-old adolescents entering a non-academic stream of senior high school education.

Methods

A total of 880 first-born twins with a baseline age range of 7 to 15 years were enrolled and followed annually until 18 years of age. Cycloplegic refractions and AL were examined. Educational exposure was divided into academic high school (AHS) and vocational high school (VHS) streams. A piecewise linear mixed-effects model was used to estimate the effect of education exposures on SE development, the slope before the age of 15 years (β2), and the slope change at the age of 15 years (β3) was compared between the 2 groups.

Results

The curves of refractive development in a myopic direction changed in parallel in the AHS and VHS group before 15 years. For nonmyopic children, β2 was -0.19 and -0.20 diopters (D)/year (P = 0.270), and β3 was 0.16 and 0.14 D/year (P = 0.270), in the AHS and VHS groups, respectively. Among patients with myopia, β2 was -0.52 and -0.54 D/year (P = 0.500), and β3 was 0.37 and 0.32 D/year (P = 0.004), in the AHS and VHS groups, respectively. The trends in AL were similar. The 3-year cumulative incidence of myopia was 35.3% (AHS) versus 14.7% (VHS; P < 0.001), and that of high myopia was 5.7% and 3.3% (P = 0.129).

Conclusions

Students undertaking a VHS rather than an AHS education have slower myopic shifts in refraction and less incident myopia after the age of 15 years.

Influence of age and race on axial elongation in myopic children: A systematic review and meta-regression

PURPOSE

Axial elongation is the basis of progression in primary myopia and the preferred metric to monitor its evolution. We conducted a meta-regression to model axial elongation and its associated factors in children with low to moderate myopia.

METHODS

A comprehensive electronic systematic search was performed using Ovid Medline, EMBASE, and Cochrane Central Register of Controlled Trials of studies conducted up until October 2021. The mean rate of axial elongation was analyzed using a multivariate linear mixed-effects meta-regression model, with backward stepwise elimination of nonsignificant covariates. The model included three levels of random effects, allowing both prediction and confidence intervals to be estimated.

RESULTS

A total of 64 studies with 83 subpopulations and 142 evaluations of mean axial change from baseline met our inclusion criteria and had no missing significant covariates in the final model. A separate analysis including all populations with axial length data (202 evaluations) but missing variance or covariate data produced a similar model to that for the analysis with complete data. The mean axial elongation is 38% greater in Asian children (95% confidence interval, 19 to 61%; p<0.01) compared with non-Asians, but both groups show a 15% decline per year as age increases (95% confidence interval, 12 to 17% p<0.0001). Prediction intervals indicate substantial variability around the axial elongation estimates.

CONCLUSIONS

This analysis provides mean values of axial elongation for evaluation of efficacy of myopia control. The broad prediction intervals emphasize the large range of individual axial elongation rates in the population, illustrating the challenge in managing individual children. Interpretation of the analysis is limited by the use of aggregated data rather than individual subject data.

Age-matched analysis of axial length growth in myopic children wearing defocus incorporated multiple segments spectacle lenses

BACKGROUND/AIMS

Defocus incorporated multiple segments (DIMS) spectacle lenses are known to be able to inhibit axial length (AL) growth in myopic children compared with single vision (SV) spectacle lenses. However, it is not known whether AL growth is sufficiently inhibited to achieve the treatment goal of physiological AL growth.

METHODS

Of the data already collected in 2014-2017 by Lam et al, the AL growth with DIMS and SV spectacle lenses was re-evaluated according to the age-matched myopia control system. The individual AL growth after the first year of treatment of each eye was plotted against the corresponding age of the same time point in a colour-coded scheme. The two treatment groups were further subdivided based on their age and their baseline AL.

RESULTS

Overall, 65% (61% of male, 70% of female) of eyes with DIMS spectacle lenses and 16% (16% of male, 16% of female) of eyes with SV spectacle lenses are within range of physiological AL growth rate. Median AL growth rate of eyes with DIMS spectacle lenses is also within the range of physiological growth. In the subgroups, eyes with DIMS spectacle lenses were also superior to the ones with SV spectacle lenses regarding this treatment goal. Of the children with SV spectacle lenses, older children and children with eyes with high baseline AL were least likely to achieve physiological AL growth rate.

CONCLUSIONS

DIMS spectacle lenses can bring the AL growth rate of myopic children to the level of physiological AL growth rate, indicating 100% reduction of excessive myopic AL growth, independent of age and baseline AL. Older children and children with eyes with high AL have the risk to have increased AL growth without treatment.

Daylight and Electric Lighting in Primary and Secondary School Classrooms in the UK-An Observational Study

Only a few recent studies report direct assessment or monitoring of light levels in the indoor learning environment, and no consensus exists on minimum exposures for children's health. For instance, myopia is a common progressive condition, with genetic and environmental risk factors. Reduced daylight exposure, electric lighting changes, increased near-work for school children, greater academic focus, and use of display screens and white boards may have important detrimental influences. Published assessment methods had varied limitations, such as incomplete compliance from participants wearing light loggers for extended periods. Climate-Based Daylight Modelling is encouraged in UK school design, but design approaches are impractical for post-occupancy assessments of pre-existing classrooms or ad hoc modifications. In this study, we investigated the potential for direct assessment and monitoring of classroom daylight and lighting measurements. Combined with objective assessments of outdoor exposures and class time use, the classroom data could inform design and light exposure interventions to reduce the various health impacts of inadequate daylight exposure. The relevant environmental measure for myopia depends on the hypothesized mechanism, so the illuminance, spectral distribution, and temporal light modulation from the electric lighting was also assessed.

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

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.

Violet light transmission through eyeglasses and its effects on myopic children: A systematic review and meta-analysis

PURPOSE

Myopia is a refractive error that impairs visual function and leads to visual blurring. This study aims to investigate the effect of violet light (VL) on controlling myopia, specifically in terms of axial length (AL), spherical equivalent refraction (SER), and visual acuity (VA).

METHODS

A systematic review was conducted to compare VL and single-vision spectacles (SVSs) for treating childhood myopia. The search terms used were "Myopia" and "Violet Light." Extensive searches were carried out in the PubMed, Embase, and Cochrane databases. The mean differences were evaluated. The effects of the therapy were examined. Publication bias was assessed with a funnel plot and further investigated through sensitivity analysis. Meta-analysis was performed using Bayesian statistics with Jeffery's Amazing Statistical Package.

RESULTS

The meta-analysis included 126 myopic children: 64 in the VL group and 62 in the SVS group. The pooled effect size for AL shortening was evaluated as 0.659 ± 0.184, with a 95% credible interval of 0.299-1.023. The pooled effect size for SER decrease was estimated as 0.669 ± 0.188, with a 95% credible interval of 0.303-1.036. Likewise, for VA in Log-MAR, after intervention (VL and SVS), the values were 0.082 ± 0.171 with a credible interval of 0.262-0.423. Publication bias was assessed with a funnel plot, which revealed no bias. Impact sizes for the fixed effect model were determined due to the similarity in study population, geography, type of intervention, and study design.

CONCLUSION

VL transmission glasses play a significant role in controlling myopia among children, resulting in axial shortening, reduction of SER, and improvement in VA. However, further investigation is required to examine the long-term rebound effect.

Myopia Control: Are We Ready for an Evidence Based Approach?

INTRODUCTION

Myopia and its vision-threatening complications present a significant public health problem. This review aims to provide an updated overview of the multitude of known and emerging interventions to control myopia, including their potential effect, safety, and costs.

METHODS

A systematic literature search of three databases was conducted. Interventions were grouped into four categories: environmental/behavioral (outdoor time, near work), pharmacological (e.g., atropine), optical interventions (spectacles and contact lenses), and novel approaches such as red-light (RLRL) therapies. Review articles and original articles on randomized controlled trials (RCT) were selected.

RESULTS

From the initial 3224 retrieved records, 18 reviews and 41 original articles reporting results from RCTs were included. While there is more evidence supporting the efficacy of low-dose atropine and certain myopia-controlling contact lenses in slowing myopia progression, the evidence about the efficacy of the newer interventions, such as spectacle lenses (e.g., defocus incorporated multiple segments and highly aspheric lenslets) is more limited. Behavioral interventions, i.e., increased outdoor time, seem effective for preventing the onset of myopia if implemented successfully in schools and homes. While environmental interventions and spectacles are regarded as generally safe, pharmacological interventions, contact lenses, and RLRL may be associated with adverse effects. All interventions, except for behavioral change, are tied to moderate to high expenditures.

CONCLUSION

Our review suggests that myopia control interventions are recommended and prescribed on the basis of accessibility and clinical practice patterns, which vary widely around the world. Clinical trials indicate short- to medium-term efficacy in reducing myopia progression for various interventions, but none have demonstrated long-term effectiveness in preventing high myopia and potential complications in adulthood. There is an unmet need for a unified consensus for strategies that balance risk and effectiveness for these methods for personalized myopia management.

Myopia and Nutrient Associations with Age-Related Eye Diseases in Korean Adults: A Cross-Sectional KNHANES Study

This study assessed the prevalence of myopia, cataracts, glaucoma, and macular degeneration among Koreans over 40, utilizing data from the 7th Korea National Health and Nutrition Examination Survey (KNHANES VII, 2018). We analyzed 204,973 adults (44% men, 56% women; mean age 58.70 ± 10.75 years), exploring the association between myopia and these eye diseases through multivariate logistic regression, adjusting for confounders and calculating adjusted odds ratios (ORs) with 95% confidence intervals (CIs). Results showed a myopia prevalence of 44.6%, cataracts at 19.4%, macular degeneration at 16.2%, and glaucoma at 2.3%, with significant differences across ages and genders. A potential link was found between myopia and an increased risk of cataracts and macular degeneration, but not with glaucoma. Additionally, a higher dietary intake of carbohydrates, polyunsaturated and n-6 fatty acids, vitamins, and minerals correlated with lower risks of these diseases, underscoring the importance of the diet in managing and preventing age-related eye conditions. These findings highlight the need for dietary considerations in public health strategies and confirm myopia as a significant risk factor for specific eye diseases in the aging Korean population.

Characterization of lncRNA and mRNA profiles in ciliary body in experimental myopia

Currently, researchers have mainly focused on the role of the tissues of the posterior segment of the eyes in the development of myopia. However, the ciliary body, an anterior ocular tissue that contracts to initiate the process of accommodation, may also play an important role in the progression of myopia due to the increased demand for near work. In the present study, we established a lens-induced myopia (LIM) animal model in guinea pigs and investigated the molecular changes in the ciliary body associated with the development of myopia based on RNA sequencing. As a result, 871 differentially expressed (DE) mRNAs and 19 DE lncRNAs were identified in the ciliary body between the LIM group and the normal control group. In addition, the lncRNA-mRNA co-expression analysis was performed to explore the target genes of lncRNAs, which were mainly enriched in the Rap1 signaling pathway, cytokine-cytokine receptor interaction, and complement and coagulation cascades pathways based on the functional enrichment analysis. Among the target genes of lncRNAs, three hub genes, including Ctnnb1, Pik3r1, and Itgb1, were found to be involved in the Rap1 signaling pathway. Interestingly, two crucial genes, Grk1 and Pde6a, which are mainly expressed in retinal photoreceptors, were enriched in visual perception in the ciliary body in functional analysis and were verified to be expressed in the ciliary body. These findings indicate the molecular pathogenetic role of the ciliary body in myopia and provide new insights into the underlying mechanism of myopia development. Further studies are needed to explore the specific contributions of these identified lncRNAs and mRNAs to the development of myopia.

Different efficacy in myopia control: Comparison between orthokeratology and defocus-incorporated multiple segment lenses

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.

Evaluation and comparison of optical coherence tomography angiography (OCTA) parameters in normal and moderate myopic individuals

OBJECTIVE

The objective of this study was to evaluate and compare Optical Coherence Tomography Angiography (OCTA) parameters in patients with moderate myopia and healthy individuals retrospectively.

METHODS

A total of 80 male individuals aged 18-20 years were included in the study with 40 moderate myopic and 40 healthy persons. All participants underwent detailed ocular examination including refraction, intraocular pressure (IOP), visual acuity, biomicroscopy, OCTA measurement and optic biometry measurement. Retinal, retinal nerve fiber layer and choroidal layer thicknesses were evaluated in µm with the help of the software available in the OCTA device.

RESULTS

The mean axial length (24.32 ± 0.53 mm) was statistically significantly higher in the moderate myopic group (24.32 mm) compared to the healthy group (23.33 ± 0.61 mm) (p < 0.001). Spherical equivalent (SE) was found as -3.79 ± 0.91 D in the moderate myopic group and -0.22 ± 0.32 D in the healthy group (p < 0.05). The mean superficial foveal mean density (FovSupMVD) and the mean deep foveal mean density (FovDepMVD) were statistically significantly lower in the moderate myopic group than in the healthy group (both, p < 0.001). The mean retinal temporal thickness (RTt) was statistically significantly lower in the moderate myopic group (p = 0.017). There was a mild negative correlation between axial length and FovSupMVD, FovDepMVD in myopes. In axial length ROC analysis, the cutoff value for moderate myopes was found to be 24.15 mm. Mean superficial foveal mean density (FovSupMVD) and mean deep foveal mean density (FovDepMVD), mean retinal temporal thickness (RTt) were significantly lower in the group above 24.15 mm axial length compared to the group below 24.15 mm axial length (all three, p < 0.001). Foveal avascular zone was significantly higher in the group above 24.15 mm axial length (p = 0.016) CONCLUSION: The results of our study indicate that the mean axial length and spherical equivalent were significantly higher, while retinal temporal thickness, the mean superficial foveal mean density and the mean deep foveal mean density were significantly lower in patients with myopia up to -6.0 D compared to the healthy individuals.

Two-Year Myopia Management Efficacy of Extended Depth of Focus Soft Contact Lenses (MYLO) in Caucasian Children

PURPOSE

To evaluate the progression of myopia as assessed by change in axial length (AL) and spherical equivalent (SE) from baseline in Caucasian children wearing extended depth of focus soft contact lenses (CLs) compared to distance single-vision spectacles.

DESIGN

Prospective non-randomized comparative clinical trial.

METHODS

A total of 90 children (6-13 years of age) with SE ranging from -0.75 to -10.00 diopters (D) were recruited. Of these children, 45 were fitted with CLs (MYLO, mark´ennovy), whereas 45 children wore spectacles. Cycloplegic refraction was measured with an auto-refractometer (Topcon-TRK-2P) and AL with an IOLMaster-700 (Zeiss) at 6-month intervals. Subjective responses after 1 month of CL wear related to vision and comfort were determined using a questionnaire with a scale from 1 (very poor) to 10 (excellent). High-contrast visual acuity (HCVA) and contrast sensitivity (CS) were evaluated at baseline, 12, and 24 months.

RESULTS

After 2 years, mean change in SE/AL in the CL group was -0.62 ± 0.30 D/0.37 ± 0.04 mm and -1.13 ± 0.20 D/0.66 ± 0.03 mm in the spectacles group (P < .001). Cumulative absolute reduction in axial elongation (CARE) was 0.29 ± 0.06 mm. Difference in SE change was -0.50 ± 0.34 D. Although 100% of CL group had an AL increase ≤0.50 mm, all participants increased ≥0.50 mm in the spectacles group. In all, 53% of the CL group and 1% in the spectacles group showed a progression in SE ≤ -0.50D. All questionnaire items showed a mean value ≥9. There was a reduction logMAR HCVA in the CL compared to the spectacles group but it was less than 1 line (P < .001).

CONCLUSIONS

Use of MYLO CLs reduced axial elongation and myopia progression compared to use of distance single-vision spectacles.

The Relationship between Selected Parameters and the Occurrence of Premyopia in a Group of 1155 Children Aged 8 in Northwestern Poland

Background: Determination of the number of pupils at risk of developing pre-myopia and selected ophthalmic parameters in a group of 1155 children aged 8. Material: Ophthalmic examinations were performed in Polish 8-year-old, /1518 individuals/; 1155 of whom presented complete data for analysis. There was a total of 554 (47.9%) girls and 602 (52.1%) boys. Examination of the anterior and posterior segment of the eye, evaluation of accommodation, convergence, heterophoria, alignment of the eyeball, muscular balance with ocular mobility in 9 directions of gaze, and spatial vision were tested. Refraction was obtained under cycloplegia. Refractions (spherical equivalent, SE). were categorized as pre-myopia (-0.50 D-+0.75 D), myopia (≤-0.5 D), emmetropia (>-0.5 D to ≤+0.5 D), mildly hyperopia (>+0.5 D to ≤+2.0 D) and hyperopia (>+2.0 D). Data analysis was performed using Statistica 13.5 software: chi-squared, Pearson's, t-Student, and U Mann-Whitney tests. p-values of <0.05 were considered statistically significant. Results: Pre-myopia was diagnosed in as many as 704 subjects (60.9%) with a similar frequency among both girls-328 (46.6%)-and boys with 376 (53.4%). Conclusions: Current data indicates that the growing group of myopic individuals in many industrialized countries is the sixth most common cause of blindness. Further research is crucial to understand the factors underlying accommodative and binocular mechanisms for myopia development and progression and to make recommendations for targeted interventions to slow the progression of myopia in a group of early school children.

Effects and potential mechanisms of exercise and physical activity on eye health and ocular diseases

In the field of eye health, the profound impact of exercise and physical activity on various ocular diseases has become a focal point of attention. This review summarizes and elucidates the positive effects of exercise and physical activities on common ocular diseases, including dry eye disease (DED), cataracts, myopia, glaucoma, diabetic retinopathy (DR), and age-related macular degeneration (AMD). It also catalogues and offers exercise recommendations based on the varying impacts that different types and intensities of physical activities may have on specific eye conditions. Beyond correlations, this review also compiles potential mechanisms through which exercise and physical activity beneficially affect eye health. From mitigating ocular oxidative stress and inflammatory responses, reducing intraocular pressure, enhancing mitochondrial function, to promoting ocular blood circulation and the release of protective factors, the complex biological effects triggered by exercise and physical activities reveal their substantial potential in preventing and even assisting in the treatment of ocular diseases. This review aims not only to foster awareness and appreciation for how exercise and physical activity can improve eye health but also to serve as a catalyst for further exploration into the specific mechanisms and key targets through which exercise impacts ocular health. Such inquiries are crucial for advancing innovative strategies for the treatment of eye diseases, thereby holding significant implications for the development of new therapeutic approaches.

Axial length, more than aging, decreases the thickness and superficial vessel density of retinal nerve fiber layer in non-glaucomatous eyes

PURPOSE

This study seeks to build a normative database for the vessel density of the superficial retina (SVD) and evaluate how changes and trends in the retinal microvasculature may be influenced by age and axial length (AL) in non-glaucomatous eyes, as measured with optical coherence tomography angiography (OCTA).

METHODS

We included 500 eyes of 290 healthy subjects visiting a county hospital. Each participant underwent comprehensive ophthalmological examinations and OCTA to measure the SVD and thickness of the macular and peripapillary areas. To analyze correlations between SVD and age or AL, multivariable linear regression models with generalized estimating equations were applied.

RESULTS

Age was negatively correlated with the SVD of the superior, central, and inferior macular areas and the superior peripapillary area, with a decrease rate of 1.06%, 1.36%, 0.84%, and 0.66% per decade, respectively. However, inferior peripapillary SVD showed no significant correlation with age. AL was negatively correlated with the SVD of the inferior macular area and the superior and inferior peripapillary areas, with coefficients of -0.522%/mm, -0.733%/mm, and -0.664%/mm, respectively. AL was also negatively correlated with the thickness of the retinal nerve fiber layer and inferior ganglion cell complex (p = 0.004).

CONCLUSION

Age and AL were the two main factors affecting changes in SVD. Furthermore, AL, a relative term to represent the degree of myopia, had a greater effect than age and showed a more significant effect on thickness than on SVD. This relationship has important implications because myopia is a significant issue in modern cities.

Myopia control: Seeing beyond efficacy

SIGNIFICANCE

The availability of a range of effective myopia control modalities enables the clinician to exercise judgment when discussing the treatment plan with the patient and their parents. This article outlines important considerations beyond efficacy.Clinically meaningful myopia control may be attained with some spectacle lenses, select soft contact lenses, some concentrations of atropine, and overnight orthokeratology. Given that satisfactory efficacy can be achieved with a range of modalities, other factors should be considered when deciding upon the best intervention for a given child. Four key factors-compliance, quality of vision, quality of life, and safety-are discussed in this review. Compliance directly impacts efficacy regardless of the modality and is the most important consideration, as it is influenced by quality of vision and comfort. Daily disposal myopia control contact lenses and overnight orthokeratology are generally associated with high compliance, provide better vision-related quality of life than spectacles, and carry a very low risk when used appropriately. A further benefit of overnight orthokeratology is the elimination of a need for optical correction during the day.

Method comparison and overview of refractive measurements in children: implications for myopia management

OBJECTIVE

This study investigated the agreement between objective wavefront-based refraction and subjective refraction in myopic children. It also assessed the impact of cyclopentolate and refraction levels on the agreement.

METHODS

A total of 84 eyes of myopic children aged 6-13 years were included in the analysis. Non-cycloplegic and cycloplegic objective wavefront-based refraction were determined and cycloplegic subjective refraction was performed for each participant. The data were converted into spherical equivalent, J0 and J45, and Bland-Altman plots were used to analyse the agreement between methods.

RESULTS

Linear functions were used to determine the dependency between the central myopic refractive error and the difference between the method of refraction (=bias). The influence of central myopia was not clinically relevant when analysing the agreement between wavefront results with and without cyclopentolate (comparison 1). The bias for wavefront-based minus subjective spherical equivalent refraction (comparison 2) was ≤-0.50 D (95% limits of agreement -0.010 D to -1.00 D) for myopia of -4.55 D and higher when cycloplegia was used (p<0.05). When no cyclopentolate was used for the wavefront-based refraction (comparison 3), the bias of -0.50 D (95% limits of agreement -0.020 D to -0.97 D) was already reached at a myopic error of -2.97 D. Both astigmatic components showed no clinically relevant bias.

CONCLUSION

The spherical equivalent, measured without cycloplegic agents, led to more myopic measurements when wavefront-based refraction was used. The observed bias increased with the amount of myopic refractive error for comparisons 2 and 3, which needs to be considered when interpreting wavefront-refraction data.

TRIAL REGISTRATION NUMBER

NCT05288335.

Myopia progression patterns among paediatric patients in a clinical setting

PURPOSE

This retrospective analysis of electronic medical record (EMR) data investigated the natural history of myopic progression in children from optometric practices in Ireland.

METHODS

The analysis was of myopic patients aged 7-17 with multiple visits and not prescribed myopia control treatment. Sex- and age-specific population centiles for annual myopic progression were derived by fitting a weighted cubic spline to empirical quantiles. These were compared to progression rates derived from control group data obtained from 17 randomised clinical trials (RCTs) for myopia. Linear mixed models (LMMs) were used to allow comparison of myopia progression rates against outputs from a predictive online calculator. Survival analysis was performed to determine the intervals at which a significant level of myopic progression was predicted to occur.

RESULTS

Myopia progression was highest in children aged 7 years (median: -0.67 D/year) and progressively slowed with increasing age (median: -0.18 D/year at age 17). Female sex (p < 0.001), a more myopic SER at baseline (p < 0.001) and younger age (p < 0.001) were all found to be predictive of faster myopic progression. Every RCT exhibited a mean progression higher than the median centile observed in the EMR data, while clinic-based studies more closely matched the median progression rates. The LMM predicted faster myopia progression for patients with higher baseline myopia levels, in keeping with previous studies, which was in contrast to an online calculator that predicted slower myopia progression for patients with higher baseline myopia. Survival analysis indicated that at a recall period of 12 months, myopia will have progressed in between 10% and 70% of children, depending upon age.

CONCLUSIONS

This study produced progression centiles of untreated myopic children, helping to define the natural history of untreated myopia. This will enable clinicians to better predict both refractive outcomes without treatment and monitor treatment efficacy, particularly in the absence of axial length data.

Analysis and validation of potential ICD-related biomarkers in development of myopia using machine learning

PURPOSE

We aimed to identify and verify potential biomarkers in the development of myopia associated with immunogenic cell death (ICD).

METHODS

We download high myopia (HM) dataset GSE136701 from Gene Expression Omnibus. Differentially expressed genes in HM were identified to overlapped with ICD-related genes. Least absolute shrinkage and selection operator were used to select the Hub genes. Furthermore, the correlation between the hub genes and immune infiltration, immune response activities, and hub genes Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways analysis was investigated using Spearman's rank correlation. Prediction of the miRNAs upstream of the Hub genes was based on the TargetScan database. We used guinea pig lens-induced myopia model's scleral tissues performed quantitative real-time polymerase chain reaction.

RESULTS

We identified overlapped with ICD-related genes (LY96, IL1A, IL33, and AGER) and two genes (LY96 and AGER) as hub genes. Single sample gene set enrichment analysis and Spearman's rank correlation revealed that hub gene expression levels in HM were significantly correlated with the infiltration percentages of CD56dim natural killer cells, macrophages, immature B cells, and the immune response activities of APC co-stimulation and Kyoto Encyclopedia of Genes and Genomes pathways, such as terpenoid backbone biosynthesis, aminoacyl-trna biosynthesis, Huntington's disease, oxidative phosphorylation; there were a few additional signaling pathways compared to normal samples. Additionally, several miRNA were predicted as upstream regulators of LY96 and AGER. LY96 was identified as a significantly differentially expressed biomarker in myopia guinea pig's scleral tissues, as verified by qPCR.

CONCLUSION

LY96 was identified and verified as a ICD-related potential myopia biomarker. Molecular mechanisms or pathways involved in myopia development by LY96 requires further research.

New Designs of Spectacle Lenses for the Control of Myopia Progression: A Scoping Review

Myopia control with new designs of spectacle lenses is a flourishing area of research. The present work reviews the effectiveness of new designs (DIMSs, defocus-incorporated multiple segments; CARE, cylindrical annular refractive element; HALs/SALs, highly/slightly aspherical lenslets; DOT, diffusion optics technology) aiming at slowing myopia progression. A search through the PubMed database was conducted for articles published between 1 January 2003 and 28 February 2023. Publications were included if they documented baseline central refraction (SER) and/or axial length (AL) data, and the change in these parameters, in myopic children wearing new designs of spectacle lenses (treatment group) compared to myopic children using single-vision lenses, SVLs (control group). The selection process revealed nine suitable articles. Comparing the mean and standard error values of the treatment and control groups, the highest differences in the change in the SER and AL were -0.80 (1.23) D [95% CI: -1.053 to -0.547; p < 0.001] and 0.35 (0.05) mm [95% CI: 0.252 to 0.448; p < 0.001], respectively; the effect of treatment provided by a HAL design, compared to SVLs, led to a deceleration of 54.8% in the SER and 50.7% in the AL. However, the heterogeneity of the results prevents reaching strong conclusions about the effectiveness of these new designs.

Effect of myopia management contact lens design on accommodative microfluctuations and eye movements during reading

BACKGROUND

Soft contact lenses have been developed and licensed for reducing myopia progression. These lenses have different designs, such as extended depth of focus (EDOF) and dual focus (DF). In this prospective, double-masked, cross-over study, different lens designs were investigated to see whether these had impact on accommodative microfluctuations and eye movements during reading.

METHODS

Participants were fitted with three lenses in a randomised order; a single vision (SV) design (Omafilcon A2; Proclear), a DF design (Omafilcon A2; MiSight), and an EDOF lens design (Etafilcon A; NaturalVue),. Accommodative microfluctuations were measured at 25 cm for at least 60s in each lens, using a Shin-Nippon SRW-5000 autorefractor adapted to continuously record accommodation at 22Hz. Eye movement data was collected with the Thomson Clinical Eye Tracker incorporating a Tobii Eye bar. Eye movements include fixations per row, fixations per minute, mean regressions per row, total number of regressions, and total rightward saccades. Accommodation data was analysed using power spectrum analysis. Differences between the lenses were compared using a related sample two-way Friedman test.

RESULTS

Twenty-three participants (18-29 years) were recruited to take part. The average mean spherical error was -2.65D ± 1.42DS, with an average age of 23.4 ± 3.5 years. No significant difference for accommodative microfluctuations was found. Significant differences were found for fixations per row (P = 0.03), fixations per minute (P = 0.008), mean regressions per row (P = 0.002), and total number of regressions (P = 0.002), but not total rightward saccades (P = 0.10). Post-hoc analysis indicated the EDOF lens results were significantly different from the other lenses, with more regressive eye movements observed.

CONCLUSIONS

Regressive saccades appear to increase when wearing EDOF lens designs, which may impact visual comfort. Further studies in children, over a longer period of adaptation are necessary to assess the potential impact of this finding on daily reading activities in children.

Low concentration atropine and myopia: a narrative review of the evidence for United Kingdom based practitioners

The prevalence of myopia is increasing across the world. Controlling myopia progression would be beneficial to reduce adverse outcomes such as retinal detachment and myopic maculopathy which are associated with increased axial length. Pharmacological control of myopia progression with atropine has been investigated since the 19th century and the benefits of slowing myopia progression are considered against the side-effects of near blur and photophobia. More recently, randomised trials have focused on determining the optimum concentration of atropine leading to low-concentration atropine being used to manage myopia progression by practitioners across the world. Currently, in the United Kingdom, there is no licensed pharmacological intervention for myopia management. The aim of this review is to interpret the available data to inform clinical practice. We conducted a narrative review of the literature and identified peer-reviewed randomised controlled trials using the search terms 'myopia' and 'atropine', limited to the English language. We identified two key studies, which were the Atropine in the Treatment Of Myopia (ATOM) and Low-concentration Atropine for Myopia Progression (LAMP). Further studies were identified using the above search terms and the references from the identified literature. Atropine 0.01% has a modest effect on controlling axial length progression. Atropine 0.05% appears to be superior to atropine 0.01% in managing myopia progression. There is a dose-dependent rebound effect when treatment is stopped. Atropine is a well-tolerated, safe, and effective intervention. Treatment would be needed for several years and into adolescence, until axial length progression is stable.