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Ma J, Yang X, Liu Z, Fu H, Fan S, Wang K, Li Y, Huang L, Zhao M. The Impact of Vergence Dysfunction on Myopia Control in Children Wearing Defocus Spectacle Lenses. Clin Ophthalmol 2024; 18:799-807. [PMID: 38495679 PMCID: PMC10944170 DOI: 10.2147/opth.s453731] [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: 12/07/2023] [Accepted: 02/28/2024] [Indexed: 03/19/2024] Open
Abstract
Purpose To investigate the impact of vergence dysfunction on myopia progression in children with Defocus incorporated multiple segments (DIMS) spectacle lenses. Patients and Methods We retrospectively enrolled children prescribed DIMS spectacle lenses to slow myopic progression. Baseline vergence dysfunction was determined according to phoria at distance and near. Axial length (AL) measurement and cycloplegic subjective refraction were performed before fitting the lenses and at six-month and one-year follow-ups. The six-month and one-year AL and spherical equivalent (SE) change from baseline were calculated and compared in subgroups stratified with the type of vergence dysfunction. Results Two hundred and ninety-two myopic children were included. Significant AL elongation and SE progression were observed at six months and one year (P < 0.05 for all comparisons). Multiple regression demonstrated that AL elongation at six months (P < 0.001) and one year (P < 0.001) was negatively correlated with age, and SE progression at six months was associated with age (P = 0.002). The AL elongation at six months in children with convergence excess was significantly greater than in normal myopic subjects (P = 0.011) and subjects with convergence insufficiency (P = 0.008), divergence excess (P = 0.007), divergence insufficiency (P = 0.024) and basic esophoria (P = 0.048) at six months. Conclusion The present research demonstrated that vergence dysfunction influences myopia progression for myopic children with DIMS, and the children with convergence excess suffer from the greatest myopia progression among different types of vergence dysfunction.
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Affiliation(s)
- Jiahui Ma
- Department of Ophthalmology, Peking University People’s Hospital, Beijing, People’s Republic of China
- Eye Diseases and Optometry Institute, Peking University People’s Hospital, Beijing, People’s Republic of China
- Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, People’s Republic of China
- College of Optometry, Peking University Health Science Center, Beijing, People’s Republic of China
| | - Xue Yang
- Department of Ophthalmology, Peking University International Hospital, Beijing, People’s Republic of China
| | - Zhiming Liu
- Department of Ophthalmology, Peking University People’s Hospital, Beijing, People’s Republic of China
- Eye Diseases and Optometry Institute, Peking University People’s Hospital, Beijing, People’s Republic of China
- Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, People’s Republic of China
- College of Optometry, Peking University Health Science Center, Beijing, People’s Republic of China
| | - Hao Fu
- Department of Ophthalmology, Peking University People’s Hospital, Beijing, People’s Republic of China
- Eye Diseases and Optometry Institute, Peking University People’s Hospital, Beijing, People’s Republic of China
- Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, People’s Republic of China
- College of Optometry, Peking University Health Science Center, Beijing, People’s Republic of China
| | - Sizhou Fan
- Department of Ophthalmology, Peking University People’s Hospital, Beijing, People’s Republic of China
- Eye Diseases and Optometry Institute, Peking University People’s Hospital, Beijing, People’s Republic of China
- Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, People’s Republic of China
- College of Optometry, Peking University Health Science Center, Beijing, People’s Republic of China
| | - Kai Wang
- Department of Ophthalmology, Peking University People’s Hospital, Beijing, People’s Republic of China
- Eye Diseases and Optometry Institute, Peking University People’s Hospital, Beijing, People’s Republic of China
- Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, People’s Republic of China
- College of Optometry, Peking University Health Science Center, Beijing, People’s Republic of China
| | - Yan Li
- Department of Ophthalmology, Peking University People’s Hospital, Beijing, People’s Republic of China
- Eye Diseases and Optometry Institute, Peking University People’s Hospital, Beijing, People’s Republic of China
- Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, People’s Republic of China
- College of Optometry, Peking University Health Science Center, Beijing, People’s Republic of China
| | - Lvzhen Huang
- Department of Ophthalmology, Peking University People’s Hospital, Beijing, People’s Republic of China
- Eye Diseases and Optometry Institute, Peking University People’s Hospital, Beijing, People’s Republic of China
- Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, People’s Republic of China
- College of Optometry, Peking University Health Science Center, Beijing, People’s Republic of China
| | - Mingwei Zhao
- Department of Ophthalmology, Peking University People’s Hospital, Beijing, People’s Republic of China
- Eye Diseases and Optometry Institute, Peking University People’s Hospital, Beijing, People’s Republic of China
- Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, People’s Republic of China
- College of Optometry, Peking University Health Science Center, Beijing, People’s Republic of China
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Sánchez-Tena MÁ, Cleva JM, Villa-Collar C, Álvarez M, Ruiz-Pomeda A, Martinez-Perez C, Andreu-Vazquez C, Chamorro E, Alvarez-Peregrina C. Effectiveness of a Spectacle Lens with a Specific Asymmetric Myopic Peripheral Defocus: 12-Month Results in a Spanish Population. CHILDREN (BASEL, SWITZERLAND) 2024; 11:177. [PMID: 38397289 PMCID: PMC10887607 DOI: 10.3390/children11020177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/10/2024] [Accepted: 01/26/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND Different designs of ophthalmic lenses have been studied to control the progression of myopia in children. This study aims to evaluate the short-term efficacy of a new design of ophthalmic lens with asymmetric myopic peripheral defocus (MPDL) on myopia progression in children compared to a control group wearing a single-vision lens (SVL). METHODS Children aged 5 to 12 with myopia up to -0.50 D, astigmatism and anisometropia under 1.50 D, and corrected visual acuity over 20/20 were randomized to either the study group (MPDL) or control group (SVL). The myopia progression was evaluated by measuring axial length (AL) growth (IOL Master; Zeiss) over a period of one year. RESULTS Ninety-two subjects were recruited. Forty-six children were randomly assigned to the control group, and 46 to the study group. In total, 83 children completed the clinical trial, with a mean age of 10.81 [9.53-11.92] years, among which 59.04% were female. After one year of treatment, there was less AL elongation in the study group compared to the control group (0.16 ± 0.16 mm vs. 0.24 ± 0.16 mm, p = 0.034). CONCLUSIONS The MPDL significantly reduced the absolute growth of AL by 39% (p = 0.014) and relative growth of AL by 37.3% (p = 0.012) after 12 months in comparison to the control group in a Spanish population.
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Affiliation(s)
- Miguel Ángel Sánchez-Tena
- Department of Optometry and Vision, Faculty of Optics and Optometry, Universidad Complutense de Madrid, 28037 Madrid, Spain; (M.Á.S.-T.); (A.R.-P.); (C.A.-P.)
- ISEC LISBOA-Instituto Superior de Educação e Ciências, 1750-179 Lisbon, Portugal;
| | - Jose Miguel Cleva
- Clinical Research Department, Indizen Optical Technologies, 28002 Madrid, Spain; (M.Á.); (E.C.)
| | - Cesar Villa-Collar
- Faculty of Biomedical and Health Science, Universidad Europea de Madrid, 28670 Madrid, Spain;
| | - Marta Álvarez
- Clinical Research Department, Indizen Optical Technologies, 28002 Madrid, Spain; (M.Á.); (E.C.)
| | - Alicia Ruiz-Pomeda
- Department of Optometry and Vision, Faculty of Optics and Optometry, Universidad Complutense de Madrid, 28037 Madrid, Spain; (M.Á.S.-T.); (A.R.-P.); (C.A.-P.)
| | - Clara Martinez-Perez
- ISEC LISBOA-Instituto Superior de Educação e Ciências, 1750-179 Lisbon, Portugal;
| | - Cristina Andreu-Vazquez
- Faculty of Biomedical and Health Science, Universidad Europea de Madrid, 28670 Madrid, Spain;
| | - Eva Chamorro
- Clinical Research Department, Indizen Optical Technologies, 28002 Madrid, Spain; (M.Á.); (E.C.)
| | - Cristina Alvarez-Peregrina
- Department of Optometry and Vision, Faculty of Optics and Optometry, Universidad Complutense de Madrid, 28037 Madrid, Spain; (M.Á.S.-T.); (A.R.-P.); (C.A.-P.)
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3
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Ramasubramanian V, Logan NS, Jones S, Meyer D, Jaskulski M, Rickert M, Chamberlain P, Arumugam B, Bradley A, Kollbaum PS. Myopia Control Dose Delivered to Treated Eyes by a Dual-focus Myopia-control Contact Lens. Optom Vis Sci 2023; 100:376-387. [PMID: 37097975 PMCID: PMC10317304 DOI: 10.1097/opx.0000000000002021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023] Open
Abstract
PURPOSE This study examined the optical impact of a DF contact lens during near viewing in a sample of habitual DF lens wearing children. METHODS Seventeen myopic children aged 14 to 18 years who had completed 3 or 6 years of treatment with a DF contact lens (MiSight 1 Day; CooperVision, Inc., San Ramon, CA) were recruited and fit bilaterally with the DF and a single-vision (Proclear 1 Day; CooperVision, Inc.) contact lens. Right eye wavefronts were measured using a pyramidal aberrometer (Osiris; CSO, Florence, Italy) while children accommodated binocularly to high-contrast letter stimuli at five target vergences. Wavefront error data were used to compute pupil maps of refractive state. RESULTS During near viewing, children wearing single-vision lenses accommodated on average to achieve approximate focus in the pupil center but, because of combined accommodative lag and negative spherical aberration, experienced up to 2.00 D of hyperopic defocus in the pupil margins. With DF lenses, children accommodated similarly achieving approximate focus in the pupil center. When viewing three near distances (0.48, 0.31, and 0.23 m), the added +2.00 D within the DF lens treatment optics shifted the mean defocus from +0.75 to -1.00 D. The DF lens reduced the percentage of hyperopic defocus (≥+0.75 D) in the retinal image from 52 to 25% over these target distances, leading to an increase in myopic defocus (≤-0.50 D) from 17 to 42%. CONCLUSIONS The DF contact lens did not alter the accommodative behavior of children. The treatment optics introduced myopic defocus and decreased the amount of hyperopically defocused light in the retinal image.
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Affiliation(s)
| | - Nicola S. Logan
- School of Optometry, Aston University, Birmingham, United Kingdom
| | - Susie Jones
- School of Optometry, Aston University, Birmingham, United Kingdom
| | - Dawn Meyer
- School of Optometry, Indiana University Bloomington, Bloomington, Indiana
| | - Matt Jaskulski
- School of Optometry, Indiana University Bloomington, Bloomington, Indiana
| | - Martin Rickert
- School of Optometry, Indiana University Bloomington, Bloomington, Indiana
| | | | | | | | - Pete S. Kollbaum
- School of Optometry, Indiana University Bloomington, Bloomington, Indiana
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4
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Vera-Diaz FA, Jnawali A, Panorgias A, Bex PJ, Kerber KL. Baseline metrics that may predict future myopia in young children. Ophthalmic Physiol Opt 2023; 43:466-481. [PMID: 36892148 PMCID: PMC10416753 DOI: 10.1111/opo.13113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 02/03/2023] [Accepted: 02/06/2023] [Indexed: 03/10/2023]
Abstract
PURPOSE We used baseline data from the PICNIC longitudinal study to investigate structural, functional, behavioural and heritable metrics that may predict future myopia in young children. METHODS Cycloplegic refractive error (M) and optical biometry were obtained in 97 young children with functional emmetropia. Children were classified as high risk (HR) or low risk (LR) for myopia based on parental myopia and M. Other metrics included axial length (AXL), axial length/corneal radius (AXL/CR) and refractive centile curves. RESULTS Based on the PICNIC criteria, 46 children (26 female) were classified as HR (M = +0.62 ± 0.44 D, AXL = 22.80 ± 0.64 mm) and 51 (27 female) as LR (M = +1.26 ± 0.44 D, AXL = 22.77 ± 0.77 mm). Based on centiles, 49 children were HR, with moderate agreement compared with the PICNIC classification (k = 0.65, p < 0.01). ANCOVA with age as a covariate showed a significant effect for AXL (p < 0.01), with longer AXL and deeper anterior chamber depth (ACD) (p = 0.01) in those at HR (differences AXL = 0.16 mm, ACD = 0.13 mm). Linear regression models showed that central corneal thickness (CCT), ACD, posterior vitreous depth (PVD) (=AXL - CCT - ACD-lens thickness (LT)), corneal radius (CR) and age significantly predicted M (R = 0.64, p < 0.01). Each 1.00 D decrease in hyperopia was associated with a 0.97 mm elongation in PVD and 0.43 mm increase in CR. The ratio AXL/CR significantly predicted M (R = -0.45, p < 0.01), as did AXL (R = -0.25, p = 0.01), although to a lesser extent. CONCLUSIONS Although M and AXL were highly correlated, the classification of pre-myopic children into HR or LR was significantly different when using each parameter, with AXL/CR being the most predictive metric. At the end of the longitudinal study, we will be able to assess the predictability of each metric.
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Affiliation(s)
| | | | | | - Peter J. Bex
- College of Science, Northeastern University, Boston, Massachusetts, USA
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5
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Gajjar S, Ostrin LA. A systematic review of near work and myopia: measurement, relationships, mechanisms and clinical corollaries. Acta Ophthalmol 2022; 100:376-387. [PMID: 34622560 DOI: 10.1111/aos.15043] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 09/02/2021] [Accepted: 09/22/2021] [Indexed: 12/17/2022]
Abstract
After decades of investigation, the role of near work in myopia remains unresolved, with some studies reporting no relationship and others finding the opposite. This systematic review is intended to summarize classic and recent literature investigating near work and the onset and progression of myopia, potential mechanisms and pertinent clinical recommendations. The impact of electronic device use is considered. PubMed and Medline were used to find peer-reviewed cross-sectional and longitudinal studies related to near work and myopia from 1980 to July 2020 using the PRISMA checklist. Studies were chosen using the Joanna Briggs Institute checklist, with a focus on studies with a sample size greater than 50. Studies were independently evaluated; conclusions were drawn per these evaluations. Numerous cross-sectional studies found increased odds ratio of myopia with increased near work. While early longitudinal studies failed to find this relationship, more recent longitudinal studies have found a relationship between myopia and near work. Rather than daily duration of near work, interest has increased regarding absolute working distance and duration of continuous near viewing. Several reports have found that shorter working distances (<30 cm) and continuous near-work activity (>30 min) are risk factors for myopia onset and progression. Novel objective continuously measuring rangefinding devices have been developed to better address these questions. The literature is conflicting, likely due to the subjective and variable nature in which near work has been quantified and a paucity of longitudinal studies. We conclude that more precise objective measures of near viewing behaviour are necessary to make definitive conclusions regarding the relationship between myopia and near work. Focus should shift to utilizing objective and continuously measuring instruments to quantify near-work behaviours in children, followed longitudinally, to understand the complex factors related to near work. A better understanding of the roles of absolute working distance, temporal properties, viewing breaks and electronic device use on myopia development and progression will aid in the development of evidence-based clinical recommendations for behavioural modifications to prevent and slow myopia.
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Affiliation(s)
- Shail Gajjar
- University of Houston College of Optometry Houston TX USA
| | - Lisa A. Ostrin
- University of Houston College of Optometry Houston TX USA
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Overview on Defocus Incorporated Multiple Segments Lenses: A Novel Perspective in Myopia Progression Management. Vision (Basel) 2022; 6:vision6020020. [PMID: 35466272 PMCID: PMC9036268 DOI: 10.3390/vision6020020] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/09/2022] [Accepted: 03/30/2022] [Indexed: 11/16/2022] Open
Abstract
Myopia is becoming more common across the world, affecting approximately two billion people and rising. Different kinds of therapies (optical, pharmaceutical, environmental, or behavioral) have been proposed to decrease myopia progression, but with variable results and a lack of standardization. The evidence that targeted myopic defocus inhibits eye length growth has paved the way for several contact and spectacle lense designs to induce a peripheral defocus, thus slowing myopia progression, but the perfect configuration has yet to be defined. One of the newest and more promising approaches in this field is the use of Defocus Incorporated Multiple Segments (DIMS) lenses. These lenses are built from the assumption that targeted myopic defocus, produced by 396 mid-peripheral lenslets with positive power, inhibits eye length growth. Recent studies have highlighted the effectiveness of these lenses compared to children who had worn single vision spectacle lenses, in terms of myopia control and tolerability. Despite the evidence that these lenses can help slow down the progression of myopia, the occasional mid-peripheral aberrations they can induce, as well as the overall eye strain that comes with wearing them, should not be overlooked. The aim of this review is to give attention to the advantages and the shortfalls of this new approach and to evaluate its effectiveness in clinical practice.
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Abstract
SIGNIFICANCE This study will enhance our understanding of the effects of orthokeratology lens design on corneal profile, results of which may be useful in developing future orthokeratology lens designs. PURPOSE To evaluate the effect of lens design on corneal power distribution after orthokeratology using mathematical methods. METHODS Sixty-five subjects were enrolled in this prospective study and assigned to four groups: Euclid with 6.2 mm back optic zone diameter (aged below 14 years), Euclid with 6.2 mm back optic zone diameter (aged above 14 years), Double Tear Reservoir Lens (DRL) with 5.0 mm back optic zone diameter and DRL with 6.0 mm back optic zone diameter. Manifest refraction and corneal topography were checked at baseline and 1 day, 1 week, 2 week, 1 month after lens wear. Relative corneal refractive power change was calculated by a polynomial function and a monomial function. The maximum Relative corneal refractive power change (Ymax) and the corresponding distance from the corneal center (Xmax) were analyzed. Relative corneal refractive power change over time and between groups were compared using repeated measures ANOVA. RESULTS Refractive reduction and central corneal flattening was seen at all follow-up visits after orthokeratology lens wear, being fastest in the 5.0 mm back optic zone diameter group (P < .001). The cornea steepened in an aspheric way towards the mid-periphery and peaked at approximately 2 to 3 mm off the apex. Overall, Ymax was not different among the four groups, but Xmax was smallest in the 5.0 mm back optic zone diameter group (P < .001). At 1/2 Xmax, relative corneal refractive power change of 5.0 mm back optic zone diameter design was significantly higher than that of the other three groups (P < .001). The power exponent of the monomial of the 5.0 mm back optic zone diameter design was greater than that of the other three groups (P < .001). CONCLUSIONS An orthokeratology lens design with smaller back optic zone diameter might yield a faster myopic reduction and a smaller aspheric treatment zone.
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8
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Sah RP, Jaskulski M, Kollbaum PS. Modelling the refractive and imaging impact of multi-zone lenses utilised for myopia control in children's eyes. Ophthalmic Physiol Opt 2022; 42:571-585. [PMID: 35170789 PMCID: PMC9544677 DOI: 10.1111/opo.12959] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 01/10/2022] [Accepted: 01/11/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE To develop an optical model of a child's eye to reveal the impact of target distance and accommodative behaviour on retinal image quality when fitted with multi-zone lenses. METHODS Pupil size, aberration levels and accommodative lag were adjusted for models viewing stimuli at 400, 100, 33 and 20 cm. Distributions of defocus across the pupil and simulated retinal images were obtained. An equivalent 16-point letter was imaged at near viewing distances, while a 0.00 logMAR (6/6) letter was imaged at 400 cm. Multi-zone lenses included those clinically utilised for myopia control (e.g., dual-focus, multi-segmented and aspherical optics). RESULTS Viewing distance adjustments to model spherical aberration (SA) and pupil radius resulted in a model eye with wider defocus distributions at closer viewing distances, especially at 20 cm. The increasing negative SA at near reduced the effective add power of dual-focus lenses, reducing the amount of myopic defocus introduced by the centre-distance, 2-zone design. The negative SA at near largely compensated for the high positive SA introduced by the aspheric lens, removing most myopic defocus when viewing at near. A 0.50 D accommodative lag had little impact on the legibility of typical text (16-point) at the closer viewing distances. CONCLUSIONS All four multi-zone lenses successfully generated myopic defocus at greater viewing distances, but two failed to introduce significant amounts of myopic defocus at the nearest viewing distance due to the combined effects of pupil miosis and negative SA. Typical 16-point type is easily legible at near even in presence of the multi-zone optics of lenses utilised for myopia control and accommodative lag.
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Affiliation(s)
- Raman Prasad Sah
- School of Optometry, Indiana University, Bloomington, Indiana, USA
| | - Matt Jaskulski
- School of Optometry, Indiana University, Bloomington, Indiana, USA
| | - Pete S Kollbaum
- School of Optometry, Indiana University, Bloomington, Indiana, USA
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Choi KY, Chun RKM, Tang WC, To CH, Lam CSY, Chan HHL. Evaluation of an Optical Defocus Treatment for Myopia Progression Among Schoolchildren During the COVID-19 Pandemic. JAMA Netw Open 2022; 5:e2143781. [PMID: 35029662 PMCID: PMC8760616 DOI: 10.1001/jamanetworkopen.2021.43781] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
IMPORTANCE Myopia progression has been found to be worsening during the COVID-19 pandemic. It is important to control the rapid myopia progression in this period. OBJECTIVE To analyze the association of COVID-19-related lockdown measures with myopia progression in schoolchildren and to compare the performance of defocus incorporated multiple segments (DIMS) lens with that of single vision lens (SVL) treatment in reducing myopia progression. DESIGN, SETTING, AND PARTICIPANTS This cohort study involved an exploratory, prespecified, comparison of 2 independent longitudinal studies performed at the same institute beginning in 2019. Data from Hong Kong schoolchildren (aged 7-13 years) were gathered and analyzed. Data analysis was performed from June to July 2021. EXPOSURE Schoolchildren in study 1 wore a DIMS lens for 18 months, and those in study 2 wore a SVL for 24 months. MAIN OUTCOMES AND MEASURES Cycloplegic spherical equivalent refraction and axial length were measured. Studies 1 and 2 started before the start of lockdown measures and continued throughout the lockdown. In both studies, periods of fewer and more COVID-19-related lockdown measures were identified. Because COVID-19 lockdown caused deviations from the visit schedule, myopia progression was normalized to 12-month change, which were compared between DIMS and SVL groups, also during the periods with less and more lockdown time. RESULTS There were 115 participants (58 girls [50.4%]; mean [SD] age, 10.3 [1.5] years) in the DIMS group; their mean (SD) baseline refraction was -4.02 (1.46) D. There were 56 participants (29 girls [51.8%]; mean [SD] age, 10.8 [1.5] years) in the SVL group; their mean (SD) baseline refraction was -2.99 (1.06) D. After controlling for the covariates, DIMS treatment was significantly associated with 34% less axial elongation (0.19 mm [95% CI, 0.16 to 0.22 mm] vs 0.30 mm [95% CI, 0.25 to 0.35 mm]; P < .001) and 46% less myopic progression after 12 months (-0.31 D [95% CI, -0.39 to -0.23 D] vs -0.57 D [95% CI, -0.69 to -0.45 D]; P = .001) compared with SVL treatment. In both the DIMS and SVL groups, more lockdown time was associated with significantly more spherical equivalent refraction (-0.54 D [95% CI, -0.64 to 0.44 D] vs -0.34 D [95% CI, -0.44 to -0.25 D]; P = .01) and axial length (0.29 mm [95% CI, 0.25 to 0.32 mm] vs 0.20 mm [95% CI, 0.16 to 0.24 mm]; P = .001) compared with less lockdown time. No significant interaction between treatment type and lockdown time was observed. CONCLUSIONS AND RELEVANCE In this exploratory analysis, myopia progressed more rapidly in schoolchildren during the period when there were more COVID-19-related lockdown measures. However, optical treatment with DIMS was significantly associated with slower myopia progression compared with SVL treatment during the lockdown period.
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Affiliation(s)
- Kai Yip Choi
- Centre for Myopia Research, School of Optometry, The Hong Kong Polytechnic University, Hong Kong
| | - Rachel Ka Man Chun
- Centre for Myopia Research, School of Optometry, The Hong Kong Polytechnic University, Hong Kong
- Research Centre for SHARP Vision, The Hong Kong Polytechnic University, Hong Kong
- Centre for Eye and Vision Research, Hong Kong
| | - Wing Chun Tang
- Centre for Myopia Research, School of Optometry, The Hong Kong Polytechnic University, Hong Kong
| | - Chi Ho To
- Centre for Myopia Research, School of Optometry, The Hong Kong Polytechnic University, Hong Kong
- Research Centre for SHARP Vision, The Hong Kong Polytechnic University, Hong Kong
- Centre for Eye and Vision Research, Hong Kong
| | - Carly Siu-yin Lam
- Centre for Myopia Research, School of Optometry, The Hong Kong Polytechnic University, Hong Kong
- Research Centre for SHARP Vision, The Hong Kong Polytechnic University, Hong Kong
- Centre for Eye and Vision Research, Hong Kong
| | - Henry Ho-lung Chan
- Centre for Myopia Research, School of Optometry, The Hong Kong Polytechnic University, Hong Kong
- Research Centre for SHARP Vision, The Hong Kong Polytechnic University, Hong Kong
- Centre for Eye and Vision Research, Hong Kong
- University Research Facilities in Behavioral and Systems Neurosciences, The Hong Kong Polytechnic University, Hong Kong
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10
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Kaymak H, Graff B, Neller K, Langenbucher A, Seitz B, Schwahn H. [Myopia treatment and prophylaxis with defocus incorporated multiple segments spectacle lenses]. Ophthalmologe 2021; 118:1280-1286. [PMID: 34236491 PMCID: PMC8648703 DOI: 10.1007/s00347-021-01452-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 06/09/2021] [Accepted: 06/16/2021] [Indexed: 12/17/2022]
Abstract
Excessive axial eye growth in children and adolescents leads to progressive myopia and can result in severe ocular diseases in adulthood. Various strategies have already been developed to inhibit progression of myopia. The novel single vision lens presented in this article features the defocus incorporated multiple segments (DIMS) technology and adds an easy to use, noninvasive option to the portfolio of myopia treatment. Initial studies showed promising results with only a very low side effect profile.
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Affiliation(s)
- Hakan Kaymak
- Internationale Innovative Ophthalmochirurgie GbR, Theo-Champion-Str. 1, 40549, Düsseldorf, Deutschland.
- Institut für Experimentelle Ophthalmologie, Universitätsklinikum des Saarlandes UKS, Homburg/Saar, Deutschland.
| | - Birte Graff
- Internationale Innovative Ophthalmochirurgie GbR, Theo-Champion-Str. 1, 40549, Düsseldorf, Deutschland
- Institut für Experimentelle Ophthalmologie, Universitätsklinikum des Saarlandes UKS, Homburg/Saar, Deutschland
| | - Kai Neller
- Internationale Innovative Ophthalmochirurgie GbR, Theo-Champion-Str. 1, 40549, Düsseldorf, Deutschland
- Institut für Experimentelle Ophthalmologie, Universitätsklinikum des Saarlandes UKS, Homburg/Saar, Deutschland
| | - Achim Langenbucher
- Institut für Experimentelle Ophthalmologie, Universitätsklinikum des Saarlandes UKS, Homburg/Saar, Deutschland
| | - Berthold Seitz
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes UKS, Homburg/Saar, Deutschland
| | - Hartmut Schwahn
- Internationale Innovative Ophthalmochirurgie GbR, Theo-Champion-Str. 1, 40549, Düsseldorf, Deutschland
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11
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Hair LA, Steffensen EM, Berntsen DA. The Effects of Center-near and Center-distance Multifocal Contact Lenses on Peripheral Defocus and Visual Acuity. Optom Vis Sci 2021; 98:983-994. [PMID: 34393205 PMCID: PMC8405543 DOI: 10.1097/opx.0000000000001753] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
SIGNIFICANCE Multifocal contact lenses (MFCLs) are being used clinically for myopia control. Center-distance designs caused myopic changes in defocus across the retina that varied by lens design, whereas the center-near design caused peripheral hyperopic changes. Multifocal lenses caused reductions in low-contrast vision that varied by lens design, affecting visual performance. PURPOSE The purpose of this study was to compare changes in defocus with four MFCLs, three center-distance and one center-near. METHODS Two cohorts of 25 nonpresbyopic myopic adults were enrolled. The first cohort was fitted with Proclear D and Biofinity D MFCL (center-distance, +2.50 D add), and the second cohort was fitted with NaturalVue MFCL (center-distance) and Clariti 1-Day MFCL (center-near, high add), both in random order. Overrefraction was performed to maximize visual acuity. Cycloplegic autorefraction was performed with each lens and without a lens along the line of sight and at nasal and temporal retinal locations out to 40°. Data were analyzed with repeated-measures ANOVAs with post hoc t tests, when indicated. RESULTS Changes in defocus at each location differed between MFCL designs (lens by location; both, P < .001). Clariti 1-Day caused peripheral hyperopic retinal changes (40 and 30° nasal, and 20, 30, and 40° temporal; all, P < .05). NaturalVue MFCL caused myopic changes centrally and hyperopic changes at 40° nasal and 30° temporal (all, P < .05). The remaining center-distance designs caused myopic changes at multiple locations (all, P < .05). CONCLUSIONS After overrefraction, the center-near MFCL design caused hyperopic defocus at multiple peripheral locations, which is not hypothesized to slow myopia progression. NaturalVue MFCL caused myopic changes in defocus centrally but hyperopic changes in the far periphery. Biofinity D and Proclear D caused myopic changes in retinal defocus. Further work is warranted to determine whether defocus profile differences between the center-distance designs influence any slowing of myopia progression.
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Affiliation(s)
- Lea A Hair
- The Ocular Surface Institute, College of Optometry, University of Houston, Houston, Texas
| | - Elaine M Steffensen
- The Ocular Surface Institute, College of Optometry, University of Houston, Houston, Texas
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12
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Jonas JB, Ang M, Cho P, Guggenheim JA, He MG, Jong M, Logan NS, Liu M, Morgan I, Ohno-Matsui K, Pärssinen O, Resnikoff S, Sankaridurg P, Saw SM, Smith EL, Tan DTH, Walline JJ, Wildsoet CF, Wu PC, Zhu X, Wolffsohn JS. IMI Prevention of Myopia and Its Progression. Invest Ophthalmol Vis Sci 2021; 62:6. [PMID: 33909032 PMCID: PMC8083117 DOI: 10.1167/iovs.62.5.6] [Citation(s) in RCA: 123] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The prevalence of myopia has markedly increased in East and Southeast Asia, and pathologic consequences of myopia, including myopic maculopathy and high myopia-associated optic neuropathy, are now some of the most common causes of irreversible blindness. Hence, strategies are warranted to reduce the prevalence of myopia and the progression to high myopia because this is the main modifiable risk factor for pathologic myopia. On the basis of published population-based and interventional studies, an important strategy to reduce the development of myopia is encouraging schoolchildren to spend more time outdoors. As compared with other measures, spending more time outdoors is the safest strategy and aligns with other existing health initiatives, such as obesity prevention, by promoting a healthier lifestyle for children and adolescents. Useful clinical measures to reduce or slow the progression of myopia include the daily application of low-dose atropine eye drops, in concentrations ranging between 0.01% and 0.05%, despite the side effects of a slightly reduced amplitude of accommodation, slight mydriasis, and risk of an allergic reaction; multifocal spectacle design; contact lenses that have power profiles that produce peripheral myopic defocus; and orthokeratology using corneal gas-permeable contact lenses that are designed to flatten the central cornea, leading to midperipheral steeping and peripheral myopic defocus, during overnight wear to eliminate daytime myopia. The risk-to-benefit ratio needs to be weighed up for the individual on the basis of their age, health, and lifestyle. The measures listed above are not mutually exclusive and are beginning to be examined in combination.
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Affiliation(s)
- Jost B Jonas
- Department of Ophthalmology, Medical Faculty Mannheim, Heidelberg University, Germany
| | - Marcus Ang
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.,Department of Ophthalmology and Visual Science, Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Pauline Cho
- School of Optometry, The Hong Kong Polytechnic University, Hong Kong, China
| | - Jeremy A Guggenheim
- School of Optometry & Vision Sciences, Cardiff University, Cardiff, United Kingdom
| | - Ming Guang He
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Sun Yatsen University, Guangzhou, China.,Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
| | - Monica Jong
- Brien Holden Vision Institute, Sydney, Australia.,School of Optometry and Vision Science, University of New South Wales, Sydney, Australia.,Discipline of Optometry and Vision Science, University of Canberra, Australia
| | - Nicola S Logan
- School of Optometry, Aston University, Birmingham, United Kingdom
| | - Maria Liu
- School of Optometry, University of California, Berkeley, Berkeley, California, United States
| | - Ian Morgan
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Sun Yatsen University, Guangzhou, China.,Research School of Biology, College of Medicine, Biology and Environment, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Kyoko Ohno-Matsui
- Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Olavi Pärssinen
- Department of Ophthalmology, Central Hospital of Central Finland, Jyväskylä, Finland.,Gerontology Research Center and Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Serge Resnikoff
- Brien Holden Vision Institute, Sydney, Australia.,School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Padmaja Sankaridurg
- Brien Holden Vision Institute, Sydney, Australia.,School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Seang-Mei Saw
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.,Eye & Retina Surgeons, Singapore, Singapore.,Duke-NUS Medical School, Singapore
| | - Earl L Smith
- Brien Holden Vision Institute, Sydney, Australia.,College of Optometry, University of Houston, Houston, Texas, United States
| | - Donald T H Tan
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.,Department of Ophthalmology and Visual Science, Duke-NUS Graduate Medical School, Singapore, Singapore.,Eye & Retina Surgeons, Singapore, Singapore
| | - Jeffrey J Walline
- The Ohio State University College of Optometry, Columbus, Ohio, United States
| | - Christine F Wildsoet
- School of Optometry, University of California, Berkeley, Berkeley, California, United States
| | - Pei-Chang Wu
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Xiaoying Zhu
- Biological and Vision Sciences, State University of New York, College of Optometry, New York, New York, United States
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13
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Patient experience and physiological response to two commercially available daily disposable myopia control contact lenses. Cont Lens Anterior Eye 2021; 45:101426. [PMID: 33618977 DOI: 10.1016/j.clae.2021.02.012] [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: 12/04/2020] [Revised: 02/04/2021] [Accepted: 02/07/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND A range of myopia management (MM) contact lenses are becoming available to practitioners. These lenses are designed to slow myopia progression and axial elongation. This study explored the initial experience of participants wearing daily disposable MM contact lenses to investigate established factors previously associated with successful lens wear. METHODS This was a prospective, double-masked, crossover study. Twenty participants aged 18-30 years old were assigned to wear two daily disposable MM lenses in a randomised order. Visual acuity, contrast sensitivity, and amplitude/lag of accommodation were assessed at baseline, post-insertion, and after 2 and 6 h of lens wear. Self-reported lens comfort and vision quality were recorded at the same timepoints, and at 10 h post-insertion. Pairwise comparisons were performed between the two lenses at each timepoint, as well as assessing changes throughout wear. The relationship of the measured parameters to overall lens satisfaction was also assessed. RESULTS There were no significant differences between the two MM lenses at any timepoint for any of the participant-reported parameters, including overall satisfaction. A small difference in visual acuity was noted at 6 h post-insertion, although this is unlikely to be clinically significant. Comfort decreased throughout the day, most notably at 10 h post-insertion. A moderate positive correlation was observed between participant-reported visual quality and overall satisfaction. A similar pattern was seen for comfort and overall satisfaction. Self-reported vision quality and measured visual acuity were poorly correlated, highlighting the benefit of subjectively assessing the quality of vision with these lenses. CONCLUSIONS The participants demonstrated comparable measures across a range of measures between the two MM lenses. Notably, half of the participants demonstrated a clear lens preference, although the preferred lens varied between individuals. Candidates for MM may benefit from trialling more than one MM lens design, to maximise initial wearing satisfaction.
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14
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Yazdani N, Sadeghi R, Ehsaei A, Taghipour A, Hasanzadeh S, Zarifmahmoudi L, Heravian Shandiz J. Under-correction or full correction of myopia? A meta-analysis. JOURNAL OF OPTOMETRY 2021; 14:11-19. [PMID: 32507615 PMCID: PMC7752985 DOI: 10.1016/j.optom.2020.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 03/23/2020] [Accepted: 04/11/2020] [Indexed: 06/11/2023]
Abstract
PURPOSE To compare the effect of full-correction versus under-correction on myopia progression. METHODS A literature search was performed in PubMed, Scopus, Science Direct, Ovid, Web of Science and Cochrane library. Methodological quality assessment of the literature was evaluated according to the Critical Appraisal Skills Program. Statistical analysis was performed using Comprehensive Meta-Analysis (version 2, Biostat Inc., USA). RESULTS The present meta-analysis included six studies (two randomized controlled trials [RCTs] and four non-RCTs) with 695 subjects (full-correction group, n=371; under-correction group, n=324) aged 6 to 33 years. Using cycloplegic refraction, the pooled difference in mean of myopia progression was - 0.179 D [lower and higher limits: -0.383, 0.025], which was higher but not in full correction group as compared to under correction group (p=0.085). Regarding studies using non-cycloplegic subjective refraction according to maximum plus for maximum visual acuity, the pooled difference in myopia progression was 0.128 D [lower and higher limits: -0.057, 0.312] higher in under-correction group compared with full-correction group (p=0.175). Although, difference in myopia progression did not reach significant level in either cycloplegic or non-cycloplegic refraction. CONCLUSIONS Our findings suggest that, myopic eyes which are fully corrected with non-cycloplegic refraction with maximum plus sphere, are less prone to myopia progression, in comparison to those which were under corrected. However, regarding cycloplegic refraction, further studies are needed to better understand these trends.
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Affiliation(s)
- Negareh Yazdani
- Refractive Errors Research Center, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran; Department of Optometry, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ramin Sadeghi
- Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Asieh Ehsaei
- Refractive Errors Research Center, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran; Department of Optometry, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Taghipour
- Health Sciences Research Centre, Department of Biostatistics and Epidemiology, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Samira Hasanzadeh
- Refractive Errors Research Center, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran; Department of Optometry, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Leili Zarifmahmoudi
- Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Javad Heravian Shandiz
- Refractive Errors Research Center, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran; Department of Optometry, Mashhad University of Medical Sciences, Mashhad, Iran.
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15
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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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16
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Delshad S, Collins MJ, Read SA, Vincent SJ. The human axial length and choroidal thickness responses to continuous and alternating episodes of myopic and hyperopic blur. PLoS One 2020; 15:e0243076. [PMID: 33264356 PMCID: PMC7710071 DOI: 10.1371/journal.pone.0243076] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 11/14/2020] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To investigate the change in axial length (AxL) and choroidal thickness (ChT) in response to continuous and alternating episodes of monocular myopic and hyperopic defocus. METHODS The right eye of sixteen young adults was exposed to 60 minute episodes of either continuous or alternating myopic and hyperopic defocus (+3 DS & -3 DS) over six separate days, with the left eye optimally corrected for distance. During alternating defocus conditions, the eye was exposed to either 30 or 15 minute cycles of myopic and hyperopic defocus, with the order of defocus reversed in separate sessions. The AxL and ChT of the right eye were measured before, during and after each defocus condition. RESULTS Significant changes in AxL were observed over time, dependent upon the defocus condition (p < 0.0001). In general, AxL exhibited a greater magnitude of change during continuous than alternating defocus conditions. The maximum AxL elongation was +7 ± 7 μm (p = 0.010) in response to continuous hyperopic defocus and the maximum AxL reduction was -8 ± 10 μm of (p = 0.046) in response to continuous myopic defocus. During both 30 and 15 minute cycles of alternating myopic and hyperopic defocus of equal duration, the effect of opposing blur sessions cancelled each other and the AxL was near baseline levels following the final defocus session (mean change from baseline across all alternating defocus conditions was +2 ± 10 μm, p > 0.05). Similar, but smaller magnitude, changes were observed for ChT. CONCLUSIONS The human eye appears capable of temporal averaging of visual cues from alternating myopic and hyperopic defocus. In the short term, this integration appears to be a cancellation of the effects of the preceding defocus condition of opposite sign.
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Affiliation(s)
- Samaneh Delshad
- Queensland University of Technology (QUT), Centre for Vision and Eye Research, School of Optometry and Vision Science, Institute of Health and Biomedical Innovation, Kelvin Grove, Queensland, Australia
- * E-mail:
| | - Michael John Collins
- Queensland University of Technology (QUT), Centre for Vision and Eye Research, School of Optometry and Vision Science, Institute of Health and Biomedical Innovation, Kelvin Grove, Queensland, Australia
| | - Scott Andrew Read
- Queensland University of Technology (QUT), Centre for Vision and Eye Research, School of Optometry and Vision Science, Institute of Health and Biomedical Innovation, Kelvin Grove, Queensland, Australia
| | - Stephen James Vincent
- Queensland University of Technology (QUT), Centre for Vision and Eye Research, School of Optometry and Vision Science, Institute of Health and Biomedical Innovation, Kelvin Grove, Queensland, Australia
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17
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Eccentricity-dependent effects of simultaneous competing defocus on emmetropization in infant rhesus monkeys. Vision Res 2020; 177:32-40. [PMID: 32942214 DOI: 10.1016/j.visres.2020.08.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 08/10/2020] [Accepted: 08/12/2020] [Indexed: 11/22/2022]
Abstract
Dual-focus lenses that impose simultaneous competing myopic defocus over the entire visual field produce axial hyperopic shifts in refractive error. The purpose of this study was to characterize the effects of eccentricity on the ability of myopic defocus signals to influence central refractive development in infant monkeys. From 24 to 152 days of age, rhesus monkeys were reared with binocular, dual-focus lenses that had central, zero-powered zones surrounded by alternating concentric annular power zones of +3D and zero power. Between subject groups the diameter of the central, zero-powered zone was varied from 2 mm to 8 mm in 2 mm steps (+3D/pl 2 mm, n = 6; +3D/pl 4 mm, n = 6; +3D/pl 6 mm, n = 8, or + 3D/pl 8 mm, n = 6). For the treatment lens with 2, 4, 6 and 8 mm central zones, objects at eccentricities beyond 11°, 16°, 19° and 23°, respectively, were imaged exclusively through the dual-power peripheral zones. Refractive status (retinoscopy), corneal power (keratometry) and axial dimensions (ultrasonography) were measured at two-week intervals. Comparison data were obtained from monkeys reared with binocular, single-vision +3D full-field lenses (+3D FF, n = 6) and 41 normal control monkeys reared with unrestricted vision. At the end of the rearing period, with the exception of the +3D/pl 8 mm group (median = +3.64 D), the ametropias for the other lens-reared groups (medians: FF = +4.39 D, 2 mm = +5.19 D, 4 mm = +5.59 D, 6 mm = +3.50 D) were significantly more hyperopic than that for the normal monkeys (+2.50 D). These hyperopic errors were associated with shallower vitreous chambers. The key finding was that the extent and consistency of these hyperopic ametropias varied with the eccentricity of the dual-focus zones. The results confirm that myopic defocus in the near periphery can slow axial growth, but that imposed defocus beyond about 20° from the fovea does not consistently alter central refractive development.
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18
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Zhang HY, Lam CSY, Tang WC, Leung M, To CH. Defocus Incorporated Multiple Segments Spectacle Lenses Changed the Relative Peripheral Refraction: A 2-Year Randomized Clinical Trial. Invest Ophthalmol Vis Sci 2020; 61:53. [PMID: 32460315 PMCID: PMC7405698 DOI: 10.1167/iovs.61.5.53] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 04/06/2020] [Indexed: 12/24/2022] Open
Abstract
Purpose To compare changes in relative peripheral refraction (RPR) associated with myopia progression in myopic children wearing Defocus Incorporated Multiple Segments (DIMS) lenses and single vision (SV) spectacle lenses over 2 years. Methods A 2-year double-blind, randomized controlled trial was conducted on 183 myopic children. Subjects were allocated to either wearing DIMS (n = 93) or SV spectacle lenses (n = 90). Peripheral refraction at 10°, 20°, and 30° of the nasal (10N, 20N, 30N) and temporal (10T, 20T, 30T) retinal eccentricities, central refraction, and axial length after cycloplegia were monitored every 6 months. Results DIMS group showed symmetrical peripheral myopic shifts between the nasal and temporal retina (comparing myopic shifts between the nasal and temporal retina, the difference between the corresponding eccentricities were nonclinically significance). SV group showed asymmetrical peripheral myopic shifts between the nasal and temporal retina, with more myopic shifts (all P ≤ 0.001) at 10T (-0.32 ± 0.62 diopters [D]), at 20T (-0.69 ± 0.95 D), and 30T (-0.85 ± 1.52 D). No significant changes in RPR spherical equivalent (M) were noted in the DIMS group, whereas significant increases (all P < 0.0001) in hyperopic RPR M were observed at 10N (0.27 ± 0.45 D), 20N (0.75 ± 0.72 D), and 30N (0.98 ± 0.76 D) in the SV group. Conclusions Wearing DIMS lenses resulted in a significantly different peripheral refraction profile and RPR changes, as well as significant myopia control effects when compared with SV lenses. Myopia control adopting myopic defocus in the midperiphery influenced peripheral refraction and slowed central myopia progression, most likely through alteration of overall retinal shape.
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Affiliation(s)
- Han Yu Zhang
- Centre for Myopia Research, School of Optometry, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Carly Siu Yin Lam
- Centre for Myopia Research, School of Optometry, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Wing Chun Tang
- Centre for Myopia Research, School of Optometry, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Myra Leung
- Centre for Myopia Research, School of Optometry, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
- Discipline of Optometry and Vision Science, Faculty of Health, University of Canberra, Canberra, Australia
| | - Chi Ho To
- Centre for Myopia Research, School of Optometry, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
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19
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Lu Y, Lin Z, Wen L, Gao W, Pan L, Li X, Yang Z, Lan W. The Adaptation and Acceptance of Defocus Incorporated Multiple Segment Lens for Chinese Children. Am J Ophthalmol 2020; 211:207-216. [PMID: 31837317 DOI: 10.1016/j.ajo.2019.12.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Revised: 12/04/2019] [Accepted: 12/05/2019] [Indexed: 11/27/2022]
Abstract
PURPOSE We investigated the adaptability and acceptance of a novel spectacle lens design that was recently reported to achieve a significant antimyopia effect. DESIGN A prospective, cross-over study. METHODS Twenty children were recruited to wear both Defocus Incorporated Multiple Segments (DIMS) and single vision (SV) lens, with a random assignment of which type of lens was experienced first. For each type of lens, high and low contrast central distant visual acuity (VA) and high contrast mid-peripheral near VA were measured at both 500 lux and 50 lux ambient illuminance after 30 minutes' and a week's wearing of the lens. A self-developed questionnaire was applied to evaluate the visual discomfort at the 1-week visit. All quantitative data were analyzed by paired t test, while qualitative data were analyzed with the χ2 or Wilcoxon signed-rank tests. RESULTS Central VA was not affected by DIMS lens compared with SV lens in all circumstances (all P > .05). However, the mid-peripheral near VA was found to reduce by approximately 0.06 logarithm of minimal angle of resolution unit in 2 of 4 quadrants (500 lux; P < .05) and in 3 quadrants (50 lux; P < .05) for DIMS lenses. No improvement was detected in the 1-week visit. Mid-peripheral blurred vision was the main visual complaint, which was noticed only once or twice a day. Being aware of the average antimyopic efficacy, 90% of children subjects preferred DIMS lenses. CONCLUSION Mid-peripheral vision through DIMS lenses was slightly affected compared with SV lenses. Otherwise, DIMS lenses received good tolerance and acceptance by Chinese children.
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Affiliation(s)
- Yiqiu Lu
- Aier School of Ophthalmology, Central South University, Changsha, China
| | - Zhenghua Lin
- Aier School of Ophthalmology, Central South University, Changsha, China
| | - Longbo Wen
- Aier School of Ophthalmology, Central South University, Changsha, China
| | - Wenyu Gao
- Aier School of Ophthalmology, Central South University, Changsha, China; Aier Institute of Optometry and Vision Science, Aier Eye Hospital Group, Changsha, China
| | - Lun Pan
- Aier School of Ophthalmology, Central South University, Changsha, China; Aier Institute of Optometry and Vision Science, Aier Eye Hospital Group, Changsha, China
| | - Xiaoning Li
- Aier School of Ophthalmology, Central South University, Changsha, China; Aier School of Optometry, Hubei University of Science and Technology, Xianning, China; Aier Institute of Optometry and Vision Science, Aier Eye Hospital Group, Changsha, China
| | - Zhikuan Yang
- Aier School of Ophthalmology, Central South University, Changsha, China; Aier School of Optometry, Hubei University of Science and Technology, Xianning, China; Aier Institute of Optometry and Vision Science, Aier Eye Hospital Group, Changsha, China
| | - Weizhong Lan
- Aier School of Ophthalmology, Central South University, Changsha, China; Aier School of Optometry, Hubei University of Science and Technology, Xianning, China; Aier Institute of Optometry and Vision Science, Aier Eye Hospital Group, Changsha, China.
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20
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Lam CSY, Tang WC, Tse DYY, Lee RPK, Chun RKM, Hasegawa K, Qi H, Hatanaka T, To CH. Defocus Incorporated Multiple Segments (DIMS) spectacle lenses slow myopia progression: a 2-year randomised clinical trial. Br J Ophthalmol 2020; 104:363-368. [PMID: 31142465 PMCID: PMC7041503 DOI: 10.1136/bjophthalmol-2018-313739] [Citation(s) in RCA: 188] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 04/01/2019] [Accepted: 05/10/2019] [Indexed: 11/17/2022]
Abstract
AIM To determine if 'Defocus Incorporated Multiple Segments' (DIMS) spectacle lenses slow childhood myopia progression. METHODS A 2-year double-masked randomised controlled trial was carried out in 183 Chinese children aged 8-13 years, with myopia between -1.00 and -5.00 D and astigmatism ≤1.50 D. Children were randomly assigned to wear DIMS (n=93) or single vision (SV) spectacle lenses (n=90). DIMS lens incorporated multiple segments with myopic defocus of +3.50 D. Refractive error (cycloplegic autorefraction) and axial length were measured at 6month intervals. RESULTS 160 children completed the study, n=79 in the DIMS group and n=81 in the SV group. Average (SE) myopic progressions over 2 years were -0.41±0.06 D in the DIMS group and -0.85±0.08 D in the SV group. Mean (SE) axial elongation was 0.21±0.02 mm and 0.55±0.02 mm in the DIMS and SV groups, respectively. Myopia progressed 52% more slowly for children in the DIMS group compared with those in the SV group (mean difference -0.44±0.09 D, 95% CI -0.73 to -0.37, p<0.0001). Likewise, children in the DIMS group had less axial elongation by 62% than those in the SV group (mean difference 0.34±0.04 mm, 95% CI 0.22 to 0.37, p<0.0001). 21.5% children who wore DIMS lenses had no myopia progression over 2 years, but only 7.4% for those who wore SV lenses. CONCLUSIONS Daily wear of the DIMS lens significantly retarded myopia progression and axial elongation in myopic children. Our results demonstrated simultaneous clear vision with constant myopic defocus can slow myopia progression. TRIAL REGISTRATION NUMBER NCT02206217.
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Affiliation(s)
- Carly Siu Yin Lam
- Centre for Myopia Research, School of Optometry, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Wing Chun Tang
- Centre for Myopia Research, School of Optometry, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Dennis Yan-Yin Tse
- Centre for Myopia Research, School of Optometry, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Roger Pak Kin Lee
- Centre for Myopia Research, School of Optometry, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Rachel Ka Man Chun
- Centre for Myopia Research, School of Optometry, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | | | - Hua Qi
- Hoya Corporation, Tokyo, Japan
| | | | - Chi Ho To
- Centre for Myopia Research, School of Optometry, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
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21
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Abstract
SIGNIFICANCE Results of this randomized, double-masked clinical trial demonstrate the effectiveness of the MiSight soft contact lens in slowing myopia progression over multiple years. PURPOSE The purpose of this study was to quantify the effectiveness of MiSight daily disposable soft contact lens in slowing the progression of juvenile-onset myopia. METHODS Myopic children (spherical equivalent refraction, -0.75 to -4.00 D; astigmatism, <1.00 D) aged 8 to 12 years with no prior contact lens experience were enrolled in a 3-year, double-masked, randomized clinical trial at four investigational sites in four countries. Subjects in each group were matched for age, sex, and ethnicity and were randomized to either a MiSight 1-day contact lens (test) or Proclear 1-day (control; omafilcon A) and worn on a daily disposable basis. Primary outcome measures were the change in cycloplegic spherical equivalent refraction and axial length. RESULTS Of the subjects enrolled, 75.5% (109/144) completed the clinical trial (53 test, 56 control). Unadjusted change in spherical equivalent refraction was -0.73 D (59%) less in the test group than in the control group (-0.51 ± 0.64 vs. -1.24 ± 0.61 D, P < .001). Mean change in axial length was 0.32 mm (52%) less in the test group than in the control group (0.30 ± 0.27 vs. 0.62 ± 0.30 mm, P < .001). Changes in spherical equivalent refraction and axial length were highly correlated (r = -0.90, P < .001). Over the course of the study, there were no cases of serious ocular adverse events reported. Four asymptomatic corneal infiltrative (one test, three control) events were observed at scheduled study visits. CONCLUSIONS Results of this clinical trial demonstrate the effectiveness of the MiSight daily disposable soft contact lens in slowing change in spherical equivalent refraction and axial length.
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Reducing treatment zone diameter in orthokeratology and its effect on peripheral ocular refraction. Cont Lens Anterior Eye 2019; 43:54-59. [PMID: 31776061 DOI: 10.1016/j.clae.2019.11.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 11/13/2019] [Accepted: 11/13/2019] [Indexed: 12/28/2022]
Abstract
PURPOSE To determine whether orthokeratology (OK) induced treatment zone (TZ) diameter can be reduced by altering OK lens design, and if so the impact of modifying TZ diameter on relative peripheral refraction (RPR). METHODS 16 subjects (mean age 23.4 ± 1.5 years; 8 female) completed the study. Standard (Control) OK lens design (PJ, Capricornia, Australia) or a modified version (Test) where the back optic zone diameter was reduced, and back optic zone asphericity and intermediate lens curves were altered, were worn overnight only for 7-nights in a randomised double masked order, with a minimum 1-week wash out (no lens wear) between lens designs. Full correction of refractive error was targeted. Refraction; best corrected visual acuity (BCVA); RPR (Shin-Nippon NVision-k 5001) along the horizontal and vertical meridians; and corneal topography (Medmont E300) were measured before starting lens wear and in the morning after lens removal after the seventh night of lens wear for both lens designs. TZ diameter and decentration was calculated from corneal topography. RESULTS After 7-nights of wear both lens designs created -2.00D refraction effect with no significant difference in refractive effect or change to BCVA between the designs. The Test design created a significantly smaller horizontal (4.78 ± 0.37 vs 5.70 ± 0.37 mm, p < 0.001) and vertical (5.09 ± 0.51 vs 5.92 ± 0.51 mm p < 0.001) TZ diameter. The TZ was decentered inferior temporal with no significant difference between designs. There was no significant difference between the lens designs in RPR along the horizontal and vertical meridians at any measurement period. CONCLUSIONS OK induced TZ diameter can be reliably reduced by altering OK lens design without detrimentally effecting lens centration or refractive effect. Reducing TZ diameter did not alter RPR, though measurement artifacts could be responsible for masking an effect. Longitudinal studies are needed to assess whether smaller TZ OK lens designs increase efficacy for slowing progression of myopia.
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Chakraborty R, Ostrin LA, Benavente-Perez A, Verkicharla PK. Optical mechanisms regulating emmetropisation and refractive errors: evidence from animal models. Clin Exp Optom 2019; 103:55-67. [PMID: 31742789 DOI: 10.1111/cxo.12991] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 09/24/2019] [Accepted: 09/25/2019] [Indexed: 12/22/2022] Open
Abstract
Our current understanding of emmetropisation and myopia development has evolved from decades of work in various animal models, including chicks, non-human primates, tree shrews, guinea pigs, and mice. Extensive research on optical, biochemical, and environmental mechanisms contributing to refractive error development in animal models has provided insights into eye growth in humans. Importantly, animal models have taught us that eye growth is locally controlled within the eye, and can be influenced by the visual environment. This review will focus on information gained from animal studies regarding the role of optical mechanisms in guiding eye growth, and how these investigations have inspired studies in humans. We will first discuss how researchers came to understand that emmetropisation is guided by visual feedback, and how this can be manipulated by form-deprivation and lens-induced defocus to induce refractive errors in animal models. We will then discuss various aspects of accommodation that have been implicated in refractive error development, including accommodative microfluctuations and accommodative lag. Next, the impact of higher order aberrations and peripheral defocus will be discussed. Lastly, recent evidence suggesting that the spectral and temporal properties of light influence eye growth, and how this might be leveraged to treat myopia in children, will be presented. Taken together, these findings from animal models have significantly advanced our knowledge about the optical mechanisms contributing to eye growth in humans, and will continue to contribute to the development of novel and effective treatment options for slowing myopia progression in children.
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Affiliation(s)
- Ranjay Chakraborty
- College of Nursing and Health Sciences, Optometry and Vision Science, Flinders University, Adelaide, Australia
| | - Lisa A Ostrin
- University of Houston College of Optometry, Houston, Texas, USA
| | | | - Pavan Kumar Verkicharla
- Myopia Research Lab, Prof. Brien Holden Eye Research Centre, LV Prasad Eye Institute, Hyderabad, India
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Kollbaum PS, Bradley A. Correction of presbyopia: old problems with old (and new) solutions. Clin Exp Optom 2019; 103:21-30. [PMID: 31734940 DOI: 10.1111/cxo.12987] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 09/05/2019] [Accepted: 09/20/2019] [Indexed: 12/23/2022] Open
Abstract
We live in a three-dimensional world and the human eye can focus images from a wide range of distances by adjusting the power of the eye's lens (accommodation). Progressive senescent changes in the lens ultimately lead to a complete loss of this ability by about age 50, which then requires alternative strategies to generate high-quality retinal images for far and close viewing distances. This review paper highlights the biomimetic properties and underlying optical mechanisms of induced anisometropia, small apertures, dynamic lenses, and multi-optic lenses in ameliorating the visual consequences of presbyopia. Specifically, the advantages and consequences of non-liner neural summation leveraged in monovision treatments are reviewed. Additionally, the value of a small pupil is quantified, and the impact of pinhole pupil location and their effects on neural sensitivity are examined. Different strategies of generating multifocal optics are also examined, and specifically the interaction between ocular and contact or intraocular lens aberrations and their effect on resulting image quality are simulated. Interestingly, most of the novel strategies for aiding presbyopic and pseudophakic eyes (for example, monovision, multifocality, pinhole pupils) have emerged naturally via evolution in a range of species.
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Affiliation(s)
- Pete S Kollbaum
- School of Optometry, Indiana University, Bloomington, Indiana, USA
| | - Arthur Bradley
- School of Optometry, Indiana University, Bloomington, Indiana, USA
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Wildsoet CF, Chia A, Cho P, Guggenheim JA, Polling JR, Read S, Sankaridurg P, Saw SM, Trier K, Walline JJ, Wu PC, Wolffsohn JS. IMI - Interventions Myopia Institute: Interventions for Controlling Myopia Onset and Progression Report. Invest Ophthalmol Vis Sci 2019; 60:M106-M131. [PMID: 30817829 DOI: 10.1167/iovs.18-25958] [Citation(s) in RCA: 198] [Impact Index Per Article: 39.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Myopia has been predicted to affect approximately 50% of the world's population based on trending myopia prevalence figures. Critical to minimizing the associated adverse visual consequences of complicating ocular pathologies are interventions to prevent or delay the onset of myopia, slow its progression, and to address the problem of mechanical instability of highly myopic eyes. Although treatment approaches are growing in number, evidence of treatment efficacy is variable. This article reviews research behind such interventions under four categories: optical, pharmacological, environmental (behavioral), and surgical. In summarizing the evidence of efficacy, results from randomized controlled trials have been given most weight, although such data are very limited for some treatments. The overall conclusion of this review is that there are multiple avenues for intervention worthy of exploration in all categories, although in the case of optical, pharmacological, and behavioral interventions for preventing or slowing progression of myopia, treatment efficacy at an individual level appears quite variable, with no one treatment being 100% effective in all patients. Further research is critical to understanding the factors underlying such variability and underlying mechanisms, to guide recommendations for combined treatments. There is also room for research into novel treatment options.
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Affiliation(s)
- Christine F Wildsoet
- Berkeley Myopia Research Group, School of Optometry and Vision Science Program, University of California Berkeley, Berkeley, California, United States
| | - Audrey Chia
- Singapore Eye Research Institute and Singapore National Eye Center, Singapore
| | - Pauline Cho
- School of Optometry, The Hong Kong Polytechnic University, Hong Kong
| | - Jeremy A Guggenheim
- School of Optometry and Vision Sciences, Cardiff University, Cardiff, United Kingdom
| | - Jan Roelof Polling
- Erasmus MC Department of Ophthalmology, Rotterdam, The Netherlands.,HU University of Applied Sciences, Optometry and Orthoptics, Utrecht, The Netherlands
| | - Scott Read
- School of Optometry and Vision Science and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Padmaja Sankaridurg
- Brien Holden Vision Institute and School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Seang-Mei Saw
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Klaus Trier
- Trier Research Laboratories, Hellerup, Denmark
| | - Jeffrey J Walline
- The Ohio State University College of Optometry, Columbus, Ohio, United States
| | - Pei-Chang Wu
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - James S Wolffsohn
- Ophthalmic Research Group, Aston University, Birmingham, United Kingdom
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Zheng H, Tse DY, Tang X, To C, Lam TC. The Interactions Between Bright Light and Competing Defocus During Emmetropization in Chicks. Invest Ophthalmol Vis Sci 2019; 59:2932-2943. [PMID: 30025112 DOI: 10.1167/iovs.17-22973] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose The environment comprises multiple optical signals that affect eye growth. We aimed to determine if the inhibitory effects of myopic defocus and bright light (BL) against myopia are additive in the presence of the myopia-genic hyperopic defocus. Methods In experiment 1, three groups of 24 chicks each were fitted with the following multizone dual-power lenses (pl): pl/-10 D (50:50 area), +10/-10 D (50:50 area), and +10/-10 D (33:67 area) monocularly for 6 days. Half of each group were raised under normal illumination of 500 lux, 12/12-hour light/dark cycle, whereas the remainder were exposed to 6-hour BL of 40 klx and 6-hour 500 lux during the light cycle. In experiment 2, 38 chicks wore +10/-10 D (33:67 area) lenses monocularly for 8 days and were exposed to one of four light intensities for 6 hours per day-500 lux, 10 klx, 20 klx, or 40 klx-and received 500 lux for the remainder of the light cycle. Results In experiment 1, interocular difference in refractions after 6 days for the three groups were -3.6 D, +2.0 D, and -4.2 D, respectively, under normal light and were -0.9 D, +4.2 D, and +0.67 D under BL, manifesting as a shorter anterior segment and vitreous chamber. In experiment 2, the effect of BL increased with light intensity in the +10/-10 D (33:67) group, with a significant difference in refraction between the 10 klx and 20 klx groups (interocular difference -2.75 ± 2.76 D vs. 1.70 ± 2.40 D, P < 0.01), but plateaued between 20 klx and 40 klx (1.70 ± 2.40 D vs. 1.70 ± 0.35 D, P > 0.05). Conclusions The protective effects of myopic defocus and BL against experimental myopia were additive. The inhibitory effect of BL against myopia was dose dependent at 10 klx and above but plateaued at 20 klx.
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Affiliation(s)
- Hui Zheng
- Centre for Myopia Research, School of Optometry, The Hong Kong Polytechnic University, Hong Kong, China.,School of Medicine, Nankai University, Tianjin, China.,Tianjin Eye Hospital, Tianjin, China
| | - Dennis Y Tse
- Centre for Myopia Research, School of Optometry, The Hong Kong Polytechnic University, Hong Kong, China
| | - Xin Tang
- School of Medicine, Nankai University, Tianjin, China.,Tianjin Eye Hospital, Tianjin, China
| | - Chiho To
- Centre for Myopia Research, School of Optometry, The Hong Kong Polytechnic University, Hong Kong, China
| | - Thomas Chuen Lam
- Centre for Myopia Research, School of Optometry, The Hong Kong Polytechnic University, Hong Kong, China
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Troilo D, Smith EL, Nickla DL, Ashby R, Tkatchenko AV, Ostrin LA, Gawne TJ, Pardue MT, Summers JA, Kee CS, Schroedl F, Wahl S, Jones L. IMI - Report on Experimental Models of Emmetropization and Myopia. Invest Ophthalmol Vis Sci 2019; 60:M31-M88. [PMID: 30817827 PMCID: PMC6738517 DOI: 10.1167/iovs.18-25967] [Citation(s) in RCA: 204] [Impact Index Per Article: 40.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Accepted: 10/20/2018] [Indexed: 11/24/2022] Open
Abstract
The results of many studies in a variety of species have significantly advanced our understanding of the role of visual experience and the mechanisms of postnatal eye growth, and the development of myopia. This paper surveys and reviews the major contributions that experimental studies using animal models have made to our thinking about emmetropization and development of myopia. These studies established important concepts informing our knowledge of the visual regulation of eye growth and refractive development and have transformed treatment strategies for myopia. Several major findings have come from studies of experimental animal models. These include the eye's ability to detect the sign of retinal defocus and undergo compensatory growth, the local retinal control of eye growth, regulatory changes in choroidal thickness, and the identification of components in the biochemistry of eye growth leading to the characterization of signal cascades regulating eye growth and refractive state. Several of these findings provided the proofs of concepts that form the scientific basis of new and effective clinical treatments for controlling myopia progression in humans. Experimental animal models continue to provide new insights into the cellular and molecular mechanisms of eye growth control, including the identification of potential new targets for drug development and future treatments needed to stem the increasing prevalence of myopia and the vision-threatening conditions associated with this disease.
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Affiliation(s)
- David Troilo
- SUNY College of Optometry, State University of New York, New York, New York, United States
| | - Earl L. Smith
- College of Optometry, University of Houston, Houston, Texas, United States
| | - Debora L. Nickla
- Biomedical Sciences and Disease, New England College of Optometry, Boston, Massachusetts, United States
| | - Regan Ashby
- Health Research Institute, University of Canberra, Canberra, Australia
| | - Andrei V. Tkatchenko
- Department of Ophthalmology, Department of Pathology and Cell Biology, Columbia University, New York, New York, United States
| | - Lisa A. Ostrin
- College of Optometry, University of Houston, Houston, Texas, United States
| | - Timothy J. Gawne
- School of Optometry, University of Alabama Birmingham, Birmingham, Alabama, United States
| | - Machelle T. Pardue
- Biomedical Engineering, Georgia Tech College of Engineering, Atlanta, Georgia, United States31
| | - Jody A. Summers
- College of Medicine, University of Oklahoma, Oklahoma City, Oklahoma, United States
| | - Chea-su Kee
- School of Optometry, The Hong Kong Polytechnic University, Hong Kong, SAR, China
| | - Falk Schroedl
- Departments of Ophthalmology and Anatomy, Paracelsus Medical University, Salzburg, Austria
| | - Siegfried Wahl
- Institute for Ophthalmic Research, University of Tuebingen, Zeiss Vision Science Laboratory, Tuebingen, Germany
| | - Lyndon Jones
- CORE, School of Optometry and Vision Science, University of Waterloo, Ontario, Canada
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El-Nimri NW, Zhang H, Wildsoet CF. The effect of part-time wear of 2-zone concentric bifocal spectacle lenses on refractive error development & eye growth in young chicks. Exp Eye Res 2018; 180:184-191. [PMID: 30582914 DOI: 10.1016/j.exer.2018.12.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 12/06/2018] [Accepted: 12/18/2018] [Indexed: 11/16/2022]
Abstract
The purpose of this study is to characterize in young chicks the myopia control effects of part-time wear of two-zone concentric bifocal lenses. Nine-day-old chicks (n = 115) were first made myopic with monocular -10 Diopter (D) single vision (SV) lenses worn for 3 days. Over the 6 days following myopia induction, either 1) two-zone bifocal lenses (-10 D center/-5 D periphery, BFDC) were worn for 12 (full-time), 10, 8, or 6 h, with -10 D SV lenses worn for the remainder of the day, or 2) BFDC or BFNC (-5 D center/-10 D periphery) lenses were worn every other day (EOD). Control birds wore -10 D SV lenses every day. Refractive error (RE) and axial ocular dimensions were monitored every three days with retinoscopy and high frequency A-scan ultrasonography respectively. Mean interocular RE and axial length differences after 3 days of myopia induction (±SEM) were -9.6 ± 0.19 D and 0.26 ± 0.01 mm across the groups. At the end of the following 6-day treatment period, equivalent values were: -10.66 ± 0.28 D, 0.42 ± 0.02 mm (SV-control); 1) -4.61 ± 0.29 D, 0.26 ± 0.02 mm (BFDC, 12 h); -4.82 ± 0.23 D, 0.28 ± 0.02 mm (BFDC, 10 h); -5.21 ± 0.27 D, 0.24 ± 0.02 mm (BFDC, 8 h); -6.34 ± 0.34 D, 0.25 ± 0.03 mm (BFDC, 6 h); 2) -8.29 ± 0.29 D, 0.32 ± 0.03 mm (BFDC, EOD), and -8.83 ± 0.36 D, 0.33 ± 0.03 mm (BFNC, EOD). Overall, full-time BFDC and part-time BFDC and BFNC lens groups exhibited similar changes and were less myopic than the SV group. The results suggest that bifocal lenses may have myopia control effects even when worn part-time, interleaved with standard (SV) myopic corrections, especially if worn for at least 6 h per day.
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Affiliation(s)
- Nevin W El-Nimri
- School of Optometry and Vision Science, University of California Berkeley, Berkeley, CA, United States.
| | - Hui Zhang
- School of Optometry and Vision Science, University of California Berkeley, Berkeley, CA, United States; Tianjin Eye Hospital, 4 Gansu Rd, Heping District, Tianjin, China
| | - Christine F Wildsoet
- School of Optometry and Vision Science, University of California Berkeley, Berkeley, CA, United States
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Lagrèze WA, Schaeffel F. Preventing Myopia. DEUTSCHES ARZTEBLATT INTERNATIONAL 2018; 114:575-580. [PMID: 28927495 DOI: 10.3238/arztebl.2017.0575] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 04/03/2017] [Accepted: 06/02/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Nearsightedness (myopia) has become more common around the world recently, mainly because of changes in visual, educational, and recreational behavior. The question arises how the risk of myopia and its progression can be reduced. This would lessen the prevalence and severity of myopia and also lower the risk of secondary diseases that impair visual acuity. METHODS The PubMed/Medline database was selectively searched for pertinent literature. RESULTS The risk of myopia is lowered by exposure to daylight and increased by activities performed at short visual distances (close-up work). A person with little exposure to daylight has a fivefold risk of developing myopia, which can rise as high as a 16-fold risk if that person also performs close-up work. Two meta-analyses and a large randomized clinical trial from Asia have shown that the progression of myopia over two years of observation can be lessened by up to 0.71 diopters by the administration of atropine eye drops in a concentration that has practically no serious side effects. At higher doses, myopia progresses more severely than in the placebo group after the cessation of therapy. This is an off-label treatment. A weaker effect on progression has been shown for multifocal optical corrections that include both a distance correction and a correction for near vision. CONCLUSION Effective pharmacological and optical measures are now available to lessen the progression of myopia. The increasing prevalence of myopia should motivate pediatricians, parents, and schools to pay attention to risk factors such as close-up work and lack of daylight exposure, particularly in view of the increased use of digital media.
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Affiliation(s)
- Wolf A Lagrèze
- Eye Center at the Medical Center and Faculty of Medicine of the University of Freiburg; Institute for Ophthalmic Research, Section for Neurobiology of the Eye, University of Tübingen
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Schulle KL, Berntsen DA, Sinnott LT, Bickle KM, Gostovic AT, Pierce GE, Jones-Jordan LA, Mutti DO, Walline JJ. Visual Acuity and Over-refraction in Myopic Children Fitted with Soft Multifocal Contact Lenses. Optom Vis Sci 2018; 95:292-298. [PMID: 29561497 PMCID: PMC5880703 DOI: 10.1097/opx.0000000000001207] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
SIGNIFICANCE Practitioners fitting contact lenses for myopia control frequently question whether a myopic child can achieve good vision with a high-add multifocal. We demonstrate that visual acuity is not different than spectacles with a commercially available, center-distance soft multifocal contact lens (MFCL) (Biofinity Multifocal "D"; +2.50 D add). PURPOSE To determine the spherical over-refraction (SOR) necessary to obtain best-corrected visual acuity (BCVA) when fitting myopic children with a center-distance soft MFCL. METHODS Children (n = 294) aged 7 to 11 years with myopia (spherical component) of -0.75 to -5.00 diopters (D) (inclusive) and 1.00 D cylinder or less (corneal plane) were fitted bilaterally with +2.50 D add Biofinity "D" MFCLs. The initial MFCL power was the spherical equivalent of a standardized subjective refraction, rounded to the nearest 0.25 D step (corneal plane). An SOR was performed monocularly (each eye) to achieve BCVA. Binocular, high-contrast logMAR acuity was measured with manifest spectacle correction and MFCLs with over-refraction. Photopic pupil size was measured with a pupilometer. RESULTS The mean (±SD) age was 10.3 ± 1.2 years, and the mean (±SD) SOR needed to achieve BCVA was OD: -0.61 ± 0.24 D/OS: -0.58 ± 0.27 D. There was no difference in binocular high-contrast visual acuity (logMAR) between spectacles (-0.01 ± 0.06) and best-corrected MFCLs (-0.01 ± 0.07) (P = .59). The mean (±SD) photopic pupil size (5.4 ± 0.7 mm) was not correlated with best MFCL correction or the over-refraction magnitude (both P ≥ .09). CONCLUSIONS Children achieved BCVA with +2.50 D add MFCLs that was not different than with spectacles. Children typically required an over-refraction of -0.50 to -0.75 D to achieve BCVA. With a careful over-refraction, these +2.50 D add MFCLs provide good distance acuity, making them viable candidates for myopia control.
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Irving EL, Yakobchuk-Stanger C. Myopia progression control lens reverses induced myopia in chicks. Ophthalmic Physiol Opt 2017; 37:576-584. [DOI: 10.1111/opo.12400] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Accepted: 06/29/2017] [Indexed: 12/17/2022]
Affiliation(s)
- Elizabeth L. Irving
- School of Optometry and Vision Science; University of Waterloo; Waterloo Canada
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Arumugam B, Hung LF, To CH, Sankaridurg P, Smith EL. The Effects of the Relative Strength of Simultaneous Competing Defocus Signals on Emmetropization in Infant Rhesus Monkeys. Invest Ophthalmol Vis Sci 2017; 57:3949-60. [PMID: 27479812 PMCID: PMC4978150 DOI: 10.1167/iovs.16-19704] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Purpose We investigated how the relative surface area devoted to the more positive-powered component in dual-focus lenses influences emmetropization in rhesus monkeys. Methods From 3 to 21 weeks of age, macaques were reared with binocular dual-focus spectacles. The treatment lenses had central 2-mm zones of zero-power and concentric annular zones that had alternating powers of either +3.0 diopters (D) and 0 D (+3 D/pL) or −3.0 D and 0 D (−3 D/pL). The relative widths of the powered and plano zones varied from 50:50 to 18:82 between treatment groups. Refractive status, corneal curvature, and axial dimensions were assessed biweekly throughout the lens-rearing period. Comparison data were obtained from monkeys reared with binocular full-field single-vision lenses (FF+3D, n = 6; FF−3D, n = 10) and from 35 normal controls. Results The median refractive errors for all of the +3 D/pL lens groups were similar to that for the FF+3D group (+4.63 D versus +4.31 D to +5.25 D; P = 0.18–0.96), but significantly more hyperopic than that for controls (+2.44 D; P = 0.0002–0.003). In the −3 D/pL monkeys, refractive development was dominated by the zero-powered portions of the treatment lenses; the −3 D/pL animals (+2.94 D to +3.13 D) were more hyperopic than the FF−3D monkeys (−0.78 D; P = 0.004–0.006), but similar to controls (+2.44 D; P = 0.14–0.22). Conclusions The results demonstrate that even when the more positive-powered zones make up only one-fifth of a dual-focus lens' surface area, refractive development is still dominated by relative myopic defocus. Overall, the results emphasize that myopic defocus distributed across the visual field evokes strong signals to slow eye growth in primates.
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Affiliation(s)
- Baskar Arumugam
- College of Optometry, University of Houston, Texas, United States 2Brien Holden Vision Institute, Sydney, Australia
| | - Li-Fang Hung
- College of Optometry, University of Houston, Texas, United States 2Brien Holden Vision Institute, Sydney, Australia
| | - Chi-Ho To
- Center for Myopia Research, School of Optometry, Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong 4State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat Sen University, Guangzhou, People's Republic of China
| | | | - Earl L Smith
- College of Optometry, University of Houston, Texas, United States 2Brien Holden Vision Institute, Sydney, Australia
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Smith EL, Hung LF, Arumugam B, Wensveen JM, Chino YM, Harwerth RS. Observations on the relationship between anisometropia, amblyopia and strabismus. Vision Res 2017; 134:26-42. [PMID: 28404522 DOI: 10.1016/j.visres.2017.03.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 03/15/2017] [Accepted: 03/19/2017] [Indexed: 11/26/2022]
Abstract
We investigated the potential causal relationships between anisometropia, amblyopia and strabismus, specifically to determine whether either amblyopia or strabismus interfered with emmetropization. We analyzed data from non-human primates that were relevant to the co-existence of anisometropia, amblyopia and strabismus in children. We relied on interocular comparisons of spatial vision and refractive development in animals reared with 1) monocular form deprivation; 2) anisometropia optically imposed by either contact lenses or spectacle lenses; 3) organic amblyopia produced by laser ablation of the fovea; and 4) strabismus that was either optically imposed with prisms or produced by either surgical or pharmacological manipulation of the extraocular muscles. Hyperopic anisometropia imposed early in life produced amblyopia in a dose-dependent manner. However, when potential methodological confounds were taken into account, there was no support for the hypothesis that the presence of amblyopia interferes with emmetropization or promotes hyperopia or that the degree of image degradation determines the direction of eye growth. To the contrary, there was strong evidence that amblyopic eyes were able to detect the presence of a refractive error and alter ocular growth to eliminate the ametropia. On the other hand, early onset strabismus, both optically and surgically imposed, disrupted the emmetropization process producing anisometropia. In surgical strabismus, the deviating eyes were typically more hyperopic than their fellow fixating eyes. The results show that early hyperopic anisometropia is a significant risk factor for amblyopia. Early esotropia can trigger the onset of both anisometropia and amblyopia. However, amblyopia, in isolation, does not pose a significant risk for the development of hyperopia or anisometropia.
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Affiliation(s)
- Earl L Smith
- College of Optometry, University of Houston, TX 77204, USA; Brien Holden Vision Institute, Sydney, Australia.
| | - Li-Fang Hung
- College of Optometry, University of Houston, TX 77204, USA; Brien Holden Vision Institute, Sydney, Australia
| | - Baskar Arumugam
- College of Optometry, University of Houston, TX 77204, USA; Brien Holden Vision Institute, Sydney, Australia
| | | | - Yuzo M Chino
- College of Optometry, University of Houston, TX 77204, USA
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Sun YY, Li SM, Li SY, Kang MT, Liu LR, Meng B, Zhang FJ, Millodot M, Wang N. Effect of uncorrection versus full correction on myopia progression in 12-year-old children. Graefes Arch Clin Exp Ophthalmol 2016; 255:189-195. [DOI: 10.1007/s00417-016-3529-1] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 09/04/2016] [Accepted: 10/17/2016] [Indexed: 11/25/2022] Open
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