Abstract
AimsTo compare the value of pre-treatment axial elongation (AE) and changes in refractive sphere (M change) for predicting the success in orthokeratology (ortho-k), in order to better identify suitable candidates for myopia control.MethodsThis study further analysed the data of 66 subjects receiving 7-month ortho-k treatment, following a 7-month observation period, during which single-vision spectacles were worn. Rate of myopia progression was determined by AE and M change and subjects categorised as slow, moderate, or rapid progressors based on these changes. Outcomes of myopia control, based on the AE reduction after ortho-k, were classified as ‘ineffectual’, ‘clinically insignificant’, or ‘beneficial’.ResultsOf the 20 subjects, initially categorised as slow by AE and, of whom 95% were similarly categorised by M change, none benefitted from ortho-k. In contrast, of the 22 subjects with moderate AE, 77% and 23% displaying slow and moderate M change, respectively, the majority (73%) benefitted from ortho-k lens wear. The 24 subjects with rapid AE were poorly identified by M change, with only 21% correctly categorised. The vast majority of rapid progressors showed significant benefit after ortho-k.ConclusionProgression of AE is a good indicator of subsequent success of ortho-k treatment. Delaying commencement of therapy is prudent for children with slow progression as results indicate that they would be unlikely to benefit from this intervention. As change in refractive error frequently underestimates rapid progression of AE, its value for identifying appropriate candidates for myopia control is poor.
Highlights
The dramatic worldwide increase in myopia has led to increasing concerns about the long term consequences of this condition, especially, in patients progressing to high myopia [1,2,3]
Of the 20 subjects, initially categorised as slow by axial elongation (AE) and, of whom 95% were categorised by M change, none benefitted from ortho-k
Progression of AE is a good indicator of subsequent success of ortho-k treatment
Summary
The dramatic worldwide increase in myopia has led to increasing concerns about the long term consequences of this condition, especially, in patients progressing to high myopia [1,2,3]. The surge in interest in myopia has resulted in development and prescription of various interventions for its control in children. These include orthokeratology (orthok) [7,8,9], atropine instillation [10, 11], specially designed soft contact lenses [12,13,14] and DIMS spectacles [15, 16]. Use of low concentration atropine, which requires medical prescription, has gained high popularity as it does not require overnight lens wear or stringent lens care routines. This is the case in regions where optometrist registration is not enforced. In general, researchers and practitioners would recommend atropine only for myopes, rather than a prophylactic treatment in pre-myopes [19, 20]
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