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12 pages, 1132 KiB

Open AccessArticle

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

by Monika Modrzejewska and Magdalena Durajczyk

J. Clin. Med. 2024, 13(7), 1977; https://doi.org/10.3390/jcm13071977 - 29 Mar 2024

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Abstract

Background: Determination of the number of pupils at risk of developing pre-myopia and selected ophthalmic parameters in a group of 1155 children aged 8. Material: Ophthalmic examinations were performed in Polish 8-year-old, /1518 individuals/; 1155 of whom presented complete data for analysis. There [...] Read more.

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

(This article belongs to the Special Issue New Frontiers in Myopia Progression in Children)

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12 pages, 3575 KiB

Open AccessArticle

Refractive Error and Axial Length and Their Related Factors in 8-Year-Old Japanese Children: The Yamanashi Adjunct Study of the Japan Environment and Children’s Study (JECS)

by Natsuki Okabe, Airi Takahashi, Yumi Shigemoto, Chio Kogure, Tadao Ooka, Ryoji Shinohara, Sanae Otawa, Anna Kobayashi, Sayaka Horiuchi, Megumi Kushima, Zentaro Yamagata, Kenji Kashiwagi and The Yamanashi Adjunct Study of the Japan Environment and Children's Study Group

J. Clin. Med. 2023, 12(18), 5929; https://doi.org/10.3390/jcm12185929 - 12 Sep 2023

Cited by 1 | Viewed by 725

Abstract

Purpose: To investigate the distribution of visual acuity, refractive error, and axial length in 8-year-old children who participated in an additional survey in Yamanashi Prefecture of the Japan Environmental Children’s Study (hereafter referred to as JECS-Y) conducted from 2019 to 2021. Participants and [...] Read more.

Purpose: To investigate the distribution of visual acuity, refractive error, and axial length in 8-year-old children who participated in an additional survey in Yamanashi Prefecture of the Japan Environmental Children’s Study (hereafter referred to as JECS-Y) conducted from 2019 to 2021. Participants and Methods: Eight-year-old children who participated in the JECS-Y study were subjected to noncycloplegic measurements of refractive error and axial length. If the uncorrected visual acuity was less than 20/20, the best corrected visual acuity was evaluated in accordance with the autorefraction data. A questionnaire was administered regarding the parent’s history of eyeglass wear or contact lens use. Results: Among the 400 participating children, the rate of uncorrected visual acuity of 20/20 or better in both eyes was 70.4%. The mean equivalent spherical equivalent error for both eyes was −0.366 ± 1.016 D. The mean axial length was 23.08 ± 0.225 mm in all patients. The males showed significantly longer axial length than the females despite no differences in body height. There was a significant correlation between axial length, spherical refractive, and uncorrected visual acuity. The children of parents with a history of wearing eyeglasses or contact lenses showed a significantly more myopic equivalent refractive error than those without a history. Conclusions: This study clarified the current state of refractive error in 8-year-old children and the association of inheritance with refractive error. In addition, the axials were significantly longer in male patients. Full article

(This article belongs to the Special Issue New Frontiers in Myopia Progression in Children)

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13 pages, 2151 KiB

Open AccessArticle

Changes in Choroidal Thickness and Retinal Activity with a Myopia Control Contact Lens

by Ana Amorim-de-Sousa, Jaume Pauné, Sara Silva-Leite, Paulo Fernandes, José Manuel Gozález-Méijome and António Queirós

J. Clin. Med. 2023, 12(11), 3618; https://doi.org/10.3390/jcm12113618 - 23 May 2023

Cited by 1 | Viewed by 2097

Abstract

Purpose: The axial elongation in myopia is associated with some structural and functional retinal changes. The purpose of this study was to investigate the effect of a contact lens (CL) intended for myopia control on the choroidal thickness (ChT) and the retinal electrical [...] Read more.

Purpose: The axial elongation in myopia is associated with some structural and functional retinal changes. The purpose of this study was to investigate the effect of a contact lens (CL) intended for myopia control on the choroidal thickness (ChT) and the retinal electrical response. Methods: Ten myopic eyes (10 subjects, 18–35 years of age) with spherical equivalents from −0.75 to −6.00 diopters (D) were enrolled. The ChT at different eccentricities (3 mm temporal, 1.5 mm temporal, sub-foveal ChT, 1.5 mm nasal, and 3 mm nasal), the photopic 3.0 b-wave of ffERG and the PERG were recorded and compared with two material-matched contact lenses following 30 min of wear: a single-vision CL (SV) and a radial power gradient CL with +1.50 D addition (PG). Results: Compared with the SV, the PG increased the ChT at all eccentricities, with statistically significant differences at 3.0 mm temporal (10.30 ± 11.51 µm, p = 0.020), in sub-foveal ChT (17.00 ± 20.01 µm, p = 0.025), and at 1.5 mm nasal (10.70 ± 14.50 µm, p = 0.044). The PG decreased significantly the SV amplitude of the ffERG photopic b-wave (11.80 (30.55) µV, p = 0.047), N35-P50 (0.90 (0.96) µV, p = 0.017), and P50-N95 (0.46 (2.50) µV, p = 0.047). The amplitude of the a-wave was negatively correlated with the ChT at 3.0T (r = −0.606, p = 0.038) and 1.5T (r = −0.748, p = 0.013), and the amplitude of the b-wave showed a negative correlation with the ChT at 1.5T (r = −0.693, p = 0.026). Conclusions: The PG increased the ChT in a similar magnitude observed in previous studies. These CLs attenuated the amplitude of the retinal response, possibly due to the combined effect of the induced peripheral defocus high-order aberrations impacting the central retinal image. The decrease in the response of bipolar and ganglion cells suggests a potential retrograde feedback signaling effect from the inner to outer retinal layers observed in previous studies. Full article

(This article belongs to the Special Issue New Frontiers in Myopia Progression in Children)

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11 pages, 1172 KiB

Open AccessArticle

Evaluation of the Prevalence of Refractive Defects and Ocular Function in a Group of 1518 Children Aged 8 Years in Northwestern Poland—A Retrospective Study

by Modrzejewska Monika and Magdalena Durajczyk

J. Clin. Med. 2023, 12(8), 2880; https://doi.org/10.3390/jcm12082880 - 14 Apr 2023

Cited by 2 | Viewed by 1528

Abstract

Purpose: To determine the prevalence of refractive errors in a group of 8-year-old school children in northwestern Poland. Material and Methods: In 2017–2019, refractive errors were examined in a group of 1518 Caucasian children aged 8 years old with cycloplegia. Refraction was obtained [...] Read more.

Purpose: To determine the prevalence of refractive errors in a group of 8-year-old school children in northwestern Poland. Material and Methods: In 2017–2019, refractive errors were examined in a group of 1518 Caucasian children aged 8 years old with cycloplegia. Refraction was obtained with a hand-held autorefractor (Retinomax 3). The refractive error reading was expressed as the spherical equivalent (SE) as myopia (≤−0.5 D), emmetropia (>−0.5 D to ≤+0.5 D), mild hyperopia (>+0.5 D to ≤+2.0 D) and hyperopia (>+2.0 D), and astigmatism (≤−0.75 DC) and anisometropia (≥1.00 D). Data analysis was performed using Statistica 13.5 software and included Pearson’s chi-squared and Mann–Whitney U tests. p-values of <0.05 were considered statistically significant. Results: Mild hyperopia was most common (37.6%), myopia was observed in 16.8% and astigmatism in 10.6% of participants. Pseudomyopia concerned up to 51.91% children. Girls were significantly more likely to have mild hyperopia (p = 0.0144) and were significantly more likely to wear glasses (p = 0.00093). Conclusions: Screening children for refractive errors after cycloplegia is key for detecting accommodative spasm and refractive errors. The largest group of children presented with mild hyperopia, which is a physiological feature of refraction in 8-year-old children, but myopia and astigmatism were the most common refractive errors. Full article

(This article belongs to the Special Issue New Frontiers in Myopia Progression in Children)

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13 pages, 704 KiB

Open AccessArticle

Peripheral Refraction and Visual Function of Novel Perifocal Ophthalmic Lens for the Control of Myopia Progression

by Sara Silva-Leite, Ana Amorim-de-Sousa, António Queirós, José Manuel González-Méijome and Paulo Fernandes

J. Clin. Med. 2023, 12(4), 1435; https://doi.org/10.3390/jcm12041435 - 10 Feb 2023

Cited by 1 | Viewed by 1751

Abstract

This study aimed to evaluate the peripheral defocus induced with a novel perifocal ophthalmic lens for myopia progression control and the potential impact on visual function. This experimental, non-dispensing crossover study evaluated 17 myopic young adults. The peripheral refraction was measured using an [...] Read more.

This study aimed to evaluate the peripheral defocus induced with a novel perifocal ophthalmic lens for myopia progression control and the potential impact on visual function. This experimental, non-dispensing crossover study evaluated 17 myopic young adults. The peripheral refraction was measured using an open-field autorefractor, at 2.50 m from the target point, in two eccentric points, 25° temporal, 25° nasal, and central vision. Visual contrast sensitivity (VCS) was measured at 3.00 m with a Vistech system VCTS 6500 in low light conditions. Light disturbance (LD) was assessed with a light distortion analyzer 2.00 m away from the device. Peripheral refraction, VCS, and LD were assessed with a monofocal lens and perifocal lens (with an add power of +2.50 D on the temporal side of the lens, and +2.00 D on the nasal side). The results showed that the perifocal lenses induced an average myopic defocus of −0.42 ± 0.38 D (p-value < 0.001) in the nasal retina, at 25° The changes induced by the lower add power in the nasal part of the lens did not induce statistically significant changes in the refraction of the temporal retina. The VCS and LD showed no significant differences between the monofocal and perifocal lenses. Full article

(This article belongs to the Special Issue New Frontiers in Myopia Progression in Children)

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9 pages, 1225 KiB

Open AccessArticle

Mathematical Estimation of Axial Length Increment in the Control of Myopia Progression

by António Queirós, Ana Amorim-de-Sousa, Paulo Fernandes, Maria Sameiro Ribeiro-Queirós, César Villa-Collar and José M. González-Méijome

J. Clin. Med. 2022, 11(20), 6200; https://doi.org/10.3390/jcm11206200 - 20 Oct 2022

Cited by 6 | Viewed by 1812

Abstract

This study aims to evaluate the existing mathematical approach for the theoretical estimation of axial length (AL) in a cross-sectional study, developing a new mathematical model and testing it in a longitudinal sample. Many professionals do not have a device to measure the [...] Read more.

This study aims to evaluate the existing mathematical approach for the theoretical estimation of axial length (AL) in a cross-sectional study, developing a new mathematical model and testing it in a longitudinal sample. Many professionals do not have a device to measure the AL due to clinic space and cost of equipment. However, this parameter plays an important role in the assessment of myopia progression to monitor treatment effects with myopia control strategies. First, a cross-sectional study based on the mathematical equation proposed by Morgan was performed. The AL was estimated based on the mean values of keratometry and spherical equivalent in 1783 subjects (52% female), aged 14.6 ± 4.6 years (6 to 25 years), of whom 738 were myopic, 770 emmetropic and 275 hyperopic. On average, the AL estimated with the Morgan formula was 0.25 ± 0.48 mm larger than the real AL value (95% limits of agreement: +0.70 to −1.20 mm). The study by gender, ametropia, type of astigmatism and age showed statistically significant differences between the real AL and predicted AL_Morgan (r > 0.750, spearman). Based on the previous sample, a multiple linear regression was applied, and a new mathematical model was proposed. The model was tested on a longitudinal sample of 152 subjects whose mean age was 13.3 ± 3.1 years (9 to 24 years) and of whom 96 were female (64%). The sample consisted of 46 myopes, 82 emmetropes and 24 hyperopes. The longitudinal study of the differences in axial length at one year between the models showed no statistically significant differences and that the mathematical equations are valid for estimating differences in axial increment for ages between 9 and 24 years, despite errors in the predicted value for axial length. Full article

(This article belongs to the Special Issue New Frontiers in Myopia Progression in Children)

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11 pages, 298 KiB

Open AccessArticle

Does Physical Activity Moderate the Relationship between Myopia and Functional Status in Children 9–11 Years of Age?

by Monika Modrzejewska, Jarosław Domaradzki, Wojciech Jedziniak, Beata Florkiewicz and Teresa Zwierko

J. Clin. Med. 2022, 11(19), 5672; https://doi.org/10.3390/jcm11195672 - 26 Sep 2022

Cited by 3 | Viewed by 1499

Abstract

Although previous studies have reported an association between physical activity (PA) and myopia in school-aged children, little is known about the link between myopia and children’s functional status. The purpose of this study was to investigate dynamic balance control in relation to the [...] Read more.

Although previous studies have reported an association between physical activity (PA) and myopia in school-aged children, little is known about the link between myopia and children’s functional status. The purpose of this study was to investigate dynamic balance control in relation to the daily PA levels of myopic schoolchildren aged 9–11 years (n = 52) versus a non-myopic control group (n = 53). A single leg stance test performed on the instability platform of the Biodex Balance System was used to assess balance control. The overall stability index (OSI), anterior-posterior stability index (APSI) and medial-lateral stability index (MLSI) were analyzed. PA levels were calculated using the World Health Organization European Childhood Obesity Surveillance Initiative family record form. Myopes and non-myopes were separated into three subgroups based on PA level (low, moderate and high). Myopia significantly affected OSI (F = 40.46, p < 0.001), APSI (F = 33.93, p < 0.001) and MLSI (F = 49.51, p < 0.001). There were significant differences (p < 0.001) between myopic and non-myopic children with low and moderate levels of PA, whilst there were no differences between compared children with high levels of PA. High PA levels had a positive impact on balance control in myopes. Our results showed that PA levels moderate the relationship between myopia and children’s functional status. Full article

(This article belongs to the Special Issue New Frontiers in Myopia Progression in Children)

9 pages, 1789 KiB

Open AccessArticle

To Achieve a Bullseye: Factors Related to Corneal Refractive Therapy Orthokeratology Lens Toricity

by Changfei Li, Li Zeng, Jiaqi Zhou, Bingjie Wang and Zhi Chen

J. Clin. Med. 2022, 11(19), 5635; https://doi.org/10.3390/jcm11195635 - 24 Sep 2022

Cited by 2 | Viewed by 2022

Abstract

This retrospective study investigated the toricity of dual-axis corneal refractive therapy (CRT) orthokeratology lenses and corneal parameters, including flat keratometry (FK), flat eccentricity (e), steep e, corneal astigmatism, and the difference in elevation at 8 mm chord length. We analyzed [...] Read more.

This retrospective study investigated the toricity of dual-axis corneal refractive therapy (CRT) orthokeratology lenses and corneal parameters, including flat keratometry (FK), flat eccentricity (e), steep e, corneal astigmatism, and the difference in elevation at 8 mm chord length. We analyzed the right eyes of 143 adolescent patients who underwent ocular examinations, subjective refraction, and corneal topography before CRT lens fitting by trial lens evaluation. After orthokeratology treatment, all patients underwent a topography map with an intact plus power ring and decentration of <1 mm. The mean patient age was 10.7 ± 2.2 years old; 33% were male. The lens toricity range was 25–100 µm. Multiple linear regression analysis showed significant associations between CRT lens toricity and corneal astigmatism (β = 10.913, t = 3.012, p = 0.003) and the difference in elevation at 8 mm chord length (β = 0.681, t = 4.049, p < 0.001); no association was found between CRT lens toricity and FK, flat e, or steep e (all p > 0.05). Corneal astigmatism was positively associated with difference in elevation at 8 mm chord length (r = 0.743, p < 0.001, Pearson’s correlation), and corneal astigmatism and the difference in elevation at 8 mm chord length were positively associated with CRT lens toricity (r = 0.657 and r = 0.643, respectively; both p < 0.01, Spearman’s correlation). These results suggest that difference in elevation at 8 mm chord length can be used to conveniently estimate CRT lens toricity in clinical practice, using the equation Y (CRT lens toricity) = 1.02X (difference in elevation at 8 mm chord length) + 20.3. Full article

(This article belongs to the Special Issue New Frontiers in Myopia Progression in Children)

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12 pages, 1753 KiB

Open AccessArticle

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

by Hanyu Zhang, Carly S. Y. Lam, Wing-Chun Tang, Myra Leung, Hua Qi, Paul H. Lee and Chi-Ho To

J. Clin. Med. 2022, 11(9), 2294; https://doi.org/10.3390/jcm11092294 - 20 Apr 2022

Cited by 16 | Viewed by 3054

Abstract

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 [...] Read more.

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. Full article

(This article belongs to the Special Issue New Frontiers in Myopia Progression in Children)

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15 pages, 4412 KiB

Open AccessArticle

The Effect of Long-Term Low-Dose Atropine on Refractive Progression in Myopic Australian School Children

by William Myles, Catherine Dunlop and Sally A. McFadden

J. Clin. Med. 2021, 10(7), 1444; https://doi.org/10.3390/jcm10071444 - 01 Apr 2021

Cited by 12 | Viewed by 3185

Abstract

Myopia will affect half the global population by 2050 and is a leading cause of vision impairment. High-dose atropine slows myopia progression but with undesirable side-effects. Low-dose atropine is an alternative. We report the effects of 0.01% or 0.005% atropine eye drops on [...] Read more.

Myopia will affect half the global population by 2050 and is a leading cause of vision impairment. High-dose atropine slows myopia progression but with undesirable side-effects. Low-dose atropine is an alternative. We report the effects of 0.01% or 0.005% atropine eye drops on myopia progression in 13 Australian children aged between 2 and 18 years and observed for 2 years without and up to 5 years (mean 2.8 years) with treatment. Prior to treatment, myopia progression was either ‘slow’ (more positive than −0.5 D/year; mean −0.19 D/year) or ‘fast’ (more negative than −0.5 D/year; mean −1.01 D/year). Atropine reduced myopic progression rates (slow: −0.07 D/year, fast: −0.25 D/year, combined: before: −0.74, during: −0.18 D/year, p = 0.03). Rebound occurred in 3/4 eyes that ceased atropine. Atropine halved axial growth in the ‘Slow’ group relative to an age-matched model of untreated myopes (0.098 vs. 0.196 mm/year, p < 0.001) but was double that in emmetropes (0.051 mm/year, p < 0.01). Atropine did not slow axial growth in ‘fast’ progressors compared to the age-matched untreated myope model (0.265 vs. 0.245 mm/year, p = 0.754, Power = 0.8). Adverse effects (69% of patients) included dilated pupils (6/13) more common in children with blue eyes (5/7, p = 0.04). Low-dose atropine could not remove initial myopia offsets suggesting treatment should commence in at-risk children as young as possible. Full article

(This article belongs to the Special Issue New Frontiers in Myopia Progression in Children)

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10 pages, 1593 KiB

Open AccessArticle

The Sankara Nethralaya Tamil Nadu Essilor Myopia (STEM) Study—Defining a Threshold for Non-Cycloplegic Myopia Prevalence in Children

by Aparna Gopalakrishnan, Jameel Rizwana Hussaindeen, Viswanathan Sivaraman, Meenakshi Swaminathan, Yee Ling Wong, James Andrew Armitage, Alex Gentle and Simon Backhouse

J. Clin. Med. 2021, 10(6), 1215; https://doi.org/10.3390/jcm10061215 - 15 Mar 2021

Cited by 10 | Viewed by 3500

Abstract

The aim of this study was to investigate the agreement between cycloplegic and non-cycloplegic autorefraction with an open-field auto refractor in a school vision screening set up, and to define a threshold for myopia that agrees with the standard cycloplegic refraction threshold. The [...] Read more.

The aim of this study was to investigate the agreement between cycloplegic and non-cycloplegic autorefraction with an open-field auto refractor in a school vision screening set up, and to define a threshold for myopia that agrees with the standard cycloplegic refraction threshold. The study was conducted as part of the Sankara Nethralaya Tamil Nadu Essilor Myopia (STEM) study, which investigated the prevalence, incidence, and risk factors for myopia among children in South India. Children from two schools aged 5 to 15 years, with no ocular abnormalities and whose parents gave informed consent for cycloplegic refraction were included in the study. All the children underwent visual acuity assessment (Pocket Vision Screener, Elite school of Optometry, India), followed by non-cycloplegic and cycloplegic (1% tropicamide) open-field autorefraction (Grand Seiko, WAM-5500). A total of 387 children were included in the study, of whom 201 were boys. The mean (SD) age of the children was 12.2 (±2.1) years. Overall, the mean difference between cycloplegic and non-cycloplegic spherical equivalent (SE) open-field autorefraction measures was 0.34 D (limits of agreement (LOA), 1.06 D to −0.38 D). For myopes, the mean difference between cycloplegic and non-cycloplegic SE was 0.13 D (LOA, 0.63D to −0.36D). The prevalence of myopia was 12% (95% CI, 8% to 15%) using the threshold of cycloplegic SE ≤ −0.50 D, and was 14% (95% CI, 11% to 17%) with SE ≤ −0.50 D using non-cycloplegic refraction. When myopia was defined as SE of ≤−0.75 D under non-cycloplegic conditions, there was no difference between cycloplegic and non-cycloplegic open-field autorefraction prevalence estimates (12%; 95% CI, 8% to 15%; p = 1.00). Overall, non-cycloplegic refraction underestimates hyperopia and overestimates myopia; but for subjects with myopia, this difference is minimal and not clinically significant. A threshold of SE ≤ −0.75 D agrees well for the estimation of myopia prevalence among children when using non-cycloplegic refraction and is comparable with the standard definition of cycloplegic myopic refraction of SE ≤ −0.50 D. Full article

(This article belongs to the Special Issue New Frontiers in Myopia Progression in Children)

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13 pages, 499 KiB

Open AccessArticle

The Influence of Genetics in Myopia Control: A Pilot Study

by Cristina Alvarez-Peregrina, Miguel Ángel Sánchez-Tena, Clara Martinez-Perez, Catalina Santiago-Dorrego, Thomas Yvert, Cristina Andreu-Vazquez and Cesar Villa-Collar

J. Clin. Med. 2021, 10(4), 808; https://doi.org/10.3390/jcm10040808 - 17 Feb 2021

Cited by 1 | Viewed by 2132

Abstract

Background: Many epidemiological and experimental studies have established that myopia is caused by a complex interaction between common genetic and environmental factors. The objective of this study was to describe and compare the allelic and genotypic frequencies of the rs524952 (GJD2), [...] Read more.

Background: Many epidemiological and experimental studies have established that myopia is caused by a complex interaction between common genetic and environmental factors. The objective of this study was to describe and compare the allelic and genotypic frequencies of the rs524952 (GJD2), rs8000973 (ZIC2), rs1881492 (CHRNG), rs1656404 (PRSS56), rs235770 (BMP2), and rs7744813 (KCNQ5) SNPs (single-nucleotide polymorphism) between responder and nonresponder patients who had undergone a two-year treatment with lenses for myopia control. Method: Twenty-eight participants from the MiSight Assessment Study Spain (MASS), who had received treatment for myopia control for two years with MiSight contact lenses, were examined. The criteria for better/worse treatment response was the change in the axial length (< / ≥ 0.22 mm two years after the treatment). The clinical procedure consisted of the extraction of a saliva sample, and the participants also underwent an optometric examination. Genetic data were analyzed using SNPStats software (Catalan Institute of Oncology, Barcelona, Spain), and statistical analysis was performed using SPSS v.25 (SPSS Inc., Chicago, IL, USA). Demographic variables were analyzed using the Student’s t-test. Results: The T allele, the one with the lowest frequency, of the “rs235770” SNP was associated with a better treatment response [AL/CR (axial length/corneal radius): OR = 3.37; CI = 1.079–10.886; SE (spherical equivalent): OR = 1.26; CI: = 0.519–57.169; p = 0.019). By performing haplotype analysis, significant differences were found between the rs235770…rs1881492 and rs235770–rs1656404 polymorphisms. The latter presented a strong linkage disequilibrium with each other (r² ≥ 0.54). Conclusion: The result of lens therapies for myopia control could vary depending on genetic variants. Studies with a larger sample are needed to confirm the results presented in this pilot study. Full article

(This article belongs to the Special Issue New Frontiers in Myopia Progression in Children)

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12 pages, 998 KiB

Open AccessArticle

Corneal Penetration of Low-Dose Atropine Eye Drops

by Henning Austermann, Frank Schaeffel, Ute Mathis, Verena Hund, Frank Mußhoff, Focke Ziemssen and Sven Schnichels

J. Clin. Med. 2021, 10(4), 588; https://doi.org/10.3390/jcm10040588 - 04 Feb 2021

Cited by 9 | Viewed by 4086

Abstract

Major studies demonstrating the inhibition of myopia in children and juveniles by low-dose atropine eye drops provide little information on the manufacturing process and the exact composition of the atropine dilutions. However, corneal penetration might significantly vary depending on preservatives, such as benzalkonium [...] Read more.

Major studies demonstrating the inhibition of myopia in children and juveniles by low-dose atropine eye drops provide little information on the manufacturing process and the exact composition of the atropine dilutions. However, corneal penetration might significantly vary depending on preservatives, such as benzalkonium chloride (BAC), and the atropine concentration. Since there is a trade-off between side effects, stability, and optimal effects of atropine on myopia, it is important to gain better knowledge about intraocular atropine concentrations. We performed an ex vivo study to determine corneal penetration for different formulations. Atropine drops (0.01%) of different formulations were obtained from pharmacies and applied to the cornea of freshly enucleated pig eyes. After 10 min, a sample of aqueous humor was taken and atropine concentrations were determined after liquid–liquid extraction followed by high-performance liquid chromatography–tandem mass spectrometry (LC-MS/MS). The variability that originated from variations in applied drop size exceeded the differences between preserved and preservative-free formulations. The atropine concentration in the anterior chamber measured after 10 min was only 3.8 × 10⁻⁸ of its concentration in the applied eye drops, corresponding to 502.4 pM. Obviously, the preservative did not facilitate corneal penetration, at least ex vivo. In the aqueous humor of children’s eyes, similar concentrations, including higher variability, may be expected in the lower therapeutic window of pharmacodynamic action. Full article

(This article belongs to the Special Issue New Frontiers in Myopia Progression in Children)

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15 pages, 2494 KiB

Open AccessArticle

Multifocal Orthokeratology versus Conventional Orthokeratology for Myopia Control: A Paired-Eye Study

by Martin Loertscher, Simon Backhouse and John R. Phillips

J. Clin. Med. 2021, 10(3), 447; https://doi.org/10.3390/jcm10030447 - 24 Jan 2021

Cited by 10 | Viewed by 5389

Abstract

We conducted a prospective, paired-eye, investigator masked study in 30 children with myopia (−1.25 D to −4.00 D; age 10 to 14 years) to test the efficacy of a novel multifocal orthokeratology (MOK) lens compared to conventional orthokeratology (OK) in slowing axial eye [...] Read more.

We conducted a prospective, paired-eye, investigator masked study in 30 children with myopia (−1.25 D to −4.00 D; age 10 to 14 years) to test the efficacy of a novel multifocal orthokeratology (MOK) lens compared to conventional orthokeratology (OK) in slowing axial eye growth. The MOK lens molded a center-distance, multifocal surface onto the anterior cornea, with a concentric treatment zone power of +2.50 D. Children wore an MOK lens in one eye and a conventional OK lens in the fellow eye nightly for 18 months. Eye growth was monitored with non-contact ocular biometry. Over 18 months, MOK-treated eyes showed significantly less axial expansion than OK-treated eyes (axial length change: MOK 0.173 mm less than OK; p < 0.01), and inner axial length (posterior cornea to anterior sclera change: MOK 0.156 mm less than OK, p < 0.01). The reduced elongation was constant across different baseline progression rates (range −0.50 D/year to −2.00 D/year). Visual acuity was less in MOK vs. OK-treated eyes (e.g., at six months, MOK: 0.09 ± 0.01 vs. OK: 0.02 ± 0.01 logMAR; p = 0.01). We conclude that MOK lenses significantly reduce eye growth compared to conventional OK lenses over 18 months. Full article

(This article belongs to the Special Issue New Frontiers in Myopia Progression in Children)

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14 pages, 1736 KiB

Open AccessArticle

The Role of Back Optic Zone Diameter in Myopia Control with Orthokeratology Lenses

by Jaume Pauné, Silvia Fonts, Lina Rodríguez and Antonio Queirós

J. Clin. Med. 2021, 10(2), 336; https://doi.org/10.3390/jcm10020336 - 18 Jan 2021

Cited by 53 | Viewed by 8970

Abstract

We compared the efficacy of controlling the annual increase in axial length (AL) in myopic Caucasian children based on two parameters: the back optic zone diameter (BOZD) of the orthokeratology (OK) lens and plus power ring diameter (PPRD) or mid-peripheral annular ring of [...] Read more.

We compared the efficacy of controlling the annual increase in axial length (AL) in myopic Caucasian children based on two parameters: the back optic zone diameter (BOZD) of the orthokeratology (OK) lens and plus power ring diameter (PPRD) or mid-peripheral annular ring of corneal steepening. Data from 71 myopic patients (mean age, 13.34 ± 1.38 years; range, 10–15 years; 64% male) corrected with different BOZD OK lenses (DRL, Precilens) were collected retrospectively from a Spanish optometric clinic. The sample was divided into groups with BOZDs above or below 5.00 mm and the induced PPRD above or below 4.5 mm, and the relation to AL and refractive progression at 12 months was analyzed. Three subgroups were analyzed, i.e., plus power ring (PPR) inside, outside, or matching the pupil. The mean baseline myopia was −3.11 ± 1.46 D and the AL 24.65 ± 0.88 mm. Significant (p < 0.001) differences were found after 12 months of treatment in the refractive error and AL for the BOZD and PPRD. AL changes in subjects with smaller BOZDs decreased significantly regarding larger diameters (0.09 ± 0.12 and 0.15 ± 0.11 mm, respectively); in subjects with a horizontal sector of PPRD falling inside the pupil, the AL increased less (p = 0.035) than matching or outside the pupil groups by 0.04 ± 0.10 mm, 0.10 ± 0.11 mm, and 0.17 ± 0.12 mm, respectively. This means a 76% lesser AL growth or 0.13 mm/year in absolute reduction. OK corneal parameters can be modified by changing the OK lens designs, which affects myopia progression and AL elongation. Smaller BOZD induces a reduced PPRDs that slows AL elongation better than standard OK lenses. Further investigations should elucidate the effect of pupillary diameter, PPRD, and power change on myopia control. Full article

(This article belongs to the Special Issue New Frontiers in Myopia Progression in Children)

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10 pages, 444 KiB

Open AccessArticle

Comparison of Methods for Estimating Retinal Shape: Peripheral Refraction vs. Optical Coherence Tomography

by Katharina Breher, Alejandro Calabuig, Laura Kühlewein, Focke Ziemssen, Arne Ohlendorf and Siegfried Wahl

J. Clin. Med. 2021, 10(2), 174; https://doi.org/10.3390/jcm10020174 - 06 Jan 2021

Cited by 3 | Viewed by 2637

Abstract

Retinal shape presents a clinical parameter of interest for myopia, and has commonly been inferred indirectly from peripheral refraction (PRX) profiles. Distortion-corrected optical coherence tomography (OCT) scans offer a new and direct possibility for retinal shape estimation. The current study compared retinal curvatures [...] Read more.

Retinal shape presents a clinical parameter of interest for myopia, and has commonly been inferred indirectly from peripheral refraction (PRX) profiles. Distortion-corrected optical coherence tomography (OCT) scans offer a new and direct possibility for retinal shape estimation. The current study compared retinal curvatures derived from OCT scans vs. PRX measurements in three refractive profiles (0

^{°}

and 90

^{°}

meridians, plus spherical equivalent) for 25 participants via Bland–Altman analysis. The radial differences between both procedures were correlated to axial length using Pearson correlation. In general, PRX- and OCT-based retinal radii showed low correlation (all intraclass correlation coefficients < 0.21). PRX found flatter retinal curvatures compared to OCT, with the highest absolute agreement found with the 90

^{°}

meridian (mean difference +0.08 mm) and lowest in the 0

^{°}

meridian (mean difference +0.89 mm). Moreover, a negative relation between axial length and the agreement of both methods was detected especially in the 90

^{°}

meridian (R = −0.38, p = 0.06). PRX measurements tend to underestimate the retinal radius with increasing myopia when compared to OCT measurements. Therefore, future conclusions from PRX on retinal shape should be made cautiously. Rather, faster and more clinically feasible OCT imaging should be performed for this purpose. Full article

(This article belongs to the Special Issue New Frontiers in Myopia Progression in Children)

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12 pages, 746 KiB

Open AccessArticle

Evaluating the Effect of Topical Atropine Use for Myopia Control on Intraocular Pressure by Using Machine Learning

by Tzu-En Wu, Hsin-An Chen, Mao-Jhen Jhou, Yen-Ning Chen, Ting-Jen Chang and Chi-Jie Lu

J. Clin. Med. 2021, 10(1), 111; https://doi.org/10.3390/jcm10010111 - 30 Dec 2020

Cited by 26 | Viewed by 4756

Abstract

Atropine is a common treatment used in children with myopia. However, it probably affects intraocular pressure (IOP) under some conditions. Our research aims to analyze clinical data by using machine learning models to evaluate the effect of 19 important factors on intraocular pressure [...] Read more.

Atropine is a common treatment used in children with myopia. However, it probably affects intraocular pressure (IOP) under some conditions. Our research aims to analyze clinical data by using machine learning models to evaluate the effect of 19 important factors on intraocular pressure (IOP) in children with myopia treated with topical atropine. The data is collected on 1545 eyes with spherical equivalent (SE) less than −10.0 diopters (D) treated with atropine for myopia control. Four machine learning models, namely multivariate adaptive regression splines (MARS), classification and regression tree (CART), random forest (RF), and eXtreme gradient boosting (XGBoost), were used. Linear regression (LR) was used for benchmarking. The 10-fold cross-validation method was used to estimate the performance of the five methods. The main outcome measure is that the 19 important factors associated with atropine use that may affect IOP are evaluated using machine learning models. Endpoint IOP at the last visit was set as the target variable. The results show that the top five significant variables, including baseline IOP, recruitment duration, age, total duration and previous cumulative dosage, were identified as most significant for evaluating the effect of atropine use for treating myopia on IOP. We can conclude that the use of machine learning methods to evaluate factors that affect IOP in children with myopia treated with topical atropine is promising. XGBoost is the best predictive model, and baseline IOP is the most accurate predictive factor for endpoint IOP among all machine learning approaches. Full article

(This article belongs to the Special Issue New Frontiers in Myopia Progression in Children)

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7 pages, 233 KiB

Open AccessArticle

Pharmacological Myopia Control Influence on Quality of Life and Psyche among Adolescents

by Andrzej Michalski, Małgorzata Rogaczewska, Magdalena Maleszka-Kurpiel and Marcin Stopa

J. Clin. Med. 2020, 9(12), 3920; https://doi.org/10.3390/jcm9123920 - 03 Dec 2020

Cited by 4 | Viewed by 1966

Abstract

Myopia is a global problem affecting all aspects of patients’ lives. Objectives: The aim of the study was to evaluate the influence of low dose atropine (LDA) myopia control on the quality of life in patients with myopia. Material and Methods: A self-constructed [...] Read more.

Myopia is a global problem affecting all aspects of patients’ lives. Objectives: The aim of the study was to evaluate the influence of low dose atropine (LDA) myopia control on the quality of life in patients with myopia. Material and Methods: A self-constructed questionnaire, including eight questions, was distributed among 40 patients. The questionnaire was divided into two subsections: (1) influence of LDA on visual functions and (2) influence of LDA on self-esteem. Answers were collected separately for boys (18 patients) and girls (22 patients) and compared considering spherical equivalent (SE) and myopia progression rate. Results: Girls reported more issues with near activities and pupil size. Boys and girls complained similarly, regarding the sun glare. We found a high level of certainty about the efficacy of LDA therapy among both examined groups and a little improvement in self-esteem. Girls recommended LDA therapy more often than boys, especially when the progression rate was low. There was no statistically significant difference in answer scores between groups with different myopia progression rates for boys. Girls with lower progression rates reported more issues with near work and sun glare and less trust in LDA therapy’s effectiveness than girls with a higher progression rate. There was no statistically significant correlation between SE and the total answer score for both genders. Conclusions: Findings concerning childrens’ and adolescents’ psyche are a new aspect of myopia control. We prove that patients during pharmacological myopia control did not report significant problems caused by LDA therapy and they were convinced about its efficacy, had greater self-esteem, and recommended it to peers. Full article

(This article belongs to the Special Issue New Frontiers in Myopia Progression in Children)

11 pages, 1217 KiB

Open AccessArticle

The Impact of Overnight Orthokeratology on Accommodative Response in Myopic Subjects

by Ana F. Pereira-da-Mota, Jéssica Costa, Ana Amorim-de-Sousa, José M. González-Méijome and António Queirós

J. Clin. Med. 2020, 9(11), 3687; https://doi.org/10.3390/jcm9113687 - 17 Nov 2020

Cited by 8 | Viewed by 2460

Abstract

This study aimed to evaluate the effects of two months of orthokeratology (OK) treatment in the accommodative response of young adult myopes. Twenty eyes (21.8 ± 1.8 years) were fitted with the Paragon CRT^® 100 LENS to treat myopia between −1.00 and [...] Read more.

This study aimed to evaluate the effects of two months of orthokeratology (OK) treatment in the accommodative response of young adult myopes. Twenty eyes (21.8 ± 1.8 years) were fitted with the Paragon CRT^® 100 LENS to treat myopia between −1.00 and −2.00 D. Low- and high-contrast visual acuity (LCDVA and HCDVA), central objective refraction, light disturbance (LD), and objective accommodative response (using the Grand Seiko WAM-5500 open-field autorefractometer coupled with a Badal system) were measured at baseline (BL) before lens wear and after 1, 15, 30, and 60 nights of OK. Refractive error correction was achieved during the first fifty days of OK lens wear, with minimal changes afterwards. LD analysis showed a transient increase followed by a reduction to baseline levels over the first 30 nights of treatment. The accommodative response was lower than expected for all target vergences in all visits (BL: 0.61 D at 1.00 D to 0.96 D at 5.00 D; 60 N: 0.36 D at 1.00 D to 0.79 D at 5.00 D). On average, the accommodative lag decreases over time with OK lens wear. However, these differences were not statistically significant (p > 0.050, repeated-measures ANOVA and Friedman test). This shows that overnight OK treatment does not affect objectively measured the accommodative response of young, low myopic eyes after two months of treatment stabilization. Full article

(This article belongs to the Special Issue New Frontiers in Myopia Progression in Children)

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9 pages, 911 KiB

Open AccessArticle

Retinal Response of Low Myopes during Orthokeratology Treatment

by António Queirós, Ana F. Pereira-da-Mota, Jéssica Costa, Ana Amorim-de-Sousa, Paulo R. B. Fernandes and José M. González-Méijome

J. Clin. Med. 2020, 9(8), 2649; https://doi.org/10.3390/jcm9082649 - 14 Aug 2020

Cited by 3 | Viewed by 3642

Abstract

The aim of this study was to evaluate the changes in retinal activity during orthokeratology (OK) treatment in 20 myopic eyes. Pattern electroretinography (PERG) and visual evoked potential (VEP) were assessed with the RETI-port/scan21 (Roland Consult, Wiesbaden, Germany). Measurements were taken at baseline [...] Read more.

The aim of this study was to evaluate the changes in retinal activity during orthokeratology (OK) treatment in 20 myopic eyes. Pattern electroretinography (PERG) and visual evoked potential (VEP) were assessed with the RETI-port/scan21 (Roland Consult, Wiesbaden, Germany). Measurements were taken at baseline (BL) and 1 night (1N), 15 nights (15N), 30 nights (30N), and 60 nights (60N) of OK lens wear. Repeated measures analysis of variance (ANOVA) and the Friedman test were used. Twenty eyes (23.20 ± 3.46 years, 70% female) with visual acuity ≤ 0.00 logMAR in post-treatment showed that despite a slight increase in retinal and cortical response amplitude, observed with both PERG and VEP, respectively, immediately after the initial treatment, these differences found were not statistically significant during the 60 days of OK treatment, despite a statistically significant increase in N95 response with PERG. This shows that retinal and cortical visual-related electrical activity is maintained or slightly increased during OK treatment. Full article

(This article belongs to the Special Issue New Frontiers in Myopia Progression in Children)

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15 pages, 2841 KiB

Open AccessArticle

Impact of Axial Eye Size on Retinal Microvasculature Density in the Macular Region

by M. Hafi Khan, Andrew K. C. Lam, James A. Armitage, Lisa Hanna, Chi-ho To and Alex Gentle

J. Clin. Med. 2020, 9(8), 2539; https://doi.org/10.3390/jcm9082539 - 06 Aug 2020

Cited by 21 | Viewed by 2779

Abstract

Mechanical tissue stresses are important contributors to the increased risk of sight-threatening pathology in larger, more myopic eyes. The contribution of altered ocular vasculature to the development of this pathology is less well defined. The current study investigated the impact of eye size [...] Read more.

Mechanical tissue stresses are important contributors to the increased risk of sight-threatening pathology in larger, more myopic eyes. The contribution of altered ocular vasculature to the development of this pathology is less well defined. The current study investigated the impact of eye size on the superficial vasculature of the macula. Subjects (n = 104) aged 18–50, with no history of ocular or vascular disease, or myopia control, were recruited from university staff and student populations in Australia and Hong Kong. Refractive error, ocular size, retinal morphology and vascular morphology were quantified through open field autorefraction, ocular biometry and ocular coherence tomography angiography. Morphology of the superficial retinal capillary plexus was assessed over a 3 × 3 mm fovea-centred area. Perfusion area and vessel length densities were analysed relative to axial eye length and retinal thickness. A significant inverse association was found between axial length and vascular density measures (perfusion area density r² = 0.186, p < 0.001; and vessel length density r² = 0.102, p = 0.001). Perfusion area and vessel length densities were reduced by 5.8% (p = 0.001) in the longest, relative to the shortest, eyes. The aggregated ganglion cell layer inner plexiform layer thickness was also inversely associated with eye size (r² = 0.083, p = 0.003), and reduced, by 8.1% (p < 0.001), in the longest eyes. An inverse association of eye size and superficial retinal vasculature density, that is not simply explained by retinal expansion or image magnification factors, was confirmed. These data support the hypothesis that ongoing metabolic challenges may underlie the development of myopia-related and -associated pathology in larger eyes. Full article

(This article belongs to the Special Issue New Frontiers in Myopia Progression in Children)

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8 pages, 515 KiB

Open AccessArticle

Endothelin-1 Serum Concentration is Lower in Children and Adolescents with High Myopia, a Preliminary Study

by Katarzyna Powierza, Beata Żelazowska-Rutkowska, Jolanta Sawicka-Powierza, Bożena Mikołuć, Beata Urban, Wojciech Zaremba, Bogdan Cylwik and Alina Bakunowicz-Łazarczyk

J. Clin. Med. 2020, 9(5), 1327; https://doi.org/10.3390/jcm9051327 - 02 May 2020

Cited by 5 | Viewed by 2226

Abstract

The aim of this study is to evaluate the levels of enothelin-1 (ET-1) in children and adolescents with high myopia and its association with the axial length of the eye and the presence of myopic retinal degeneration. The cross-sectional study was carried out [...] Read more.

The aim of this study is to evaluate the levels of enothelin-1 (ET-1) in children and adolescents with high myopia and its association with the axial length of the eye and the presence of myopic retinal degeneration. The cross-sectional study was carried out in 57 patients with high myopia and 29 control subjects. Serum concentrations of ET-1 were measured using enzyme-linked immunosorbent assay (ELISA) kit. A significantly lower concentration of ET-1 in highly myopic patients compared to controls was found (1.47 (0.91; 1.87) vs. 1.94 (1.1; 2.69) pg/mL, p = 0.005). In patients with high myopia, a weak negative correlation between ET-1 concentration and the longest axial length out of the two eyes was found (r = −0.255, p = 0.0558). Further analysis revealed statistically significant differences in ET-1 concentration between patients with the axial length of the eye > 26 and ≤ 26 mm (p < 0.041) and patients with the axial length of the eye > 26 mm and controls (p < 0.001). ET-1 expression is disturbed in highly myopic children and adolescents. Lower ET-1 concentration in patients with the axial length of the eye > 26 mm may co-occur with high myopia and should be considered a risk factor in the pathophysiology of high myopia progression. Full article

(This article belongs to the Special Issue New Frontiers in Myopia Progression in Children)

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Review

Jump to: Research, Other

12 pages, 1029 KiB

Open AccessReview

The Effectiveness and Tolerability of Atropine Eye Drops for Myopia Control in Non-Asian Regions

by Dovile Simonaviciute, Andrzej Grzybowski, Carla Lanca, Chi Pui Pang, Arvydas Gelzinis and Reda Zemaitiene

J. Clin. Med. 2023, 12(6), 2314; https://doi.org/10.3390/jcm12062314 - 16 Mar 2023

Cited by 2 | Viewed by 2555

Abstract

Myopia is the most common ocular disorder worldwide with an increasing prevalence over the past few decades. It is a refractive error associated with excessive growth of the eyeball. Individuals with myopia, especially high myopia, are prone to develop sight-threatening complications. Currently, atropine [...] Read more.

Myopia is the most common ocular disorder worldwide with an increasing prevalence over the past few decades. It is a refractive error associated with excessive growth of the eyeball. Individuals with myopia, especially high myopia, are prone to develop sight-threatening complications. Currently, atropine is the only drug that is used to slow myopia progression in clinical practice. However, there are still areas of uncertainty such as treatment strategy, optimal concentration when considering risk–benefit ratio and active treatment period. Since the prevalence of myopia is much higher in Asian countries, most of the research on myopia control has been conducted in Asia. Data on the efficacy and tolerability to atropine eye drops in the non-Asian population remains limited. In this review, we summarize the results of published clinical trials on the effectiveness and tolerability of atropine eye drops for myopia control in non-Asian regions. The efficacy was evaluated by the mean change in spherical equivalent (SE) or axial length (AL). The tolerability of atropine eye drops was analyzed based on patients complains and adverse events. The results of this review suggest that 0.01% atropine eye drops are effective in non-Asian regions achieving less side effects compared to 0.5% concentration. Full article

(This article belongs to the Special Issue New Frontiers in Myopia Progression in Children)

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22 pages, 1237 KiB

Open AccessReview

Bayesian Meta-Analysis of Myopia Control with Multifocal Lenses

by Saulius Varnas, Xiaomeng Gu and Andrew Metcalfe

J. Clin. Med. 2021, 10(4), 730; https://doi.org/10.3390/jcm10040730 - 12 Feb 2021

Cited by 9 | Viewed by 3261

Abstract

The aim of this study is to provide reliable guidelines for the mean percentage efficacy together with the 95% credibility interval in slowing down progression of myopia by a specific intervention over defined time periods, derived from a substantial number of randomised controlled [...] Read more.

The aim of this study is to provide reliable guidelines for the mean percentage efficacy together with the 95% credibility interval in slowing down progression of myopia by a specific intervention over defined time periods, derived from a substantial number of randomised controlled clinical trials (RCTs) with consistent outcomes. Multifocal spectacles and contact lenses represent interventions with the largest number of RCTs carried out. Our meta-analyses considered 10 RCTs involving 1662 children which have tested the efficacy of progressive addition spectacle lenses (PALs). In a separate model for comparison purposes nine RCTs with 982 children trialling soft multifocal contact lenses (MFCLs) were analysed. Bayesian random-effects hierarchical models were fitted. The highest efficacy in retarding progression of the scaled sphere equivalent refraction was achieved after 12 M follow-up with the mean 28% reduction in progression and the 95% credibility interval between 21% and 35%. For comparison, the 95% credibility interval for the mean efficacy of soft MFCLs at 12 M follow up is 21% to 37%. We conclude that both multifocal spectacle and contact lenses moderately slow down progression of myopia, relative to single-vision spectacle lenses (SVLs) in the first 12 months after intervention. The relative efficacy of PALs tends to weaken after the first 12 months. Full article

(This article belongs to the Special Issue New Frontiers in Myopia Progression in Children)

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13 pages, 261 KiB

Open AccessReview

The Combined Effect of Low-dose Atropine with Orthokeratology in Pediatric Myopia Control: Review of the Current Treatment Status for Myopia

by José-María Sánchez-González, Concepción De-Hita-Cantalejo, María-José Baustita-Llamas, María Carmen Sánchez-González and Raúl Capote-Puente

J. Clin. Med. 2020, 9(8), 2371; https://doi.org/10.3390/jcm9082371 - 24 Jul 2020

Cited by 23 | Viewed by 5927

Abstract

Pediatric myopia has become a major international public health concern. The prevalence of myopia has undergone a significant increase worldwide. The purpose of this review of the current literature was to evaluate the peer-reviewed scientific literature on the efficacy and safety of low-dose [...] Read more.

Pediatric myopia has become a major international public health concern. The prevalence of myopia has undergone a significant increase worldwide. The purpose of this review of the current literature was to evaluate the peer-reviewed scientific literature on the efficacy and safety of low-dose atropine treatment combined with overnight orthokeratology for myopia control. A search was conducted in Pubmed and Web of Science with the following search strategy: (atropine OR low-dose atropine OR 0.01% atropine) AND (orthokeratology OR ortho-k) AND (myopia control OR myopia progression). All included studies improved myopia control by the synergistic effect of orthokeratology with low-dose atropine, compared with orthokeratology treatment alone. All studies included a short or medium follow-up period; therefore longer-term studies are necessary to validate these results. Full article

(This article belongs to the Special Issue New Frontiers in Myopia Progression in Children)

10 pages, 1074 KiB

Open AccessReview

To Correct or Not Correct? Actual Evidence, Controversy and the Questions That Remain Open

by Miguel García García, Katharina Breher, Arne Ohlendorf and Siegfried Wahl

J. Clin. Med. 2020, 9(6), 1975; https://doi.org/10.3390/jcm9061975 - 24 Jun 2020

Cited by 4 | Viewed by 3181

Abstract

Clinical studies and basic research have attempted to establish a relationship between myopia progression and single vision spectacle wear, albeit with unclear results. Single vision spectacle lenses are continuously used as the control group in myopia control trials. Hence, it is a matter [...] Read more.

Clinical studies and basic research have attempted to establish a relationship between myopia progression and single vision spectacle wear, albeit with unclear results. Single vision spectacle lenses are continuously used as the control group in myopia control trials. Hence, it is a matter of high relevance to investigate further whether they yield any shift on the refractive state, which could have been masked by being used as a control. In this review, eye development in relation to eyes fully corrected versus those under-corrected is discussed, and new guidelines are provided for the analysis of structural eye changes due to optical treatments. These guidelines are tested and optimised, while ethical implications are revisited. This newly described methodology can be translated to larger clinical trials, finally exerting the real effect of full correction via single vision spectacle lens wear on eye growth and myopia progression. Full article

(This article belongs to the Special Issue New Frontiers in Myopia Progression in Children)

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Other

Jump to: Research, Review

15 pages, 12872 KiB

Open AccessSystematic Review

Efficacy and Safety of Low-Dose Atropine on Myopia Prevention in Premyopic Children: Systematic Review and Meta-Analysis

by Ssu-Hsien Lee, Bor-Yuan Tseng, Jen-Hung Wang and Cheng-Jen Chiu

J. Clin. Med. 2024, 13(5), 1506; https://doi.org/10.3390/jcm13051506 - 05 Mar 2024

Viewed by 755

Abstract

Background: Early-onset myopia increases the risk of irreversible high myopia. Methods: This study systematically evaluated the efficacy and safety of low-dose atropine for myopia control in children with premyopia through meta-analysis using random-effects models. Effect sizes were calculated using risk ratios (RRs) with [...] Read more.

Background: Early-onset myopia increases the risk of irreversible high myopia. Methods: This study systematically evaluated the efficacy and safety of low-dose atropine for myopia control in children with premyopia through meta-analysis using random-effects models. Effect sizes were calculated using risk ratios (RRs) with 95% confidence intervals (CIs). Comprehensive searches of PubMed, EMBASE, Cochrane CENTRAL, and ClinicalTrials.gov were conducted until 20 December 2023, without language restrictions. Results: Four studies involving 644 children with premyopia aged 4–12 years were identified, with atropine concentrations ranging from 0.01% to 0.05%. The analysis focused on myopia incidence and atropine-related adverse events. Lower myopia incidence (RR, 0.62; 95% CI, 0.40–0.97 D/y; p = 0.03) and reduction in rapid myopia shift (≥0.5 D/1y) (RR, 0.50; 95% CI, 0.26–0.96 D/y; p < 0.01) were observed in the 12–24-month period. Spherical equivalent and axial length exhibited attenuated progression in the atropine group. No major adverse events were detected in either group, whereas the incidence of photophobia and allergic conjunctivitis did not vary in the 12–24-month period. Conclusions: Our meta-analysis supports atropine’s efficacy and safety for delaying myopia incidence and controlling progression in children with premyopia. However, further investigation is warranted due to limited studies. Full article

(This article belongs to the Special Issue New Frontiers in Myopia Progression in Children)

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