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Neller B, Neller K, Schwahn H, Mattern AI, Devenijn M, Langenbucher A, Seitz B, Kaymak H. Effect of defocus incorporated multiple segments (DIMS) spectacle lenses on myopia progression in children: a retrospective analysis in a German real-life clinical setting. BMC Ophthalmol 2024; 24:403. [PMID: 39266992 PMCID: PMC11391804 DOI: 10.1186/s12886-024-03666-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2024] [Accepted: 09/02/2024] [Indexed: 09/14/2024] Open
Abstract
OBJECTIVES This retrospective analysis evaluates the treatment success of "Defocus Incorporated Multiple Segments" (DIMS) spectacle lenses in a real-life clinical setting in Germany. MATERIALS AND METHODS Axial length (AL) and objective refraction of 166 eyes treated with DIMS at baseline and 12-month follow-up were analyzed. Annual AL growth rate within the range of physiological growth rate was considered a successful treatment. Myopia progression of ≥ -0.5 D/yr accounted as treatment success. Differences in percentages of treatment success of subgroups depending on baseline AL and age against treatment success of the total population were investigated. RESULTS Considering all eyes, treatment success regarding AL growth and myopia progression was achieved in 46% and 65%, respectively. Male eyes with moderate AL showed treatment success in a higher proportion (73%, p < 0.01; 89%, p < 0.01); eyes with high AL showed treatment success in a lower proportion (25%, p < 0.01; 51%, n.s.). Female eyes showed the same trend but without statistical significance (moderate AL: 49%; 68%; high AL: 40%; 62%). Younger children showed treatment success in a lower proportion (male: 11%, p < 0.01; 38%, p < 0.05; female: 25%, p < 0.01; 42%, p < 0.01). Older children showed treatment success in a higher proportion (male: 60%, p < 0.05; 78% p < 0.05; female: 53%, n.s.; 77% p < 0.05). CONCLUSIONS Eyes with moderate baseline AL and of older children showed treatment success after 12 months of DIMS treatment. Eyes with a high baseline AL and of younger children showed treatment success in a smaller proportion, therefore combination treatment should be considered. In future studies, males and females should be assessed separately.
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Affiliation(s)
- Birte Neller
- Internationale Innovative Ophthalmochirurgie, Breyer Kaymak Klabe Augenchirurgie, Düsseldorf, Germany
- Institute of Experimental Ophthalmology, Saarland University, Homburg, Germany
| | - Kai Neller
- Internationale Innovative Ophthalmochirurgie, Breyer Kaymak Klabe Augenchirurgie, Düsseldorf, Germany
- Institute of Experimental Ophthalmology, Saarland University, Homburg, Germany
| | - Hartmut Schwahn
- Internationale Innovative Ophthalmochirurgie, Breyer Kaymak Klabe Augenchirurgie, Düsseldorf, Germany
| | - Ann-Isabel Mattern
- Internationale Innovative Ophthalmochirurgie, Breyer Kaymak Klabe Augenchirurgie, Düsseldorf, Germany
| | - Machteld Devenijn
- Internationale Innovative Ophthalmochirurgie, Breyer Kaymak Klabe Augenchirurgie, Düsseldorf, Germany
| | - Achim Langenbucher
- Institute of Experimental Ophthalmology, Saarland University, Homburg, Germany
| | - Berthold Seitz
- Department of Ophthalmology, Saarland University Medical Center UKS, Homburg, Germany
| | - Hakan Kaymak
- Internationale Innovative Ophthalmochirurgie, Breyer Kaymak Klabe Augenchirurgie, Düsseldorf, Germany.
- Gottfried O.H. Naumann-Institute of Epidemiology and Prevention of Myopia, Saarland University, Homburg, Germany.
- MVZ Makula-Netzhaut-Zentrum Breyer Kaymak Klabe, Theo-Champion-Str. 1, D-40549, Duesseldorf, Germany.
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Wen L, Liu H, Xu Q, Pan W, Lin Z, Xiao Z, Yang Z, Lan W, Chen Z. Add-on effect of using 0.05% atropine in fast progressors of orthokeratology: A preliminary retrospective study. Cont Lens Anterior Eye 2024:102282. [PMID: 39069400 DOI: 10.1016/j.clae.2024.102282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 07/22/2024] [Accepted: 07/24/2024] [Indexed: 07/30/2024]
Abstract
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. METHODS Average axial length (AL) elongation of both eyes in 70 participants using OK lenses alone or OK lenses combined with 0.05 % atropine ophthalmic solution was retrospectively reviewed. During the observation period (phase 1), all participants exhibited an AL elongation that exceeded 0.15 mm over a 6-month period or 0.3 mm over a 12-month period. Subsequently, the participants were divided into two groups: one group received nightly 0.05 % atropine ophthalmic solution in addition to OK lenses for another 1 year (OKA), while the other group continued using OK lenses alone (phase 2). The changes in AL elongation over time and the differences in AL elongation between the two groups were then compared. RESULTS The baseline and phase 1 demographics and characteristics of the participants was similar between the two groups (all p > 0.05). when considering a one-year timeframe, the OKA group displayed a significantly less AL elongation compared to the OK group (0.14 ± 0.13 mm vs 0.27 ± 0.12 mm, p < 0.001). Within the OKA group, the AL elongation in the second half of the year was significantly faster than in the first half (0.12 ± 0.11 mm vs 0.02 ± 0.14 mm, p = 0.01). Conversely, there was no significant difference in AL elongation between the OK group in the first and second half of the year (0.12 ± 0.07 mm vs 0.15 ± 0.08 mm, p = 0.71). The combination of 0.05 % atropine ophthalmic solution had a significant effect on 1-year AL elongation (p < 0.001). 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.
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Affiliation(s)
- Longbo Wen
- Aier School of Ophthalmology, Central South University, Changsha Aier Eye Hospital, Aier Eye Hospital Group, Hunan, China; Hunan Province Optometry Engineering and Technology Research Center, Changsha, China; Hunan Province International Cooperation Base for Optometry Science and Technology, Changsha, China
| | - Hong Liu
- Aier School of Ophthalmology, Central South University, Changsha Aier Eye Hospital, Aier Eye Hospital Group, Hunan, China; Hunan Province Optometry Engineering and Technology Research Center, Changsha, China; Hunan Province International Cooperation Base for Optometry Science and Technology, Changsha, China
| | - Qinglin Xu
- Aier School of Ophthalmology, Central South University, Changsha Aier Eye Hospital, Aier Eye Hospital Group, Hunan, China; Hunan Province Optometry Engineering and Technology Research Center, Changsha, China; Hunan Province International Cooperation Base for Optometry Science and Technology, Changsha, China
| | - Wei Pan
- Aier School of Ophthalmology, Central South University, Changsha Aier Eye Hospital, Aier Eye Hospital Group, Hunan, China; Hunan Province Optometry Engineering and Technology Research Center, Changsha, China; Hunan Province International Cooperation Base for Optometry Science and Technology, Changsha, China
| | - Zhenghua Lin
- Aier School of Ophthalmology, Central South University, Changsha Aier Eye Hospital, Aier Eye Hospital Group, Hunan, China; Hunan Province Optometry Engineering and Technology Research Center, Changsha, China; Hunan Province International Cooperation Base for Optometry Science and Technology, Changsha, China
| | | | - Zhikuan Yang
- Aier School of Ophthalmology, Central South University, Changsha Aier Eye Hospital, Aier Eye Hospital Group, Hunan, China; Hunan Province Optometry Engineering and Technology Research Center, Changsha, China; Hunan Province International Cooperation Base for Optometry Science and Technology, Changsha, China
| | - Weizhong Lan
- Aier School of Ophthalmology, Central South University, Changsha Aier Eye Hospital, Aier Eye Hospital Group, Hunan, China; Hunan Province Optometry Engineering and Technology Research Center, Changsha, China; Hunan Province International Cooperation Base for Optometry Science and Technology, Changsha, China; Guangzhou Aier Eye Hospital, Jinan University, Guangdong, China.
| | - Zhao Chen
- Aier School of Ophthalmology, Central South University, Changsha Aier Eye Hospital, Aier Eye Hospital Group, Hunan, China; Hunan Province Optometry Engineering and Technology Research Center, Changsha, China; Hunan Province International Cooperation Base for Optometry Science and Technology, Changsha, China.
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3
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Graff B, Lam CSY, Vlasak N, Kaymak H. Age-matched analysis of axial length growth in myopic children wearing defocus incorporated multiple segments spectacle lenses. Br J Ophthalmol 2024; 108:1060-1066. [PMID: 38041675 PMCID: PMC11287573 DOI: 10.1136/bjo-2023-324508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 09/24/2023] [Indexed: 12/03/2023]
Abstract
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.
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Affiliation(s)
- Birte Graff
- Internationale Innovative Ophthalmochirurgie GbR, Duesseldorf, Germany
- Institute of Experimental Ophthalmology, Saarland University, Homburg/Saar, Germany
| | - Carly S Y Lam
- Centre for Myopia Research, School of Optometry, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
- Centre for Eye and Vision Research (CEVR), Hong Kong, Hong Kong
| | - Natalia Vlasak
- HOYA Vision Care, Research and Development, Amsterdam, The Netherlands
| | - Hakan Kaymak
- Internationale Innovative Ophthalmochirurgie GbR, Duesseldorf, Germany
- Institute of Experimental Ophthalmology, Saarland University, Homburg/Saar, Germany
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Sartor L, Hunter DS, Vo ML, Samarawickrama C. Benefits and risks of orthokeratology treatment: a systematic review and meta-analysis. Int Ophthalmol 2024; 44:239. [PMID: 38904856 PMCID: PMC11192849 DOI: 10.1007/s10792-024-03175-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 06/15/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND This meta-analysis reviews the evidence for the risks and benefits associated with orthokeratology (OK) treatment compared with other methods of myopia control in children and adults. METHODS A systematic search of Cochrane Central Register of Controlled Trials, Pubmed, Embase and Ovid was conducted from database inception to 22nd August 2021. Studies that reported on risks, visual and ocular biometric effects of OK in patients > 5 years of age with myopia (- 0.75 to - 6.00D) were included. Main outcomes are change in axial length and any adverse event. RESULTS Fourty-five papers were included in this systematic review and meta-analysis. The quality of data was variable and of moderate certainty, and selection bias likely skewed the results towards a relative benefit for OK. The rate of axial elongation in children was lower for OK treatment compared to other treatment modalities at one year (MD - 0.16 mm, 95% CI - 0.25 to - 0.07). Rate of change in axial length in children rebounded after OK discontinuation compared to participants who continued treatment (MD 0.10 mm, 95% CI 0.06 to 0.14). Adults and children wearing OK were up to 3.79 times more likely to experience an adverse event when compared with conventional contact lenses (OR 3.79, 95% CI 1.24 to ll.), though this evidence base is underdeveloped and requires additional well-designed studies for substantial conclusions to be drawn. CONCLUSIONS OK arrests myopia progression while in use, however, there remain unanswered questions about the optimal duration of treatment, discontinuation effects and long-term risk for adverse events.
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Affiliation(s)
- Lauren Sartor
- Centre for Vision Research, Westmead Institute of Medical Research, Sydney, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Department of Ophthalmology, Westmead Hospital, Sydney, NSW, Australia
| | - Damien S Hunter
- Centre for Vision Research, Westmead Institute of Medical Research, Sydney, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Mai Linh Vo
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Chameen Samarawickrama
- Centre for Vision Research, Westmead Institute of Medical Research, Sydney, Australia.
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
- Department of Ophthalmology, Westmead Hospital, Sydney, NSW, Australia.
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Tang T, Lu Y, Li X, Zhao H, Wang K, Li Y, Zhao M. Comparison of the long-term effects of atropine in combination with Orthokeratology and defocus incorporated multiple segment lenses for myopia control in Chinese children and adolescents. Eye (Lond) 2024; 38:1660-1667. [PMID: 38418604 PMCID: PMC11156845 DOI: 10.1038/s41433-024-02987-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 01/13/2024] [Accepted: 02/05/2024] [Indexed: 03/01/2024] Open
Abstract
PURPOSE The aim of this study was to evaluate the efficacy of Orthokeratology (Ortho-K), defocus incorporated multiple segment (DIMS) lens, combined Ortho-K/atropine, and combined DIMS/atropine for myopia control in children. METHODS A retrospective study included 167 myopic children aged 6-14 years with a spherical equivalent refraction (SER) of -0.75 to -4.00 diopter treated with Ortho-K (OK, n = 41), combined Ortho-K/atropine (OKA, n = 43), DIMS (n = 41), or combined DIMS/atropine (DIMSA, n = 42). Axial length (AL) was measured at baseline and at 3, 6, 9 and 12 months. Axial elongation over time and between groups were analysed. RESULTS After 12 months, the AL change was 0.20 ± 0.12 mm, 0.12 ± 0.14 mm, 0.22 ± 0.14 mm, and 0.15 ± 0.15 mm in the OK, OKA, DIMS, and DIMSA, respectively. There was no significant difference in AL change between OK and DIMS. OKA and DIMSA significantly slowed axial elongation compared to OK and DIMS monotherapy. After stratification by age, in the subgroup aged 6-10 years, there was significant difference in AL change between OKA and DIMS (p = 0.013), and no difference between other groups, while in the subgroup aged 10-14 years, the difference between OKA and DIMS became insignificant (p = 0.237), and the difference between OK and OKA, OK and DIMSA, DIMS and DIMSA became significant. CONCLUSIONS Ortho-K and DIMS lenses show similar reductions in myopia progression among children with low initial myopia. Atropine can significantly improve the efficacy of myopia control of both Ortho-K and DIMS lenses, and this add-on effect is better in older children.
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Affiliation(s)
- Tao Tang
- Department of Ophthalmology & Clinical Centre of Optometry, Peking University People's Hospital, Beijing, China
- Institute of Medical Technology, Peking University Health Science Center, Beijing, China
- College of Optometry, Peking University Health Science Center, Beijing, China
- Eye Disease and Optometry Institute, Peking University People's Hospital, Beijing, China
- Beijing Key Laboratory of the Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, China
| | - Yuchang Lu
- Department of Ophthalmology & Clinical Centre of Optometry, Peking University People's Hospital, Beijing, China
- Institute of Medical Technology, Peking University Health Science Center, Beijing, China
- College of Optometry, Peking University Health Science Center, Beijing, China
- Eye Disease and Optometry Institute, Peking University People's Hospital, Beijing, China
- Beijing Key Laboratory of the Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, China
| | - Xuewei Li
- Department of Ophthalmology & Clinical Centre of Optometry, Peking University People's Hospital, Beijing, China
- Institute of Medical Technology, Peking University Health Science Center, Beijing, China
- College of Optometry, Peking University Health Science Center, Beijing, China
- Eye Disease and Optometry Institute, Peking University People's Hospital, Beijing, China
- Beijing Key Laboratory of the Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, China
| | - Heng Zhao
- Department of Ophthalmology & Clinical Centre of Optometry, Peking University People's Hospital, Beijing, China
- Institute of Medical Technology, Peking University Health Science Center, Beijing, China
- College of Optometry, Peking University Health Science Center, Beijing, China
- Eye Disease and Optometry Institute, Peking University People's Hospital, Beijing, China
- Beijing Key Laboratory of the Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, China
| | - Kai Wang
- Department of Ophthalmology & Clinical Centre of Optometry, Peking University People's Hospital, Beijing, China.
- Institute of Medical Technology, Peking University Health Science Center, Beijing, China.
- College of Optometry, Peking University Health Science Center, Beijing, China.
- Eye Disease and Optometry Institute, Peking University People's Hospital, Beijing, China.
- Beijing Key Laboratory of the Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, China.
| | - Yan Li
- Department of Ophthalmology & Clinical Centre of Optometry, Peking University People's Hospital, Beijing, China
- College of Optometry, Peking University Health Science Center, Beijing, China
- Eye Disease and Optometry Institute, Peking University People's Hospital, Beijing, China
- Beijing Key Laboratory of the Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, China
| | - Mingwei Zhao
- Department of Ophthalmology & Clinical Centre of Optometry, Peking University People's Hospital, Beijing, China
- Institute of Medical Technology, Peking University Health Science Center, Beijing, China
- College of Optometry, Peking University Health Science Center, Beijing, China
- Eye Disease and Optometry Institute, Peking University People's Hospital, Beijing, China
- Beijing Key Laboratory of the Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, China
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Jawaid I, Saunders K, Hammond CJ, Dahlmann-Noor A, Bullimore MA. Low concentration atropine and myopia: a narrative review of the evidence for United Kingdom based practitioners. Eye (Lond) 2024; 38:434-441. [PMID: 37717107 PMCID: PMC10858250 DOI: 10.1038/s41433-023-02718-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 07/05/2023] [Accepted: 08/25/2023] [Indexed: 09/18/2023] Open
Abstract
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.
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Affiliation(s)
- Imran Jawaid
- Nottingham University Hospitals NHS Trust, Derby Road, Nottingham, UK.
| | - Kathryn Saunders
- School of Biomedical Sciences, Ulster University, Northern Ireland, UK
| | - Christopher J Hammond
- Section of Academic Ophthalmology, School of Life Course Sciences, King's College London, London, UK
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Ehongo A. Understanding Posterior Staphyloma in Pathologic Myopia: Current Overview, New Input, and Perspectives. Clin Ophthalmol 2023; 17:3825-3853. [PMID: 38105912 PMCID: PMC10725704 DOI: 10.2147/opth.s405202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 12/01/2023] [Indexed: 12/19/2023] Open
Abstract
Posterior staphyloma (PS) is considered the hallmark of pathologic myopia and is defined as an outpouching of a circumscribed portion of the eyeball with a radius of curvature smaller than that of the adjacent zone. Although more common in eyes with high myopia, it can affect those without it. The presence of PS is associated with a structurally and functionally worse course of high myopia that can lead to visual disability. Unfortunately, the pathogenesis of PS is unclear so far. Thus, due to the increasing prevalence of myopia which has been further exacerbated by the advent of COVID-19 lockdown, researchers are eager to elucidate the pathogenesis of pathologic myopia and that of its complications, especially PS, which will allow the development of preventive strategies. The aim of this work was to review the morphological characteristics of PS with emphasis on similarities with peripapillary staphyloma and to discuss the pathogenesis of PS considering recent suggestions about that of peripapillary staphyloma.
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Affiliation(s)
- Adèle Ehongo
- Ophthalmology Department, Erasmus Hospital, Brussels, Belgium
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Xu S, Li Z, Zhao W, Zheng B, Jiang J, Ye G, Feng Z, Long W, He L, He M, Hu Y, Yang X. Effect of atropine, orthokeratology and combined treatments for myopia control: a 2-year stratified randomised clinical trial. Br J Ophthalmol 2023; 107:1812-1817. [PMID: 36229177 DOI: 10.1136/bjo-2022-321272] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 09/26/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE To investigate the 2-year efficacy of atropine, orthokeratology (ortho-k) and combined treatment on myopia. To explore the factors influencing the efficacy. METHODS An age-stratified randomised controlled trial. Children (n=164) aged 8-12 years with spherical equivalent refraction of -1.00 to -6.00 D were stratified into two age subgroups and randomly assigned to receive placebo drops+spectacles (control), 0.01% atropine+spectacles (atropine), ortho-k+placebo (ortho-k) or combined treatment. Axial length was measured at baseline and visits at 6, 12, 18 and 24 months. The primary analysis was done following the criteria of intention to treat, which included all randomised subjects. RESULTS All interventions can significantly reduce axial elongation at all visits (all p<0.05). Overall, the 2-year axial elongation was significantly reduced in combined treatment than in monotherapies (all p<0.05). After stratification by age, in the subgroup aged 8-10, the difference between combined treatment and ortho-k became insignificant (p=0.106), while in the subgroup aged 10-12, the difference between combined treatment and atropine became insignificant (p=0.121). A significant age-dependent effect existed in the ortho-k group versus the control group (p for interaction=0.013), and a significant age-dependent effect existed in the ortho-k group versus the atropine group (p for interaction=0.035), which indicated that ortho-k can achieve better efficacy in younger children. CONCLUSIONS Atropine combined with ortho-k treatment can improve the efficacy of myopia control compared with monotherapy in children aged 8-12. Younger children might benefit more from ortho-k. TRIAL REGISTRATION NUMBER ChiCTR1800015541.
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Affiliation(s)
- Shengsong Xu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Zhouyue Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Wenchen Zhao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Bingru Zheng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Jinyun Jiang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Guitong Ye
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Zhibin Feng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Wen Long
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Liying He
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Mingguang He
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, Guangdong, China
- Department of Surgery, Centre for Eye Research Australia, University of Melbourne, Melbourne, Victoria, Australia
| | - Yin Hu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Xiao Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, Guangdong, China
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9
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Wnękowicz-Augustyn E, Teper S, Wylęgała E. Preventing the Progression of Myopia in Children-A Review of the Past Decade. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1859. [PMID: 37893579 PMCID: PMC10608552 DOI: 10.3390/medicina59101859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 10/05/2023] [Accepted: 10/11/2023] [Indexed: 10/29/2023]
Abstract
The growing incidence of myopia worldwide justifies the search for efficient methods of myopia prevention. Numerous pharmacological, optical, and lifestyle measures have already been utilized, but there remains a need to explore more practical and predictable methods for myopia control. This paper presents a review of the most recent studies on the prevention of myopia progression using defocus-incorporated multiple-segment spectacle lenses (DIMSsl), repeated low-level red-light (RLRL) therapy, and a combination of low-dose atropine (0.01%) with orthokeratology lenses.
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Affiliation(s)
- Emilia Wnękowicz-Augustyn
- Chair and Clinical Department of Ophthalmology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Okręgowy Szpital Kolejowy, Panewnicka 65, 40-760 Katowice, Poland; (S.T.); (E.W.)
- Municipal Hospital Group, Truchana 7, 41-500 Chorzów, Poland
- Eye and Optics Center Augmed, Łabędzka 20d, 44-100 Gliwice, Poland
| | - Sławomir Teper
- Chair and Clinical Department of Ophthalmology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Okręgowy Szpital Kolejowy, Panewnicka 65, 40-760 Katowice, Poland; (S.T.); (E.W.)
| | - Edward Wylęgała
- Chair and Clinical Department of Ophthalmology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Okręgowy Szpital Kolejowy, Panewnicka 65, 40-760 Katowice, Poland; (S.T.); (E.W.)
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Du L, Chen J, Ding L, Wang J, Yang J, Xie H, Xu X, He X, Zhu M. Add-On Effect of 0.01% Atropine in Orthokeratology Wearers for Myopia Control in Children: A 2-Year Retrospective Study. Ophthalmol Ther 2023; 12:2557-2568. [PMID: 37405578 PMCID: PMC10442030 DOI: 10.1007/s40123-023-00755-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 06/08/2023] [Indexed: 07/06/2023] Open
Abstract
INTRODUCTION Orthokeratology (OK) and low-concentration atropine are recommended approaches for controlling myopia. However, children with younger age and lower myopia are more likely to experience rapid axial progression during OK or atropine monotreatment. This study aimed to assess the efficacy of OK combined with low-concentration atropine for myopia control in children over 24 months and to determine whether the effect was sustainable. METHODS In this retrospective study, we reviewed medical records of baseline and follow-up visits from children (7-14 years) applying OK for myopia control. Sixty-eight children receiving monoorthokeratology treatment (OK group) and 68 children who received 0.01% atropine in combination with orthokeratology simultaneously (AOK group) were included. A series of ophthalmic tests at baseline were conducted, and axial length (AL) was measured every 6 months. The comparison of AL change at different visits between the two groups was performed by repeated measures multivariate analyses of variance (RM-MANOVA). RESULTS There were no significant differences in baseline characters between the two groups (p > 0.05). The AL significantly increased over time in both groups (all p < 0.05), and the 2-year change in AOK was 0.16 mm (36%) lower than in OK (0.28 ± 0.22 mm versus 0.44 ± 0.34 mm, p = 0.001). Compared with OK group, the significant suppression of AL elongation in the AOK group was observed in 0-6, 6-12, and 12-18 month periods (suppression rate: 62.5%, 33.3%, 38.5%, respectively, p < 0.05), while there was no significant difference in the 18-24 month period (p = 0.105). The multiple regression analysis showed an interaction between age and treatment effect (interaction coefficient = 0.06, p = 0.040), indicating one year age decrease approximately associated with 0.06 mm increased retardation in AL elongation in the AOK group. CONCLUSION The add-on effect of 0.01% atropine in OK wearers only occurred within 1.5 years, and younger children benefited more from the combination treatment.
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Affiliation(s)
- Linlin Du
- Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai Vision Health Center & Shanghai Children Myopia Institute, No. 1440 Hongqiao Road, Shanghai, 201103, China
| | - Jun Chen
- Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai Vision Health Center & Shanghai Children Myopia Institute, No. 1440 Hongqiao Road, Shanghai, 201103, China
| | - Li Ding
- Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai Vision Health Center & Shanghai Children Myopia Institute, No. 1440 Hongqiao Road, Shanghai, 201103, China
| | - Jingjing Wang
- Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai Vision Health Center & Shanghai Children Myopia Institute, No. 1440 Hongqiao Road, Shanghai, 201103, China
| | - Jinliuxing Yang
- Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai Vision Health Center & Shanghai Children Myopia Institute, No. 1440 Hongqiao Road, Shanghai, 201103, China
| | - Hui Xie
- Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai Vision Health Center & Shanghai Children Myopia Institute, No. 1440 Hongqiao Road, Shanghai, 201103, China
| | - Xun Xu
- Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai Vision Health Center & Shanghai Children Myopia Institute, No. 1440 Hongqiao Road, Shanghai, 201103, China
- National Clinical Research Center for Eye Diseases, Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai General Hospital, Shanghai Jiao Tong University, No. 85 Wujin Road, Shanghai, 200080, China
| | - Xiangui He
- Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai Vision Health Center & Shanghai Children Myopia Institute, No. 1440 Hongqiao Road, Shanghai, 201103, China.
- National Clinical Research Center for Eye Diseases, Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai General Hospital, Shanghai Jiao Tong University, No. 85 Wujin Road, Shanghai, 200080, China.
| | - Mengjun Zhu
- Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai Vision Health Center & Shanghai Children Myopia Institute, No. 1440 Hongqiao Road, Shanghai, 201103, China.
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11
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Zambrano Peralta P, Ortiz Quito M, Guerrero Ortiz F, Cervantes Anaya L. Orthokeratology vs. orthokeratology combined with atropine for the control of myopia in children: systematic review. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2023; 98:568-576. [PMID: 37619667 DOI: 10.1016/j.oftale.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 06/20/2023] [Indexed: 08/26/2023]
Abstract
The purpose of this investigation is to determine the efficacy of orthokeratology (OK) compared to orthokeratology combined with atropine (AOK) for the control of myopia in children. A systematic review that included systematic reviews with meta-analyses, as well as randomized and controlled clinical trials, was carried out in the PubMed, Web of Science, Scopus, Cochrane Library, ProQuest, Taylor & Francis, Science Direct databases, as well as a manual search. Of the Q1-Q4 journals of the Scimago Journal & Country Rank, published in the last 5 years in English and Spanish. Eighteen studies that met the eligibility criteria were considered. The articles selected included 6,866 patients for analysis, where orthokeratology combined with 0.01% atropine was found to be more effective due to its ability to reduce the progression of myopia and axial elongation. In our investigation, it was determined that there could be an additive effect in the combination of 0.01% atropine with orthokeratology in a period of 1-2 years of treatment in patients with mild myopia; however, more multiethnic studies should be carried out, in where a correct evaluation of the progression of myopia, genetic and environmental factors that may influence the results is considered.
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Affiliation(s)
| | - M Ortiz Quito
- Universidad Católica de Cuenca, Sede Matriz, Cuenca, Ecuador
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12
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Wang Z, Wang P, Jiang B, Meng Y, Qie S, Yan Z. The efficacy and safety of 0.01% atropine alone or combined with orthokeratology for children with myopia: A meta-analysis. PLoS One 2023; 18:e0282286. [PMID: 37494360 PMCID: PMC10370708 DOI: 10.1371/journal.pone.0282286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 02/13/2023] [Indexed: 07/28/2023] Open
Abstract
OBJECTIVE To evaluate the efficacy and safety of 0.01% atropine alone and in combination with orthokeratology for myopia control using a meta-analysis. METHODS PubMed, Cochrane Library, and EMBASE were searched. We included eligible randomized controlled trials (RCTs), non-RCTs, and retrospective cohort studies, published up to August 1, 2022. We calculated the weighted mean difference (WMD) and 95% confidence interval (CI) for all outcomes and plotted them in forest plots. RESULTS Fourteen studies were included; 4 and 11 in the 0.01% atropine monotherapy and atropine-orthokeratology (AOK) groups, respectively. Compared with orthokeratology (OK) alone, 0.01% atropine alone had similar effects on slowing the axial elongation (WMD: -0.00 mm; 95% CI: -0.05-0.04, p<0.31), while AOK significantly lowered axial growth. Moreover, the baseline myopic degree and duration of treatment were influential for the change in axial elongation (WMD: -0.12 mm; 95% CI: -0.17--0.07, p = 0.00001 and WMD: -0.11 mm; 95% CI: -0.15--0.108, p<0.00001, respectively). Additionally, the AOK may reduce the change rate of the spherical equivalent refraction and the accommodation amplitude (WMD: -0.13 D; 95% CI: 0.07-0.19, p<0.001 and WMD: -1.08 mm; 95% CI: -1.73--0.43, p<0.0001, respectively), and cause a slight increase in the diameter of the pupil (WMD: 0.56 mm; 95% CI: 0.43-0.70, p = 0.007). No significant differences in the uncorrected distant visual acuity, best corrected visual acuity, intraocular pressure, tear film break-up time, lipid layer thickness, and corneal endothelial cell density were found between the OK and AOK groups. CONCLUSION In slowing the axial elongation, 0.01% atropine alone and OK alone have similar effects, while AOK is more effective than OK alone in slowing down the axial elongation. Furthermore, the baseline degree of myopia and treatment duration may affect changes in axial elongation.
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Affiliation(s)
- Zengying Wang
- The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Pengfei Wang
- The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Bohua Jiang
- The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Yifei Meng
- The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Sufang Qie
- The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Zhipeng Yan
- The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
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13
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Hiraoka T, Kiuchi G, Hiraoka R, Maruo K, Oshika T. Multifocal Contact Lenses and 0.01% Atropine Eye Drops for Myopia Control Study: Research Protocol for a 1-Year, Randomized, Four-Arm, Clinical Trial in Schoolchildren. Eye Contact Lens 2023; 49:172-177. [PMID: 36848188 DOI: 10.1097/icl.0000000000000977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2023] [Indexed: 03/01/2023]
Abstract
OBJECTIVES Previous studies have shown that combined use of orthokeratology and 0.01% atropine (AT) eye drops can strongly prevent axial elongation in myopic children. However, the efficacy of combined use with multifocal contact lens (MFCL) and 0.01% AT remains unclear. The aim of this trial is to clarify the efficacy of MFCL+0.01% AT combination therapy for myopia control and safety. METHODS This prospective study is a randomized, double-masked, placebo-controlled trial with four arms. A total of 240 children aged 6 to 12 years with myopia is recruited and randomly assigned to one of the four groups in a ratio of 1:1:1:1 as follows: group 1: MFCL+AT combination therapy, group 2: MFCL monotherapy, group 3: AT monotherapy, and group 4: placebo. The participants will continue the assigned treatment for 1 year. The primary and secondary outcomes are the comparisons of axial elongation and myopia progression in the four groups during the 1-year study period. DISCUSSION The present trial would determine whether the MFCL+AT combination therapy is more effective in slowing axial elongation and myopia progression in schoolchildren as compared with each monotherapy or placebo, and it also confirm acceptable safety of the combination therapy.
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Affiliation(s)
- Takahiro Hiraoka
- Department of Ophthalmology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
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14
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Zhang M, Qiu W, An M, Sun Y, Zhang Z, Yu C. Analysis of the reports of low-concentration atropine in controlling myopia in children. J Fr Ophtalmol 2023; 46:239-248. [PMID: 36797093 DOI: 10.1016/j.jfo.2022.09.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 09/28/2022] [Accepted: 09/28/2022] [Indexed: 02/16/2023]
Abstract
PURPOSE To evaluate the efficacy of 0.01% atropine to slow the progression of myopia in children. METHODS We searched PubMed, Embase, ClinicalTrials.gov, CNKI, Cqvip and Wan fang databases from inception to January 2022, including RCTs (randomized controlled trials) and non-RCTs (non-randomized controlled trials). The search strategy was 'myopia' OR 'refractive error' and 'atropine.' Two researchers independently reviewed the articles, and stata12.0 was used for meta-analysis. The Jadad score was used to assess the quality of RCT, and the Newcastle-Ottawa scale was used for non-RCTs. RESULTS Five RCTs and two non-RCTs (1 prospective non-randomized controlled study, 1 retrospective cohort study) were identified (including 1000 eyes). Results of the meta-analysis showed statistical heterogeneity among the 7 included studies (P=0. 026, I2 =47.1%). According to different durations of atropine use - 4 months, 6 months and greater than 8 months, subgroup analysis results showed that the axial elongation of all experimental groups relative to control groups were respectively -0.03mm (95% [CI], (confidence interval), -0.07 to 0.01), -0.07mm (95% [CI], -0.10 to -0.05), -0.09mm (95% [CI], -0.12 to -0.06). Each P was greater than 0.05, which indicated that there is little heterogeneity among the subgroups. CONCLUSIONS In this meta-analysis of the short-term efficacy of atropine in myopia patients, it was found that there was little heterogeneity when grouped by usage time. It is suggested that the use of atropine in the treatment of myopia is not only related to its concentration but also related to the duration of use.
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Affiliation(s)
- M Zhang
- School of Basic Medical Sciences, Qingdao University, Qingdao 266071, China.
| | - W Qiu
- Qingdao Municipal Hospital, Qingdao, China.
| | - M An
- Qingdao Municipal Hospital, Qingdao, China.
| | - Y Sun
- School of Basic Medical Sciences, Qingdao University, Qingdao 266071, China.
| | - Z Zhang
- School of Basic Medical Sciences, Qingdao University, Qingdao 266071, China.
| | - C Yu
- School of Basic Medical Sciences, Qingdao University, Qingdao 266071, China.
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Lawrenson JG, Shah R, Huntjens B, Downie LE, Virgili G, Dhakal R, Verkicharla PK, Li D, Mavi S, Kernohan A, Li T, Walline JJ. Interventions for myopia control in children: a living systematic review and network meta-analysis. Cochrane Database Syst Rev 2023; 2:CD014758. [PMID: 36809645 PMCID: PMC9933422 DOI: 10.1002/14651858.cd014758.pub2] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
BACKGROUND Myopia is a common refractive error, where elongation of the eyeball causes distant objects to appear blurred. The increasing prevalence of myopia is a growing global public health problem, in terms of rates of uncorrected refractive error and significantly, an increased risk of visual impairment due to myopia-related ocular morbidity. Since myopia is usually detected in children before 10 years of age and can progress rapidly, interventions to slow its progression need to be delivered in childhood. OBJECTIVES To assess the comparative efficacy of optical, pharmacological and environmental interventions for slowing myopia progression in children using network meta-analysis (NMA). To generate a relative ranking of myopia control interventions according to their efficacy. To produce a brief economic commentary, summarising the economic evaluations assessing myopia control interventions in children. To maintain the currency of the evidence using a living systematic review approach. SEARCH METHODS: We searched CENTRAL (which contains the Cochrane Eyes and Vision Trials Register), MEDLINE; Embase; and three trials registers. The search date was 26 February 2022. SELECTION CRITERIA: We included randomised controlled trials (RCTs) of optical, pharmacological and environmental interventions for slowing myopia progression in children aged 18 years or younger. Critical outcomes were progression of myopia (defined as the difference in the change in spherical equivalent refraction (SER, dioptres (D)) and axial length (mm) in the intervention and control groups at one year or longer) and difference in the change in SER and axial length following cessation of treatment ('rebound'). DATA COLLECTION AND ANALYSIS: We followed standard Cochrane methods. We assessed bias using RoB 2 for parallel RCTs. We rated the certainty of evidence using the GRADE approach for the outcomes: change in SER and axial length at one and two years. Most comparisons were with inactive controls. MAIN RESULTS We included 64 studies that randomised 11,617 children, aged 4 to 18 years. Studies were mostly conducted in China or other Asian countries (39 studies, 60.9%) and North America (13 studies, 20.3%). Fifty-seven studies (89%) compared myopia control interventions (multifocal spectacles, peripheral plus spectacles (PPSL), undercorrected single vision spectacles (SVLs), multifocal soft contact lenses (MFSCL), orthokeratology, rigid gas-permeable contact lenses (RGP); or pharmacological interventions (including high- (HDA), moderate- (MDA) and low-dose (LDA) atropine, pirenzipine or 7-methylxanthine) against an inactive control. Study duration was 12 to 36 months. The overall certainty of the evidence ranged from very low to moderate. Since the networks in the NMA were poorly connected, most estimates versus control were as, or more, imprecise than the corresponding direct estimates. Consequently, we mostly report estimates based on direct (pairwise) comparisons below. At one year, in 38 studies (6525 participants analysed), the median change in SER for controls was -0.65 D. The following interventions may reduce SER progression compared to controls: HDA (mean difference (MD) 0.90 D, 95% confidence interval (CI) 0.62 to 1.18), MDA (MD 0.65 D, 95% CI 0.27 to 1.03), LDA (MD 0.38 D, 95% CI 0.10 to 0.66), pirenzipine (MD 0.32 D, 95% CI 0.15 to 0.49), MFSCL (MD 0.26 D, 95% CI 0.17 to 0.35), PPSLs (MD 0.51 D, 95% CI 0.19 to 0.82), and multifocal spectacles (MD 0.14 D, 95% CI 0.08 to 0.21). By contrast, there was little or no evidence that RGP (MD 0.02 D, 95% CI -0.05 to 0.10), 7-methylxanthine (MD 0.07 D, 95% CI -0.09 to 0.24) or undercorrected SVLs (MD -0.15 D, 95% CI -0.29 to 0.00) reduce progression. At two years, in 26 studies (4949 participants), the median change in SER for controls was -1.02 D. The following interventions may reduce SER progression compared to controls: HDA (MD 1.26 D, 95% CI 1.17 to 1.36), MDA (MD 0.45 D, 95% CI 0.08 to 0.83), LDA (MD 0.24 D, 95% CI 0.17 to 0.31), pirenzipine (MD 0.41 D, 95% CI 0.13 to 0.69), MFSCL (MD 0.30 D, 95% CI 0.19 to 0.41), and multifocal spectacles (MD 0.19 D, 95% CI 0.08 to 0.30). PPSLs (MD 0.34 D, 95% CI -0.08 to 0.76) may also reduce progression, but the results were inconsistent. For RGP, one study found a benefit and another found no difference with control. We found no difference in SER change for undercorrected SVLs (MD 0.02 D, 95% CI -0.05 to 0.09). At one year, in 36 studies (6263 participants), the median change in axial length for controls was 0.31 mm. The following interventions may reduce axial elongation compared to controls: HDA (MD -0.33 mm, 95% CI -0.35 to 0.30), MDA (MD -0.28 mm, 95% CI -0.38 to -0.17), LDA (MD -0.13 mm, 95% CI -0.21 to -0.05), orthokeratology (MD -0.19 mm, 95% CI -0.23 to -0.15), MFSCL (MD -0.11 mm, 95% CI -0.13 to -0.09), pirenzipine (MD -0.10 mm, 95% CI -0.18 to -0.02), PPSLs (MD -0.13 mm, 95% CI -0.24 to -0.03), and multifocal spectacles (MD -0.06 mm, 95% CI -0.09 to -0.04). We found little or no evidence that RGP (MD 0.02 mm, 95% CI -0.05 to 0.10), 7-methylxanthine (MD 0.03 mm, 95% CI -0.10 to 0.03) or undercorrected SVLs (MD 0.05 mm, 95% CI -0.01 to 0.11) reduce axial length. At two years, in 21 studies (4169 participants), the median change in axial length for controls was 0.56 mm. The following interventions may reduce axial elongation compared to controls: HDA (MD -0.47mm, 95% CI -0.61 to -0.34), MDA (MD -0.33 mm, 95% CI -0.46 to -0.20), orthokeratology (MD -0.28 mm, (95% CI -0.38 to -0.19), LDA (MD -0.16 mm, 95% CI -0.20 to -0.12), MFSCL (MD -0.15 mm, 95% CI -0.19 to -0.12), and multifocal spectacles (MD -0.07 mm, 95% CI -0.12 to -0.03). PPSL may reduce progression (MD -0.20 mm, 95% CI -0.45 to 0.05) but results were inconsistent. We found little or no evidence that undercorrected SVLs (MD -0.01 mm, 95% CI -0.06 to 0.03) or RGP (MD 0.03 mm, 95% CI -0.05 to 0.12) reduce axial length. There was inconclusive evidence on whether treatment cessation increases myopia progression. Adverse events and treatment adherence were not consistently reported, and only one study reported quality of life. No studies reported environmental interventions reporting progression in children with myopia, and no economic evaluations assessed interventions for myopia control in children. AUTHORS' CONCLUSIONS Studies mostly compared pharmacological and optical treatments to slow the progression of myopia with an inactive comparator. Effects at one year provided evidence that these interventions may slow refractive change and reduce axial elongation, although results were often heterogeneous. A smaller body of evidence is available at two or three years, and uncertainty remains about the sustained effect of these interventions. Longer-term and better-quality studies comparing myopia control interventions used alone or in combination are needed, and improved methods for monitoring and reporting adverse effects.
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Affiliation(s)
- John G Lawrenson
- Centre for Applied Vision Research, School of Health & Psychological Sciences , City, University of London, London, UK
| | - Rakhee Shah
- Centre for Applied Vision Research, School of Health & Psychological Sciences , City, University of London, London, UK
| | - Byki Huntjens
- Centre for Applied Vision Research, School of Health & Psychological Sciences , City, University of London, London, UK
| | - Laura E Downie
- Department of Optometry and Vision Sciences, The University of Melbourne, Melbourne, Australia
| | - Gianni Virgili
- Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Rohit Dhakal
- Myopia Research Lab, Prof. Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, India
| | - Pavan K Verkicharla
- Myopia Research Lab, Prof. Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, India
| | - Dongfeng Li
- Centre for Public Health, Queen's University Belfast, Belfast, UK
- Department of Ophthalmology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Sonia Mavi
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Ashleigh Kernohan
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Tianjing Li
- Department of Ophthalmology, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA
| | - Jeffrey J Walline
- College of Optometry, The Ohio State University, Columbus, Ohio, USA
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Accommodation and vergence function in children using atropine combined with orthokeratology. Cont Lens Anterior Eye 2023; 46:101704. [PMID: 35527114 DOI: 10.1016/j.clae.2022.101704] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 04/24/2022] [Accepted: 04/29/2022] [Indexed: 01/18/2023]
Abstract
PURPOSE This study aimed to evaluate binocular vision in terms of vergence and accommodative measurements in children treated with 0.01% atropine combined with orthokeratology (OK). METHODS This was a prospective and randomized controlled clinical trial involving participants aged 8 to 12 years, with a spherical equivalent (SE) ranging from - 1.00 to - 6.00D. Participants were randomly divided into four groups: 1) a combination group using 0.01% atropine solution and OK lens; 2) an OK group using placebo solution and OK lens; 3) an atropine group using 0.01% atropine solution and wearing spectacles; and 4) a control group using placebo solution and wearing spectacles. Binocular vision was determined at baseline and at 3-month visits, with evaluations including horizontal phoria, fusional vergence, the accommodative convergence/accommodation (AC/A) ratio, accommodative lag, and accommodative amplitude (AA). The Wilcoxon signed-rank test was used to compare the changes in binocular vision in each group, and the Kruskal-Wallis test was used for comparisons of four groups. RESULTS Sixty-two participants completed the study. There was no significant difference in baseline refraction, accommodation or vergence measurements among the groups (all P > 0.05). Three months later, the accommodative lag significantly decreased in the OK group (P = 0.002) but remained unchanged in the other three groups (all P > 0.05). In addition, binocular accommodative facilities and positive relative accommodations increased in the combination and OK groups (both P < 0.05) but remained unchanged in the atropine and control groups (both P > 0.05). Only the participants with esophoria in the OK group had a significant decrease in esophoria (P = 0.008). Moreover, the changes in fusional vergence and AC/A did not significantly differ between the four groups (all P > 0.05). CONCLUSION Accommodative measurements changed similarly in the groups treated with OK. Changes in vergence measurements after treatment with 0.01% atropine were not significant.
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Huang Z, Chen XF, He T, Tang Y, Du CX. Synergistic effects of defocus-incorporated multiple segments and atropine in slowing the progression of myopia. Sci Rep 2022; 12:22311. [PMID: 36566245 PMCID: PMC9789944 DOI: 10.1038/s41598-022-25599-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 12/01/2022] [Indexed: 12/25/2022] Open
Abstract
Myopia is a leading cause of visual impairment in young people worldwide. It sometimes increases the risk of blindness and reduces life quality. Previous reports have revealed the treatment effects of defocus-incorporated multiple segments (DIMS) and topical atropine (ATP) on myopia control. However, no study has evaluated these two interventions together. In this retrospective study, we aimed to determine whether the combination of DIMS lenses and 0.01% ATP can slow the progression of myopia compared with DIMS lenses or single vision (SV) lenses alone. We included 107 children with myopia who were treated with DIMS and 0.01% ATP combination (DIMS + ATP group), DIMS monotherapy (DIMS group), or a control group (SV group). We compared treatment effects among three groups in axial length and myopia progression. After a 1-year follow-up, the DIMS + ATP group showed a smaller change in axial length and myopia progression than the DIMS and SV groups (P < 0.05). Hence, combination treatment with DIMS and 0.01% ATP might be a better choice for children with myopia.
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Affiliation(s)
- Zhu Huang
- grid.13402.340000 0004 1759 700XDepartment of Ophthalmology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003 China ,grid.13402.340000 0004 1759 700XDepartment of Ophthalmology, The Fourth Affiliated Hospital, School of Medicine, Zhejiang University, Yiwu, 322000 China
| | - Xu-Fei Chen
- grid.13402.340000 0004 1759 700XDepartment of Ophthalmology, The Fourth Affiliated Hospital, School of Medicine, Zhejiang University, Yiwu, 322000 China
| | - Ting He
- grid.13402.340000 0004 1759 700XDepartment of Ophthalmology, The Fourth Affiliated Hospital, School of Medicine, Zhejiang University, Yiwu, 322000 China
| | - Yun Tang
- grid.13402.340000 0004 1759 700XDepartment of Ophthalmology, The Fourth Affiliated Hospital, School of Medicine, Zhejiang University, Yiwu, 322000 China
| | - Chi-Xin Du
- grid.13402.340000 0004 1759 700XDepartment of Ophthalmology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003 China ,grid.13402.340000 0004 1759 700XDepartment of Ophthalmology, The Fourth Affiliated Hospital, School of Medicine, Zhejiang University, Yiwu, 322000 China
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18
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Yu S, Du L, Ji N, Li B, Pang X, Li X, Ma N, Huang C, Fu A. Combination of orthokeratology lens with 0.01% atropine in slowing axial elongation in children with myopia: a randomized double-blinded clinical trial. BMC Ophthalmol 2022; 22:438. [PMID: 36380280 PMCID: PMC9665032 DOI: 10.1186/s12886-022-02635-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 10/12/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND To evaluate the additive effects of orthokeratology (OK) lenses and 0.01% atropine on slowing axial elongation in myopic children. METHODS A prospective, randomized, double-blinded, placebo-controlled trial was conducted over a 12-month period. Sixty children aged 8 to 12 years with spherical equivalent refraction from - 1.00 to -4.00 D who had been wearing OK lenses successfully for 2 months (as baseline) were randomly assigned in a 1:1 ratio to combination group (combination of OK lens and 0.01% atropine eye drops) and control group (combination of OK lens and placebo). The primary outcome was change in axial length, along with secondary outcomes including change in pupil diameter (PD) and accommodative amplitude (AMP) at 12 months (measured at 4-month intervals). RESULTS After 12 months, the overall axial elongation was 0.10 ± 0.14 mm and 0.20 ± 0.15 mm (p = 0.01) in the combination and control groups, respectively. The change in axial length in the two groups showed significant differences only in the first four months (median [Q1, Q3] (95% CI), -0.01 mm [-0.07, 0.05] (-0.06, 0.04) vs. 0.04 mm [0.00, 0.10] (0.02, 0.09); p = 0.04), but no difference thereafter. Multivariate linear regression analysis showed that the axial elongation was significantly slower in the combination group than in the control group (standard β = -0.10, p = 0.02). PD significantly increased by 0.45 mm [0.20, 0.68] at the 4th month visit (p < 0.001) and then remained stable in the combination group. The PD in the control group and AMP in the two groups remained stable from baseline to 12 months (all p > 0.05). CONCLUSION The combination therapy was more effective than the OK lens alone in slowing axial elongation after 12 months of treatment, and mainly in the first 4 months. TRIAL REGISTRATION The First Affiliated Hospital of Zhengzhou University, ChiCTR2000033904. Registered 16/06/2020, http://www.chictr.org.cn/login.aspx?referurl=%2flistbycreater.aspx.
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Affiliation(s)
- Shiao Yu
- The First Affiliated Hospital of Zhengzhou University, 450000, Zhengzhou, China
| | - Liping Du
- The First Affiliated Hospital of Zhengzhou University, 450000, Zhengzhou, China
| | - Na Ji
- The Affiliated Eye Hospital of Suzhou Vocational Health College, 215000, Suzhou, China
| | - Binbin Li
- The First Affiliated Hospital of Zhengzhou University, 450000, Zhengzhou, China
| | - Xuena Pang
- The First Affiliated Hospital of Zhengzhou University, 450000, Zhengzhou, China
| | - Xiuhong Li
- The First Affiliated Hospital of Zhengzhou University, 450000, Zhengzhou, China
| | - Nana Ma
- The First Affiliated Hospital of Zhengzhou University, 450000, Zhengzhou, China
| | - Congcong Huang
- The First Affiliated Hospital of Zhengzhou University, 450000, Zhengzhou, China
| | - Aicun Fu
- The First Affiliated Hospital of Zhengzhou University, 450000, Zhengzhou, China.
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19
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Zheng NN, Tan KW. The synergistic efficacy and safety of combined low-concentration atropine and orthokeratology for slowing the progression of myopia: A meta-analysis. Ophthalmic Physiol Opt 2022; 42:1214-1226. [PMID: 35919929 DOI: 10.1111/opo.13029] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 06/24/2022] [Accepted: 06/24/2022] [Indexed: 12/01/2022]
Abstract
PURPOSE To explore the efficacy and safety of combined low-concentration atropine and orthokeratology (OK) for slowing the progression of myopia. METHODS We performed a systematic search of English and Chinese databases to collect potentially eligible randomised controlled trials (RCTs), nonrandomised controlled trials (non-RCTs) and retrospective cohort studies (REs) published between the establishment of the database and 1 January 2022. The weighted mean difference (WMD) and 95% confidence interval (CI) were calculated for each outcome. RESULTS Fifteen studies were ultimately included in the meta-analysis, which indicated that compared with OK lenses alone, the combination of low-concentration atropine with OK lenses significantly slowed axial growth (WMD = -0.12 mm; 95% CI: -0.13 to -0.11, p < 0.001) and reduced the rate of change of the spherical equivalent refraction (WMD = 0.15 D; 95% CI: 0.06 to 0.24, p < 0.001). Additionally, the combined treatment may cause a slight increase in pupil diameter (WMD = 0.62 mm; 95% CI: 0.42 to 0.81, p < 0.001). No significant difference in the amplitude of accommodation, intraocular pressure, tear film break-up time or corneal endothelial cell density was found between the OK and combination therapy groups. CONCLUSIONS The combination therapy of low-concentration atropine and OK lenses had a greater effect in slowing myopia progression during a 6-to-12-month treatment interval and was still effective over a 24-month period. Increased pupil diameter was the major side effect of the combination therapy, with no negative impact on the amplitude of accommodation, intraocular pressure, tear film break-up time or corneal endothelial cell density.
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Affiliation(s)
| | - Kai-Wen Tan
- SuZhou Medical College of Soochow University, Suzhou, China
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20
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Myopia: Mechanisms and Strategies to Slow Down Its Progression. J Ophthalmol 2022; 2022:1004977. [PMID: 35747583 PMCID: PMC9213207 DOI: 10.1155/2022/1004977] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 05/29/2022] [Indexed: 12/15/2022] Open
Abstract
This topical review aimed to update and clarify the behavioral, pharmacological, surgical, and optical strategies that are currently available to prevent and reduce myopia progression. Myopia is the commonest ocular abnormality; reinstated interest is associated with high and increasing prevalence, especially but not, in the Asian population and progressive nature in children. The growing global prevalence seems to be associated with both genetic and environmental factors such as spending more time indoor and using digital devices, particularly during the coronavirus disease 2019 pandemic. Various options have been assessed to prevent or reduce myopia progression in children. In this review, we assess the effects of several types of measures, including spending more time outdoor, optical interventions such as the bifocal/progressive spectacle lenses, soft bifocal/multifocal/extended depth of focus/orthokeratology contact lenses, refractive surgery, and pharmacological treatments. All these options for controlling myopia progression in children have various degrees of efficacy. Atropine, orthokeratology/peripheral defocus contact and spectacle lenses, bifocal or progressive addition spectacles, and increased outdoor activities have been associated with the highest, moderate, and lower efficacies, respectively.
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21
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Yu Y, Liu J. The effect of 0.01% atropine and orthokeratology on ocular axial elongation for myopia children: A meta-analysis (a PRISMA-compliant article). Medicine (Baltimore) 2022; 101:e29191. [PMID: 35550467 PMCID: PMC9276445 DOI: 10.1097/md.0000000000029191] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 03/09/2022] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVES This meta-analysis aimed to identify the therapeutic effect of 0.01% atropine with orthokeratology on ocular axial elongation for myopia children. METHODS We searched PubMed, Cochrane Library, and CBM databases from inception to July 1st, 2021. Meta-analysis was conducted using STATA version 14.0 and Review Manager version 5.3 softwares. We calculated the weighted mean differences to analyze the change of ocular axial length (AL) between orthokeratology combined with 0.01% atropine (OKA) and) alone. The Cochran's Q-statistic and I2 test were used to evaluate potential heterogeneity between studies. To evaluate the influence of single studies on the overall estimate, a sensitivity analysis was performed. We also performed sub group and meta-regression analyses to investigate potential sources of heterogeneity. We conducted Begger funnel plots and Egger linear regression tests to investigate publication bias. RESULTS Nine studies that met all inclusion criteria were included in this meta-analysis. A total of 191 children in OKA group and 196 children in orthokeratology (OK) group were assessed. The pooled summary weighted mean differences of AL change was -0.90 (95% CI = -1.25-0.55) with statistical significance (t = -5.03, P < .01), which indicated there was obvious difference between OKA and OK in myopic children. Subgroup analysis also showed that OKA treatment resulted in significantly less axial elongation compared to OK treatment alone according to SER. We found no evidence for publication bias. CONCLUSIONS Our meta-analysis indicates 0.01% atropine atropine is effective in slowing axial elongation in myopia children with orthokeratology.
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Affiliation(s)
- Yan Yu
- Ophthalmology Department of the First Affiliated Hospital of Dalian Medical University, Dalian City, Liaoning Province, China
| | - Jiasu Liu
- Ophthalmology Department of the Second Affiliated Hospital of Dalian Medical University, Dalian City, Liaoning Province, China
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22
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Abstract
ABSTRACT A number of studies regarding the effect of orthokeratology (OK) on myopia progression have been published and shown that it can slow myopia progression in school-aged children. Recently, OK has been considered to be one of the most effective optical treatments for myopia control. This article reviewed the peer-reviewed literature on the efficacy of OK for myopia control. Although it cannot halt myopia progression completely, the inhibitory effect on axial elongation for 2 years has been reported to be from 32% to 63%, as compared with single-vision spectacles and contact lenses. In addition, the efficacy and acceptable safety have been confirmed even in several long-term studies up to 10 years. However, the possibility of a rebound phenomenon in myopia progression after OK discontinuation remains unknown. It is also unclear how long the treatment should be continued to attain the maximum benefit in each patient. In the near future, further research including assessment of rebound phenomenon should be conducted with longer follow-up periods in more diverse populations.
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Affiliation(s)
- Takahiro Hiraoka
- From the Department of Ophthalmology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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23
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Axial length growth difference between eyes after monocular laser refractive surgery: eight patients who underwent myopic laser ablation for both eyes at intervals of several years. BMC Ophthalmol 2022; 22:20. [PMID: 35016626 PMCID: PMC8753812 DOI: 10.1186/s12886-022-02243-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 12/31/2021] [Indexed: 11/17/2022] Open
Abstract
Background Myopia is a global public health issue. Controlling myopia progression is a primary focus of myopia studies today. Peripheral retinal myopic defocus is considered the mechanism for reduced myopia progression in orthokeratology studies. The topographic change in the front corneal surface after laser refractive surgery and orthokeratology procedures may appear similar. The purpose of this study was to explore the role of myopic laser ablation on axial length (AL) growth. Methods Myopic patients who underwent monocular excimer laser refractive surgery first in one eye and then in another eye several years later because of myopia occurrence or myopia progression were recruited. The axial length elongation and refraction (spherical equivalent) between the two eyes were observed and compared. Results A total of 8 myopic patients were enrolled in the study. The AL increased from 24.52 ± 0.96 mm to 24.68 ± 1.03 mm but without significance (T = 1.49, P > 0.05) in the ablated eyes. The AL increased significantly from 23.73 ± 0.91 mm to 24.26 ± 0.95 mm in the nonablated eyes (T = 6.76, P < 0.001). The AL elongation of the ablated eyes with 0.16 ± 0.30 mm growth was significantly lower than that of the nonablated eyes with 0.53 ± 0.32 mm growth (T = 8.98, P < 0.001). The spherical equivalent (SE) increased significantly in the ablated eyes (− 0.59 ± 0.21 (D), T = 6.36, P < 0.001) and in the nonablated eyes (− 0.97 ± 0.55 (D), T = 4.91, P < 0.01), and the difference between the two eyes was significant (T = 3.05, P < 0.05). Conclusions The inhibitory effect of myopic laser ablation on AL elongation reported in the limited case studies argues for animal research on its efficacy as a new intervention for myopia progression.
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24
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Ji N, Niu Y, Qin J, Fu AC, Cui C. Orthokeratology Lenses Versus Administration of 0.01% Atropine Eye Drops for Axial Length Elongation in Children With Myopic Anisometropia. Eye Contact Lens 2022; 48:45-50. [PMID: 34924543 DOI: 10.1097/icl.0000000000000848] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate the effect of orthokeratology (OK) lenses and that of 0.01% atropine eye drops on axial length (AL) elongation in children with myopic anisometropia. METHODS Ninety-five children with myopic anisometropia who used OK lenses (N=49) or 0.01% atropine eye drops (N=46) were enrolled in this retrospective 1-year study. For all children, the eyes with higher spherical equivalent refractive error (SER) were assigned to the H-eye subgroup, whereas the fellow eyes with lower SER were assigned to the L-eye subgroup. RESULTS After 1-year treatment, the mean change in the AL of H eyes and L eyes in the OK lenses group was 0.18±0.16 mm and 0.24±0.15 mm, respectively (P=0.15), and 0.28±0.20 mm and 0.25±0.18 mm, respectively (P=0.48), in the 0.01% atropine group. Multivariate regression analyses showed significant differences in AL change between H and L eyes after treatment with OK lens (P=0.03), whereas no significant difference in the 0.01% atropine (P=0.22). The change in the AL in the H-eye group was less with OK lenses than with 0.01% atropine (P=0.04), whereas there was no significant difference between the change in AL in the L-eye group between treatment with OK lens and 0.01% atropine (P=0.89). CONCLUSIONS In myopic anisometropic children, AL differences between 2 eyes decrease by wearing OK lenses but do not change after administration of 0.01% atropine eye drops. The increased effect of OK lenses, but not 0.01% atropine, in reducing axial elongation at 1 year in the eye with higher SER in anisometropic children warrants further investigation.
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Affiliation(s)
- Na Ji
- From the The Affiliated Eye Hospital of Suzhou Vocational Health College; Suzhou, China
- Henan Provincial People's Hospital, Henan Eye Hospital, Zhengzhou, China ; and
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yan Niu
- From the The Affiliated Eye Hospital of Suzhou Vocational Health College; Suzhou, China
- Henan Provincial People's Hospital, Henan Eye Hospital, Zhengzhou, China ; and
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jian Qin
- From the The Affiliated Eye Hospital of Suzhou Vocational Health College; Suzhou, China
- Henan Provincial People's Hospital, Henan Eye Hospital, Zhengzhou, China ; and
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ai-Cun Fu
- From the The Affiliated Eye Hospital of Suzhou Vocational Health College; Suzhou, China
- Henan Provincial People's Hospital, Henan Eye Hospital, Zhengzhou, China ; and
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Can Cui
- From the The Affiliated Eye Hospital of Suzhou Vocational Health College; Suzhou, China
- Henan Provincial People's Hospital, Henan Eye Hospital, Zhengzhou, China ; and
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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25
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Yuan Y, Zhu C, Liu M, Zhou Y, Yang X, Zheng B, Li Z, Mao X, Ke B. Efficacy of combined orthokeratology and 0.01% atropine for myopia control: the study protocol for a randomized, controlled, double-blind, and multicenter trial. Trials 2021; 22:863. [PMID: 34852833 PMCID: PMC8633914 DOI: 10.1186/s13063-021-05825-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 11/13/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The prevalence of myopia is increasing worldwide and is presently recognized as a major public health issue. Researchers and clinicians have been devoted in exploring appropriate clinical interventions to slow its progression in children. Mounting publications have proven that both orthokeratology (OK lens) and 0.01% atropine eyedrop can retard eye growth and myopia progression. However, it remains unclear whether the combination of OK lens and 0.01% atropine has the potential to magnify the effectiveness of myopia control. The present study aims to compare the myopia control efficiency of the combination of OK lens and 0.01% atropine with the monotherapy of OK lens in children. METHODS The present study is a randomized, controlled, double-blind and multicenter clinical trial. A total of 96 children within 8-12 years old were recruited. These participants are treated with the combination of OK lens and 0.01% atropine eyedrop or the combination of OK lens and placebo eyedrop. Each group includes 48 participants. The inclusion criteria are as follows: myopia between - 1.00 and - 4.00 D in either eye and astigmatism of no more than 1.50 D. The follow-up time points will be 1, 6, 12, 18, and 24 months from randomization. The primary outcome is determined by the difference in axial length of the two groups, between the baseline and 24 months from randomization. DISCUSSION The present randomized, controlled clinical trial would indicate the additive effects of the combination of OK lens and 0.01% atropine, and the extent of these effects, in retarding myopia progression and axial elongation in children. TRIAL REGISTRATION Chinese Clinical Trial Registry (ChiCTR), ChiCTR1800018419 . Registered on 17 September 2018. http://www.chictr.org.cn/showproj.aspx?proj=29216.
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Affiliation(s)
- Ying Yuan
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China.,National Clinical Research Center for Eye Diseases, Shanghai, China.,Shanghai Key Laboratory of Fundus Disease, Shanghai, China
| | - Chengcheng Zhu
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China.,Shanghai Key Laboratory of Fundus Disease, Shanghai, China.,Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China
| | - Mingming Liu
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China.,Shanghai Key Laboratory of Fundus Disease, Shanghai, China.,Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China
| | - Yali Zhou
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China.,Shanghai Key Laboratory of Fundus Disease, Shanghai, China.,Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China
| | - Xiao Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center Sun Yat-Sen University, Guangzhou, China
| | - Bingru Zheng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center Sun Yat-Sen University, Guangzhou, China
| | - Zhouyue Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center Sun Yat-Sen University, Guangzhou, China
| | - Xinjie Mao
- School of Ophthalmology and Optometry and Eye Hospital, Wenzhou Medical University, 270 Xueyuan Road, Wenzhou, 325027, Zhejiang, China.
| | - Bilian Ke
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China. .,National Clinical Research Center for Eye Diseases, Shanghai, China. .,Shanghai Key Laboratory of Fundus Disease, Shanghai, China.
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26
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Cui C, Li X, Lyu Y, Wei L, Zhao B, Yu S, Rong J, Bai Y, Fu A. Safety and efficacy of 0.02% and 0.01% atropine on controlling myopia progression: a 2-year clinical trial. Sci Rep 2021; 11:22267. [PMID: 34782708 PMCID: PMC8592985 DOI: 10.1038/s41598-021-01708-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 10/27/2021] [Indexed: 11/09/2022] Open
Abstract
Four hundred myopic children randomly received atropine 0.02% (n = 138) or 0.01% (n = 142) in both eyes once-nightly or only wore single-vision spectacles (control group) (n = 120) for 2 years. Spherical equivalent refractive error (SER), axial length (AL), pupil diameter (PD), and amplitude of accommodation (AMP) were measured every 4 months. After 2 years, the SER changes were - 0.80 (0.52) D, - 0.93 (0.59) D and - 1.33 (0.72) D and the AL changes were 0.62 (0.29) mm, 0.72 (0.31) mm and 0.88 (0.35) mm in the 0.02% and 0.01% atropine groups and control group, respectively. There were significant differences between changes in SER and AL in the three groups (all P < 0.001). The changes in SER and AL in the 2nd year were similar to the changes in the 1st year in the three groups (all P > 0.05). From baseline to 2 years, the overall decrease in AMP and increase in PD were not significantly different in the two atropine groups, whereas the AMP and PD in the control group remained stable (all P > 0.05). 0.02% atropine had a better effect on myopia control than 0.01% atropine, and its effects on PD and AMP were similar to 0.01% atropine. 0.02% or 0.01% atropine controlled myopia progression and AL elongation synchronously and had similar effects on myopia control each year.
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Affiliation(s)
- Can Cui
- The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe Road, Zhengzhou, 450000, China
| | - Xiujuan Li
- The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe Road, Zhengzhou, 450000, China
| | - Yong Lyu
- The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe Road, Zhengzhou, 450000, China
| | - Li Wei
- The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe Road, Zhengzhou, 450000, China
| | - Bingxin Zhao
- The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe Road, Zhengzhou, 450000, China
| | - Shiao Yu
- The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe Road, Zhengzhou, 450000, China
| | - Junbo Rong
- The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe Road, Zhengzhou, 450000, China
| | - Yanhui Bai
- The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe Road, Zhengzhou, 450000, China
| | - Aicun Fu
- The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe Road, Zhengzhou, 450000, China.
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27
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Chen YX, Liao CM, Tan Z, He MG. Who needs myopia control? Int J Ophthalmol 2021; 14:1297-1301. [PMID: 34540602 DOI: 10.18240/ijo.2021.09.01] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 04/14/2021] [Indexed: 12/16/2022] Open
Abstract
Myopia has become a major visual disorder among school-aged children in East Asia due to its rising prevalence over the past few decades and will continue to be a leading health issue with an annual incidence as high as 20%-30%. Although various interventions have been proposed for myopia control, consensus in treatment strategies has yet to be fully developed. Atropine and orthokeratology stand out for their effectiveness in myopia progression control, but children with rapid progression of myopia require treatment with higher concentrations of atropine that are associated with increased rates of side effects, or with orthokeratology that carries risk of significant complication. Therefore, improved risk assessment for myopia onset and progression in children is critical in clinical decision-making. Besides traditional prediction models based on genetic effects and environmental exposures within populations, individualized prediction using machine learning and data based on age-specific refraction is promising. Although emerging treatments for myopia are promising and some have been incorporated into clinical practice, identifying populations who require and benefit from intervention remains the most important initial step for clinical practice.
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Affiliation(s)
- Yan-Xian Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510000, Guangdong Province, China.,Department of Ophthalmology, Peking University Shenzhen Hospital, Shenzhen Peking University-The Hong Kong University of Science and Technology Medical Center, Shenzhen 518000, Guangdong Province, China
| | - Chi-Mei Liao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510000, Guangdong Province, China
| | - Zachary Tan
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, Melbourne 3010, Australia
| | - Ming-Guang He
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510000, Guangdong Province, China.,Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, Melbourne 3010, Australia
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28
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Zhou H, Zhao G, Li Y. Adjunctive effects of orthokeratology and atropine 0.01% eye drops on slowing the progression of myopia. Clin Exp Optom 2021; 105:520-526. [PMID: 34228946 DOI: 10.1080/08164622.2021.1943318] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
CLINICAL RELEVANCE All eye health care practitioners should know how to control myopia. BACKGROUND Investigating the adjunctive effects of orthokeratology and 0.01% atropine eye drops on controlling the progression of myopia in Chinese children. METHODS The prospective study included Chinese children aged 8 to 13 years having a spherical equivalent refractive error ranging from -2.00 to -5.00 D. Participants were categorised into two groups: combination group (orthokeratology and 0.01% atropine) or atropine group (0.01% atropine). The axial length and spherical equivalent refraction were measured at baseline and every three months post-treatment and compared over two years. RESULTS The combinaion and atropine groups comprised 20 and 22 participants. Following two years of treatment, the average spherical equivalent refraction change was 0.88 ± 0.31 D and 1.14 ± 0.63 D in the combination group and atropine group, respectively (P = 0.026), with an average increment in axial length of 0.50 ± 0.17 mm and 0.61 ± 0.21 mm, respectively (P = 0.091). In the atropine group, increased axial length was positively correlated with baseline spherical equivalent refraction (P = 0.018) and negatively correlated with baseline age (P = 0.003). However, these correlations were not observed in the combination group. In the subgroup of subjects aged 8-10 years and another subgroup of subjects with shorter initial axial length (22.00 to 24.50 mm), the changes in axial length over two years were significantly smaller in the combination group than the atropine group. CONCLUSION Orthokeratology and 0.01% atropine eye drops combination therapy were found to be more effective in reducing progression of myopia, as measured through spherical equivalent refraction changes, than atropine monotherapy in children over two years. Combinatorial therapy was more effective in controlling the elongation of axial length in children with younger baseline age or shorter baseline axial length.
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Affiliation(s)
- Hangshuai Zhou
- Department of Ophthalmology, Dongyang People's Hospital, Dongyang, China
| | - Guangjin Zhao
- Department of Ophthalmology, Dongyang People's Hospital, Dongyang, China
| | - Yunyun Li
- Department of Ophthalmology, Dongyang People's Hospital, Dongyang, China
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29
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Risk factors for rapid axial length elongation with low concentration atropine for myopia control. Sci Rep 2021; 11:11729. [PMID: 34083576 PMCID: PMC8175344 DOI: 10.1038/s41598-021-88719-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 04/08/2021] [Indexed: 11/20/2022] Open
Abstract
Three hundred and twenty-eight myopic children, randomized to use either 0.01% (N = 166) or 0.02% (N = 162) atropine were enrolled in this study. Gender, age, body mass index(BMI), parental myopia status, atropine concentration used, pupil diameter, amplitude of accommodation, spherical equivalent refractive error (SER), anterior chamber depth (ACD) and axial length (AL) were collected at baseline and 1 year after using atropine. Rapid AL elongation was defined as > 0.36 mm growth per year. Univariate analyses showed that children with rapid AL elongation tend to be younger, have a smaller BMI, use of 0.01% atropine, narrow ACD, lower SER, shorter AL, smaller change in pupil diameter between 1 year and baseline (all P < 0.05). Multivariate logistic regression analyses confirmed that rapid AL elongation was associated with children that were younger at baseline (P < 0.0001), use of 0.01% atropine (P = 0.04), a shorter baseline AL (P = 0.03) and a smaller change in pupil diameter between 1 year and baseline (P = 0.04). Younger children with shorter AL at baseline, less change in their pupil diameter with atropine treatment and using the lower of the two atropine concentrations may undergo rapid AL elongation over a 12 months myopia control treatment period.
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Li X, Ding C, Li Y, Lim EW, Gao Y, Fermigier B, Yang A, Chen H, Bao J. Influence of Lenslet Configuration on Short-Term Visual Performance in Myopia Control Spectacle Lenses. Front Neurosci 2021; 15:667329. [PMID: 34113234 PMCID: PMC8185291 DOI: 10.3389/fnins.2021.667329] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 04/08/2021] [Indexed: 12/14/2022] Open
Abstract
Purpose: This study aimed to evaluate short-term visual performance and optical quality of three different lenslet configurations on myopia control spectacle lenses. Materials and Methods: This study utilized a cross-over design. Distance visual acuity (VA) was measured in 50 myopic children; contrast sensitivity (CS) was measured in 36 myopic children. For each test, four spectacle lenses were evaluated in a random order: single-vision lens (SVL), lens with concentric rings of highly aspherical lenslets (HAL), lens with concentric rings of slightly aspherical lenslets (SAL), and lens with honeycomb configuration of spherical lenslets (HC). The modulation transfer function (MTF) and MTF area (MTFa) were used to determine optical quality. All tests were performed monocularly on the right eye with full correction. Results: HAL and SAL had larger MTFa than HC. VA in lenses with lenslets was significantly reduced compared to SVL (all p < 0.01). The reduction in VA was worse with HC than with SAL (p = 0.02) and HAL (p = 0.03); no effect of lenslet asphericity was found (p > 0.05). VA changes induced by lenslets showed no correlation with spherical equivalent refraction (all p > 0.05) and were weakly positively associated with age for SAL (r = 0.36, p = 0.01) and HC (r = 0.31, p = 0.03), but not for HAL (p = 0.30). The area under the log contrast sensitivity function (AULCSF) decreased with HAL and HC (all p < 0.001) in all illumination levels, and AULCSF with HAL was higher than that with HC in a photopic condition (1.17 ± 0.10 vs. 1.10 ± 0.13, p = 0.0004). The presence of lenslets did not affect CS at 3 cycles per degree (cpd) (p = 0.80). At 6 to 18 cpd, CS was significantly reduced by HAL and HC (all p < 0.05), but not SAL (p > 0.05) compared to SVL. At high spatial frequencies (>12 cpd) both SAL and HAL reduced CS significantly less than HC (all p < 0.01). Conclusion: Short-term visual performance was minimally impaired by looking through the lenslet structure of myopia control spectacle lenses. Concentric rings with aspherical lenslets had a significantly lower impact on both VA and CS than honeycomb configuration with spherical lenslets.
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Affiliation(s)
- Xue Li
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China.,National Clinical Research Center for Ocular Diseases, Wenzhou, China.,Wenzhou Medical University-Essilor International Research Center (WEIRC), Wenzhou, China
| | - Chenglu Ding
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China.,National Clinical Research Center for Ocular Diseases, Wenzhou, China
| | - Yuhao Li
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China.,National Clinical Research Center for Ocular Diseases, Wenzhou, China
| | - Ee Woon Lim
- Wenzhou Medical University-Essilor International Research Center (WEIRC), Wenzhou, China.,R&D AMERA, Essilor International, Singapore, Singapore
| | - Yi Gao
- Wenzhou Medical University-Essilor International Research Center (WEIRC), Wenzhou, China.,R&D AMERA, Essilor International, Singapore, Singapore
| | | | - Adeline Yang
- Wenzhou Medical University-Essilor International Research Center (WEIRC), Wenzhou, China.,R&D AMERA, Essilor International, Singapore, Singapore
| | - Hao Chen
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China.,National Clinical Research Center for Ocular Diseases, Wenzhou, China.,Wenzhou Medical University-Essilor International Research Center (WEIRC), Wenzhou, China
| | - Jinhua Bao
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China.,National Clinical Research Center for Ocular Diseases, Wenzhou, China.,Wenzhou Medical University-Essilor International Research Center (WEIRC), Wenzhou, China
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Hao Q, Zhao Q. Changes in subfoveal choroidal thickness in myopic children with 0.01% atropine, orthokeratology, or their combination. Int Ophthalmol 2021; 41:2963-2971. [PMID: 33954859 PMCID: PMC8364521 DOI: 10.1007/s10792-021-01855-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 04/08/2021] [Indexed: 12/22/2022]
Abstract
PURPOSE To compare the changes in subfoveal choroidal thickness (SFChT) in myopic children treated with 0.01% atropine, orthokeratology (OK), or their combination in myopic children, and to study the connection between increase in SFChT and axial length (AL) elongation. METHODS This is a prospective, randomized, controlled study. A total of 67 children were included; 22 patients were randomly assigned to the SA group (patients with spectacles and 0.01% atropine), 24 patients were randomly assigned to the OK group (OK), and 21 patients were randomly assigned to the OKA group (OK and 0.01% atropine). Comprehensive ophthalmologic examinations were performed at baseline, 1 month, 6 months, and 12 months. RESULTS After 1 month, SFChT increased by 5.41 ± 1.65 μm in the SA group, 17.46 ± 2.79 μm in the OK group, and 20.19 ± 2.18 μm in the OKA group (P = 0.00), whereas AL was not significantly increased. After 12 months, the changes of SFChT were not increased significantly compared with that at 1 month; AL increased by 0.20 ± 0.03 mm in the SA group, 0.28 ± 0.03 mm in the OK group, and 0.14 ± 0.03 mm in the OKA group (P = 0.00). The change in SFChT at 12 month was negatively correlated with the change in AL at 12 months. CONCLUSION The control of AL elongation was better in SA group than OK group. The increase in SFChT was best in OKA group, followed by OK group, and the changes were significant after only 1 month. In addition, the increase in SFChT may influence AL elongation and myopia progression.
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Affiliation(s)
- Qian Hao
- Department of Ophthalmology, The Second Hospital of Dalian Medical University, 467 Zhongshan Road, Shahekou District, Dalian, China
| | - Qi Zhao
- Department of Ophthalmology, The Second Hospital of Dalian Medical University, 467 Zhongshan Road, Shahekou District, Dalian, China.
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Németh J, Tapasztó B, Aclimandos WA, Kestelyn P, Jonas JB, De Faber JTHN, Januleviciene I, Grzybowski A, Nagy ZZ, Pärssinen O, Guggenheim JA, Allen PM, Baraas RC, Saunders KJ, Flitcroft DI, Gray LS, Polling JR, Haarman AEG, Tideman JWL, Wolffsohn JS, Wahl S, Mulder JA, Smirnova IY, Formenti M, Radhakrishnan H, Resnikoff S. Update and guidance on management of myopia. European Society of Ophthalmology in cooperation with International Myopia Institute. Eur J Ophthalmol 2021; 31:853-883. [PMID: 33673740 PMCID: PMC8369912 DOI: 10.1177/1120672121998960] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 02/04/2021] [Indexed: 12/13/2022]
Abstract
The prevalence of myopia is increasing extensively worldwide. The number of people with myopia in 2020 is predicted to be 2.6 billion globally, which is expected to rise up to 4.9 billion by 2050, unless preventive actions and interventions are taken. The number of individuals with high myopia is also increasing substantially and pathological myopia is predicted to become the most common cause of irreversible vision impairment and blindness worldwide and also in Europe. These prevalence estimates indicate the importance of reducing the burden of myopia by means of myopia control interventions to prevent myopia onset and to slow down myopia progression. Due to the urgency of the situation, the European Society of Ophthalmology decided to publish this update of the current information and guidance on management of myopia. The pathogenesis and genetics of myopia are also summarized and epidemiology, risk factors, preventive and treatment options are discussed in details.
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Affiliation(s)
- János Németh
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Beáta Tapasztó
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
- Faculty of Health Sciences, Semmelweis University, Budapest, Hungary
| | | | | | - Jost B Jonas
- Department of Ophthalmology, Heidelberg University, Mannheim, Germany
| | | | | | - Andrzej Grzybowski
- Department of Ophthalmology, University of Warmia and Mazury, Olsztyn, Poland
- Institute for Research in Ophthalmology, Foundation for Ophthalmology Development, Poznan, Poland
| | - Zoltán Zsolt Nagy
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Olavi Pärssinen
- Gerontology Research Centre and Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | | | - Peter M Allen
- Vision and Hearing Sciences Research Centre, Anglia Ruskin University, Cambridge, UK
| | - Rigmor C Baraas
- National Centre for Optics, Vision and Eye Care, University of South-Eastern Norway, Kongsberg, Norway
| | - Kathryn J Saunders
- Centre for Optometry and Vision Science research, Ulster University, Coleraine, UK
| | - Daniel Ian Flitcroft
- Temple Street Children’s Hospital, Dublin, Ireland
- Centre for Eye Research Ireland (CERI) Technological University Dublin, Ireland
| | | | - Jan Roelof Polling
- Department of Ophthalmology and Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Optometry and Orthoptics, Hogeschool Utrecht, University of Applied Science, Utrecht, The Netherlands
| | - Annechien EG Haarman
- Department of Ophthalmology and Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - J Willem L Tideman
- Department of Ophthalmology and Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - James Stuart Wolffsohn
- Optometry and Vision Science, College of Health and Life Sciences, Aston University, Birmingham, UK
| | - Siegfried Wahl
- Institute for Ophthalmic Research, University Tübingen, Tübingen, Germany
- Carl Zeiss Vision International GmbH, Tübingen, Germany
| | - Jeroen A Mulder
- Department of Optometry and Orthoptics, Hogeschool Utrecht, University of Applied Science, Utrecht, The Netherlands
| | | | - Marino Formenti
- Department of Physics, School of Science, University of Padova, Padova, Italy
| | | | - Serge Resnikoff
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
- Brien Holden Vision Institute, Sydney, Australia
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Jong M, Jonas JB, Wolffsohn JS, Berntsen DA, Cho P, Clarkson-Townsend D, Flitcroft DI, Gifford KL, Haarman AEG, Pardue MT, Richdale K, Sankaridurg P, Tedja MS, Wildsoet CF, Bailey-Wilson JE, Guggenheim JA, Hammond CJ, Kaprio J, MacGregor S, Mackey DA, Musolf AM, Klaver CCW, Verhoeven VJM, Vitart V, Smith EL. IMI 2021 Yearly Digest. Invest Ophthalmol Vis Sci 2021; 62:7. [PMID: 33909031 PMCID: PMC8088231 DOI: 10.1167/iovs.62.5.7] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 01/24/2021] [Indexed: 12/17/2022] Open
Abstract
Purpose The International Myopia Institute (IMI) Yearly Digest highlights new research considered to be of importance since the publication of the first series of IMI white papers. Methods A literature search was conducted for articles on myopia between 2019 and mid-2020 to inform definitions and classifications, experimental models, genetics, interventions, clinical trials, and clinical management. Conference abstracts from key meetings in the same period were also considered. Results One thousand articles on myopia have been published between 2019 and mid-2020. Key advances include the use of the definition of premyopia in studies currently under way to test interventions in myopia, new definitions in the field of pathologic myopia, the role of new pharmacologic treatments in experimental models such as intraocular pressure-lowering latanoprost, a large meta-analysis of refractive error identifying 336 new genetic loci, new clinical interventions such as the defocus incorporated multisegment spectacles and combination therapy with low-dose atropine and orthokeratology (OK), normative standards in refractive error, the ethical dilemma of a placebo control group when myopia control treatments are established, reporting the physical metric of myopia reduction versus a percentage reduction, comparison of the risk of pediatric OK wear with risk of vision impairment in myopia, the justification of preventing myopic and axial length increase versus quality of life, and future vision loss. Conclusions Large amounts of research in myopia have been published since the IMI 2019 white papers were released. The yearly digest serves to highlight the latest research and advances in myopia.
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Affiliation(s)
- Monica Jong
- Discipline of Optometry and Vision Science, University of Canberra, Canberra, Australian Capital Territory, Australia
- Brien Holden Vision Institute, Sydney, New South Wales, Australia
- School of Optometry and Vision Science, School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
| | - Jost B. Jonas
- Department of Ophthalmology Medical Faculty Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - James S. Wolffsohn
- Optometry and Vision Science Research Group, Aston University, Birmingham, United Kingdom
| | - David A. Berntsen
- The Ocular Surface Institute, College of Optometry, University of Houston, Houston, Texas, United States
| | - Pauline Cho
- Centre for Myopia Research, School of Optometry, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Danielle Clarkson-Townsend
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Healthcare System, Decatur, Georgia, United States
- Gangarosa Department of Environmental Health, Emory University, Atlanta, Georgia, United States
| | - Daniel I. Flitcroft
- Department of Ophthalmology, Children's University Hospital, Dublin, Ireland
| | - Kate L. Gifford
- Myopia Profile Pty Ltd, Brisbane, Queensland, Australia
- Queensland University of Technology (QUT) School of Optometry and Vision Science, Kelvin Grove, Queensland, Australia
| | - Annechien E. G. Haarman
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands
- Department of Ophthalmology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Machelle T. Pardue
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Healthcare System, Decatur, Georgia, United States
- Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia, United States
| | - Kathryn Richdale
- College of Optometry, University of Houston, Houston, Texas, United States
| | - Padmaja Sankaridurg
- Brien Holden Vision Institute, Sydney, New South Wales, Australia
- School of Optometry and Vision Science, School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
| | - Milly S. Tedja
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands
- Department of Ophthalmology, Erasmus Medical Center, Rotterdam, the Netherlands
| | | | - Joan E. Bailey-Wilson
- Computational and Statistical Genomics Branch, National Human Genome Research Institute, National Institutes of Health, Baltimore, Maryland, United States
| | - Jeremy A. Guggenheim
- School of Optometry and Vision Sciences, Cardiff University, Cardiff, United Kingdom
| | - Christopher J. Hammond
- Section of Academic Ophthalmology, School of Life Course Sciences, King's College London, London, United Kingdom
| | - Jaakko Kaprio
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland
| | - Stuart MacGregor
- Statistical Genetics, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - David A. Mackey
- Centre for Eye Research Australia, Ophthalmology, Department of Surgery, University of Melbourne, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
- Department of Ophthalmology, Menzies Institute of Medical Research, University of Tasmania, Hobart, Tasmania, Australia
- Centre for Ophthalmology and Visual Science, Lions Eye Institute, University of Western Australia, Perth, Western Australia, Australia
| | - Anthony M. Musolf
- Computational and Statistical Genomics Branch, National Human Genome Research Institute, National Institutes of Health, Baltimore, Maryland, United States
| | - Caroline C. W. Klaver
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands
- Department of Ophthalmology, Radboud University Medical Center, Nijmegen, the Netherlands
- Department of Ophthalmology, Erasmus Medical Center, Rotterdam, the Netherlands
- Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland
| | - Virginie J. M. Verhoeven
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands
- Department of Ophthalmology, Erasmus Medical Center, Rotterdam, the Netherlands
- Department of Clinical Genetics, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Veronique Vitart
- Medical Research Council Human Genetics Unit, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom
| | - Earl L. Smith
- College of Optometry, University of Houston, Houston, Texas, United States
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Nti AN, Berntsen DA. Optical changes and visual performance with orthokeratology. Clin Exp Optom 2021; 103:44-54. [DOI: 10.1111/cxo.12947] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 06/17/2019] [Accepted: 06/18/2019] [Indexed: 12/24/2022] Open
Affiliation(s)
- Augustine N Nti
- The Ocular Surface Institute, College of Optometry, University of Houston, Houston, Texas, USA,
| | - David A Berntsen
- The Ocular Surface Institute, College of Optometry, University of Houston, Houston, Texas, USA,
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García Del Valle I, Alvarez-Lorenzo C. Atropine in topical formulations for the management of anterior and posterior segment ocular diseases. Expert Opin Drug Deliv 2021; 18:1245-1260. [PMID: 33787441 DOI: 10.1080/17425247.2021.1909568] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Atropine is an old-known drug which is gaining increasing attention due to the myriad of therapeutic effects it may trigger on eye structures. Nevertheless, novel applications may require more adequate topical formulations. AREAS COVERED This review aims to gather the existing knowledge about atropine and its clinical applications in the ophthalmological field when administered topically. Atropine ocular pharmacokinetics is paid a special attention, including recent evidences of the capability of the drug to access to the posterior segment. Ocular bioavailability and systemic bioavailability are counterbalanced. Finally, limitations of traditional dosage forms and potential advantages of under investigation delivery systems are analyzed. EXPERT OPINION Mydriasis and cyclopegia have been widely exploited for eye examination, management of anterior segment diseases, and more recently as antidotes of chemical weapons. Improved knowledge on drug receptors and related pathways explains atropine repositioning as an outstanding tool to prevent myopia. The ease with which atropine penetrates ocular tissues is a double edged sword, that is, while it ensures therapeutic levels in the posterior segment, the unspecific distribution causes a wide variety of untoward effects. The design of formulations that can selectively deliver atropine to the target tissue for each specific application is an urgent unmet need.
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Affiliation(s)
- Ines García Del Valle
- Departamento De Farmacología, Farmacia Y Tecnología Farmacéutica, I+D FarmaGroup, Facultad De Farmacia and Health Research Institute of Santiago De Compostela (IDIS), Universidade De Santiago De Compostela, Santiago De Compostela, Spain
| | - Carmen Alvarez-Lorenzo
- Departamento De Farmacología, Farmacia Y Tecnología Farmacéutica, I+D FarmaGroup, Facultad De Farmacia and Health Research Institute of Santiago De Compostela (IDIS), Universidade De Santiago De Compostela, Santiago De Compostela, Spain
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Vincent SJ, Cho P, Chan KY, Fadel D, Ghorbani-Mojarrad N, González-Méijome JM, Johnson L, Kang P, Michaud L, Simard P, Jones L. CLEAR - Orthokeratology. Cont Lens Anterior Eye 2021; 44:240-269. [DOI: 10.1016/j.clae.2021.02.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 02/01/2021] [Indexed: 12/25/2022]
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Jones L, Hui A, Phan CM, Read ML, Azar D, Buch J, Ciolino JB, Naroo SA, Pall B, Romond K, Sankaridurg P, Schnider CM, Terry L, Willcox M. CLEAR - Contact lens technologies of the future. Cont Lens Anterior Eye 2021; 44:398-430. [PMID: 33775384 DOI: 10.1016/j.clae.2021.02.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 02/01/2021] [Indexed: 12/20/2022]
Abstract
Contact lenses in the future will likely have functions other than correction of refractive error. Lenses designed to control the development of myopia are already commercially available. Contact lenses as drug delivery devices and powered through advancements in nanotechnology will open up further opportunities for unique uses of contact lenses. This review examines the use, or potential use, of contact lenses aside from their role to correct refractive error. Contact lenses can be used to detect systemic and ocular surface diseases, treat and manage various ocular conditions and as devices that can correct presbyopia, control the development of myopia or be used for augmented vision. There is also discussion of new developments in contact lens packaging and storage cases. The use of contact lenses as devices to detect systemic disease has mostly focussed on detecting changes to glucose levels in tears for monitoring diabetic control. Glucose can be detected using changes in colour, fluorescence or generation of electric signals by embedded sensors such as boronic acid, concanavalin A or glucose oxidase. Contact lenses that have gained regulatory approval can measure changes in intraocular pressure to monitor glaucoma by measuring small changes in corneal shape. Challenges include integrating sensors into contact lenses and detecting the signals generated. Various techniques are used to optimise uptake and release of the drugs to the ocular surface to treat diseases such as dry eye, glaucoma, infection and allergy. Contact lenses that either mechanically or electronically change their shape are being investigated for the management of presbyopia. Contact lenses that slow the development of myopia are based upon incorporating concentric rings of plus power, peripheral optical zone(s) with add power or non-monotonic variations in power. Various forms of these lenses have shown a reduction in myopia in clinical trials and are available in various markets.
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Affiliation(s)
- Lyndon Jones
- Centre for Ocular Research & Education (CORE), School of Optometry & Vision Science, University of Waterloo, Waterloo, Canada; Centre for Eye and Vision Research (CEVR), 17W Hong Kong Science Park, Hong Kong.
| | - Alex Hui
- School of Optometry and Vision Science, UNSW Sydney, Sydney, NSW, Australia
| | - Chau-Minh Phan
- Centre for Ocular Research & Education (CORE), School of Optometry & Vision Science, University of Waterloo, Waterloo, Canada; Centre for Eye and Vision Research (CEVR), 17W Hong Kong Science Park, Hong Kong
| | - Michael L Read
- Eurolens Research, Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Dimitri Azar
- Department of Ophthalmology and Visual Sciences, University of Illinois College of Medicine, Chicago, IL, USA; Verily Life Sciences, San Francisco, CA, USA
| | - John Buch
- Johnson & Johnson Vision Care, Jacksonville, FL, USA
| | - Joseph B Ciolino
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - Shehzad A Naroo
- College of Health and Life Sciences, Aston University, Birmingham B4 7ET, UK
| | - Brian Pall
- Johnson & Johnson Vision Care, Jacksonville, FL, USA
| | - Kathleen Romond
- Department of Ophthalmology and Visual Sciences, University of Illinois College of Medicine, Chicago, IL, USA
| | - Padmaja Sankaridurg
- School of Optometry and Vision Science, UNSW Sydney, Sydney, NSW, Australia; Brien Holden Vision Institute, Sydney, Australia
| | | | - Louise Terry
- School of Optometry and Vision Sciences, Cardiff University, UK
| | - Mark Willcox
- School of Optometry and Vision Science, UNSW Sydney, Sydney, NSW, Australia
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Is It Possible to Predict Progression of Childhood Myopia Using Short-Term Axial Change After Orthokeratology? Eye Contact Lens 2021; 46:136-140. [PMID: 31842031 DOI: 10.1097/icl.0000000000000665] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES To investigate changes in axial length in children undergoing orthokeratology (OK) and evaluate short-term axial change in predicting post-OK myopia progression. METHODS In this retrospective study, the subjects included 70 myopic children aged 8 to 15 years wearing OK contact lenses for more than 3 years. Axial length changes at 0.5, 1, 2, and 3 years relative to the baseline were measured. Patients were evaluated for age, spherical equivalent refraction (SER), pupil size, and half-year axial change using repeated analysis of variance and multivariate linear regression analysis to predict half to 3 year-axial elongation (AE, seventh-36th month post-OK). RESULTS The axial length grew significantly during the 3 years; the mean annual axial growth was 0.20±0.12 mm. The half-year axial change was 0.04±0.12 mm. The univariate linear analyses showed that half to 3-year AE was correlated with baseline age (r=-0.393, P<0.001) and half-year axial change (r=0.379, P=0.001), but not pupil diameter (P=0.692) or SER (P=0.673). In a multiple linear regression model, the half to 3-year AE was related with the baseline age (standardized β=-0.312, P=0.007) and half-year axial change (standardized β=0.293, P=0.01). The model was fair (adjusted R=0.21) and statistically significant (F=10.24, P<0.001). CONCLUSIONS It is practical to predict long-term AE with half-year axial change for children with OK correction. Therefore, this may aid in fast and timely measures in children who are predicted to have rapid myopia progression.
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Chen Z, Zhou J, Xue F, Qu X, Zhou X. Two-year add-on effect of using low concentration atropine in poor responders of orthokeratology in myopic children. Br J Ophthalmol 2021; 106:1069-1072. [PMID: 33707188 DOI: 10.1136/bjophthalmol-2020-317980] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 02/09/2021] [Accepted: 02/16/2021] [Indexed: 12/13/2022]
Abstract
METHODS Axial elongation in 73 eyes of 73 subjects who completed 3 years of orthokeratology (ortho-k) treatment was retrospectively reviewed. During their first year of ortho-k treatment (phase 1), they all demonstrated an axial elongation of 0.30 mm or greater. They were then divided into two groups: orthokeratology and atropine (OKA) group (n=37) being treated with nightly 0.01% atropine in addition to ortho-k treatment for another 2 years and orthokeratology (OK) group (n=36) continued to be treated with ortho-k without atropine (phase 2). Axial elongation over time and between groups was compared. RESULTS Baseline biometrics was similar between the two groups in phase 1 (all p>0.05). The mean axial elongation was 0.47±0.15, 0.21±0.15, 0.23±0.13 mm for the OKA group and 0.41±0.09, 0.30±0.11, 0.20±0.13 mm for the OK group during the first, second and third year, respectively. The cumulative axial elongation over 3 years was 0.91±0.30 mm for the OKA group and 0.91±0.24 mm for the OK group. The overall AL change was not significantly different between the two groups (p=0.262). Baseline myopic refractive error had a significant impact on axial elongation over 3 years of treatment (p<0.001). None of baseline age (p=0.129), lens design (p=0.890) or treatment modality (p=0.579) had a significant impact on axial elongation. CONCLUSIONS For fast myopia progressors and poor responders of ortho-k, combining 0.01% nightly atropine did not significantly change the3-year axial elongation outcome as compared to ortho-k mono-therapy.
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Affiliation(s)
- Zhi Chen
- Ophthalmology and Visual Science, Fudan University Eye Ear Nose and Throat Hospital, Shanghai, Shanghai, China
| | - Jiaqi Zhou
- Ophthalmology and Visual Science, Fudan University Eye Ear Nose and Throat Hospital, Shanghai, Shanghai, China
| | - Feng Xue
- Ophthalmology and Visual Science, Fudan University Eye Ear Nose and Throat Hospital, Shanghai, Shanghai, China
| | - Xiaomei Qu
- Ophthalmology and Visual Science, Fudan University Eye Ear Nose and Throat Hospital, Shanghai, Shanghai, China
| | - Xingtao Zhou
- Ophthalmology and Visual Science, Fudan University Eye Ear Nose and Throat Hospital, Shanghai, Shanghai, China
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Yang N, Bai J, Liu L. Low concentration atropine combined with orthokeratology in the treatment of axial elongation in children with myopia: A meta-analysis. Eur J Ophthalmol 2021; 32:221-228. [PMID: 33678055 DOI: 10.1177/1120672121998903] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To evaluate the effect of low concentration atropine combined with Orthokeratology (OK) lens compared with the OK lens on the changes of axial length in children with moderate and low myopia by meta-analysis. METHODS Databases such as PubMed, Web of Science, Embase, and Cochrane Library were comprehensively searched to collect related studies on atropine combined with the OK lens in the treatment of children with moderate and low myopia. The retrieval time was from the establishment of the database to December 2020. The standardized mean difference (SMD) and its 95% confidence interval (CI) were selected as the effect to analyze the changes of the axial length of the eye axis in children with low and moderate myopia treated with low concentration atropine combined with OK lens. RESULTS A total of eight articles were included in this study. Compared with OK lens treatment, low concentration atropine combined with the OK lens significantly slowed down the axial elongation of low and moderate myopia, SMD = -0.68(95% CI: -0.86--0.50, p < 0.05). According to the subgroup analysis of treatment time, when the treatment time was less than or equal to 6 months, SMD = -0.63(95% CI: -0.88--0.37, p < 0.05), when the treatment time was 1 year, SMD = -0.76(95% CI: -1.08--0.43, p < 0.05), and when the treatment time was 2 years, SMD = -0.69(95% CI: -1.07--0.31, p < 0.05). CONCLUSION Low concentration atropine combined with the OK lens is more effective than the OK lens in the treatment of children with low to moderate myopia in reducing axial elongation.
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Affiliation(s)
- Ning Yang
- Your Bright Eye Clinic of Chengdu Hi-tech Zone, Chengdu, Sichuan, China
| | | | - Li Liu
- Your Bright Eye Clinic of Chengdu Hi-tech Zone, Chengdu, Sichuan, China
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Gao C, Wan S, Zhang Y, Han J. The Efficacy of Atropine Combined With Orthokeratology in Slowing Axial Elongation of Myopia Children: A Meta-Analysis. Eye Contact Lens 2021; 47:98-103. [PMID: 33060414 DOI: 10.1097/icl.0000000000000746] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Previous studies have found that atropine can slow axial elongation and control the progression of myopia. Some ongoing trials have applied atropine combined with orthokeratology for myopia control, but few studies explored the effect of the strategy on axial elongation. This meta-analysis made a preliminary evaluation of the effect of atropine combined with orthokeratology on axial elongation to provide a reference for further researches. METHODS We performed a specific search on PubMed, EMBASE, Cochrane library, Web of Science, Ovid and Chinese electronic databases of VIP and Wanfang for randomized controlled trials, cohort studies and case-control studies conducted up to December 2019. The weighted mean difference (WMD) of mean change in axial elongation between the combination group of atropine and orthokeratology and the orthokeratology group was used for evaluation. Publication bias was detected using the Funnel plots test. RESULTS A total of five studies involving 341 participants younger than 18 years old met our inclusion criteria. The axial elongation was lower in the combination group of atropine and orthokeratology than that of the orthokeratology group (0.25 vs. 0.35; WMD=-0.09 mm, [95% confidence intervals, -0.15 to -0.04], Z=3.39, P=0.0007). CONCLUSIONS This meta-analysis demonstrates atropine combined with orthokeratology is effective in slowing axial elongation in myopia children. This effect may be superior to that of the orthokeratology alone.
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Affiliation(s)
- Canran Gao
- School of Clinical Medicine (C.G., S.W., Y.Z.), Capital Medical University, Beijing, China ; and Department of Ophthalmology (J.H.), Tangdu Hospital, the Air Force Medical University, Xi'an, Shaanxi, China
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Modjtahedi BS, Abbott RL, Fong DS, Lum F, Tan D. Reducing the Global Burden of Myopia by Delaying the Onset of Myopia and Reducing Myopic Progression in Children: The Academy's Task Force on Myopia. Ophthalmology 2020; 128:816-826. [PMID: 33388160 DOI: 10.1016/j.ophtha.2020.10.040] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 10/27/2020] [Accepted: 10/29/2020] [Indexed: 01/08/2023] Open
Abstract
In 2019, the American Academy of Ophthalmology (AAO) created the Task Force on Myopia in recognition of the substantial global increases in myopia prevalence and its associated complications. The Task Force, led by Richard L. Abbott, MD, and Donald Tan, MD, comprised recognized experts in myopia prevention and treatment, public health experts from around the world, and organization representatives from the American Academy of Family Physicians, American Academy of Optometry, and American Academy of Pediatrics. The Academy's Board of Trustees believes that myopia is a high-priority cause of visual impairment, warranting a timely evaluation and synthesis of the scientific literature and formulation of an action plan to address the issue from different perspectives. This includes education of physicians and other health care providers, patients and their families, schools, and local and national public health agencies; defining health policies to ameliorate patients' access to appropriate therapy and to promote effective public health interventions; and fostering promising avenues of research.
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Affiliation(s)
- Bobeck S Modjtahedi
- Department of Ophthalmology, Southern California Kaiser Permanente, Baldwin Park, California; Department of Research and Evaluation, Southern California Permanente Medical Group, Pasadena, California
| | - Richard L Abbott
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California
| | - Donald S Fong
- Department of Ophthalmology, Southern California Kaiser Permanente, Baldwin Park, California; Department of Research and Evaluation, Southern California Permanente Medical Group, Pasadena, California
| | - Flora Lum
- American Academy of Ophthalmology, San Francisco, California.
| | - Donald Tan
- Eye and Retina Surgeons, Singapore, Republic of Singapore
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Abstract
Myopia, also known as short-sightedness or near-sightedness, is a very common condition that typically starts in childhood. Severe forms of myopia (pathologic myopia) are associated with a risk of other associated ophthalmic problems. This disorder affects all populations and is reaching epidemic proportions in East Asia, although there are differences in prevalence between countries. Myopia is caused by both environmental and genetic risk factors. A range of myopia management and control strategies are available that can treat this condition, but it is clear that understanding the factors involved in delaying myopia onset and slowing its progression will be key to reducing the rapid rise in its global prevalence. To achieve this goal, improved data collection using wearable technology, in combination with collection and assessment of data on demographic, genetic and environmental risk factors and with artificial intelligence are needed. Improved public health strategies focusing on early detection or prevention combined with additional effective therapeutic interventions to limit myopia progression are also needed.
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Zhao C, Cai C, Ding Q, Dai H. Efficacy and safety of atropine to control myopia progression: a systematic review and meta-analysis. BMC Ophthalmol 2020; 20:478. [PMID: 33287746 PMCID: PMC7720573 DOI: 10.1186/s12886-020-01746-w] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 11/25/2020] [Indexed: 12/11/2022] Open
Abstract
Background The effect and safety of atropine on delaying the progression of myopia has been extensively studied, but its optimal dose is still unclear. Therefore, the purpose of this meta-analysis is to systematically evaluate the safety and effectiveness of atropine in controlling the progression of myopia, and to explore the relationship between the dose of atropine and the effectiveness of controlling the progression of myopia. Methods This work was done through the data searched from PubMed, MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials. The Cochrane Handbook was also used to evaluate the quality of the included studies. In addition, a meta-analysis was performed using Revman5.3 software. Results A total of 10 randomized controlled trials (RCTs) were included. Myopia progression was mitigated greater in the atropine treatment group than that in the control group, with MD = − 0.80, 95% CI (− 0.94, − 0.66) during the whole observation period. There was a statistical difference among 0.05, 0.5, and 1.0% atropine (P = 0.004). In addition, less axial elongation was shown, with MD = − 0.26, 95% CI (− 0.33, − 0.18) during the whole observation period. Conclusion The effectiveness of atropine in controlling the progression of myopia was dose related. A 0.05% atropine was likely to be the optimal dose.
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Affiliation(s)
- Congling Zhao
- Aier Eye Hospital of Wuhan university, Wuhan, Hubei Province, China
| | - Chunyan Cai
- Aier Eye Hospital of Wuhan university, Wuhan, Hubei Province, China
| | - Qiang Ding
- Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Hongbin Dai
- Aier Eye Hospital of Wuhan university, Wuhan, Hubei Province, China.
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Additive effect of atropine eye drops and short-term retinal defocus on choroidal thickness in children with myopia. Sci Rep 2020; 10:18310. [PMID: 33110130 PMCID: PMC7591535 DOI: 10.1038/s41598-020-75342-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 10/09/2020] [Indexed: 12/21/2022] Open
Abstract
Atropine eye drops and myopic retinal defocus each slow progression of myopia (short-sight). They also cause thickening of the choroid, and it has been suggested that the thickening is a precursor for reduced eye growth and slowed myopia progression. We investigated whether choroidal thickening due to optical defocus would add to thickening due to atropine when both were applied simultaneously. Addition would suggest that combining the two clinical treatments may improve efficacy of myopia control. We studied 20 children receiving 0.3% atropine daily for myopia control, over a period of 6 months. We imposed short periods of retinal defocus (1 h of myopic or hyperopic defocus (± 2.00D)) both before, and after 1 week and 3 and 6 months of atropine treatment. Prior to atropine, myopic or hyperopic defocus caused significantly thicker or thinner choroids respectively (± 12 µm, p < 0.001). After one week of atropine alone, thickness had increased (+ 21 µm; SD 17 µm; p < 0.001), and it increased further (by + 13 µm; SD 6 µm; p < 0.001) when exposed to myopic defocus. Atropine abolished choroidal thinning in response to hyperopic defocus. These effects remained the same after 3 and 6 months of atropine treatment. Our results show that additive effects of atropine and optical defocus are present at the level of the choroid, and suggest that combining optical and pharmaceutical treatments is likely to enhance efficacy of clinical myopia control.
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46
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Ruiz-Pomeda A, Villa-Collar C. Slowing the Progression of Myopia in Children with the MiSight Contact Lens: A Narrative Review of the Evidence. Ophthalmol Ther 2020; 9:783-795. [PMID: 32915454 PMCID: PMC7708530 DOI: 10.1007/s40123-020-00298-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Indexed: 12/16/2022] Open
Abstract
Myopia has become a major public health problem in the world due to the increase in its prevalence in the past few decades and due to sight-threatening pathologies associated with high myopia such as cataracts, glaucoma and especially myopic maculopathy. This article is a narrative review of the evidence that currently exists on a contact lenses (CLs) specifically designed to correct myopia and to slow its progression. To contextualise the topic we discuss the different classifications and definitions that have been used for myopia, the current burden of being myopic, and current treatment options to prevent and control its progression. There is evidence that exposure to sunlight reduces the risk of myopia onset and pharmacological treatment with atropine has been shown to be the most effective therapy for controlling its progression, followed by optical interventions such as CL fitting (orthokeratology or CLs specific for myopia control) designed to decrease retinal peripheral hyperopic defocus that seems to be the theory that suggests that axial elongation is driven by this defocus and explains why the eye continues to grow abnormally after emmetropisation and generates myopia. We will especially focus on MiSight CLs. MiSight is a daily replacement soft contact lens that has been clinically proven and approved by the US Food and Drug Administration (FDA) to control the progression of myopia in children. We analyse the optical design of MiSight CLs, as well as the results of the different efficacy and safety studies that led to the approval of the lens by the FDA. We also expose current knowledge gaps, limitations and future directions.
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Affiliation(s)
- Alicia Ruiz-Pomeda
- Department of Ophthalmology, Hospital Universitario de Mostoles, Mostoles, 28935, Madrid, Spain
| | - César Villa-Collar
- Department of Pharmacy, Biotechnology, Nutrition and Optics and Optometry, Universidad Europea de Madrid, Villaviciosa de Odón, 28670, Madrid, Spain.
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Vincent SJ, Tan Q, Ng ALK, Cheng GPM, Woo VCP, Cho P. Higher order aberrations and axial elongation in combined 0.01% atropine with orthokeratology for myopia control. Ophthalmic Physiol Opt 2020; 40:728-737. [PMID: 32888318 DOI: 10.1111/opo.12730] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 06/30/2020] [Accepted: 08/03/2020] [Indexed: 12/22/2022]
Abstract
PURPOSE To compare the changes in higher order aberrations (HOA's) for photopic and mesopic pupil diameters in children undergoing orthokeratology treatment (OK) or combined 0.01% atropine with orthokeratology treatment (AOK), and their association with axial elongation. METHODS Children aged 6 to <11 years with 1.00-4.00 D of myopia were randomly assigned to each treatment group. Photopic and mesopic pupil diameters were quantified using automated pupillometry and HOA's were measured with a Hartmann-Shack aberrometer and Badal system to control for accommodation. HOA's were rescaled to photopic and mesopic pupil diameters and fitted with a 6th order Zernike polynomial expansion. Axial length was measured using an optical biometer under cycloplegia. RESULTS Baseline and six-month data from 25 AOK and 28 OK participants were analysed. At the six-month visit, pupil diameter was larger in the AOK group under photopic conditions (3.70 ± 0.42 vs 3.12 ± 0.33 mm, p < 0.001), along with a range of HOA metrics [3rd to 6th order and higher order root mean square error values (HO RMS), all p ≤ 0.003] and individual Zernike terms (primary spherical aberration, and oblique quadrafoil, both p ≤ 0.03). Axial elongation was greater in the OK treatment group (0.05 ± 0.08 vs -0.01 ± 0.12 mm, p = 0.02). In the AOK group, axial elongation was correlated with the increase in photopic pupil diameter (r = -0.45, p = 0.02) and with several HOA metrics; however, these associations were not observed in the OK group. CONCLUSION AOK treatment resulted in increased photopic pupil size and HOA's, and significantly less axial elongation over a six-month period compared to OK treatment alone. The improved myopia control observed with combination 0.01% atropine and orthokeratology may be a result of an enhanced optical effect due to a larger photopic pupil size.
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Affiliation(s)
- Stephen J Vincent
- Contact Lens and Visual Optics Laboratory, School of Optometry and Vision Science, Centre for Vision and Eye Research, Queensland University of Technology, Brisbane, Australia
| | - Qi Tan
- School of Optometry, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Alex L K Ng
- Department of Ophthalmology, The University of Hong Kong, Hong Kong, Hong Kong.,Hong Kong Ophthalmic Associates, Hong Kong, Hong Kong
| | | | - Victor C P Woo
- Department of Ophthalmology, The University of Hong Kong, Hong Kong, Hong Kong.,Hong Kong Ophthalmic Associates, Hong Kong, Hong Kong
| | - Pauline Cho
- School of Optometry, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
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Wang S, Wang J, Wang N. Combined Orthokeratology with Atropine for children with Myopia: A Meta-analysis. Ophthalmic Res 2020; 64:723-731. [PMID: 32781450 DOI: 10.1159/000510779] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 08/10/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Myopia has become a worldwide public health issue, which is occurring at a younger age, leading to an increased risk of high myopia. Ocular complications associated with high myopia can lead to irreversible vision loss. It is urgent and critical to explore effective treatment to slow or even stop the progression of myopia in young children. OBJECTIVE To evaluate the additive effects of orthokeratology (OK) and 0.01% atropine ophthalmic solution for myopia in children. METHODS We searched PubMed, Cochrane Library, EMBASE, MEDLINE, Web of science, Ovid, EBSCO host, CNKI, CBM to collect eligible studies. Efficacy and safety were evaluated in terms of the axial length, uncorrected distant visual acuity, corneal endothelial cell density, and intraocular pressure. We calculated the weighted mean difference (WMD) and the 95% confidence intervals (CIs) of all outcomes, and plotted on forest plots. RESULTS Four studies were ultimately included, involving a total of 267 subjects. This meta-analysis revealed that the mean axial length of the subjects in the experimental group was 0.09 mm less than that of subjects in the control group [WMD=-0.09, 95%CI (-0.15, -0.03), P=0.003]. There was no significant difference in uncorrected distant visual acuity, corneal endothelial cell density, and intraocular pressure between the two groups [WMD was -0.01 (95% CI: -0.03, 0.01), 11.75 (95% CI: -4.09, 27.58), 0.12 (95% CI: -0.40, 0.63), respectively]. None of the studies reported severe adverse events. CONCLUSION Our study suggests that the combination of OK and 0.01% atropine is more effective in slowing axial elongation than OK monotherapy in children with myopia in a relatively short duration of treatment. In addition, the combination therapy has no negative influence on uncorrected distant visual acuity, corneal endothelial cell density, and intraocular pressure.
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Affiliation(s)
- Suzhen Wang
- Eye School of Chengdu University of Traditional Chinese Medicine, Ineye Hospital of Chengdu University of Traditional Chinese Medicine, Key Laboratory of Sichuan Province Ophthalmopathy Prevention & Cure and Visual Function Protection, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Jie Wang
- Aier Eye Hospital (East of Chengdu), Chengdu, China
| | - Ningli Wang
- Eye School of Chengdu University of Traditional Chinese Medicine, Ineye Hospital of Chengdu University of Traditional Chinese Medicine, Key Laboratory of Sichuan Province Ophthalmopathy Prevention & Cure and Visual Function Protection, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
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Tan Q, Ng AL, Choy BN, Cheng GP, Woo VC, Cho P. One-year results of 0.01% atropine with orthokeratology (AOK) study: a randomised clinical trial. Ophthalmic Physiol Opt 2020; 40:557-566. [PMID: 32776533 DOI: 10.1111/opo.12722] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 06/29/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE To report the 1-year results of an investigation into whether there is an additive effect between 0.01% atropine and orthokeratology (ortho-k), in a single-masked, two-arm, randomised controlled trial: Combined Atropine with Orthokeratology (AOK) for myopia control study (ClinicalTrials.gov number: NCT02955927). METHODS Chinese children aged between 6 and 11 years with 1.00-4.00 D of myopia, astigmatism <2.50 D, and no more than 1.00 D anisometropia, were randomly assigned either to an AOK group or ortho-k only (OK) group at a 1:1 ratio. Subjects in the AOK group instilled one drop of 0.01% atropine into each eye, 10 min before nightly wear of ortho-k lenses. The primary outcome, axial elongation, was examined at 6-monthly intervals, along with secondary outcomes including best-corrected visual acuity (BCVA), manifest refraction, accommodation, pupil size, and corneal topography. RESULTS 29 AOK and 30 OK subjects completed the 1-year visit. The overall axial elongation rate was significantly slower in the AOK group than in the OK group (mean (S.D.), 0.07 (0.16) mm vs 0.16 (0.15) mm, respectively; p = 0.03). A significant between-group difference in axial elongation was observed over the first 6-month period only (p < 0.001), but not over the second period (p = 0.818). At the 1-year visit, increases in mean (S.D.) mesopic and photopic pupil sizes in the AOK group were 0.64 (0.48) mm and 0.36 (0.34) mm, respectively, which were significantly higher than 0.10 (0.50) mm and 0.02 (0.28) mm in the OK group (p < 0.001). At the 6-month visit, a significant moderate negative correlation was found between axial elongation and the increase in photopic pupil size (r = -0.42, p = 0.02) in the AOK group. CONCLUSIONS There is an additive effect between 0.01% atropine and ortho-k over one year, with mean axial elongation in the AOK group 0.09 mm slower than that in the OK group. It appears that the additive effect was only during the first six months; a second-year investigation is warranted to determine whether the effect is sustained over time.
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Affiliation(s)
- Qi Tan
- School of Optometry, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Alex Lk Ng
- Department of Ophthalmology, The University of Hong Kong, Hong Kong SAR, China.,Hong Kong Ophthalmic Associates, Hong Kong SAR, China
| | - Bonnie Nk Choy
- Department of Ophthalmology, The University of Hong Kong, Hong Kong SAR, China
| | | | - Victor Cp Woo
- Department of Ophthalmology, The University of Hong Kong, Hong Kong SAR, China.,Hong Kong Ophthalmic Associates, Hong Kong SAR, China
| | - Pauline Cho
- School of Optometry, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
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Kinoshita N, Konno Y, Hamada N, Kanda Y, Shimmura-Tomita M, Kaburaki T, Kakehashi A. Efficacy of combined orthokeratology and 0.01% atropine solution for slowing axial elongation in children with myopia: a 2-year randomised trial. Sci Rep 2020; 10:12750. [PMID: 32728111 PMCID: PMC7391648 DOI: 10.1038/s41598-020-69710-8] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Accepted: 07/17/2020] [Indexed: 02/07/2023] Open
Abstract
Eighty Japanese children, aged 8–12 years, with a spherical equivalent refraction (SER) of − 1.00 to − 6.00 dioptres (D) were randomly allocated into two groups to receive either a combination of orthokeratology (OK) and 0.01% atropine solution (combination group) or monotherapy with OK (monotherapy group). Seventy-three subjects completed the 2-year study. Over the 2 years, axial length increased by 0.29 ± 0.20 mm (n = 38) and 0.40 ± 0.23 mm (n = 35) in the combination and monotherapy groups, respectively (P = 0.03). Interactions between combination treatment and age or SER did not reach significance level (age, P = 0.18; SER, P = 0.06). In the subgroup of subjects with an initial SER of − 1.00 to − 3.00 D, axial length increased by 0.30 ± 0.22 mm (n = 27) and 0.48 ± 0.22 mm (n = 23) in the combination and monotherapy groups, respectively (P = 0.005). In the − 3.01 to − 6.00 D subgroup, axial length increased by 0.27 ± 0.15 mm (n = 11) and 0.25 ± 0.17 mm (n = 12) in the combination and monotherapy groups, respectively (P = 0.74). The combination therapy may be effective for slowing axial elongation, especially in children with low initial myopia.
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Affiliation(s)
- Nozomi Kinoshita
- Department of Ophthalmology, Saitama Medical Centre, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama-shi, Saitama, 330-8503, Japan.
| | | | | | - Yoshinobu Kanda
- Department of Hematology, Saitama Medical Centre, Jichi Medical University, Saitama, Japan
| | - Machiko Shimmura-Tomita
- Department of Ophthalmology, Saitama Medical Centre, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama-shi, Saitama, 330-8503, Japan
| | - Toshikatsu Kaburaki
- Department of Ophthalmology, Saitama Medical Centre, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama-shi, Saitama, 330-8503, Japan
| | - Akihiro Kakehashi
- Department of Ophthalmology, Saitama Medical Centre, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama-shi, Saitama, 330-8503, Japan
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