Management Of Myopia Research Articles

Method comparison and overview of refractive measurements in children: implications for myopia management

ObjectiveThis study investigated the agreement between objective wavefront-based refraction and subjective refraction in myopic children. It also assessed the impact of cyclopentolate and refraction levels on the agreement.MethodsA total of...

Exploring the Impact of Low-Concentration Atropine Eye Drops on the Progression of Myopia: A Systematic Review

Abstract
 Introduction & Objectives : Low-concentration atropine eye drops have emerged as a promising therapy for the management of myopia. However, the effectiveness of atropine for myopia has not been widely studied. This paper aims to analyze the efficacy of low-concentration atropine eye drops for progression of myopia.
 Methods : A comprehensive literature search was performed on 3 online databases: PubMed, Cochrane, and ProQuest. We used 'Low-concentration atropine eye drops’, ‘Atropine’, ‘Eye Drops’, ‘Myopia’, and their MeSH terms as keywords. All studies included in analysis were available in English and full text format. We analyzed children myopia progression rates from all studies. We used Rayyan, an online-based tool, to conduct the screening process.
 Results : Three randomized control trials (RCTs), two cohort studies, and three case report studies with a total of 1389 participants were analyzed. Most studies were done in Asia, except one RCT in Australia. The participants range from 4-12 years old. Atropine eye drops concentrations that had been used were 0,01%, 0,025%, 0,05%, 0,1%, 0,125%, and 0,2%. All studies showed slower progression rate of myopia compared to the control group (-0,31 D vs -0,90 D; -0,05 D vs -1,05 D; -0,27 D vs -0,81 D; -0,28 D vs -0,54 D; -0,18 D vs -0,45 D;−0.31 D vs −0.76 D; -0.91 vs -1.00 D; -0,38D vs -0,55 D) with P < 0,05, except one study P = 0,94.
 Conclusion : Low-concentration atropine eye drops have shown promising effects in slowing progression of myopia. However, further research is needed, particularly in non-Asian countries.

UK Optometrists' Professional Learning Needs Toward Engaging with Myopia Control Interventions.

This study aimed to explore the support that UK optometrists feel they require to facilitate their engagement with myopia control intervention. A self-administered online survey was distributed via QualtricsXM to practising optometrists in the UK via email lists and newsletters of local optical committees, social media, and optometric networks. Questions focussed on learning styles, training needs and barriers to learning. Fifty-five respondents completed the survey. Forty-eight respondents answered the question on where they get information about myopia control and learning style, 79.2% indicated that conferences offering Continuing Professional Development (CPD) material were their main source, and 20.8% preferred online learning as the preferred format of delivery. Optometrists would like to receive training in clinical assessments (78.9%), evaluating suitable interventions (76.3%), developing and implementing specific patient intervention plans (76.3%), carrying out chosen myopia control interventions (fitting/prescribing) (73.7%), and the use of pharmacological interventions (94.4%). Of the 40 respondents who answered professional development questions, 97 5% were most interested in finding, identifying and applying evidencebased practice (EBP), followed by clinical decision-making in myopia control (95.0%). When asked about barriers to learning in this field, 29.7% reported limited time to attend training as the greatest barrier. Optometrists felt they need training in various aspects of myopia management, from practical skills to assessing and fitting/prescribing appropriate myopia control interventions. They were also interested in learning more on EBP and clinical decision-making related to myopia control. To improve the uptake of myopia control among optometrists, various learning methods, especially online learning, and providing sufficient time for training are crucial.

Atropine: Updates on myopia pharmacotherapy.

The prevalence of myopia has rapidly increased over the last 30 years, with the World Health Organization estimating a worldwide incidence of 23%, projected to increase to 50% by 2050. The myopia epidemic has prompted a reincarnation in efforts to overcome this challenge. The exploration of atropine use in myopia was a result due to a lack of treatment in effect. This study aimed at reviewing the role of atropine in the management of myopia worldwide based on currently available findings. A literature search was conducted using PubMed/MEDLINE and Google Scholar for studies published up to April 2022 inclusive. Articles with high or medium clinical relevance were selected for this review. Multiple studies have demonstrated the relevance and efficacy rates of different concentrations of atropine, despite still insufficiently explained the exact site and mechanism of action of atropine in slowing myopia progression. Currently available findings highlight that topical atropine opened a new page in pharmacotherapy of myopia and have shown a high therapeutic effect on myopia progression in Asian and European child population, irrespective of ethnicity. There is potential for myopia control with fewer side effects using lower concentrations but still exists a room for improvement, underscoring the requirement of modified atropine topical preparations with increased bioavailability, potentially with nanoparticle formulations, to enable the effective management of myopia.

Myopia intervention and ultraviolet radiation related eye diseases: A narrative literature review.

There has been an increased understanding of the protective effect of two or more hours in high lux light on the development and progression of myopia. The aim of myopia management is to reduce the incidence of high myopia and sight-threatening myopic complications. Equally important are the sight-threatening complications of ultraviolet radiation (UVR) on the eye and adnexal structures. This review will analyze the literature for both these epidemics to help guide public health policy. Whilst increasing childhood high lux light exposure is important, consideration of a holistic eye health policy should ensure that UV eye diseases are also prevented. The advent of ultraviolet (UV) fluorescence photography has increased our understanding that significant UV eye damage occurs in childhood, with 81% of children aged 12-15 years having signs of UV eye damage. Hence, the need to reduce myopia and protect from UV-related eye diseases needs simultaneous consideration. Advocating for eye protection is important, particularly as the natural squint reflex is disabled with dark sunglasses lenses. The pathways UV reaches the eye need to be considered and addressed to ensure that sunglasses offer optimum UV eye protection. The design of protective sunglasses that simultaneously allow high lux light exposure and protect from UVR is critical in combating both these epidemics.

The long and short of it: a comprehensive assessment of axial length estimation in myopic eyes from ocular and demographic variables.

Axial length, a key measurement in myopia management, is not accessible in many settings. We aimed to develop and assess machine learning models to estimate the axial length of young myopic eyes. Linear regression, symbolic regression, gradient boosting and multilayer perceptron models were developed using age, sex, cycloplegic spherical equivalent refraction (SER) and corneal curvature. Training data were from 8135 (28% myopic) children and adolescents from Ireland, Northern Ireland and China. Model performance was tested on an additional 300 myopic individuals using traditional metrics alongside the estimated axial length vs age relationship. Linear regression and receiver operator characteristics (ROC) curves were used for statistical analysis. The contribution of the effective crystalline lens power to error in axial length estimation was calculated to define the latter's physiological limits. Axial length estimation models were applicable across all testing regions (p ≥ 0.96 for training by testing region interaction). The linear regression model performed best based on agreement metrics (mean absolute error [MAE] = 0.31 mm, coefficient of repeatability = 0.79 mm) and a smooth, monotonic estimated axial length vs age relationship. This model was better at identifying high-risk eyes (axial length >98th centile) than SER alone (area under the curve 0.89 vs 0.79, respectively). Without knowing lens power, the calculated limits of axial length estimation were 0.30 mm for MAE and 0.75 mm for coefficient of repeatability. In myopic eyes, we demonstrated superior axial length estimation with a linear regression model utilising age, sex and refractive metrics and showed its clinical utility as a risk stratification tool.

Accurate prediction of myopic progression and high myopia by machine learning.

Myopia is a leading cause of visual impairment in Asia and worldwide. However, accurately predicting the progression of myopia and the high risk of myopia remains a challenge. This study aims to develop a predictive model for the development of myopia. We first retrospectively gathered 612 530 medical records from five independent cohorts, encompassing 227 543 patients ranging from infants to young adults. Subsequently, we developed a multivariate linear regression algorithm model to predict the progression of myopia and the risk of high myopia. The model to predict the progression of myopia achieved an R2 value of 0.964 vs a mean absolute error (MAE) of 0.119D [95% confidence interval (CI): 0.119, 1.146] in the internal validation set. It demonstrated strong generalizability, maintaining consistent performance across external validation sets: R2 = 0.950 vs MAE = 0.119D (95% CI: 0.119, 1.136) in validation study 1, R2 = 0.950 vs MAE = 0.121D (95% CI: 0.121, 1.144) in validation study 2, and R2 = 0.806 vs MAE = -0.066D (95% CI: -0.066, 0.569) in the Shanghai Children Myopia Study. In the Beijing Children Eye Study, the model achieved an R2 of 0.749 vs a MAE of 0.178D (95% CI: 0.178, 1.557). The model to predict the risk of high myopia achieved an area under the curve (AUC) of 0.99 in the internal validation set and consistently high area under the curve values of 0.99, 0.99, 0.96 and 0.99 in the respective external validation sets. Our study demonstrates accurate prediction of myopia progression and risk of high myopia providing valuable insights for tailoring strategies to personalize and optimize the clinical management of myopia in children.

Myopia management in practice

Nicky Latham of CooperVision outlines her vision for the future of myopia management, while Wendy Sethi and Craig McArthur share some practical guidance to help achieve success in practice

Eyecare practitioner perspectives and attitudes towards myopia and myopia management in the UK

ObjectiveMany children with progressive myopia are still prescribed single-vision correction. An investigation into UK eyecare practitioners’ (ECPs) perceptions of myopia management was carried out to ascertain factors which may be...

Using big data to understand interest in myopia.

Popularity of publicly searched myopia terminologies is reported, for example, myopia control over myopia management and myopia over nearsighted or shortsighted. Insights are also provided for searches on specific myopia control interventions. The findings offer an evidence-based starting point for public messaging and communications by clinicians, policymakers, and other industry leaders. Public understanding of myopia can be difficult to ascertain for clinicians. Although small-scale studies provide valuable snapshots of data, findings tend to be population-specific and thus difficult to extrapolate to global audiences. In this study, big data were used to provide a more comprehensive depiction of global market interest in myopia. Google Trends data were used to analyze searches relating to myopia between January 2004 and August 2023. Data extracted were related to use of the terms myopia control and myopia management, with further searches executed for common myopia control interventions: orthokeratology, contact lenses, atropine, and glasses. Analysis into the search interest of other refractive error states, hyperopia and astigmatism, was also undertaken along with alternative terms that may be used to describe myopia. Where relevant, search trends were considered worldwide, by country, and over time. Myopia was a more popular search term than common layman alternatives such as nearsighted or shortsighted. Myopia control was found to be more popular than myopia management, and of the specific myopia interventions, atropine was most popular. Compared with astigmatism and hyperopia, relative search volumes were greatest for myopia, on average accounting for approximately 50% of the relative search volume at the country level. The differences identified in both popularity of myopia-related search terms and specific interventions may provide the basis for improvements in public messaging and facilitate patient-practitioner communication.

Prevention, Control and Management of Myopia– An Easy Approach

Prevention, Control and Management of Myopia– An Easy Approach

Peripheral refraction and retinal activity with dual focus contact lenses for myopia control

Aims/Purpose: Contact lenses (CLs) for myopia control have shown optimistic eye growth retention in children but, the retinal mechanisms of defocus still unclear. This work evaluated the retinal response and peripheral refraction with a soft CL for myopia management in myopic eyes.Methods: The visual acuity (VA), peripheral refraction and the retinal electrical activity were obtained from sixteen myopic (between −0.75 D and − 6.00 D, astigmatism >1.00 D) subjects (27.5 ± 5.7 years, 12 female), with two material‐matched CLs (Omafilcon A): a single‐vision CL (SV) and a myopia management dual‐focus CL (DF). Peripheral refraction was assessed with an open‐field autorefractometer (WAM‐5500, GrandSeiko Co. Lt) in four meridians separated by 45° at 2.50 meters distance. The global‐flash multifocal electroretinogram (gf‐mfERG) was recorded with the Reti‐port/scan21 (Roland Consult) using a stimulus of 61‐hexagons. The implicit time and response density (in nV/deg2) of the direct (DC) and induced (IC) components were analysed. Only the data of a single eye per subject was randomly used for analysis.Results: The two CLs designs showed similar VA (p > 0.050). The DF induced a myopic shift of the SV peripheral refraction in most retinal eccentricities (p < 0.050). There were no differences in the implicit times of the retinal response between CLs designs. The DF increased the response density of both DC and IC components at all retinal areas, with a statistically significant difference in the parafoveal DC component (median difference of 2.77 [6.23–1.44] nV/deg2, p = 0.038).Conclusions: The results showed that the retina responds differently to a SV and a DF CLs. The myopia management CL increased the electrophysiological response of the retina without affecting the time domain of the response. Besides other mechanisms potentially involved, the foveal and parafoveal retinal activities might be involved in the mechanism of myopia control with these lenses.

Choroidal thickness as a biomarker for axial length change

Aims/Purpose: Assessing axial eye growth is a key component in myopia management; however, access to biometry is limited in primary eye care settings. This study evaluated choroidal thickness, compared to spherical equivalent refraction, as a potential biomarker of axial elongation.Methods: The Myopia Outcome Study of Atropine in Children (MOSAIC) is a double‐blind, randomized controlled trial of 0.01% atropine eye drops. Irish myopic participants aged 6–16 years used either 0.01% atropine or placebo eye drops nightly for 2 years. Spherical equivalent refraction (SER) was measured by cycloplegic autorefraction, axial length (AL) by partial coherence interferometry and choroidal thickness (ChT) by Swept Source‐OCT. The respective 12‐month changes in both eyes were included in mixed linear regression analysis, while controlling for treatment group and within‐subject correlation. ROC analysis was conducted to assess the ability of ChT and/or SER to identify eyes in the top 25% (fast progressors) of AL change.Results: Of the 250 participants enrolled in MOSAIC (mean age 11.8 years, 62% female), 217 (87%) completed the 12‐month visit. Mean 12‐month change in AL, ChT and SER were 0.268 ± 0.19 mm, −3.62 ± 33.3 um and −0.437 ± 0.346 DS respectively. Analysis revealed a significant association between change in ChT and AL (−0.01 ± 0.002 mm per 10 μm; p < 0.001) and change in SER and AL (−0.28 ± 0.02 mm per 1D; p < 0.001). When both SER and ChT were combined in a single model, a 1D myopic change in SER and a 10um decrease in ChT were associated with a 0.27 mm (p < 0.001) and 0.007 mm increase in AL (p = 0.002), respectively. ROC analysis revealed that change in ChT was a stronger predictor of fast AL progression (AUC = 0.77) compared to SER change (AUC = 0.72), with the combined model performing better than either variable alone (AUC = 0.80).Conclusions: ChT change was significantly associated with AL change over 12 months and better than SER alone at identifying fast AL progressors, with a combined SER and ChT model achieving the best results.

Anterior chamber phakic lens implantation after deep anterior lamellar keratoplasty. Retrospective cohort with 24‐month follow‐up

Aims/Purpose: To report the outcome of correction of high myopia with anterior chamber phakic intraocular lenses (IOLs) implantation after deep anterior lamellar keratoplasty (DALK).Methods: Retrospective study with 7 eyes of patients who underwent DALK. The main variables measured were corrected visual acuity (CVA) and uncorrected visual acuity (UCVA), spherical equivalent, and endothelial cell density (ECD). Follow‐up was performed up to 24 months after the lens implant.Results: The spherical equivalent (SE) recorded a mean of −14.16 (± 3.50) before the lens implant and −0.30 (±0.93) after the implant, with a mean difference of 13.85 (10.25 to 13.85) and a p‐value of <0.001. The mean of uncorrected visual acuity (UCVA) before the lens was 1.82 (±0.63), 6 months after lens implant was 0.22 (±0.07), and after 24 months, 0.30 (±0.14) with a p‐value of 0.001. Among patients, 85.71% had a UCVA equal to or better than 0.3 logMAR and 42.85% had a UCVA of 0.2 logMAR vs. 0% preoperatively. 71.42% of the patients had residual ametropia within ±1.00 D. The mean corrected visual acuity (CVA) was 0.31 (±0.06) before lens implantation, 0.12 (±0.04) 6 months post‐ implantation and 0.14 (±0.05) 24 months post‐implantation. All patients had improvement of UCVA of at least 10 lines of vision (range 10 to 14); at 6 months, 71.42% of patients had a gain of at least 2 lines of vision in CVA and at 24 months only one patient had a decrease in UCVA. The mean difference in ECD was 68.71 (95% CI 11.97 to 125.44), corresponding to a loss of 1.26% of cells per year.Conclusions: Phakic IOLs are an effective and stable procedure for management of high myopia after DALK, demonstrating stable safety and efficacy rates up to 24 months. The known risk of endothelial loss should be closely monitored, as such loss is higher compared to eyes with phakic IOL implants without DALK.

Can Google Help Your Nearsightedness? A Google Trend Analysis of Public Interest in Myopic Progression.

To explore public interest in myopia progression and management and to correlate these trends to available treatments. Keywords were chosen for interest in myopia overall and those signifying interest in myopia treatments. Treatment options were separated into four main categories: atropine, glasses, contact lenses, and orthokeratology. Search terms were queried across ten years of Google Trends data and the relative search volume was analyzed to quantify the change in search volume over time. A positive linear trend over time was present for all myopia interest keywords except "nearsighted" (p = 0.074) and "near work myopia" (p = 0.086). Interest in the four myopia treatment categories included in this study also displayed a significant positive trend over time. There is also a statistically significant positive correlation between all four treatment options and four of the seven categories of population interest, "myopia control", "myopia", "myopia progression", and "screen time myopia". This study demonstrates the utility of GT to correlate public interest in myopia treatments over time. All treatment terms had statistically significant linear search volume growth over a ten-year period. The positive correlation between interest in myopia as a health problem and available treatments supports existing evidence that GT can track rising public health concerns and corresponding treatment-seeking behaviors.

Emerging Role of Axial Length Trajectories in the Management of Myopia

Emerging Role of Axial Length Trajectories in the Management of Myopia

Myopia management algorithm. Annexe to the article titled Update and guidance on management of myopia. European Society of Ophthalmology in cooperation with International Myopia Institute.

Myopia is becoming increasingly common in young generations all over the world, and it is predicted to become the most common cause of blindness and visual impairment in later life in the near future. Because myopia can cause serious complications and vision loss, it is critical to create and prescribe effective myopia treatment solutions that can help prevent or delay the onset and progression of myopia. The scientific understanding of myopia's causes, genetic background, environmental conditions, and various management techniques, including therapies to prevent or postpone its development and slow its progression, is rapidly expanding. However, some significant information gaps exist on this subject, making it difficult to develop an effective intervention plan. As with the creation of this present algorithm, a compromise is to work on best practices and reach consensus among a wide number of specialists. The quick rise in information regarding myopia management may be difficult for the busy eye care provider, but it necessitates a continuing need to evaluate new research and implement it into daily practice. To assist eye care providers in developing these strategies, an algorithm has been proposed that covers all aspects of myopia mitigation and management. The algorithm aims to provide practical assistance in choosing and developing an effective myopia management strategy tailored to the individual child. It incorporates the latest research findings and covers a wide range of modalities, from primary, secondary, and tertiary myopia prevention to interventions that reduce the progression of myopia.

Myopia brought into focus

Tina Arbon-Black reports from ABDO's first myopia management clinical conference last month at the NRC

Two-Year Myopia Management Efficacy of Extended Depth of Focus Soft Contact Lenses (MYLO) in Caucasian Children

To evaluate the progression of myopia as assessed by change in axial length (AL) and spherical equivalent (SE) from baseline in Caucasian children wearing extended depth of focus soft contact lenses (CLs) compared to distance single-vision spectacles. Prospective non-randomized comparative clinical trial. A total of 90 children (6-13 years of age) with SE ranging from -0.75 to -10.00 diopters (D) were recruited. Of these children, 45 were fitted with CLs (MYLO, mark´ennovy), whereas 45 children wore spectacles. Cycloplegic refraction was measured with an auto-refractometer (Topcon-TRK-2P) and AL with an IOLMaster-700 (Zeiss) at 6-month intervals. Subjective responses after 1 month of CL wear related to vision and comfort were determined using a questionnaire with a scale from 1 (very poor) to 10 (excellent). High-contrast visual acuity (HCVA) and contrast sensitivity (CS) were evaluated at baseline, 12, and 24 months. After 2 years, mean change in SE/AL in the CL group was -0.62 ± 0.30 D/0.37 ± 0.04 mm and -1.13 ± 0.20 D/0.66 ± 0.03 mm in the spectacles group (P < .001). Cumulative absolute reduction in axial elongation (CARE) was 0.29 ± 0.06 mm. Difference in SE change was -0.50 ± 0.34 D. Although 100% of CL group had an AL increase ≤0.50 mm, all participants increased ≥0.50 mm in the spectacles group. In all, 53% of the CL group and 1% in the spectacles group showed a progression in SE ≤ -0.50D. All questionnaire items showed a mean value ≥9. There was a reduction logMAR HCVA in the CL compared to the spectacles group but it was less than 1 line (P < .001). Use of MYLO CLs reduced axial elongation and myopia progression compared to use of distance single-vision spectacles.

Effect of myopia management contact lens design on accommodative microfluctuations and eye movements during reading

BackgroundSoft contact lenses have been developed and licensed for reducing myopia progression. These lenses have different designs, such as extended depth of focus (EDOF) and dual focus (DF). In this prospective, double-masked, cross-over study, different lens designs were investigated to see whether these had impact on accommodative microfluctuations and eye movements during reading. MethodsParticipants were fitted with three lenses in a randomised order; a single vision (SV) design (Omafilcon A2; Proclear), a DF design (Omafilcon A2; MiSight), and an EDOF lens design (Etafilcon A; NaturalVue),. Accommodative microfluctuations were measured at 25 cm for at least 60s in each lens, using a Shin-Nippon SRW-5000 autorefractor adapted to continuously record accommodation at 22Hz. Eye movement data was collected with the Thomson Clinical Eye Tracker incorporating a Tobii Eye bar. Eye movements include fixations per row, fixations per minute, mean regressions per row, total number of regressions, and total rightward saccades. Accommodation data was analysed using power spectrum analysis. Differences between the lenses were compared using a related sample two-way Friedman test. ResultsTwenty-three participants (18–29 years) were recruited to take part. The average mean spherical error was −2.65D ± 1.42DS, with an average age of 23.4 ± 3.5 years. No significant difference for accommodative microfluctuations was found. Significant differences were found for fixations per row (P = 0.03), fixations per minute (P = 0.008), mean regressions per row (P = 0.002), and total number of regressions (P = 0.002), but not total rightward saccades (P = 0.10). Post-hoc analysis indicated the EDOF lens results were significantly different from the other lenses, with more regressive eye movements observed. ConclusionsRegressive saccades appear to increase when wearing EDOF lens designs, which may impact visual comfort. Further studies in children, over a longer period of adaptation are necessary to assess the potential impact of this finding on daily reading activities in children.