Effect of Defocus Incorporated Multiple Segments Spectacle Lens Wear on Visual Function in Myopic Chinese Children

Peripheral myopic defocus signal affects the efficiency of visual information processing in myopic children

PURPOSE

Spectacle lenses with peripheral lenslets have shown promise for myopia control by providing peripheral myopic defocus signals. Here, we aimed to investigate the impact of prolonged exposure (>6 months) to peripheral myopic defocus on visual information processing in myopic children.

METHODS

The study included 30 myopic children who habitually wore spectacle lenses with highly aspherical lenslets (HAL group) and 34 children who habitually wore single-vision (SV group) spectacles. The quick contrast sensitivity function (qCSF) was used to measure contrast sensitivity (CS) under conditions of no or high noise. Both groups were tested with HAL and SV lenses. The perceptual template model was utilised to fit the contrast sensitivity function (CSF) and determine differences in information processing efficiency through internal additive noise (N add $$ {N}_{\mathrm{add}} $$ ) and perceptual template gain (β).

RESULTS

The areas under the log CSF in the SV group were significantly higher than for the HAL group in both zero-noise conditions with the SV test lens (p = 0.03) and high-noise conditions with the HAL test lens (p = 0.02). For 2 cycle per degree (cpd) stimuli, β was significantly higher in the SV group with the HAL test lens than in the HAL group (p = 0.02), while there was a trend towards a significant difference in β for 6 cpd stimuli (p = 0.07). However, there were no significant differences inN add $$ {N}_{\mathrm{add}} $$ between the two groups, with or without noise interference.

CONCLUSION

The reduced CS observed in myopic children wearing HAL lenses for 6 months or more may be due to decreased β. This suggests that prolonged use of spectacle lenses with peripheral myopic defocus signals may compromise the central visual system's ability to process additional external noise, resulting in decreased efficiency in visual information processing.

Evaluation of Lag of Accommodation with Full-Field Diffusion Optics Technology™ (DOT) Contrast Management Spectacle Lenses in Emmetropic Children

Purpose

To evaluate the impact on the lag of accommodation (LOA) in emmetropic children after short-term wear of full-field Diffusion Optics TechnologyTM (DOT) spectacle lenses, designed to modulate retinal contrast to control myopia progression.

Patients and Methods

This was a single-visit, prospective, randomized, subject-masked study of emmetropes (ametropes ±1.00D or less in each meridian) with no history of myopia control treatment. Unaided logMAR visual acuity was measured, and ocular dominance was determined using the sighting method. In a randomized order, participants wore plano full-field contrast management (DOT) spectacles (no clear central aperture) or control spectacles (standard single vision spectacle lenses). Each participant was given 5 minutes for adaptation to the respective lenses before open field autorefraction measurements were taken at 6 meters and 40 cm. Ten measurements were taken for each eye. Data were evaluated from the right eye and the dominant eye separately.

Results

A total of 30 participants (20 females and 10 males) with a mean age of 10.4 ± 2.8 (7 to 17) years completed the study. There was no significant difference in right eye mean LOA with contrast management spectacles 0.57 ± 0.39D versus control spectacles 0.62 ± 0.34D; Wilcoxon test, p = 0.37. For dominant eyes, LOA values were 0.60 ± 0.40D and 0.68 ± 0.33D with contrast management spectacles and control spectacles, respectively (p = 0.14). Additionally, no significant difference was observed in mean LOA between males and females or between age groups (7-11 years vs 12-17 years) for either right or dominant eyes with contrast management or control spectacles (all p > 0.05).

Conclusion

Full-field contrast management spectacle lenses had no significant effect on LOA compared to standard single vision spectacle lenses, indicating no differential impact on accommodative response over the short period of lens wear tested.

The Impact of Back Optic Zone Design in Orthokeratology on Visual Performance

Purpose

To evaluate the visual performance in adolescents undergoing orthokeratology (OrthoK) treatment with two different optical zone diameters (OZDs).

Methods

This randomized, double-masked, self-controlled prospective study was conducted at Tianjin Eye Hospital (Tianjin, China) in June 2022. Thirty-six eligible schoolchildren were enrolled and fitted with corneal refractive therapy lenses with two sizes of OZDs (5 mm [5OZ] and 6 mm [6OZ]). Each participant was randomized to wear the 5OZ in one eye and the 6OZ in the contralateral eye. Subjective visual quality was assessed using visual acuity, refraction, contrast sensitivity function, and visual symptoms, and the objective optical quality was assessed using ocular higher order aberrations (HOAs) and modulation transfer function (MTF).

Results

Thirty-five myopic children completed a 1-month follow-up visit. The 5OZ lens induced significantly smaller treatment zone diameters than the 6OZ lens (P < 0.001). Subjective visual quality did not differ significantly between the two groups. Compared to baseline, aberrations of Z40, coma-like, spherical-like, and total HOAs in both groups increased significantly (P < 0.05). For the 3-mm pupils, spherical aberration in the 5OZ group was significantly higher than that in the 6OZ group (P < 0.05). The MTF value of the 6OZ group was significantly higher than that of 5OZ group for 0.3 and 1.5 cycles per degree for the 3-mm pupils (P = 0.006 and P = 0.026, respectively). However, HOAs or MTF did not differ significantly between the two groups for the 5-mm pupils.

Conclusions

The difference induced by varying OZD was significant only in the smaller pupil condition. The selection of OZD in OrthoK designs in real-world patient management should be done while considering individual pupil size.

Translational Relevance

This study revealed that the objective visual quality of small OZD lenses was only slightly affected for the small pupil size.

Visual performance of optical films utilizing Spatio-Temporal Optical Phase technology

SIGNIFICANCE

Spatio-Temporal Optical Phase technology utilizes film pairs containing optical elements applied to standard single-vision spectacle lenses. This technology provides a dynamic optical cue that may have efficacy in reducing the rate of myopia progression, but the visual performance of this technology is unknown.

PURPOSE

This study aimed to assess the visual performance of film pairs containing optical elements (tests) and a film pair with no optical elements (control).

METHODS

In this randomized, single-masked, bilateral wear study, 42 participants aged 18 to 40 years wore four test designs (E, F-1, G, and F-2) and the control. Subjective data (subjective ratings [1 to 10 scale]: clarity of vision [far-away, intermediate, near] and vision [at night, while walking, overall satisfaction], and willingness to purchase [yes/no response]) were collected after 3 days. Visual acuity (VA)-based measures (monocular high/low-contrast VA [6 m], contrast sensitivity [6 m], and binocular high-contrast VA [6 m and 40 cm]) were collected at dispensing. Visual acuity-based measures were also collected while wearing spectacles with no film. Analyses were performed using linear mixed models and the χ2 test. Significance was set at 5%.

RESULTS

The control performed better than any test for all subjective ratings (mean differences, 1.6 to 3.1 units: p<0.001), willingness to purchase (p<0.001), and designs F-1 and F-2 for binocular high-contrast VA at 40 cm (p=0.001 and p=0.01, respectively). Clarity of vision was significantly worse with F-2 compared with F-1 and G (p<0.001 and p=0.02, respectively). There were no differences between tests for any other subjective rating (p>0.1), willingness to purchase (p=0.11), or any VA-based measure (p>0.08). There were no differences between control and spectacles with no film for any VA-based measure (p>0.08).

CONCLUSIONS

All four test film pairs reduced visual performance compared with control to a degree comparable with other myopia management devices. There was no difference in visual performance between three of the four test film pairs.

Astigmatism and maternal myopia as important factors affecting success rate of DIMS lens treatment

OBJECTIVE

To assess the efficacy of myopia control spectacle lenses (defocus incorporated multiple segments/DIMS) in slowing myopia progression among a diverse Central European paediatric population and investigate the contribution of baseline parameters on treatment outcomes.

METHODS AND ANALYSIS

This retrospective observational study included 62 individuals aged 4-17 years (mean±SD: 10.21±2.70) with progressing myopia but without ocular pathology with a range of -0.88 to -8.25 D spherical equivalent refraction (SER) (-3.73±1.56), coupled with astigmatism up to -3.25 D cylindrical. All participants were prescribed DIMS (Hoya MiyoSmart) spectacles. Key outcome variables were cycloplegic SER, measured for all participants and axial length (AL), assessed in a subset of patients, recorded at baseline, 6 months and 12 months. Quality of life assessments were conducted at baseline, at 2 weeks, and 3, 6, 9 and 12 months. Additionally, parental myopic dioptre was recorded when applicable.

RESULTS

At the 12-month mark, myopia progression in patients (mean±SE: -0.40±0.05) mirrored findings from prior European DIMS studies, but with 50% of patients showing no progression. A multivariate analysis of covariance model revealed that baseline astigmatism and younger age adversely affected therapy outcomes in both SER and AL, while severe maternal myopia led to greater SER progression. In contrast, only young age but not astigmatism was associated with AL increase in a comparable group of children with myopia, part of the LIFE Child Study, wearing single-vision spectacles. Patients reported consistent satisfaction with treatment, with minimal side effects, which diminished over the year.

CONCLUSION

In the European population, astigmatism, young age and severe maternal myopia are risk factors for suboptimal outcomes following DIMS therapy. Further research is necessary to elucidate the impact of astigmatism on myopic defocus therapy.

Baseline Accommodation and Binocular Vision Measures in Malay Schoolchildren Enrolled in the Myopia Control Study Using Spectacle Lenses in Kuala Lumpur

Myopia control lenses have been shown to modify visual function; however, it is arguable if these changes are short-term or long-term. We investigated the changes in accommodative behaviour and binocular vision functions of Malay myopic children who participated in a myopia control trial utilising spectacle lenses (n = 40). This article presents baseline accommodation and binocular vision measurements. The mean (± SD) age, spherical equivalent measured by cycloplegic autorefraction, and axial length (AL) for the right eyes were 10.00 ± 1.47 years, -3.02 ± 1.20 D, and 24.42 ± 0.93 mm, respectively. All participants had good distance and near visual acuities with high-contrast charts (100%), which were significantly better than low-contrast charts (10%) (p < 0.001). The mean (± SD) accommodative lag at baseline was 1.14 ± 0.35 D, while monocular and binocular accommodative amplitudes were 15.35 ± 2.07 D and 16.82 ± 2.27 D, respectively. Malay schoolchildren in this study were more esophoric at near compared to distance, with an accommodative-convergence over accommodation (AC/A) ratio of 5.64 ± 0.66 ∆/D. A higher degree of myopia was found to be associated with a longer AL (r = -0.49, p < 0.05) and higher esophoria at near (r = -0.46, p < 0.05). These baseline measures are consistent with data from other studies showing that myopic children have a high accommodative lag, an elevated AC/A ratio, a longer AL, and are more esophoric at near. The measures reported herein will serve as a basis for examining changes that occur within 12 months of wearing myopia control spectacle lenses.

Exploring the impact of optical corrections on visual functions in myopia control-a scoping review

PURPOSE

Myopia is controlled optically with peripheral defocus spectacles, multifocal contact lenses, or orthokeratology lenses. However, it is unknown which optical correction will improve visual performance. This scoping review aimed to identify and summarize studies on various visual functions using optical corrections for myopia control.

METHODS

To develop the search strategy, population (Myopia), concept (visual performance), and context (unrestricted race/region) were used. PubMed, SCOPUS, Cochrane Library, and Web of Science databases were searched using the keywords myopia, contrast sensitivity, high and low contrast visual acuity, stereopsis, and optical correction of myopia control. This scoping review protocol was registered in the Open Science Framework registry and followed the framework for scoping review outlined by the Joanna Briggs Institute.

RESULTS

Eight studies (n = 8) met the inclusion criteria and were included in the review. Four were conducted in Europe, two were conducted in China, and one was conducted in Japan and Singapore. Five studies were randomized controlled trials, out of which three used contact lenses and two studies used peripheral defocus spectacles lenses. Studies ranged from one day to 2 years. Three studies that used orthokeratology lenses were prospective study designs. Among the studies that used orthokeratology lenses and contact lenses, two studies measured the contrast sensitivity function with CSV1000 (Vector Vision) under mesopic and photopic conditions, with and without glare. Two studies measured the central and peripheral contrast sensitivity using psychophysics experiments. High and low contrast visual acuity was measured using the Freiburg Vision Test (n = 1) and ETDRS charts (n = 3), and stereopsis was assessed using a random dot stereogram (n = 1). The studies showed a reduction in central and peripheral contrast sensitivity function and low contrast acuity when treated with multifocal contact lenses, orthokeratology lenses, and peripheral defocus lenses compared with single-vision lenses.

CONCLUSION

This scoping review found a reduction in central and peripheral contrast sensitivity function, as well as low contrast visual acuity when using various optical corrections for myopia control, while high-contrast visual acuity remained the same. The impact of visual functions may not influence the effectiveness of myopia control. Eye care practitioners should provide awareness to the parent and patient population about the potential visual impact of recent designs for optical corrections of myopia control.

Effectiveness of a Spectacle Lens with a Specific Asymmetric Myopic Peripheral Defocus: 12-Month Results in a Spanish Population

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.

Six-year cumulative treatment effect and treatment efficacy of a dual focus myopia control contact lens

PURPOSE

Accumulated axial growth observed during a 6-year clinical trial of a dual focus myopia control contact lens was used to explore different approaches to assess treatment efficacy.

METHODS

Axial length measurements from 170 eyes in a 6-year clinical trial of a dual focus myopia control lens (MiSight 1 day, CooperVision) were analysed. Treatment groups comprised one having undergone 6 years of treatment and the other (the initial control group) having 3 years of treatment after 3 years of wearing a single vision control lens. Efficacy was assessed by comparing accumulated ocular growth during treatment to that expected of untreated myopic and emmetropic eyes. The impact of treatment on delaying axial growth was quantified by comparing the increased time required to reach criterion growths for treated eyes and survivor analysis approaches.

RESULTS

When compared to the predicted accumulated growth of untreated eyes, 6 years of treatment reduced growth by 0.52 mm, while 3 years of treatment initiated 3 years later reduced growth by 0.19 mm. Accumulated differences between the growth of treated and untreated myopic eyes ranged between 67% and 52% of the untreated myopic growth, and between 112% and 86% of the predicted difference in growth between untreated myopic and age-matched emmetropic eyes. Treated eyes took almost 4 years longer to reach their final accumulated growth than untreated eyes. Treatment increased the time to reach criterion growths by 2.3-2.7 times.

CONCLUSION

Estimated growth of age-matched emmetropic and untreated myopic eyes provided evidence of an accumulated slowing in axial elongation of 0.52 mm over 6 years, and the treated growth remained close to that expected of emmetropic eyes. Six years of dual focus myopia control delayed the time to reach the final growth level by almost 4 years.

Association between choriocapillaris perfusion and axial elongation in children using defocus incorporated multiple segments (DIMS) spectacle lenses

PURPOSE

To investigate choroidal and ocular biological variables that influence axial length (AL) elongation in children wearing defocused incorporated multiple segments (DIMS) spectacle lenses.

METHODS

This cohort study included 106 myopic children aged 7-14 years with a 1-year follow-up. Participants were divided into two groups according to the increase in AL in one year: rapid (>0.2 mm) and slow (≤0.2 mm) axial elongation groups. Cycloplegic autorefraction and AL were measured at baseline and after 6 and 12 months. The area of choriocapillaris flow voids (FVs) and choroidal thickness (ChT) at baseline were measured.

RESULTS

Univariate linear regression analysis showed that AL elongation were significantly associated with the FVs area (standardised β = 0.198, P < 0.05) and age (standardised β = -0.201, P < 0.05). Multiple linear regression showed that the FVs area, age, and average K reading were associated with AL elongation. Multiple logistic regression analyses showed that greater degrees of myopia and larger FVs areas were risk factors for rapid axial elongation, while older age, large pupil diameter and steeper cornea were protective factors. In estimating axial elongation, the FVs area alone demonstrated an area under the curve (AUC) of 0.672 (95% CI, 0.569-0.775, P < 0.01), and that of FVs area and other ocular variables was 0.788 (95% CI, 0.697-0.878, P < 0.001).

CONCLUSION

Larger choriocapillaris FVs area at baseline may help to predict axial elongation in myopic eyes. The association between FVs area and axial elongation should be taken into consideration in further myopic cohort studies.

Preventing the Progression of Myopia in Children-A Review of the Past Decade

The growing incidence of myopia worldwide justifies the search for efficient methods of myopia prevention. Numerous pharmacological, optical, and lifestyle measures have already been utilized, but there remains a need to explore more practical and predictable methods for myopia control. This paper presents a review of the most recent studies on the prevention of myopia progression using defocus-incorporated multiple-segment spectacle lenses (DIMSsl), repeated low-level red-light (RLRL) therapy, and a combination of low-dose atropine (0.01%) with orthokeratology lenses.

Multiple segment spectacle lenses for myopia control. Part 1: Optics

PURPOSE

To understand and compare the optics of two multiple segment (MS) spectacle lenses (Hoya MiyoSmart and Essilor Stellest) designed to inhibit myopia progression in children.

METHODS

The optics of the two designs are presented, together with geometrical optics-based calculations to understand the impact of the lenses on the optics of the eye. Lenses were evaluated with three techniques: surface images, Twyman-Green interferometry and focimetry. The carrier lens powers and the spatial distribution, powers and forms of the lenslets were measured.

RESULTS

MS lenses as manufactured were found to match most of the design specifications provided by their manufacturers, although some apparent small discrepancies were found. The focimeter-measured power of the lenslets was approximately +3.50 D for the MiyoSmart and +4.00 D for the highly aspheric lenslets of the Stellest design. For both lens designs, image contrast would be expected to become modestly reduced in the focal planes of the distance-correcting carrier lenses. Images become much more degraded in the combined carrier-lenslet focal plane, due to the generation of multiple laterally displaced images formed by adjacent lenslets within the effective pupil. The exact effects observed depended on the effective pupil size and its location with respect to the lenslets, as well as the power and arrangement of the lenslets.

CONCLUSION

Wearing either of these lenses will produce broadly similar effects on retinal imagery.

Multiple segment spectacle lenses for myopia control. Part 2: Impact on myopia progression

PURPOSE

Initial studies have suggested that multiple segment (MS) spectacle lenses can reduce the progression rate of childhood myopia and axial eye growth. This paper aimed to compare the effectiveness of two different available designs of MS lens and to explore the nature of their control effect.

METHOD

Published data from the only two clinical trials in which changes in mean spherical equivalent refraction (SER) and axial length (AL) for matched groups of myopic children wearing either MS or single-vision (SV) spectacle corrections, recorded over a period of at least 2 years, were further analysed and compared. Both trials involved Chinese children of similar ages and visual characteristics, but the trials were located in different cities. The two MS lenses examined were MiyoSmart or DIMS (Hoya) and Stellest (Essilor).

RESULTS

Absolute changes in SER and AL differed over time during the two trials. However, if the results were expressed in terms of efficacy over successive 6-month periods, then the two MS lenses produced broadly similar results (initial efficacy for the control of myopia progression of about 60%-80%, declining over 2 years to about 35%-55%). Control appears to be absolute rather than proportional.

DISCUSSION

Myopia control may be due to either the additional myopic defocus induced by the MS lenses (i.e., asymmetry of the through-focus image changes about the distance focus) or to the general reduction in image contrast that the lenslets create in the peripheral field.

CONCLUSION

Multiple segment spectacle lenses offer a valuable new approach to the control of myopia progression in children. Further work is required to clarify their mechanism of action and to optimise their design parameters.

Myopia Control Dose Delivered to Treated Eyes by a Dual-focus Myopia-control Contact Lens

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.

The Influence of Accommodation on Retinal Peripheral Refraction Changes in Different Measurement Areas

Background

The change in refraction caused by accommodation inevitably affects the peripheral defocus state and thus may influence the effect of retinal peripheral myopic defocus measures in myopia control. This study investigated accommodation changes in different peripheral retinas under cycloplegia to help improve myopia control.

Methods

Fifty-six eyes of fifty-six myopic subjects were recruited for this prospective study. The center and peripheral retina refractions were measured using multispectral refractive topography. The subjects were divided into low-to-moderate myopia group (range: -1.25 D to -6.00 D) and high myopia group (range: -6.25 D to -9.75 D) according to spherical equivalent (SE). The compound tropicamide (0.5% tropicamide and 0.5% phenylephrine) was used to relax the accommodation. The difference between cycloplegia and non-cycloplegia peripheral retinal refraction was analyzed using the t-test. The correlation between eccentricity and changes in peripheral refraction was analyzed using Pearson's correlation analysis.

Results

The manifest refraction of the retina significantly decreased with an increase in eccentricity after cycloplegia. The annular refraction difference value at 50°-53° (ARDV 50-53) showed the largest refraction decrease of 1.31 D compared with the central retinal refraction decrease of 0.84 D. The inferior quadrantal refraction difference value had the least change compared to the other quadrants. The relative peripheral refraction (RPR) changes in refraction difference value (RDV) at 15° (RDV-15), RDV-30, and RDV-45 were less than 0.15 D. When the range of annulus narrowed to 5°, the narrower annulus showed faster change with eccentricity increase in ARDV 30-35, ARDV 35-40, ARDV 40-45, ARDV 45-50, and ARDV 50-53. The RPR was highly correlated with eccentricity (R = 0.938 and P < 0.001). The high myopia group had a greater hyperopic shift in the periphery than the low-to-moderate group after cycloplegia.

Conclusions

Peripheral refraction showed a significant hyperopic shift after cycloplegia with an increase in eccentricity. The RPR became more hyperopic than the central refraction. The high myopia group showed more hyperopic shifts in the peripheral region. Accommodation should be taken into consideration in peripheral defocus treatment.

IMI 2023 Digest

Myopia is a dynamic and rapidly moving field, with ongoing research providing a better understanding of the etiology leading to novel myopia control strategies. In 2019, the International Myopia Institute (IMI) assembled and published a series of white papers across relevant topics and updated the evidence with a digest in 2021. Here, we summarize findings across key topics from the previous 2 years. Studies in animal models have continued to explore how wavelength and intensity of light influence eye growth and have examined new pharmacologic agents and scleral cross-linking as potential strategies for slowing myopia. In children, the term premyopia is gaining interest with increased attention to early implementation of myopia control. Most studies use the IMI definitions of ≤-0.5 diopters (D) for myopia and ≤-6.0 D for high myopia, although categorization and definitions for structural consequences of high myopia remain an issue. Clinical trials have demonstrated that newer spectacle lens designs incorporating multiple segments, lenslets, or diffusion optics exhibit good efficacy. Clinical considerations and factors influencing efficacy for soft multifocal contact lenses and orthokeratology are discussed. Topical atropine remains the only widely accessible pharmacologic treatment. Rebound observed with higher concentration of atropine is not evident with lower concentrations or optical interventions. Overall, myopia control treatments show little adverse effect on visual function and appear generally safe, with longer wear times and combination therapies maximizing outcomes. An emerging category of light-based therapies for children requires comprehensive safety data to enable risk versus benefit analysis. Given the success of myopia control strategies, the ethics of including a control arm in clinical trials is heavily debated. IMI recommendations for clinical trial protocols are discussed.

Additive effects of narrowband light and optical defocus on chick eye growth and refraction

BACKGROUND

In the past decade and during the COVID pandemic, the prevalence of myopia has reached epidemic proportions. To address this issue and reduce the prevalence of myopia and its complications, it is necessary to develop more effective interventions for controlling myopia. In this study, we investigated the combined effects of narrowband lights and competing defocus on eye growth and refraction in chicks, an important step in understanding the potential for these interventions to control myopia. This is the first time these effects have been characterized.

METHODS

Three groups of five-day-old chicks (n = 8 per group) were raised in three different lighting conditions: white, red, and blue for 13 days in a 12/12-h light/dark diurnal cycle. One eye was randomly selected for applications of a dual-power optical lens (- 10 D/ + 10 D, 50∶50), while another eye was left untreated as control. Vitreous chamber depth (VCD), axial length (AL), choroidal thickness (CT) and refractive errors were measured at pre-exposure (D0) and following 3 (D3), 7 (D7), 10 (D10), and 13 days (D13) of light exposure.

RESULTS

Under white light, the dual-power lens induced a hyperopic shift [at D13, mean spherical equivalent refraction (SER), treated vs. control: 4.81 ± 0.43 D vs. 1.77 ± 0.21 D, P < 0.001] and significantly reduced the progression of axial elongation (at D13, change in AL, treated vs. control: 1.25 ± 0.04 mm vs. 1.45 ± 0.05 mm, P < 0.01). Compared to white light alone, blue light alone induced a hyperopic shift (at D13, mean SER, blue vs. white: 2.75 ± 0.21 D vs. 1.77 ± 0.21 D, P < 0.01) and significantly reduced axial elongation (at D13, change in AL, blue vs. white: 1.17 ± 0.06 mm vs. 1.45 ± 0.05 mm, P < 0.01) in control eyes. When comparing all conditions, eyes exposed to blue light plus dual-power lens had the least axial elongation (at D13, change in AL, 0.99 ± 0.05 mm) and were the most hyperopic (at D13, mean SER, 6.36 ± 0.39 D).

CONCLUSIONS

Both narrowband blue light and dual-power lens interventions were effective in inducing a hyperopic shift in chicks, and provided protection against myopia development. The combination of these interventions had additive effects, making them potentially even more effective. These findings support the use of optical defocus interventions in combination with wavelength filters in clinical studies testing their effectiveness in treating myopia in children.

Impact of myopia control spectacle lenses with highly aspherical lenslets on peripheral visual acuity and central visual acuity with peripheral gaze

PURPOSE

Myopia control spectacle lenses with peripheral lenslets are gaining popularity because they are non-invasive and easy to manage, and ongoing clinical trials have shown promising results. This study aimed to evaluate peripheral and central visual acuity (VA) with peripheral gaze in conditions where the eyes are turned to look obliquely through the lenslets.

METHODS

High-contrast (100%) VA was measured at 300 cm and 10 lx. For each test, two lens designs were evaluated in counterbalanced order: a spectacle lens with highly aspherical lenslets (HALs) and a standard single-vision lens (SVL). The target screen was placed at a visual angle of 21.6° to the nasal side of the right eye. Sixteen adults (27-52 years of age; spherical equivalent refraction (SER), -8.75 D to +0.50 D) wearing their habitual visual correction performed all tests monocularly.

RESULTS

Mean (SD) central VAs with peripheral gaze through the SVL and the HAL lens were 0.08 (0.13) and 0.17 (0.12) logMAR, respectively. The HAL lens reduced central VA with peripheral gaze by 0.10 (0.08) logMAR (p = 0.03). No significant correlation was observed between the impact of the HAL lens and other factors, such as age or SER. Peripheral VA was not significantly different through the two lenses (1.09 (0.06) logMAR and 1.09 (0.09) logMAR for the SVL and the HAL lens, respectively; p = 0.86).

CONCLUSIONS

Under high-contrast and low-luminance conditions, the HAL lens reduced central VA with peripheral gaze by approximately one line compared with the SVL. The impact on central VA did not vary with gaze direction, age or SER. The HAL lens did not affect peripheral VA in this condition.

A comparison of myopia control in European children and adolescents with defocus incorporated multiple segments (DIMS) spectacles, atropine, and combined DIMS/atropine

PURPOSE

To evaluate the efficacy of a myopia control spectacle lens (DIMS) at slowing the progression of myopia in a population of European children in comparison with 0.01% atropine and combined DIMS and atropine.

METHODS

The study was a non-randomised experimenter-masked prospective controlled observational study of individuals aged 6-18 years with progressing myopia but no ocular pathology. Participants were allocated, according to patient/parent choice, to receive 0.01% atropine eyedrops, DIMS (Hoya® MiyoSmart®) spectacles, combined atropine+DIMS or single vision spectacle lenses (control group). The key outcome variables, cycloplegic autorefraction spherical equivalent refraction (SER) and axial length (AL), were measured at baseline and after three, six, and 12 months.

RESULTS

Of the 146 participants (mean age 10.3y ±3.2), 53 received atropine, 30 DIMS spectacles, 31 atropine+DIMS, and 32 single vision control spectacles. Generalized linear mixed model analysis revealed for SER, whilst controlling for age and SER at baseline, at each stage all treatment groups had significantly reduced progression compared with the control group (p<0.016). For AL, whilst controlling for baseline age and AL, at 6 and 12 months all treatment groups had significantly less progression than the control group (p<0.005). For SER only, in pairwise comparisons at 12 months the atropine+DIMS group had significantly reduced progression compared with the DIMS only and Atropine only groups (p<0.001).

CONCLUSION

In a European population, DIMS and atropine are effective at reducing myopia progression and axial elongation in progressing myopia and are most successful at reducing myopia progression when used in combination.

[Recommendations for Progressive Myopia in Childhood and Adolescence. Statement of the DOG, BVA and the Bielschowsky Society for Strabismus Research and Neuroophthalmology - Status June 2022]

Since the last and at the same time first statement of the German ophthalmological societies on the possibilities of reducing myopia progression in childhood and adolescence, many new details and aspects have emerged in clinical research. This second statement updates the previous document and specifies the recommendations on visual and reading behavior as well as on pharmacological and optical therapy options, which have been both refined and newly developed in the meantime.

[Recommendations for progressive myopia in childhood and adolescence. Statement of the DOG, BVA and the Bielschowsky Society for Strabismus Research and Neuroophthalmology : Status June 2022]

Since the last and at the same time first statement of the German ophthalmological societies on the possibilities of reducing myopia progression in childhood and adolescence, many new details and aspects have emerged in clinical research. This second statement updates the previous document and specifies the recommendations on visual and reading behavior as well as on pharmacological and optical therapy options, which have been both refined and newly developed in the meantime.

One-year Efficacy of the Defocus Incorporated Multiple Segment Lens in Chinese Myopic Children

SIGNIFICANCE

These data demonstrate that defocus incorporated multiple segment (DIMS) lens reduces myopia progression in children during the first year of use.

PURPOSE

This study aimed to investigate the efficacy of DIMS myopia control spectacle lens in Chinese myopic children aged 6 to 15 years.

METHODS

This is a retrospective study of 1-year longitudinal data. A total of 180 Chinese myopic children were selected from patients at Zhongshan Ophthalmic Center, Sun Yat-sen University, from February 2018 to January 2021. One group consisted of 90 children aged 6 to 15 years, with spherical equivalent refraction -0.50 to -7.75 D (-3.82 ± 1.57 D) and fitted with the DIMS lens. The other group consisted of 90 children fitted with single-vision spectacle lenses and matched with the DIMS group for age, sex, refraction, and progression of myopia in the previous year. One-year myopia progression was measured retrospectively in two groups. Unpaired t test was used to compare the myopia progression between the DIMS group and the control group. Pearson correlation was used to explore the relationship between myopia progression, age, and baseline refraction.

RESULTS

After 1 year of DIMS lens wear, myopia progression was significantly lower in the DIMS group (-0.51 ± 0.50 vs. -0.85 ± 0.51 D, P < .001). Myopia progression was positively correlated with age in both groups. The difference between the DIMS and control groups was more pronounced for children aged 10 to 15 years than for children aged 6 to 9 years.

CONCLUSIONS

This study confirms that the DIMS lens reduces myopia progression during the first year of use. Efficacy seems to increase with age.

Synergistic effects of defocus-incorporated multiple segments and atropine in slowing the progression of myopia

Myopia is a leading cause of visual impairment in young people worldwide. It sometimes increases the risk of blindness and reduces life quality. Previous reports have revealed the treatment effects of defocus-incorporated multiple segments (DIMS) and topical atropine (ATP) on myopia control. However, no study has evaluated these two interventions together. In this retrospective study, we aimed to determine whether the combination of DIMS lenses and 0.01% ATP can slow the progression of myopia compared with DIMS lenses or single vision (SV) lenses alone. We included 107 children with myopia who were treated with DIMS and 0.01% ATP combination (DIMS + ATP group), DIMS monotherapy (DIMS group), or a control group (SV group). We compared treatment effects among three groups in axial length and myopia progression. After a 1-year follow-up, the DIMS + ATP group showed a smaller change in axial length and myopia progression than the DIMS and SV groups (P < 0.05). Hence, combination treatment with DIMS and 0.01% ATP might be a better choice for children with myopia.

Spectacles with highly aspherical lenslets for myopia control do not change visual sensitivity in automated static perimetry

Purpose

Spectacle lenses with arrays of lenslets have gained popularity in myopia control due to their high efficacy, low impact on visual performance, and non-invasiveness. One of the questions regarding their impact on visual performance that still remain is that: do the lenslets impact visual field sensitivity? The current study aims to investigate the impact of wearing spectacle lenses with highly aspherical lenslets (HAL) on the visual field sensitivity.

Methods

An automated static perimetry test (Goldman perimeter target III) was employed to measure the detection sensitivity in the visual field. Targets were white light dots of various luminance levels and size 0.43°, randomly appearing at 76 locations within 30° eccentricity. Twenty-one adult subjects (age 23-61, spherical equivalent refractive error (SER) -8.75 D to +0.88 D) participated in the study. Sensitivities through two lenses, HAL and a single vision lens (SVL) as the control condition, were measured in random order.

Results

The mean sensitivity differences between HAL and SVL across the 76 tested locations ranged between -1.14 decibels (dB) and 1.28 dB. Only one location at 30° in the temporal visual field reached statistical significance (p < 0.00065) whereby the sensitivity increased by 1.1 dB with HAL. No significant correlation was found between the difference in sensitivity and age or SER. Such a difference is unlikely to be clinically relevant.

Conclusion

Compared to the SVL, the HAL did not change detection sensitivity to static targets in the whole visual field within 30° eccentricity.

Effect of Spectacle Lenses with Highly Aspherical Lenslets on Binocular Vision and Accommodation in Myopic Children with and without Intermittent Exotropia

Purpose

To evaluate the influence of spectacle lenses with highly aspherical lenslets (HAL) on binocular vision and accommodation in myopic children with intermittent exotropia (IXT) and compare the changes after wearing HAL in binocular vision and accommodation in myopic children with or without IXT.

Method

Forty myopic subjects aged 8–12 years were recruited: 20 with IXT and 20 visually normal children. Stereoacuity, phoria, accommodative facility, fusional vergence, vergence facility, near point of convergence, amplitude of accommodation, and accommodative response (AR) were measured by wearing HAL or single vision spectacle lenses (SVL) in a random order after adapting for 20 minutes. Accommodative microfluctuation (AMF) was defined as the standard deviation of AR. Changes in binocular vision and accommodation after wearing HAL were compared between the two groups.

Results

No significant differences were found in binocular vision after wearing HAL versus SVL in either group (all P > 0.05). A greater AMF was found after wearing HAL than after wearing SVL in both groups (0.04 D, 95% confidence interval (CI), 0.03 to 0.05 D, P < 0.001 for the IXT group; 0.05 D, 95% CI, 0.03 to 0.07 D, P < 0.001 for the visually normal group); however, the other accommodation parameters did not change significantly (all P > 0.05). There were no differences in the changes after wearing HAL in any parameter between the two groups (all P > 0.05).

Conclusion

HAL did not significantly change the binocular vision and accommodation for myopic children with or without IXT except for AMF in the short term.

Effect of peripheral refractive errors on driving performance

The effect of peripheral refractive errors on driving while performing secondary tasks at 40° of eccentricity was studied in thirty-one young drivers. They drove a driving simulator under 7 different induced peripheral refractive errors (baseline (0D), spherical lenses of +/- 2D, +/- 4D and cylindrical lenses of +2D and +4D). Peripheral visual acuity and contrast sensitivity were also evaluated at 40°. Driving performance was significantly impaired by the addition of myopic defocus (4D) and astigmatism (4D). Worse driving significantly correlated with worse contrast sensitivity for the route in general, but also with worse visual acuity when participants interacted with the secondary task. Induced peripheral refractive errors may negatively impact driving when performing secondary tasks.

Visual acuity, near phoria and accommodation in myopic children using spectacle lenses with aspherical lenslets: results from a randomized clinical trial

Objectives

To investigate the short- and long-term effects of myopia control spectacle lenses with highly aspherical lenslets (HAL) and slightly aspherical lenslets (SAL) on visual function and visual quality using data obtained from a randomized controlled clinical trial.

Methods

This was a prospective, randomized, controlled, and double-blinded study; 170 myopic children aged 8–13 years were randomly assigned to the HAL, SAL, or single-vision spectacle lenses (SVL) groups. Distance and near visual acuity (VA) at high (100%) and low (10%) contrast in photopic and scotopic conditions, near phoria, stereoacuity, and accommodative lag, microfluctuations (AMFs), amplitude (AA) were measured after wearing lenses for 10 min, 6 months, and 12 months.

Results

In total, 161 subjects completed all follow-up in 12 months and were included in the analysis. After 10 min of wearing, the HAL and SAL groups had lower scotopic and low-contrast VA than the SVL group (decreased 0.03–0.08 logMAR and 0.01–0.04 logMAR in different VAs in the HAL and SAL groups, respectively, all P < 0.05). The reduction in VA was recovered at 12 months as the HAL and SAL groups exhibited significant VA improvements, and the VA was not different among the three groups (all P > 0.05). The HAL and SAL groups had significantly larger AMFs than the SVL group (HAL vs. SAL vs. SVL: 0.21 ± 0.08 D vs. 0.16 ± 0.05 D vs. 0.15 ± 0.06 D at baseline, 0.19 ± 0.07 D vs. 0.17 ± 0.05 D vs. 0.13 ± 0.07 D at 12 months, all P < 0.05). There were no significant differences in accommodative lag, AA, or phoria between the groups (all P > 0.05). The HAL and SAL groups had reduced stereoacuity compared to the SVL group at baseline (70’ vs. 60’ vs. 50’, P = 0.005), but no difference was observed at 12 months (70’ vs. 70’ vs. 70’, P = 0.11).

Conclusions

HAL and SAL have no significant influence on accommodation and phoria except had larger AMF than SVL. Scotopic VA and low-contrast VA are reduced with short-term HAL and SAL use but recovered to be at same level with the SVL after 1 year of use.

Trial registration Chinese Clinical Trial Registry: ChiCTR1800017683. Registered on 9 August 2018. http://www.chictr.org.cn/showproj.aspx?proj=29789

Myopia Control Effect Is Influenced by Baseline Relative Peripheral Refraction in Children Wearing Defocus Incorporated Multiple Segments (DIMS) Spectacle Lenses

The aim of this study is to investigate if baseline relative peripheral refraction (RPR) influences the myopia control effects in Chinese myopic children wearing Defocus Incorporated Multiple Segments (DIMS) lenses. Peripheral refraction at 10°, 20°, and 30° nasal (10 N, 20 N, 30 N) and temporal (10 T, 20 T, 30 T) retina were measured at six-month intervals for children who participated in a 2-year randomized controlled trial. The relationship between the baseline peripheral refractions and myopia progression and axial length changes were analysed. A total of 79 children and 81 children in the DIMS and single vision (SV) group were investigated, respectively. In the DIMS group, more baseline myopic RPR spherical equivalent (SE) was associated with more myopic progression (10 N: r = 0.36, p = 0.001; 20 N: r = 0.35, p = 0.001) and greater axial elongation (10 N: r = −0.34, p = 0.001; 20 N: r = −0.29, p = 0.006) after adjusting for co-factors. In the SV group, baseline RPR had association with only myopia progression (10 N: r = 0.37, p = 0.001; 20 N: r = 0.36, p = 0.001; 30 N: r = 0.35, p = 0.002) but not with axial elongation after Bonferroni correction (p > 0.008). No statistically significant relationship was found between temporal retina and myopia progression or axial elongation in both groups. Children with baseline myopic RPR had statistically significant more myopia progression (mean difference around −0.40 D) and more axial elongation (mean difference 0.15 mm) when compared with the children having baseline hyperopic RPR in the DIMS group but not in the SV group. In conclusion, the baseline RPR profile may not influence future myopia progression or axial elongation for the SV lens wearers. However, DIMS lenses slowed down myopia progression and was better in myopia control for the children with baseline hyperopic RPR than the children with myopic RPR. This may partially explain why myopia control effects vary among myopic children. Customised myopic defocus for individuals may optimise myopia control effects, and further research to determine the optimal dosage, with consideration of peripheral retinal profile, is warranted.

Overview on Defocus Incorporated Multiple Segments Lenses: A Novel Perspective in Myopia Progression Management

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.

Modelling the refractive and imaging impact of multi-zone lenses utilised for myopia control in children's eyes

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.

Myopia Control With Multifocal Lens in School-Aged Children: A Meta-Analysis

BACKGROUND

Myopia is one of the most common eye diseases in school-aged children. Multifocal lens (MFL) is one of the interventions that has being widely applied to control the progress of myopia. However, the treatment effects of MFLs in school-aged children require to be systematically evaluated.

METHODS

A systematic analysis on qualified randomized controlled trials (RCTs) in which MFLs were prescribed as the intervention and single-vision lenses (SVLs) as the control was conducted. The treatment effects referring to the mean differences in spherical equivalent refraction (SER) and axial length (AL) between MFLs and SVLs groups were analyzed.

RESULTS

With annual visit (3-years follow-up), the weighted mean differences (WMDs) in SER between MFLs and SVLs were 0.29 D (95% CI, 0.21 ∼ 0.37, p < 0.00001), 0.46 D (95% CI, 0.32 ∼ 0.60, p < 0.00001), and 0.64 D (95% CI, 0.40 ∼ 0.88, p < 0.00001) at the first, second, and third year; in AL were -0.12 mm (95% CI, -0.14 ∼-0.11, p < 0.00001), -0.19 mm (95% CI, -0.22 ∼-0.16, p < 0.00001), and -0.26 mm (95% CI, -0.31 ∼-0.21, p < 0.00001) at the first, second, and third year. With 6-months interval trials (2-years follow-up), the WMDs in SER from MFLs were 0.14 D (95% CI, 0.08 ∼ 0.20, p < 0.0001), 0.19 D (95% CI, 0.11 ∼ 0.28, p < 0.0001), 0.24 D (95% CI, 0.16 ∼ 0.33, p < 0.0001), 0.31 D (95% CI, 0.18 ∼ 0.44, p < 0.0001) and in AL from MFLs were -0.08 mm (95% CI, -0.09 ∼-0.07, p < 0.00001), -0.10 mm (95% CI, -0.12 ∼-0.09, p < 0.00001), -0.14 mm (95% CI, -0.17 ∼-0.11, p < 0.00001), and -0.18 mm (95% CI, -0.22 ∼-0.14, p < 0.00001) slower comparing with SVLs at follow up of 6, 12, 18, and 24 months, respectively.

CONCLUSION

The treatment effects of MFLs to slow down the myopic progress are positive in both 6-months and annual-visit trials and which could be sustained till 36 months. While a slight weaker treatment effect was observed after the first visit in 6-months visit, a slight rebound was observed at the following visit points. Furthermore, the treatment effects in annual visit are more profound than 6-months visit at almost all stages especially in SER. Our analysis encourages the MFLs users to maintain a long-term treatment with annual visit.

[Myopia treatment and prophylaxis with defocus incorporated multiple segments spectacle lenses]

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.

Evaluation of axial length to identify the effects of monocular 0.125% atropine treatment for pediatric anisometropia

The aim of the study is to determine the effects of monocular 0.125% atropine daily treatment on the longer axial length (AL) eyes in children with pediatric anisometropia. This was a retrospective cohort study. The charts of children with anisometropia (aged 6–15 years) who had a > 0.2-mm difference in AL between the two eyes were reviewed. Children who received monocular treatment of 0.125% atropine in the eye with longer AL were included for final analysis. The main outcome measure was the difference in AL between the two eyes after treatment. Regression analysis was used to model the changes in AL according to the time of treatment in both eyes. Finally, forty eyes in 20 patients (mean age 10.2 years) were included in the analyses. During the treatment period, AL was controlled in the treated eyes (p = 0.389) but elongated significantly in the untreated eyes (p < 0.001). The difference in AL between the treated and untreated eyes decreased from 0.57 to 0.22 mm (p < 0.001) after the 1-year treatment period. In the regression model, the best fit for the relationship between changes in AL and time during the treatment period in the treated eyes was the quadratic regression model with a concave function. In conclusion, these data suggest that 0.125% atropine daily is an effective treatment to reduce the interocular difference of AL in eyes with axial anisometropia. This pilot study provides useful information for future prospective and larger studies of atropine for the treatment of pediatric axial anisometropia.

A retrospective analysis of the therapeutic effects of 0.01% atropine on axial length growth in children in a real-life clinical setting

BACKGROUND

Several randomized controlled studies have demonstrated the beneficial effects of 0.01% atropine eye drops on myopia progression in children. However, treatment effects may be different in a routine clinical setting. We performed a retrospective analysis of our clinical data from children to investigate the effect of 0.01% atropine eye drops on myopia progression in a routine clinical setting.

METHODS

Atropine-treated children were asked to instill one drop of 0.01% atropine in each eye every evening at 5 days a week. Myopic children who did not undergo atropine treatment served as controls. Objective refraction and ocular biometry of 80 atropine-treated and 103 untreated children at initial visit and 1 year later were retrospectively analyzed.

RESULTS

Myopic refractions in the treated and untreated children at initial visit ranged from -0.625 to -15.25 D (-4.21 ± 2.90 D) and from -0.125 to -9.375 D (-2.92 ± 1.77 D), respectively. Ages at initial visit ranged from 3.2 to 15.5 years (10.1 ± 2.7 years) in the treated and from 3.4 to 15.5 years (11.2 ± 3.0 years) in untreated children. Two-factor ANOVA for age and atropine effects on axial length growth confirmed that axial length growth rates declined with age (p<0.0001) and revealed a significant inhibitory effect of atropine on axial length growth (p<0.0015). The atropine effect on axial length growth averaged to 0.08 mm (28%) inhibition per year. Effects on refraction were not statistically significant.

CONCLUSION

The observed atropine effects were not very distinctive: Statistical analysis confirmed that atropine reduced axial length growth, but to an extent of minor clinical relevance. It was also shown that beneficial effects of 0.01% atropine may not be obvious in each single case, which should be communicated with parents and resident ophthalmologists.