AI-guided personalized predictions on myopia progression and interventions.

Myopia incidence and progression has been described extensively in children. However, few data exist regarding myopia incidence and progression in early adulthood. To describe the 8-year incidence of myopia and change in ocular biometry in young adults and their association with the known risk factors for childhood myopia. The Raine Study is a prospective single-center cohort study. Baseline and follow-up eye assessments were conducted from January 2010 to August 2012 and from March 2018 to March 2020. The data were analyzed from June to July 2021. A total of 1328 participants attended the baseline assessment, and 813 participants attended the follow-up assessment. Refractive information from both visits was available for 701 participants. Participants with keratoconus, previous corneal surgery, or recent orthokeratology wear were excluded. Participants' eyes were examined at ages 20 years (baseline) and 28 years. Incidence of myopia and high myopia; change in spherical equivalent (SE) and axial length (AL). A total of 516 (261 male [50.6%]) and 698 (349 male [50.0%]) participants without myopia or high myopia at baseline, respectively, were included in the incidences analyses, while 691 participants (339 male [49%]) were included in the progression analysis. The 8-year myopia and high myopia incidence were 14.0% (95% CI, 11.5%-17.4%) and 0.7% (95% CI, 0.3%-1.2%), respectively. A myopic shift (of 0.50 diopters [D] or greater in at least 1 eye) occurred in 261 participants (37.8%). Statistical significance was found in longitudinal changes in SE (-0.04 D per year; P < .001), AL (0.02 mm per year; P <.001), and lens thickness (0.02 mm per year; P < .001). Incident myopia was associated with self-reported East Asian vs White race (odds ratio [OR], 6.13; 95% CI, 1.06-35.25; P = .04), female vs male sex (OR, 1.81; 95% CI, 1.02-3.22; P = .04), smaller conjunctival ultraviolet autofluorescence area (per 10-mm2 decrease, indicating less sun exposure; OR, 9.86; 95% CI, 9.76-9.97; P = <.009), and parental myopia (per parent; OR, 1.57; 95% CI, 1.03-2.38; P = <.05). Rates of myopia progression and axial elongation were faster in female participants (estimate: SE, 0.02 D per year; 95 % CI, 0.01-0.02 and AL, 0.007 mm per year, 95 % CI, 0.00.-0.011; P ≤ .001) and those with parental myopia (estimate per parent: SE, 0.01 D per year; 95% CI, 0.00-0.02 and AL, 95% CI, 0.002-0.008; P ≤ .001). Education level was not associated with myopia incidence or progression. These findings suggest myopia progression continues for more than one-third of adults during the third decade of life, albeit at lower rates than during childhood. The protective effects of time outdoors against myopia may continue into young adulthood.

Background: The purpose of this study is to evaluate the effectiveness of Defocus Incorporated Multiple Segments (DIMSs) in slowing myopia progression in pediatric patients as a function of age. Methods: This was a non-randomized experimenter-masked retrospective controlled observational study of European individuals aged 6-16 years with progressive myopia but no ocular pathology. We retrospectively reviewed the charts of the participants allocated to receive DIMS spectacles (Hoya® MiyoSmart®) or single-vision spectacle lenses (control group). Cycloplegic spherical equivalent (SE) and axial length (AL) were measured at baseline and at 12-, 24-, and 36-month follow-ups. The results were stratified by age into four groups: patients wearing DIMS spectacles older or younger than 10 years of age (group A, 20 patients mean age 13.6 ± 2.2, and group C, 20 patients mean age 9.0 ± 1.2) and age-matched control groups (group B, 18 patients mean age 13.2 ± 2.5, and group D, 22 patients mean age 8.5 ± 0.9). Results: At 36 months, SE and AL increase were significantly reduced in groups A and C, respectively, compared to groups B and D (p < 0.05). Linear regression analysis showed a significant correlation (p < 0.05) between patient age and myopia progression for SE in groups A and C, but only in group A for AL. Groups B and D did not show any significant correlation (p > 0.05). Conclusions: DIMS spectacles seem to slow myopia progression in pediatric patients; however, their effectiveness shows the greatest results in children older than 10 years of age. Moreover, our findings suggest that AL may be the more reliable parameter for evaluating myopia progression.

Purpose: This study investigated the effects of low-dose atropine eye drops on myopia progression and axial length changes in pediatric patients with myopia for &gt; 2 years.Methods: We retrospectively analyzed the medical records of patients with myopia who visited our hospital and underwent axial length measurement between January 2018 and June 2022. This study compared the outcomes of the atropine (106 patients) and control (38 patients) groups. Changes in spherical equivalent (SE) and axial length were analyzed over 2 years before and after using low-dose atropine eye drops.Results: The median change in axial length was 0.72 mm for the right eye (OD) and 0.71 mm for the left eye (OS) in the atropine group, whereas the control group showed a median change of 0.48 mm (OD) and 0.55 mm (OS). However, there was no significant difference between both groups (OD: p = 0.136; OS: p = 0.155). The median change in SE was 1.63 diopters (D) and 2.25 D in the atropine and control groups, respectively, with a significant difference between both groups (OD: p = 0.009; OS: p &lt; 0.001) for 2 years.Conclusions: In pediatric and adolescent patients, the use of low-dose atropine eye drops for &gt; 2 years appeared to delay changes in the SE, suggesting its potential effectiveness in slowing myopia progression.

Re: Li et al.: Age effect on treatment responses to 0.05%, 0.025%, and 0.01% atropine: Low-concentration Atropine for Myopia Progression (LAMP) Study (Ophthalmology. 2021;128:1180-1187)

The aim of this study was to explore the correlation between the parameters associated with the prevention and management of myopia and cylinder power (CP) progression in individuals who wear defocus incorporated multiple segments (DIMS) lenses. In total, 179 children (6–12 years old) prescribed DIMS lenses for 1 year were enrolled in this retrospective cohort study. Cycloplegic refraction, spherical equivalent (SE), axial length (AL), CP, and corneal astigmatism (CA) were measured. The relationship between myopia and CP progression was assessed using binary logistic regression analyses, stratified analyses, and interaction tests. These 179 DIMS lens wearers were, on average, 9.51 ± 1.48 years old, and 51.4% were male. In total, 24.02% of these participants had CP progression ≥ 0.25 D within one year. A fully-adjusted binary logistic regression analysis revealed that ΔSE (odds ratio (OR) = 1.73, 95% CI (1.32, 2.27), P < 0.001) and CA at admission (OR = 1.17, 95% CI (1, 1.36), P = 0.049) were associated with CP progression following adjustment for potential confounding factors. Interaction analysis revealed no significant interactive relationships. Our results showed a significant positive association between ΔSE and CP progression in DIMS lens wearers. Furthermore, baseline CA was also associated with ΔCP in participants over the course of the study. This suggested that myopia progression and baseline CA levels contribute to variations in CP progression. This study helps optimize astigmatism control in preventing and controlling myopia in DIMS lens wearers.

Two-Year Clinical Trial of the Low-Concentration Atropine for Myopia Progression (LAMP) Study: Phase 2 Report

Background/Objectives: Preceding studies have reported the efficacy of multifocal contact lenses (MFCLs) in slowing myopia progression. Recently, a novel type of MFCL, i.e., extended depth-of-focus (EDOF) contact lens (CL), was designed. Here, we retrospectively investigated myopia progression associated with EDOF CL wear. Methods: Twenty-four consecutive myopic children (24 eyes; mean age, 13.9 years) received EDOF CLs to control myopia progression and participated in the study. We measured the axial length (AL), spherical equivalent (SE), and choroidal thickness (CT) at baseline and after 1 year of lens wear and compared the changes. Results: The mean baseline AL, SE, and CT were, respectively, 26.31 mm, -6.38 diopter (D), and 235 μm, and at 1 year 26.40 mm (p = 0.03), -6.61 D (p = 0.05), and 244 μm (p = 0.18). The AL decreased in 20.8% of cases (≧-0.05 mm/year), whereas 20.8% and 58.4% of cases had stabilization of the AL or an increased AL (≧+0.05 mm/year), respectively. The patients with a decreased AL engaged in a mean outdoor activity time of 200.6 min/day, the patients with an increased AL (≧+0.05 mm/year) engaged in a mean outdoor activity time of 126.7 min/day. The change in the AL was correlated significantly with the change in the CT (β = -0.46, p < 0.05), and 80% of patients with a shortened AL had increased CT (≧+20 μm/year). Conclusions: Our data showed that the AL stabilized or decreased in over 40% of myopic patients wearing EDOF CLs.

Purpose Recent studies have demonstrated the effects of low-concentration atropine eye drops in slowing myopia progression. However, some studies have shown a rebound effect after treatment cessation. This study compares the rate of myopic progression following a rapid washout versus tapered cessation of 0.01% atropine. Methods This retrospective study included children treated with atropine 0.01% between 2015 and 2022. After 24 months of treatment, the gradual cessation (GC) group stopped atropine by reducing usage by one day per week each month until complete discontinuation. The prompt cessation (PC) group stopped treatment immediately. Subjective refraction was measured after cycloplegia, and axial length was assessed before drop instillation to compare myopia progression between the GC and PC groups during the 12 months following treatment cessation. Results Each group included 25 patients matched for age and spherical equivalent (SE) refractive error. The GC group had a mean age of 10.55 ± 1.19 years and the PG group 10.10 ± 1.7 years. The baseline SE refractive error averaged −4.33 ± 1.62D in GC and −4.50 ± 1.87D in PG. Mean follow-up was 12.4 ± 3.2 months (GC) and 12.2 ± 2.04 months (PG At follow up, the GC group had a mean SE refractive error progression of 0.21 ± 0.24 D and axial elongation of 0.15 ± 0.1 mm, while the PC group showed 0.43 ± 0.26 D and 0.25 ± 0.18 mm, respectively. However, linear mixed model (LMM) analysis revealed no statistically significant differences between the groups for axial length (p = 0.682) or SE (p = 0.541) change after treatment cessation. Conclusions The findings indicate that neither gradual nor prompt discontinuation of 0.01% atropine resulted in statistically significant differences in myopia progression. These results suggest no significant differences in myopia progression after treatment cessation between the two methods and provide no evidence of a rebound effect.

Purpose: To investigate the long-term effects of wearing orthokeratology (OK) lenses for more than 5 years on the progression of myopia and the elongation of axial length in children.Methods: The study included patients aged 6-12 years with myopia ranging from -0.5 D to -5.0 D and astigmatism of ≤ 2.0 D who had worn lenses for ≥ 5 years. A retrospective analysis was conducted comparing with a control group of similar demographics who wore glasses. Spherical equivalent (SE) changes were compared between 28 subjects (56 eyes) in the OK lens group and 37 subjects (74 eyes) in the control group. Additionally, changes in axial length (AXL), anterior chamber depth, and central corneal thickness were compared between 23 subjects (46 eyes) in the lens group and 24 subjects (48 eyes) in the control group.Results: The annual changes in SE were -0.21 ± 0.18 D/year in the OK lens group and -0.38 ± 0.17 D/year in the control group. The annual changes in AXL were 0.13 ± 0.09 mm/year in the OK lens group and 0.21 ± 0.10 mm/year in the control group, both showing significant differences (&lt;i&gt;p&lt;/i&gt; &lt; 0.001, &lt;i&gt;p&lt;/i&gt; &lt; 0.001, respectively). Within the lens group, further analysis based on age 11 was conducted. SE changes were -0.23 ± 0.18 D/year in those age &lt; 11 and -0.13 ± 0.18 D/year in those age ≥ 11. AXL changes were 0.15 ± 0.10 mm/year in the younger group and 0.06 ± 0.06 mm/year in the older group with both showing significant differences (&lt;i&gt;p&lt;/i&gt; = 0.048, &lt;i&gt;p&lt;/i&gt; = 0.012, respectively).Conclusions: The progression of myopia and elongation of AXL were significantly inhibited in the OK lens group compared to the control group. Additionally, younger age within the lens group was associated with greater myopia progression and AXL elongation.

Slowing myopia progression is quickly becoming the clinical standard of care, but little is known about how changing treatment alters treatment effect. This case series provides insight on how changing treatment modality may affect treatment outcomes in myopia management. Aiming to control myopia progression in children is becoming the clinical standard of care. Little is known about the effect of changing treatment on myopic progression. We present a case series of real-world myopia management patients who underwent a change in treatment method and report the observed effect on axial length. Clinical records from the University of Houston Myopia Management Service were reviewed to identify children who underwent a change in treatment. The analyzed dataset consisted of 44 clinic assessments from seven children including two who were switched from peripheral defocus soft contact lenses to orthokeratology, two who were switched from orthokeratology to peripheral defocus soft contact lenses, and three who received combination therapy following an initial period of treatment with either orthokeratology, peripheral defocus soft contact lenses, or atropine alone. Axial length measurements were adjusted by subtracting central corneal thickness from the raw axial length value and then converted to an annualized rate (mm/y) by subtracting the previous corneal thickness-adjusted from the current corneal thickness-adjusted axial length and dividing by elapsed time between the successive clinic visits. Age at initial assessment ranged from 6.6 to 12.6 years (M = 9.3 ± 2.4) with follow-up times ranging between 26 and 78 months (M = 43 ± 18.5). Each individual had a minimum of two clinical visits per treatment type. The mean (SD) for central corneal thickness-annualized adjusted axial length growth in both the eyes and chronological age at the beginning of each treatment type was calculated. Estimated progression rates are summarized separately for each individual and treatment. Data are grouped by patients who switched treatments for either lack of efficacy or other clinical issues. In a real-world setting, there are various reasons that necessitate a change in treatment. In this sample, change in treatment continued to show slowing of myopia progression, regardless of reason for change.

BackgroundAtropine, specifically 0.05% eyedrops, has proven effective in slowing myopia progression. This study aims to investigate peripheral refraction (PR) characteristics in myopic children treated with 0.05% atropine eyedrops at different frequencies.MethodsOne hundred thirty-eight myopic children completed this one-year prospective study, randomly assigned to once daily (7/7), twice per week (2/7), or once per week (1/7) groups. Spherical equivalent (SE) and axial length (AL) were measured. PR was assessed using a custom-made Hartmann-Shack wavefront peripheral sensor, covering a visual field of horizontal 60° and vertical 36°. Relative peripheral refraction (RPR) was calculated by subtracting central from peripheral measurements.ResultsAfter one year, SE increased more significantly in the 1/7 group compared to the 7/7 group (P < 0.001) and 2/7 group (P = 0.004); AL elongation was also greater in the 1/7 group compared to the 7/7 group (P < 0.001). In comparison with higher frequency groups, 1/7 group exhibited more myopic PR in the fovea and its vertical superior, inferior, and nasal retina; and less myopic RPR in the periphery retina after one-year (P < 0.05). Additionally, RPR in the 7/7 group demonstrated myopic shift across the entire retina, the 2/7 group in temporal and inferior retina, while the 1/7 group showed a hyperopic shift in the superior retina (P < 0.05). Moreover, myopic shift of RPR in the temporal retina is related to less myopia progression, notably in the 7/7 group (P < 0.05).ConclusionsAtropine inhibits myopia progression in a frequency-dependent manner. The once-daily group showed the slowest myopia progression but exhibited more myopic shifts in RPR. Additionally, RPR in the temporal retina was related to myopia progression in all groups.Trial registrationChinese Clinical Trial Registry, ChiCTR2100043506. Registered 21 February 2021, https://www.chictr.org.cn/showproj.html?proj=122214

To evaluate the age-related efficacy and safety of atropine 0.01% eye drops over 2 years for myopia control in a multicentric pediatric Spanish cohort. A non-controlled, interventional, prospective multicenter study was conducted as an extension of the Spanish Group of Atropine Treatment for Myopia Control Study (GTAM 1). Children aged 6–14 years with myopia from − 2.00 to − 6.00 D, astigmatism < 1.50 D and documented annual myopic progression of at least − 0.50 D under cycloplegic examination were recruited. From the original cohort of 105 participants, 92 children who had been receiving atropine 0.01% eye drops once nightly in each eye for 1 year continued their participation in this extended study (GTAM 2). All the patients underwent a standardized quarterly follow-up protocol, which included measurements of best-corrected visual acuity (BCVA), cycloplegic autorefraction, axial length (AL), anterior chamber depth (ACD), and pupil diameter. The study sample was divided into three age groups: 6–8, 9–11, and 12–14 years old. The mean change in cycloplegic spherical equivalent (SE) and axial length (AL) during the 24 months of follow-up was analyzed. Correlations between SE and AL, as well as the distribution of annual progression, were evaluated. Adverse effects were recorded using a specific questionnaire. Finally, 81 children completed the follow-up and were included in the analysis. Over the 2-year period, the mean changes in SE and AL were − 0.88 ± 0.60 D and 0.49 ± 0.25 mm, respectively. Additionally, 51 patients (63%) experienced SE annual progression lower than − 0.50 D. The correlation between the progression of SE and AL during the total period of treatment was mild (r = − 0.36; p < 0.001). There were no differences between the first and the second year of treatment in the progression of SE (− 0.42 ± 0.41 D versus − 0.45 ± 0.39 D; p = 0.69) or AL (0.25 ± 0.16 mm versus 0.23 ± 0.14 mm; p = 0.43). Older patients (12–14 years old) showed less AL progression than younger children (6–8 years old): 0.36 ± 0.18 mm versus 0.59 ± 0.30 mm; p = 0.01. Adverse effects were mild, infrequent, and decreased over time. On average, the myopia progression in control groups from other published biannual studies exceeded that observed in our study. Over 2 years, atropine 0.01% demonstrated a safe treatment for controlling myopia progression in a multicentric cohort of Spanish children. The effect remained stable during this period. Older patients exhibited a more favorable response in terms of AL enlargement. However, further studies are needed to investigate the age-related effect of low-dose atropine in the Caucasian population.

Treatment of myopic children with a dual-focus soft contact lens (DFCL; MiSight 1 day) produced sustained slowing of myopia progression over a 6-year period. Significant slowing was also observed in children switched from a single vision control to treatment lenses (3 years in each lens). This study aimed to evaluate the effectiveness of DFCLs in sustaining slowed progression of juvenile-onset myopia over a 6-year treatment period and assess myopia progression in children who were switched to a DFCL at the end of year 3. Part 1 was a 3-year clinical trial comparing DFCLs with a control contact lens (Proclear 1 day) at four investigational sites. In part 2, subjects completing part 1 were invited to continue for 3 additional years during which all children were treated with MiSight 1 day DFCLs (52 and 56 from the initially treated [T6] and control [T3] groups, respectively). Eighty-five subjects (45 [T3] and 40 [T6]) completed part 2. Cyclopleged spherical equivalent refractive errors (SEREs) and axial lengths (ALs) were monitored, and a linear mixed model was used to compare their adjusted change annually. Average ages at part 2 baseline were 13.2 ± 1.3 and 13.0 ± 1.5 years for the T6 and T3 groups, respectively. Slowed myopia progression in the T6 group observed during part 1 was sustained throughout part 2 (mean ± standard error of the mean: change from baseline SERE [in diopters], -0.52 ± 0.076 vs. -0.51 ± 0.076; change in AL [in millimeters], 0.28 ± 0.033 vs. 0.23 ± 0.033; both P > .05). Comparing progression rates in part 2 for the T6 and T3 groups, respectively, indicates that prior treatment does not influence efficacy (SERE, -0.51 ± 0.076 vs. -0.34 ± 0.077; AL, 0.23 ± 0.03 vs. 0.18 ± 0.03; both P > .05). Within-eye comparisons of AL growth revealed a 71% slowing for the T3 group (3 years older than part 1) and further revealed a small subset of eyes (10%) that did not respond to treatment. Dual-focus soft contact lenses continue to slow the progression of myopia in children over a 6-year period revealing an accumulation of treatment effect. Eye growth of the initial control cohort with DFCL was slowed by 71% over the subsequent 3-year treatment period.

Efficacy of Cylindrical Annular Refractive Elements (CARE) Spectacle Lenses in Slowing Myopia Progression Over 2 Years.

The development of tools to predict the risk of myopia onset and myopia progression has increased in the past few years. Currently, several myopia control therapies are available to slow the rate of progression. Additionally, environmental counselling, such as increasing outdoor time, can be used to delay the onset of myopia. However, the assessment of the need for treatment or counselling is dependent on an evaluation of the risk to develop myopia or the risk of myopia progression. Several tools to predict the risk of myopia development and myopia progression have been developed, such as percentile growth curves or artificial intelligence growth curve estimations for refractive error and axial length. Among these tools are web‐based and app resources on myopia risk calculators that display myopia risk and progression graphically. The diversity of calculators is wide and customisable fields allow the introduction of data necessary for predictions, such as age, spherical equivalent, ethnicity, axial length, and parental history of myopia or others. Some calculators allow the comparison of the risk of myopia development with myopia management and without. The use of myopia calculators, including axial length growth charts, has been encouraged as an educational tool that can be helpful to discuss myopia management with parents and children. How effective those tools are as part of a myopia workup in clinical practice is still unknown. In clinical practice, some biometers for axial length measurements have incorporated growth charts that allow to monitor axial length progression. However, scientific research or evidence of the accuracy of those calculators is scarce. Previous research has shown that some calculators may not provide accurate estimates for all children and should be used with cation, especially when taking ethnicity in consideration. Problems identified with the available calculators were related with underestimation and over estimation of the extent of myopia progression in about 64% of children. Overestimations may be more likely in younger children. Thus, calculators should be used with cation as relying on predictions of average progressors alone, may not be the best approach when considering individual myopia control management. Presently, available calculators may not be able to replace individual risk assessment and management. Further research is necessary with larger sample sizes, longer follows‐ups and wide range of ethnicities to validate the existing calculators before adoption into daily clinical practice to predict the individual risk of future myopia progression.