Axial Length Elongation Research Articles

Myopia control strategies: A systematic review and meta-meta-analysis.

To summarise pooled estimates of the efficacies of various myopia control interventions, as drawn from published meta-analyses. PubMed, SCOPUS and Web of Science were searched from inception to February 2024 for systematic reviews and meta-analyses reporting treatment effects of various myopia control strategies. The qualities of the included meta-analyses were assessed using the 16-item A MeaSurement Tool to Assess systematic Reviews (AMSTAR) 2. An intervention was defined as having a clinically significant effect if it resulted in a change in spherical equivalent refraction (SER) of ≥0.50 D/year or axial length (AL) change of ≤-0.18 mm/year. A total of 38 studies were identified. The overall respective changes in SER and AL, mean difference (95% CI) were high-concentration (≥0.5%) atropine 0.67 D (0.58-0.77) and -0.24 mm (-0.36 to -0.11); moderate-concentration (>0.05% to <0.5%) atropine 0.48 D (0.34-0.62) and -0.23 mm (-0.27 to -0.19); low-concentration (0.01%, 0.025%, 0.05%) atropine 0.33 D (0.23-0.43) and -0.14 mm (-0.19 to -0.09); orthokeratology -0.47 mm (-0.66 to -0.28); peripheral plus soft contact lenses 0.30 D (0.18-0.42) and -0.35 mm (-0.62 to -0.08); peripheral plus spectacles 0.77 D (0.40-1.14) and -0.43 mm (-0.78 to -0.08); multifocal spectacles 0.21 D (0.11-0.31); repeated low-level red light therapy 0.55 D (0.46-0.65) and -0.25 mm (-0.29 to -0.20); outdoor time 0.17 D (0.16-0.18) and -0.04 mm (-0.06 to -0.01). High and moderate concentrations of atropine, orthokeratology, peripheral plus spectacles and repeated low-level red light demonstrated clinically significant effects on slowing AL elongation, while high and moderate concentrations of atropine, peripheral plus spectacles and repeated low-level red light demonstrated clinically significant effects on slowing SER progression.

Multifocal Soft Contact Lenses for the Treatment of Myopia Progression in Children: A Report by the American Academy of Ophthalmology

To review the published literature assessing the efficacy of multifocal soft contact lenses for the treatment of myopia progression in children 18 years of age and younger. A literature search of the PubMed database was conducted last in March 2024 and was limited to articles published in English without date restrictions. The search yielded 76 articles, which were reviewed by the primary author in abstract form, and 28 articles were selected for full-text review. Twelve articles were deemed to have met the inclusion criteria and were assigned a level of evidence rating by the panel methodologist. Eleven studies were rated level I and 1 study was rated level II. All studies showed less myopic progression, with changes in spherical equivalent (SE) ranging from 0.22 to 0.81 diopters (D) for multifocal soft contact lenses compared with 0.50 to 1.45 D in control groups who used single-vision spectacles or single-vision contact lenses over the course of at least 1 year. Additionally, axial elongation was less in the multifocal soft contact lens group compared with control groups, with a change in axial length (AL) of 0.05 to 0.39 mm in treatment groups compared with 0.17 to 0.67 mm in control groups with at least 1 year of follow-up. The difference in change between the groups was clinically modest and statistically significant in 11 studies for SE and in all 12 studies for AL. No serious adverse events were reported in any of the studies. Level 1 evidence supports slower myopia progression and AL elongation in children who used multifocal soft contact lenses compared with spectacles or single-vision contact lenses over at least 1 year of follow-up. However, few data are available on optimal treatment duration, the progression over longer periods, or progression after discontinuation of the multifocal contact lenses. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Association between myopia and sleep duration among primary school students in minority regions of Southwest China: a school-based cross-sectional research.

To investigate the relationship between sleep duration and myopia among primary school students in minority regions of Southwest China. The school-based, cross-sectional study was conducted from October 2020 to January 2021. All participants underwent a comprehensive ocular examination and completed a questionnaire on demographic characteristics, ophthalmological history and major environmental factors for myopia. Spherical equivalent (SE) and ocular biometric parameters were measured after cycloplegia, with myopia being defined as SE ≤-0.5 D (Diopter). Multivariate regression models were used to examine the association of sleep duration with myopia, SE and axial length (AL). A total of 857 students from grades 2 to 4 were included in the analysis, of which 63.6% were myopic and 62.0% belonged to ethnic minorities. Boys had a slightly higher prevalence of myopia compared with girls (66.7% vs 60.6%, p=0.06). Myopic students had longer AL, deeper anterior chamber depth and thinner central corneal thickness compared with non-myopic students (all p<0.05). There was no significant association between sleep duration and myopia in both boys and girls (p=0.319 and 0.186, respectively). Moreover, girls with a sleep duration of 8-9 hour/day had higher SE and shorter AL compared with those with less than 8 hour/day of sleep (β=0.41 and -0.32, respectively, all p<0.05). This cross-sectional study did not find a significant association between sleep duration and myopia. However, it suggests that 8-9 hours of sleep per day may have a protective effect on SE progression and AL elongation in girls. Future studies with objectively measured sleep duration are needed to validate the findings.

Effects of different orthokeratology lens designs on slowing axial length elongation in children with myopia.

To elucidate whether differences exist in the impact on retarding the elongation of axial length (AL) among children with myopia when utilizing orthokeratology (ortho-k) lenses employing the corneal refractive therapy (CRT) design versus those employing the vision shaping treatment (VST) design. This retrospective clinical trial aimed to collect and analyze AL data from individuals who wore ortho-k lenses for three years. A total of 654 subjects were enrolled and prescribed one of the three specific brands of ortho-k lenses: CRT, Euclid, and Mouldway. The study's primary focus was to compare the rates of AL elongation and myopic progression across these three brands of ortho-k lenses. In the 3-year follow-up, the AL elongation exhibited variations of 0.73±0.36 mm in the CRT lens group, 0.59±0.37 mm in the Euclid lens group, and 0.63±0.38 mm in the Mouldway lens group. A noteworthy disparity emerged between the CRT and Mouldway groups (P<0.01), as well as between the CRT and Euclid groups (P<0.001). Additionally, it was observed that 32.1% of participants who wore CRT lenses experienced a decelerated progression of myopia, in contrast to 47.2% in the Euclid group and 44.4% in the Mouldway group. Statistical analyses revealed a statistically significant distinction between the CRT and Euclid groups (P<0.01), and similarly, the CRT group demonstrated a statistically significant difference when compared to the Mouldway group (P<0.05). Ortho-k lenses represent a pragmatic strategy for mitigating the advancement of myopia. In contradistinction to ortho-k lenses utilizing the CRT design, those employing the VST design exhibited a more favorable impact regarding retarding AL elongation.

Effects of orthokeratology and spectacle lenses with highly aspherical lenslets on unilateral myopic anisometropia control.

To evaluate the 1-year effects of orthokeratology (OK) lenses and spectacle lenses with highly aspherical lenslets (HALs) on axial length (AL) elongation in children with unilateral myopic anisometropia. This ambispective cohort study recruited 81 children aged 8-14 years with unilateral myopic anisometropia. Of these, 42 participants (mean age 11.07 ± 1.54 years; 23 males) were treated with monocular OK lenses (OK group), and 39 (mean age 10.64 ± 1.72 years; 22 males) with binocular HALs (HAL group). Changes in AL and spherical equivalent refraction (SER) from baseline at 3, 6 and 12 months were compared between eyes and groups. Kaplan-Meier estimation and Cox proportional hazard regression were performed to analyse the risk of myopia onset in the initially non-myopic eyes. Mean axial elongation in the myopic and non-myopic eyes at the 12-month follow-up visit were 0.17 ± 0.20 and 0.41 ± 0.26 mm in the OK group (p < 0.001) and 0.10 ± 0.15 and 0.12 ± 0.12 mm in the HAL group (p = 0.32), respectively. Compared with the OK group, the non-myopic eyes in the HAL group had less axial elongation, lower cumulative myopia incidence and percentage of participants with rapid myopic shift at the 6- and 12 month follow-up (all p < 0.05). Cox regression analysis showed that a higher initial SER decreased the risk of myopia onset significantly in the initially non-myopic eyes (B = -2.06; 95% CI, 0.03-0.49; p = 0.003). Monocular OK lenses suppressed axial elongation in the myopic eye and minimised anisometropia; however, the non-treated contralateral eye may experience faster myopia onset and myopic shift. Binocular HALs can effectively reduce axial elongation in both eyes of children with unilateral myopic anisometropia.

Myopic shift in female mice after ovariectomy

Myopia is a global public health concern, with a higher prevalence in women than that in male. As the relationship between sex hormone and myopia remains unclear, we aimed to reveal the relationship between sex hormone and myopia by removing the ovaries of mice and measuring changes in ocular parameters related to myopia. Lens-induced myopia (LIM) surgeries were performed on 3-week-old male mice and age-matched female mice to evaluate the effects of sex on myopia development, which indicated a high degree of myopia and rapid progression of axial elongation in male mice. Bilateral ovariectomy (OVX) performed on 4-week-old female mice induced myopic refraction status in ovariectomized mice. Although axial length elongation was larger in ovariectomized mice than that in sham control mice, the result was insignificant. To further reveal the relationship between female sex hormones and myopia, LIM combined with OVX was performed, which revealed a magnified myopic refraction status in ovariectomized mice. Nevertheless, elongation of the anterior chamber depth in the − 30 D lens-treated eyes significantly increased in LIM + OVX mice compared with the frame-treated eyes in LIM + OVX mice and − 30 D lens-treated eyes in LIM + Sham surgery mice. Sex hormones play a role in regulating myopia development in female mice.

Efficacy of Combining Highly Aspherical Lenslets Spectacles With 0.01% Atropine Eye Drops in Myopia Control

To explore the difference in myopia control efficacy between spectacle lenses with highly aspherical lenslets (HAL) combined with 0.01% atropine eye drops and spectacle lenses with HAL alone or single vision spectacle lenses (SVL) in children and adolescents. A retrospective cohort study was conducted with a total of 105 myopic children aged 6-15 years. According to the specific myopia correction and control methods of each subject, they were evenly divided into the HAL+0.01% atropine (HAL+AT) group, the HAL group, and the SVL group, with 35 subjects in each group. Relevant data, such as cycloplegic refraction and axial length (AL) at baseline and 12 months after wearing spectacles, were retrieved. One-way analysis of variance, or the Kruskal-Wallis test, was used to analyze the changes in AL and spherical equivalent refraction (SER) after wearing spectacles for 12 months in comparison to those at baseline in the three groups. There was no statistically significant difference in the baseline parameters and duration of wearing spectacles among the three groups (P>0.05). After wearing spectacles for 12 months, the changes in SER were －0.13 (－0.25, 0.00) D, －0.25 (－0.63, －0.25) D, and －0.63 (－1.00, －0.25) D in the HAL+AT group, HAL group, and SVL group, respectively; AL elongation in the three groups was (0.09±0.11) mm, (0.19±0.16) mm, and (0.34±0.16) mm, respectively. The HAL+AT group exhibited slower SER changes (P HAL+AT vs. HAL=0.001, P HAL+AT vs. SVL=0.002) and AL elongation (P HAL+AT vs. HAL=0.009, P HAL+AT vs. SVL=0.001) than those of the HAL and the SVL groups. Compared with those of the SVL group, myopia progression was reduced by 79.4% and AL elongation was slowed down by 73.5% in the HAL+AT group, while in the HAL group, myopia progression and AL elongation were reduced by 60.3% and 44.1%, respectively. According to stratified analysis based on age and myopia progression rate, among younger children aged 6 to 8 years and older children aged 9 to 15 years, the HAL+AT group had a significantly lower proportion of subjects experiencing fast AL elongation (AL>0.36 mm/year) and a significantly higher proportion of subjects experiencing slow AL elongation (AL≤0.18 mm/year) compared to the SVL group (P<0.017). The combination intervention of spectacle lenses with HAL and 0.01% atropine eye drops is effective in controlling myopia progression in children and adolescents, with better myopia control effect achieved using this combination intervention in myopic children of all ages.

Prediction of Axial Length From Macular Optical Coherence Tomography Using Deep Learning Model.

The purpose of this study was to develop a deep learning model for predicting the axial length (AL) of eyes using optical coherence tomography (OCT) images. We retrospectively included patients with AL measurements and OCT images taken within 3months. We utilized a 5-fold cross-validation with the ResNet-152 architecture, incorporating horizontal OCT images, vertical OCT images, and dual-input images. The mean absolute error (MAE), R-squared (R2), and the percentages of eyes within error ranges of ±1.0, ±2.0, and ±3.0mm were calculated. A total of 9064 eyes of 5349 patients (total image number of 18,128) were included. The average AL of the eyes was 24.35 ± 2.03 (range = 20.53-37.07). Utilizing horizontal and vertical OCT images as dual inputs, deep learning models predicted AL with MAE and R2 of 0.592mm and 0.847mm, respectively, in the internal test set (1824 eyes of 1070 patients). In the external test set (171 eyes of 123 patients), the deep learning models predicted AL with MAE and R2 of 0.556mm and 0.663mm, respectively. Regarding error margins of ±1.0, ±2.0, and ±3.0mm, the dual-input models showed accuracies of 83.50%, 98.14%, and 99.45%, respectively, in the internal test set, and 85.38%, 99.42%, and 100.00%, respectively, in the external test set. A deep learning-based model accurately predicts AL from OCT images. The dual-input model showed the best performance, demonstrating the potential of macular OCT images in AL prediction. The study provides new insights into the relationship between retinal and choroidal structures and AL elongation using artificial intelligence models.

Efficacy of orthokeratology lens with the modified small treatment zone on myopia progression and visual quality: a randomized clinical trial

BackgroundTo evaluate the long-term effectiveness of orthokeratology (ortho-K) lenses with small treatment zone (STZ) or conventional treatment zone (CTZ) in controlling axial elongation in children with myopia as well as the impact on visual quality. We also sought to determine the effect of retinal visual signal quality on axial elongation.MethodsThis is a prospective randomized controlled study. A total of 140 participants (age ranging from 8 to 12 years) were randomly assigned to wear either STZ or CTZ ortho-K lenses. STZ ortho-K lenses design was achieved by changing the depth of reverse zone and the sagitta height of the optical zone. Using the IOL-Master 500, axial length (AL) was measured at baseline and after 6, 12 and 18 months of ortho-K treatment. Spherical aberration (SA) and corneal topographic parameters were obtained by the Pentacam anterior segment analyzer at baseline and the 1-month follow-up visit, and optical qualities were assessed by optical quality analysis system-II (OQAS-II) at baseline and after 1 month of lens wearing. Optical quality parameters mainly included the modulation transfer function (MTF) cutoff, Strehl ratio (SR), objective scattering index (OSI), and predicted visual acuity (PVA).ResultsA total of 131 participants completed the study, including 68 in the STZ group and 63 in the CTZ group. The STZ group had significantly reduced AL elongation compared to the CTZ group after treatment (12 months: 0.07 ± 0.11 mm vs. 0.14 ± 0.12 mm, P = 0.002; 18 months: 0.17 ± 0.15 mm vs. 0.26 ± 0.16 mm, P = 0.002). The topography in the STZ group showed a smaller treatment zone (TZ) diameter (2.50 ± 0.23 mm vs. 2.77 ± 0.18 mm, P < 0.001), a wider defocus ring width (2.45 ± 0.28 mm vs. 2.30 ± 0.30 mm, P = 0.006), and larger values of total amount of defocus (119.38 ± 63.71 D·mm2 vs. 91.40 ± 40.83 D·mm2, P = 0.003) and total SA (0.37 ± 0.25 μm vs. 0.25 ± 0.29 μm, P = 0.015), compared with the CTZ group. Objective visual quality decreased in both groups (P < 0.001). This was evidenced by a greater decrease in MTF cutoff (− 14.24 ± 10.48 vs. − 10.74 ± 9.46, P = 0.047) and SR values (− 0.09 ± 0.07 vs. − 0.06 ± 0.07, P = 0.026), and an increase in OSI value (0.84 ± 0.72 vs. 0.58 ± 0.53, P = 0.019). PVA9% decreased significantly in the STZ group but not the CTZ group. A statistically significant negative correlation was found between the changes in total SA and MTF cutoff values (r = − 0.202, P = 0.025). AL changes were associated with sex, change of MTF cutoff value, increment of total SA and TZ area.ConclusionsCompared with CTZ ortho-K lenses, STZ ortho-K lenses significantly inhibited axial elongation in children with myopia while moderately reducing their objective visual quality. Axial elongation was affected by retinal visual quality, and it may be a possible mechanism for ortho-K slowing myopia progression.Trial registration This trial is registered at Chinese Clinical Trial Registry on November 5, 2019 with trial registration number: ChiCTR1900027218. https://www.chictr.org.cn/showproj.html?proj=45380

Posterior scleral reinforcement surgery effectively slows the rate of high myopic progression in children

To investigate the rate of axial length elongation and high myopia progression in operated eyes before and after posterior scleral reinforcement (PSR) surgery. This was a retrospective study. Children with pathological myopia treated with PSR at Beijing Tongren Hospital between May 2013 and May 2020 were recruited into the PSR surgery group. Children matched for age and myopia were recruited into the control group. All children underwent comprehensive ophthalmologic examinations. The presurgical and postsurgical rates of axial length elongation and myopic (spherical equivalent) progression were calculated. A total of 35 PSR patients were included in the study. The mean age was 6.5±3.0years (range 2 to 14years). Mean follow-up was 544days (range 216 to 1657days). The rate of axial length elongation was significantly less after posterior scleral reinforcement surgery (0.505±0.048mm per year prior to surgery; 0.382±0.045mm per year after surgery, P<0.001). The rate of myopic progression decreased after posterior scleral reinforcement surgery (1.162±0.118D per year prior to surgery; 0.153±0.437D per year after surgery, P=0.0239). There was no statistically significant difference in axial length elongation or myopic progression between pre-inclusion and post-inclusion in the control group. Moreover, the children's best-corrected visual acuity was significantly improved after posterior scleral reinforcement surgery (P<0.001). Posterior scleral reinforcement surgery effectively decreased the rate of high myopic progression and axial length elongation in children.

Spectacle correction may affect refractive progression in children with unilateral myopic anisometropia: A retrospective study.

To investigate the effect of spectacle correction on refractive progression in children with unilateral myopic anisometropia (UMA). In this retrospective study, 153 children with UMA (aged 8-12 years) were recruited and classified into an uncorrected (UC) group (n = 47) and a spectacle (SP) group (n = 106). The spherical equivalent refraction (SER) of the myopic eyes ranged from -0.75 to -4.00 D; the SER of the emmetropic eyes ranged from +1.00 to -0.25 D; anisometropia was ≥1.00 D and the follow-up duration was 1 year. Nineteen subjects from the SP group with follow-up records spanning at least 6 months before and after wearing spectacles were selected as a subgroup. Changes in the SER and axial length (AL), the degree of anisometropia and interocular AL differences of the two groups and the subgroup were analysed. During the 1-year follow-up period, AL and SER changes in myopic eyes were significantly greater than those in emmetropic eyes in the UC group (p < 0.001). For the UC group, the degree of anisometropia and AL change increased (all p < 0.001). For the SP group, there were no significant differences in the degree of anisometropia or AL change (all p > 0.05). When comparing the groups, AL elongation of the myopic eyes in the UC group occurred significantly faster than in the SP group (p = 0.02), and AL elongation for the emmetropic eyes in the UC group occurred significantly slower than in the SP group (p = 0.04). For the subgroup, the AL and SER changes in the myopic eyes 6 months before wearing spectacles occurred significantly faster than those after correction (p < 0.001). Spectacle correction could prevent increased anisometropia in uncorrected children with UMA by slowing myopia progression in the myopic eyes and accelerating the myopic shift in the contralateral eye.

Spectacle Lenses With Highly Aspherical Lenslets for Slowing Axial Elongation and Refractive Change in Low-Hyperopic Chinese Children: A Randomized Controlled Trial

Purpose: Spectacle lenses with highly aspherical lenslets (HAL) have been shown to effectively retard myopia progression in myopic children. This study aimed to investigate the impact of spectacle lenses with HAL on refractive and axial length (AL) changes in Chinese children with low amount of hyperopia. Design: Randomized controlled trial Methods: A total of 108 Chinese children aged 6.0 to 9.9 years and spherical equivalent refractive error (SERE) from 0.00 to +2.00 D were randomly allocated into two groups: the HAL group and the single vision spectacle lens (SVL) group. Cycloplegic refraction, AL, and uncorrected visual acuity (UCVA) was measured at baseline, three months, six months, and 12 months after lens dispensing. The duration of spectacle lens wear was monitored using a wearable device attached to the spectacle frame and by questionnaire logs provided by participants at each follow up visit. Results: The one-year SERE change was -0.19 [-0.32, 0.03] D and −0.23 [-0.36, 0.05] D in the SVL and HAL groups (P=0.883). The one-year AL elongation was 0.24 [0.18, 0.34] mm and 0.19 [0.12, 0.27] mm in the SVL and HAL groups (P=0.057). In the HAL group, changes in AL and SERE were significantly correlated to lens wearing time (P<0.001 and P=0.024, respectively). Participants in the HAL group who wore their lenses for more than 30 hours per week had significantly slower AL elongation (0.11 [0.05, 0.17] mm) compared to their SVL counterparts (0.27 [0.21, 0.33] mm) (P<0.001). Conclusion: Spectacle lenses with HAL significantly reduced AL elongation in low hyperopic children who wore lenses for over 30 hours per week. A dose-response relationship was evident with longer lens wearing time associated with less AL change.

Regional Summed Corneal Refractive Power Changes in Myopic Orthokeratology and Their Relationships With Axial Elongation.

To determine the relationship between regional summed corneal refractive power changes (CRPCs) in myopic orthokeratology and axial elongation. This retrospective study included 70 eyes of 70 patients aged 8 years to 13 years who underwent orthokeratology lens (OK lens) treatment, and all patients underwent regular follow-ups at 1 week, 1 month, 6 months, and 12 months at Zhongshan Ophthalmic Center between January 2019 and May 2021. Axial length (AL) was measured at baseline and 12 months by an IOLmaster 5.0. Refractive error power was measured using cycloplegia. Regional summed CRPCs were calculated by MATLAB software using difference tangential power maps at the sixth month acquired by corneal topography measurements (Medmont E300 Corneal Topographer; Medmont Pty, Victoria, Australia) and defined as changes in corneal refractive power at the sixth month from baseline. The regional summed CRPCs were then subdivided into 4-mm diameter circles, 4- to 5-mm diameter chords, and 5- to 6-mm diameter chords according to the distance from the central of the pupil and into negative, positive, and total according to the values. Pearson correlation, multiple linear regression analysis, and stepwise multiple linear regression analysis were performed to analyze the relationships among these parameters. Axial elongation had a negative relationship with positive regional summed corneal refractive power in the central 4-mm diameter circle and age (r=-0.282, P =0.018; r=-0.473, P <0.001, respectively) and a positive relationship with negative regional summed corneal refractive power in the 5- to 6-mm diameter chord (r=0.361, P =0.002). Stepwise multiple linear regression analysis identified age (standardized β =-0.434, P <0.001) and negative regional summed corneal refractive power in the 5- to 6-mm diameter chord (standardized β =0.305, P =0.004) as factors influencing AL elongation. Negative regional summed corneal refractive power in a 5- to 6-mm diameter chord after OK lens treatment may be an important index for evaluating the control effects of axial elongation.

Association of Accommodation and Convergence with Axial Length Elongation in Children with Basic Intermittent Exotropia: A 12-Month Observational Study.

The aim of the study was to investigate the association of parameters related to accommodation and convergence and axial elongation in basic intermittent exotropia (IXT) patients and the potential clinical predictors of axial length (AL) growth. A total of 140 basic IXT patients were recruited in this study. The medians of AL growth in different age brackets were chosen to divide the subjects into group A (slower axial elongation group, n = 69) and group B (faster axial elongation group, n = 71). Parameters of dominant and nondominant eyes were compared and analyzed during the 12-month follow-up period. The parameters, including baseline refraction, angle of deviation, Newcastle control score (NCS), accommodative amplitude (AMP), accommodative facility (AMF), accommodative response, positive or negative relative accommodation (PRA/NRA), and near point of convergence (NPC), were analyzed via univariate and multivariate regression. Subjects in the faster axial elongation group tended to have more myopic spherical equivalents (t = 3.956, p &lt; 0.001), greater AMPs of dominant eyes (t = -2.238, p = 0.027), and fewer near points of convergence (t = 2.347, p = 0.020) than in the slower axial elongation group. For dominant eyes, logistic and linear regression analysis revealed that more negative spherical equivalents (OR = 0.603, p &lt; 0.001; β = -0.045, p &lt; 0.001), greater AMPs (OR = 1.201, p = 0.027; β = 0.023, p = 0.010), and less near points of convergence (OR = 0.883, p = 0.021; β = -0.012, p = 0.019) were correlated with the faster axial elongation. For nondominant eyes, a more myopic spherical equivalent (OR = 0.682; p = 0.001; β = -0.029, p = 0.005) was the only parameter correlated with faster axial elongation through regression analysis. In children with basic IXT, faster axial elongation in the dominant eyes was associated with more myopic spherical equivalents, greater AMPs, and lower NPCs. These accommodative parameters can serve as potential clinical indicators for monitoring myopia progression in addition to AL.

Choroidal Vascularity and Axial Length Elongation in Highly Myopic Children: A 2-Year Longitudinal Investigation.

To examine the influence of subfoveal choroidal thickness (SFCT) and choroidal vascularity index (CVI) on axial length (AL) elongation over a 2-year period in highly myopic children. In this is prospective, longitudinal, observational study, 163 participants (74%), who were 8 to 18years of age with bilateral high myopia (sphere ≤ -6.0 D) and without pathologic myopia, completed follow-up visits over 2years. All participants underwent baseline and follow-up ocular examinations, including swept-source optical coherence tomography (SS-OCT) and AL measurements. SFCT and CVI were derived from SS-OCT scans using a deep-learning-based program for choroidal structure assessment. The mean age of the participants at baseline was 15.0years (±2.3), with males constituting 47% of the cohort. An inverse relationship was observed between AL elongation and increases in baseline age, baseline SFCT, and CVI, as well as a decrease in baseline AL. Adjusting for other factors, every 10-µm increase in SFCT and each 1% increase in CVI were associated with decreases in AL elongation of 0.007mm (95% confidence interval [CI], -0.013 to -0.002; P = 0.011) and 0.010mm (95% CI, -0.019 to 0.000; P = 0.050), respectively. The incorporation of SFCT or CVI into predictive models improved discrimination over models using only age, gender, and baseline AL (both P < 0.05, likelihood ratio test). Our findings suggest a possible association between a thinner choroid and increased AL elongation over 2 years in children with high myopia, after adjusting for potential baseline risk factors such as age, gender, and initial AL.

Frequency-dependent effects of 0.05% atropine eyedrops on myopia progression and peripheral defocus: a prospective study

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

Add-on effect of using 0.05% atropine in fast progressors of orthokeratology: A preliminary retrospective study

PurposeTo investigate the potential benefit of combining orthokeratology (OK) lenses with 0.05% atropine ophthalmic solution on the efficacy of myopia control in the fast progressors of OK. MethodsAverage axial length (AL) elongation of both eyes in 70 participants using OK lenses alone or OK lenses combined with 0.05 % atropine ophthalmic solution was retrospectively reviewed. During the observation period (phase 1), all participants exhibited an AL elongation that exceeded 0.15 mm over a 6-month period or 0.3 mm over a 12-month period. Subsequently, the participants were divided into two groups: one group received nightly 0.05 % atropine ophthalmic solution in addition to OK lenses for another 1 year (OKA), while the other group continued using OK lenses alone (phase 2). The changes in AL elongation over time and the differences in AL elongation between the two groups were then compared. ResultsThe baseline and phase 1 demographics and characteristics of the participants was similar between the two groups (all p > 0.05). when considering a one-year timeframe, the OKA group displayed a significantly less AL elongation compared to the OK group (0.14 ± 0.13 mm vs 0.27 ± 0.12 mm, p < 0.001). Within the OKA group, the AL elongation in the second half of the year was significantly faster than in the first half (0.12 ± 0.11 mm vs 0.02 ± 0.14 mm, p = 0.01). Conversely, there was no significant difference in AL elongation between the OK group in the first and second half of the year (0.12 ± 0.07 mm vs 0.15 ± 0.08 mm, p = 0.71). The combination of 0.05 % atropine ophthalmic solution had a significant effect on 1-year AL elongation (p < 0.001). ConclusionsThis study provided preliminary evidence that the combination of OK lenses and 0.05% atropine ophthalmic solution can significantly enhance the effectiveness of myopia control.

Ocular surface in patients with different degrees of myopia.

To investigate the clinical features of the ocular surface in patients with different degrees of myopia. A cross-sectional study was conducted involving 122 participants with myopia in Beijing Tongren Hospital from February to June, 2023. After completing the Ocular Surface Disease Index (OSDI) score scale, measurements were taken for refraction, biometric parameters and ocular surface parameters. The prevalence, severity and related parameters of the dry eye among different groups based on axial length (AL) were compared. Correlation analysis was performed between ocular surface parameters and refraction/biometric measurement parameters. Statistically significant differences were observed in refractive error, corneal thickness, anterior chamber depth, and subfoveal choroidal thickness among the groups (all P<0.05). With the increase in AL, the incidence and severity of dry eye increased significantly (P<0.05). Moreover, the tear film break-up time (BUT) shortened (P<0.05), and the corneal fluorescein staining (CFS) points increased significantly (P<0.05). OSDI scores were positively correlated with AL and spherical equivalent (SE; both P<0.05); BUT was negatively correlated with AL, SE, and corneal astigmatism (AST; all P<0.05); Schirmer I test (SIT) results were negatively correlated with AL and SE (both P<0.05). AL elongation is a risk factor for dry eye onset in myopic participants. The longer the AL, the more severe the dry eye is, with the increased CFS spots and tear film instability. Additionally, SE and AST exhibit negative correlations with dry eye symptom scores and ocular surface parameters.

0.01% Atropine Eye Drops in Children With Myopia and Intermittent Exotropia

Exotropia and myopia are commonly coexistent. However, evidence is limited regarding atropine interventions for myopia control in children with myopia and intermittent exotropia (IXT). To evaluate the efficacy and safety of 0.01% atropine eye drops on myopia progression, exotropia conditions, and binocular vision in individuals with myopia and IXT. This placebo-controlled, double-masked, randomized clinical trial was conducted from December 2020 to September 2023. Children aged 6 to 12 years with basic-type IXT and myopia of -0.50 to -6.00 diopters (D) after cycloplegic refraction in both eyes were enrolled. Participants were randomly assigned in a 2:1 ratio to 0.01% atropine or placebo eye drops administered in both eyes once at night for 12 months. The primary outcome was change in cycloplegic spherical equivalent from baseline at 1 year. Secondary outcomes included change in axial length (AL), accommodative amplitude (AA), exotropia conditions, and binocular vision at 1 year. Among 323 screened participants, 300 children (mean [SD] age, 9.1 [1.6] years; 152 male [50.7%]) were included in this study. A total of 200 children (66.7%) were in the atropine group, and 100 (33.3%) were in the placebo group. At 1 year, the 0.01% atropine group had slower spherical equivalent progression (-0.51 D vs -0.75 D; difference = 0.24 D; 95% CI, 0.11-0.37 D; P < .001) and AL elongation (0.31 mm vs 0.42 mm; difference = -0.11 mm; 95% CI, -0.17 to -0.06 mm; P < .001) than the placebo group. The mean AA change was -3.06 D vs 0.12 D (difference = -3.18 D; 95% CI, -3.92 to -2.44 D; P < .001) in the atropine and placebo groups, respectively. The 0.01% atropine group had a decrease in near magnitude of exodeviation whereas the placebo group had an increase (-1.25 prism diopters [PD] vs 0.74 PD; difference = -1.99 PD; 95% CI, -3.79 to -0.19 PD; P = .03). In the atropine vs placebo group, respectively, the incidence of study drug-related photophobia was 6.0% (12 of 200 participants) vs 8.0% (8 of 100 participants; difference = -2.0%; 95% CI, -9.4% to 3.7%; P = .51) and for blurred near vision was 6.0% (12 of 200 participants) vs 7.0% (7 of 100 participants) (difference = -1.0%; 95% CI, -8.2% to 4.5%; P = .74). The findings of this randomized clinical trial support use of 0.01% atropine eye drops, although compromising AA to some extent, for slowing myopia progression without interfering with exotropia conditions or binocular vision in children with myopia and IXT. Chinese Clinical Trial Registry Identifier: ChiCTR2000039827.

Long-term effect of orthokeratology on controlling myopia progression in children with allergic conjunctivitis

BackgroundTo observe whether the effect of orthokeratology (OK) lenses on myopia control in children with allergic conjunctivitis (AC) after three years of wear differs from that in children without allergic conjunctivitis (nAC) and to identify the potential influencing factors. MethodsThis was a retrospective case–control study. Patients aged 8–15 years who were fitted with OK lenses in 2019 were collected. A three-year follow-up was also conducted, documenting all corneal adverse events (AEs) and the increase in axial length (AL) of the eye after three years of wearing OK lenses. Patients were divided into groups with and without AC based on their medical history and physical signs at the initial fitting. Baseline data and AL elongation after three years were compared between the two groups. ResultsA total of 309 patients were included in this study, with 47 in the AC group and 262 in the nAC group. There were no statistically significant differences between the two groups in terms of age, sex, spherical equivalent (SE), AL of the eye and environment. After three years of OK lens wear, the AL elongation in the AC group was 0.96 ± 0.45 mm, whereas it was 0.69 ± 0.45 mm in the nAC group (P < 0.001). The extent of AL elongation in AC patients was significantly greater than that in nAC patients. During the three-year follow-up period, the duration of OK lenses discontinuation due to corneal AEs in the AC group was greater than that in the nAC group (P < 0.05). ConclusionsThis study found that allergic conjunctivitis can affect the efficacy of OK lenses in controlling myopia after three years of treatment.