Myopia Progression Research Articles

Refraction dynamics in schoolchildren with congenital partial atrophy of the optic nerve over a ten-year observation period

Introduction. Optic nerve atrophy is a degenerative condition and a prevalent cause of visual impairment, including in children. Data on refractogenesis in schoolchildren with partial atrophy of the optic nerve (PAON) are scarce, with existing literature focusing primarily on the correction of low vision associated with this disorder. Purpose: to assess the refraction dynamics in schoolchildren with congenital PAON over a ten-year observation period.Materials and methods. We conducted a retrospective analysis of refraction changes over a decade among three groups: 1) 47 schoolchildren with PAON, 2) 49 schoolchildren with ametropia without PAON, and 3) 49 schoolchildren without any ophthalmopathology.Results. All groups exhibited a trend towards myopization (р < 0.001). In groups with myopic and emmetropic refractions (without ophthalmopathology at the start), either the emergence or an increase in myopic refraction was noted. In hypermetropic children, a gradual decrease towards emmetropic refraction or a shift to myopic refraction was observed. For myopic schoolchildren using contact lenses and perifocal glasses from the ages of 11–13, myopia progression stabilized, particularly with perifocal optical correction (р < 0.01). Despite refractive changes during the school years, regular courses of functional treatment and accommodation training led to a slight improvement in visual acuity in PAON patients (by an average of 0.05 ± 0.01 (p = 0.001) in myopes and 0.06 ± 0.01 (р < 0.001) in hypermetropes) and a significant increase in visual acuity in children with normal fundus ametropia (by an average of 0.14 ± 0.02 (р < 0.001) in myopes and 0.18 ± 0.02 (р < 0.001) in hypermetropes).Conclusion. The ten-year observation demonstrates a myopization trend in all groups of schoolchildren, which holds particular relevance for those with PAON due to their inherently lower visual acuity. An optimal optical correction strategy, employing modern myopia control measures in tandem with regular functional treatment and accommodation training, is essential for a health-preserving educational approach in schoolchildren with PAON.

Effects of Acute Mental Stress on Choroidal Thickness.

Purpose: Previous studies have indicated an association between education and myopia, suggesting that numerous stress events during the educational process may influence eye health. This study aimed to investigate the impact of mental stress induced by mental arithmetic (MA) on choroidal thickness (CT). Methods: This study included 33 participants aged between 19 and 29 years. Swept-source optical coherence tomography (SS-OCT) was used to capture images of the posterior segment of the left eye during baseline and MA to assess changes in the CT. After denoising and compensation, the baseline images and MA images that had been rigidly registered and resampled to the baseline images were segmented using a deep learning-based method. Based on the segmentation results, the CT within the regions of 1 mm and 3 mm diameter centered at the lowest point of the fovea was calculated. Results: Significant increases were observed in both CT1mm and CT3mm during MA, with mean changes of 2.742 ± 7.098 μm (p = 0.034) and 3.326 ± 6.143 μm (p < 0.001), respectively. Conclusions: Thickening of the choroid has been observed during acute mental stress. We speculate that long-term or chronic mental stress could have a potential adverse impact on myopia progression.

In-vivo high-frequency quantitative ultrasound-derived parameters of the anterior sclera correlated with level of myopia and presence of staphyloma.

A high-frequency point-of-care (POC) ultrasound instrument was used to evaluate the microstructural and biomechanical properties of the anterior sclera in vivo using parameters computed from quantitative ultrasound (QUS) methods. In this cross-sectional study, both eyes of 85 enrolled patients were scanned with the POC instrument and ultrasound data were processed to obtain QUS parameters. Pearson correlation and multi-linear regression were used to identify relationships between QUS parameters and refractive error (RE) or axial length. After categorising eyes based on RE, binary support vector machine (SVM) classifiers were trained using the QUS or ophthalmic parameters (anterior chamber depth, central corneal thickness, corneal power, and intraocular pressure) to classify each eye. Classifier performance was evaluated by computing the area under the receiver-operating characteristic curve (AUC). Individual QUS parameters correlated with RE and axial length (p < 0.05). Multi-linear regression revealed significant correlation between the set of QUS parameters and both RE (R = 0.49, p < 0.001) and axial length (R = 0.46, p = 0.001). Classifiers trained with QUS parameters achieved higher AUC (𝑝 = 0.06) for identifying myopic eyes (AUC = 0.71) compared to classifiers trained with ophthalmic parameters (AUC = 0.63). QUS-based classifiers attained the highest AUC when identifying highly myopic eyes (AUC = 0.77). QUS parameters correlate with progressing myopia and may be indicative of myopia-induced microstructural and biomechanical changes in the anterior sclera. These methods may provide critical clinical information complementary to standard ophthalmic measurements for predicting myopia progression and risk assessment for posterior staphyloma formation.

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.

Preoperative, Intraoperative and Post-Operative Optical Coherence Tomography for Pediatric Epiretinal Membranes Presenting with Strabismus

Abstract Purpose To highlight the value of optical coherence tomography (OCT) in the surgical decision making process of pediatric epiretinal membranes (ERMs). Methods A retrospective interventional case series that included the review of records of pediatric cases with ERMs presenting with strabismus who underwent pars plana vitrectomy by a single surgeon from March 2018 till June 2022. Demographic, clinical, and surgical details were extracted, as well as follow-up visits and outcomes. Results Five eyes of 5 cases with unilateral squint secondary to ERM were included. Age at presentation ranged from 2-7 years (mean 3.6 +/- 1.9), The male to female ration was 4:1. Two cases (40%) were idiopathic, 2 (40%) were secondary to familial exudative vitreoretinopathy (FEVR) and 1 (20%) was secondary to traumatic rupture globe. Preoperative and postoperative OCT was obtained in all cases, while preoperative fundus fluorescein angiography was obtained in 4 cases (80%). Intraoperative OCT was used in 4 cases (80%) to confirm complete release of the membrane from the fovea, and ILM was peeled in 3 cases (60%). The decision for surgical intervention and plan of surgery was totally dependent on preoperative OCT to confirm the extent of the ERM and the plane of cleavage. Intraoperative OCT helped assess areas of strong adherence of the membrane to avoid iatrogenic retinal injury. Initial restoration of the foveal anatomy with appearance of the fovea was seen after 3.6 +/- 2.8 months from the surgery with a range of 1-8 months. Squint improvement was seen in all cases. Time range to squint improvement was 1-4 months (mean 2.8 +/- 1.6). One case (20%) continued 4 years of follow up and two cases (40%) terminated follow up at 6 months due to squint improvement. Only one case (20%) showed progressive myopia post-surgery and one case did not achieve complete restoration of the fovea. Conclusion Surgical removal of pediatric epiretinal membranes presenting with strabismus leads to squint and visual improvement even if complete restoration of the foveal anatomy has not been reached yet. Combined use of preoperative, intraoperative and postoperative OCT in those cases helps better surgical and anatomical outcomes.

Automated eyeball volume measurement based on CT images using neural network-based segmentation and simple estimation

With the increase in the dependency on digital devices, the incidence of myopia, a precursor of various ocular diseases, has risen significantly. Because myopia and eyeball volume are related, myopia progression can be monitored through eyeball volume estimation. However, existing methods are limited because the eyeball shape is disregarded during estimation. We propose an automated eyeball volume estimation method from computed tomography images that incorporates prior knowledge of the actual eyeball shape. This study involves data preprocessing, image segmentation, and volume estimation steps, which include the truncated cone formula and integral equation. We obtained eyeball image masks using U-Net, HFCN, DeepLab v3 +, SegNet, and HardNet-MSEG. Data from 200 subjects were used for volume estimation, and manually extracted eyeball volumes were used for validation. U-Net outperformed among the segmentation models, and the proposed volume estimation method outperformed comparative methods on all evaluation metrics, with a correlation coefficient of 0.819, mean absolute error of 0.640, and mean squared error of 0.554. The proposed method surpasses existing methods, provides an accurate eyeball volume estimation for monitoring the progression of myopia, and could potentially aid in the diagnosis of ocular diseases. It could be extended to volume estimation of other ocular structures.

Scleral collagen crosslinking as a promising direction of sclera-strengthening treatment of progressive myopia

The review presents recent research works on new technologies of scleral collagen crosslinking, a promising approach to sclerastrengthening treatment of progressive myopia. We assess the advantages and limitations of a number of experimental techniques of photochemical and medicinal crosslinking of the sclera, as well as donor tissue crosslinking aimed at optimizing the plastic material for sclera-strengthening surgery. Successful experiments and effective first clinical implementation results of the approach can be viewed as the basis for its further improvement and wider introduction of the technology into ophthalmological practice.

Myopia trends among children and adolescents: a nationwide study in South Korea

PurposeTo evaluate gender disparities in the progression of myopia among children and adolescents in South Korea. MethodsNationwide cross-sectional data of 1,190 subjects aged 10-18 years was obtained for the years of 2011 (baseline) and 2021 using the Korea National Health and Nutrition Examination Surveys. The prevalence of myopia, as well as data regarding age, household income, height, weight, body mass index, and age of menarche, were evaluated. Myopia was defined as a spherical equivalent (SE) ≤ −0.5 D. ResultsThe prevalence of myopia among boys was stable in2021 compared to 2011, with rates of 53.7% and 52.8%, respectively (P = 0.372). Among girls, however, there was a statistically significant increase in myopia prevalence in 2021 compared to 2011, with rates of 73.7% and 51.6% (P < 0.001), respectively. Over 10 years, the adjusted prevalence ratio for myopia in boys was 1.11 (95% CI, 0.77-1.61), whereas myopia prevalence in girls underwent a 1.87-fold increase over the same period (95% CI, 1.30-2.69), and menarche at <12 years of age was associated with myopia in girls (PR = 0.84; 95% CI, 0.72-0.99). The spherical equivalent refraction in girls increased significantly over the same 10-year period, from −1.09 ± 0.13 D to −1.58 ± 0.17 D (P < 0.017), whereas in boys, there was no significant difference (P = 0.604). ConclusionsIn our study cohort, the prevalence of myopia increased significantly among girls compared with boys over the course of decade. Additionally, an association between early menarche in girls and the prevalence of myopia was observed.

Characteristics of astigmatism in school-age children aged 5 to 13 years in northeast Sichuan: a cross-sectional school-based study.

Astigmatism is closely associated with myopia progression, vision loss, eye fatigue and amblyopia, which seriously endangers children's eye health. This study aims to investigate the prevalence and characteristic distribution of astigmatism in children in Langzhong City, providing valuable insights for allocating resources and develop prevention and control strategies. A cross-sectional study and random sampling survey were conducted. Between January and November 2021, 21,415 students aged 5 to 13 years from 14 primary schools in Langzhong City underwent non-cycloplegic refractive testing using autorefraction. The data on myopia were analyzed using SPSS (Statistical Package for the Social Sciences) version 23.0. The inclusion criterion was set at an absolute astigmatism value of ≥0.50D. Among the 21,415 children studied, 61.70% were found to have astigmatism. The prevalence of astigmatism varied significantly across different grades (χ2=501.414, P<0.001). The predominant types of astigmatism were mild astigmatism (0.50-1.00D) and with-the-rule astigmatism. Mixed astigmatism was primarily observed in children in grades 1 and 2, while compound myopic astigmatism was more common in children in grades 3 to 6. These differences were statistically significant. As the degree of astigmatism increased, the proportions of against-the-rule astigmatism, oblique astigmatism, compound myopic astigmatism, and simple hyperopic astigmatism decreased, whereas the proportions of with-the-rule astigmatism, mixed astigmatism, and compound hyperopic astigmatism increased. The prevalence of astigmatism among school-age children aged 5 to 13 years in northeast Sichuan is notably high, with compound myopic astigmatism and with-the-rule astigmatism being the most common types. Regular refractive examinations are crucial for the early detection and management of astigmatism.

Novel Lenslet-ARray-Integrated Spectacle Lenses for Myopia Control: A 1-Year Randomized, Double-Masked, Controlled Trial

PurposeTo investigate the myopia control efficacy of novel Lenslet-ARray-Integrated (LARI) spectacle lenses with positive (PLARI) and negative (NLARI) power lenslets worn for one year in myopic children. DesignRandomized, double-masked, controlled clinical trial. ParticipantsA total of 240 children, aged 6 to 12 years, with spherical equivalent refraction (SER) between -4.00 and -1.00 diopter (D), astigmatism of 1.50 D or less, and anisometropia of 1.00 D or less. MethodsParticipants were assigned randomly in a 1:1:1 ratio to PLARI, NLARI, and a control (single-vision (SV)) groups. Cycloplegic autorefraction and axial length were measured at baseline and 6-month intervals after lens wear. Main Outcome MeasuresChanges in SER, axial elongation (AE), and differences between groups. ResultsAfter 1-year, SER changes and AE in the PLARI and NLARI groups were significantly less than those in the SV group (SER: -0.30 ± 0.48 D, -0.21 ± 0.35 D, -0.66 ± 0.40 D; AE: 0.19 ± 0.20 mm, 0.17 ± 0.14 mm, 0.34 ± 0.18 mm, respectively) (all P < 0.001). There were no significant differences in SER changes and AE between PLARI and NLARI groups (P = 0.54 and P = 1.00, respectively). Younger age was associated with more rapid SER increase and larger AE in the SV (r = 0.40, P < 0.001 and r = -0.59, P < 0.001, respectively) and PLARI (r= 0.46, P < 0.001 and r = -0.52, P < 0.001, respectively) groups, but not in the NLARI group (r = -0.002, P = 0.98 and r = -0.08, P = 0.48, respectively). ConclusionsCompared with the SV group, both PLARI and NARI groups showed significantly slower myopia progression in terms of SER and axial elongation. Faster myopia progression, in terms of both SER and AE, was associated with younger age in the SV and PLARI groups, but not in the NLARI group.

Deep Learning‐Enabled Vasculometry Depicts Phased Lesion Patterns in High Myopia Progression

PurposeTo investigate the potential phases in myopic retinal vascular alterations for further elucidating the mechanisms underlying the progression of high myopia (HM). MethodsFor this retrospective study, participants diagnosed with high myopia at Beijing Tongren Hospital were recruited. Based on bionic mechanisms of human vision, an intelligent image processing model was developed and utilized to extract and quantify the morphological characteristics of retinal vasculatures in different regions measured by papilla-diameter (PD), including vascular caliber, arteriole-to-venule ratio (AVR), tortuosity, the angle of the vascular arch (AVA), the distance of the vascular arch (DVA), density, fractal dimension, and venular length. In addition, the optic disc and the area of peripapillary atrophy (PPA) were also quantified. The characteristics of the overall population, as well as patients aged less than 25 years old, were compared by different genders. Univariate and multiple linear regression analyses were conducted to investigate the correlation of retinal vasculature parameters with PPA width, and detailed trends of the vascular indicators were analyzed to explore the potential existence of staged morphological changes. FindingsThe study included 14,066 fundus photographs of 5775 patients (aged 41.2 ± 18.6 years), of whom 7379 (61.2 %) were female. The study included 12,067 fundus photographs of 5320 patients (aged 41.2 ± 18.6 years). Significant variations in the morphological parameters of retinal vessels were observed between males and females. After adjusting for age and sex, multiple linear regression analysis showed that an increased PPA width ratio was associated with lower AVA (1PD), DVA (1PD), vascular caliber (0.5–1.0 PD), tortuosity (0.5–1.0 PD), density and fractal dimension (all P < 0.001, Spearman’s ρ < 0). Overall, the changes in retinal vascular morphology showed two phases: tortuosity (0.5–1.0PD) and AVA (1PD) decreased rapidly in the first stage but significantly more slowly in the second stage, while vascular density and fractal dimension showed a completely opposite trend with an initial slow decline followed by a rapid decrease. ConclusionsThis study identified two distinct phases of retinal vascular morphological changes during the progression of HM. Traction lesions were predominant in the initial stage, while atrophic lesions were predominant in the later stage. These findings provide further insight into the development mechanism of HM from the perspective of retinal vasculature.

Refractive and ocular biometric characteristics of non-myopic and pseudomyopic eyes in mild hyperopic Chinese children aged 3–12 years

PurposeTo investigate the refractive and ocular biometric characteristics of children with mild hyperopia and distinguish between non-myopic and pseudomyopic eyes before cycloplegia. MethodsThe eligible children underwent refractive error measurements using a NIDEK autorefractor before and after the administration of 0.5 % tropicamide. Ocular biometric parameters, including axial length (AL), anterior chamber depth (ACD), and lens thickness (LT), were measured using the IOLMaster 700 before cycloplegia. We performed comparative analyses between the non-myopic and pseudomyopic groups, categorized based on whether the spherical equivalent (SE) before cycloplegia exceeded −0.50 diopters (D). Univariable and multivariable regression analyses were performed to control for confounding factors. ResultsThe final analysis included 968 eyes. The participants with pseudomyopia were more likely to be boys (P = 0.029), younger (P = 0.004), less hyperopic (P < 0.001) after cycloplegia, and exhibit a higher delta SE (P < 0.001) compared to the non-myopic participants. Pseudomyopic eyes were associated with a shallower ACD (P = 0.004) and thicker LT (P < 0.001) than non-myopic eyes. After adjusting for sex, age, and SE, pseudomyopic eyes showed increased AL (P = 0.001) and LT (P < 0.001) and decreased ACD (P = 0.005) compared with non-myopic eyes before cycloplegia. ConclusionsAmong the children with mild hyperopia, pseudomyopia was more common in younger boys with a lower cycloplegic SE and higher delta SE. A thicker LT, shallower ACD, and increased AL may indicate the presence of pseudomyopia, which may provide insights into the rapid progression of myopia in children with pseudomyopia.

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.

Association Between Myopia and Pupil Diameter in Preschoolers: Evidence from a Machine Learning Approach Based on a Real-World Large-Scale Dataset.

Previous studies have explored the connections between various ocular biological parameters with myopia. Our previous study also found that pupil data can predict the myopic progression during the interventions for myopia. However, studies exploring the association between pupil diameter and myopia in preschoolers with myopia were lacking. Hence this study was aimed to investigate the association between pupil diameter and myopia in preschoolers with myopia based on a real-world, large-scale dataset. Data containing 650,671 preschoolers were collected from a total of 1943 kindergartens in Shenzhen, China. Refraction and pupil parameters were collected. After data filtering, the occurrence of myopia and its association with age, gender, pupil diameter, and other variables, were analyzed. Random forest (RF) and eXtreme gradient boosting (XGBoost) were selected from seven machine learning algorithms to build the model. The mean decrease accuracy (MDA), mean decrease Gini (MDG), and gain feature importance (GFI) techniques were employed to quantify the importance of pupil diameter and other features. After the assessments, 51,325 valid records with complete pupil data were included, and 3468 (6.76%) were identified as myopia based on the calculated cycloplegic refraction. Preschoolers with myopia presented reduced pupil diameter and greater variation (5.00 ± 0.99mm) compared to non-myopic preschoolers (6.22 ± 0.67mm). A nonlinear relationship was found according to the scatterplots between pupil diameter and refraction (R2 = 0.14). Especially preschoolers with myopia had reduced pupil diameter compared to emmetropic preschoolers, but hyperope did not experience additional pupil enlargement. After adjusting for other covariates, this relationship is still consistent (P < 0.001). XGBoost and RF algorithms presented the highest performance and validated the importance of pupil diameter in myopia. Based on a real-world large-scale dataset, the current study illuminated that preschoolers with myopia had a reduced pupil diameter compared to emmetropic preschoolers with a nonlinear pattern. Machine learning algorithms visualized and validated the pivotal role of pupil diameter in myopia. chictr.org Identifier: ChiCTR2200057391.

Using spectacle lenses with embedded rings of high-spherical microlenses Stellest® for the myopia control in children: two-year results

Purpose: to evaluate the effect of wearing glasses with Stellest® lenses on the spherical equivalent of refraction (SER) dynamics, the yearly progression gradient (YPG) and the axial length (AL) of the eye in children with progressive myopia 12, 18 and 24 months after the start of use. Material and methods. The main and the control groups of the study included children aged 8 to 13 years with low to moderate myopia at the beginning of observation. Stellest® glasses (the main group) were prescribed to 35 children with myopia 3.15 ± 0.19 D, while single vision (SV) glasses (the control group) were prescribed to 32 children with myopia 2.68 ± 0.18 D. The dynamics of the SER, YPG, and AL of the eye were assessed. Results. In the main (Stellest®) group, after 24 months of observation, SER increased by ave. 0.20 ± 0.06 D. YPG was shown to decrease in 93.5 % of cases by ave. 0.81 ± 0.05 D. The AL increased by an average of 0.15 ± 0.03 mm. In the control group, after 24 months of observation, the SER averaged 0.95 ± 0.08 D. YPG showed a decrease of ave. 0.38 ± 0.05 D in 61.1 % of cases. The AL of the eye increased by an average of 0.48 ± 0.04 mm. Conclusion. Stellest® glasses, if worn constantly, effectively slow myopia progression and axial elongation as compared with SV glasses. By the end of the follow-up period, in the Stelest® group, SER showed an increase by 79 % less than in the control group of SV glasses, and the AL showed increase in the length of the eye which was 69 % less than in the control group. Over the 24 months’ wearing of Stellest® glasses, YPG turned out to be 4.8 times lower than in the control group.

Результаты двухлетнего применения очков с высокоасферичными микролинзами для контроля миопии у детей

Purpose. To study the efficacy of spectacle lenses with highly aspherical lenslets (Stellest™) on refraction, axial length (AL) and accommodation in children with progressive myopia. Methods. The study included 259 children (518 eyes) aged 7 to 16 years (10.0±1.7 years) with progressive myopia from –0.5 D to –7.0 D (mean cycloplegic spherical equivalent refraction –2.6±1.6 D), astigmatism was present in 31 % of cases. Spectacles with Stellest™ lenses were always prescribed for continuous wear (at least 12 hours per day). Follow-up period was 6 months in 129 children (258 eyes), 12 months in 110 children (220 eyes) and 24 months in 47 children (94 eyes) from the beginning of Stellest™ wearing. Results In the first 6 months, stabilization of refraction was achieved in 82 % of patients (212 eyes), and in 14 % of patients (36 eyes) a hyperopic shift of refraction within +0.5 D was revealed. During 12 months of follow-up, stable cycloplegic refraction was detected in 80 % of cases (178 eyes). A hyperopic shift of refraction within +0.5 D and myopia progression up to –0.75 D were equally common: in 10 % of patients (21 eye in each group). During 2 years of follow-up, stable cycloplegic refraction was detected in 53 % of cases (50 eyes). A hyperopic shift of refraction within +0.5–0,75 D was noted in 17 % of patients. In some children myopia progressed, but the rate of progression decreased by 2 times or more. Thus, myopia progression by 0.25 D over 2 years of follow-up was detected in 14 % of patients (14 eyes), by 0.5 D – in 6 % (6 eyes) and by 1.25–1.5 D – in 10 % of patients (10 eyes). Mean initial axial length (AL) of the eyes was 24.5±0.1 mm. For the first 6 months, AL increase did not exceed 0.02±0.01 mm, for 12 and 24 months – 0.1±0.02 mm. Conclusions. Spectacle lenses with highly aspherical lenslets (HAL) effectively slow down myopia progression and axial elongation of the eyeball. Stabilization of refraction within 24 months was achieved in 70 % of patients. Accommodation has improved in all patients. Key words: myopia progression in children; peripheral myopic defocus; lenses with highly aspherical lenslets; Stellest™.

Impact of Myopia Progression and Its Intervention Methods on Choroidal Thickness

As the prevalence of myopia has recently increased, there is growing interest in interventions to slow myopia progression. The choroid, the rearmost and largest part of the uveal layer, is a tissue rich in blood vessels located between the retina and the sclera. Recent advancements in diagnostic equipment have enabled direct imaging of the choroid, leading to increased research on its role in both normal and pathological conditions. Regarding myopia, it has been reported that; 1) the choroidal thickness decreases as the degree of myopia and axial length increase, 2) in the case of moderate to high concentrations of atropine or orthokeratology lenses, which are known to slow myopic progression, choroidal thickening is accompanied from the early stages of application, and 3) the mechanism by which choroidal thickening slows myopia progression is also being actively investigated. As a result, the choroid is being recognized as a therapeutic target for developing new interventions to slow myopia progression. Additionally, the increase in choroidal thickness has been reported as a predictive factor for the subsequent myopia progression, suggesting its potential role as a biomarker for assessing the likelihood of future myopia progression.

Myopia Control in Caucasian Children with 0.01% Atropine Eye Drops: 1-Year Follow-Up Study.

Background and Objectives: Myopia is the most widespread ocular disorder globally and its prevalence has been increasing over the past decades. Atropine eye drops stand out as the only pharmacological intervention used in clinical practice to control myopia progression. The aim of this study was to explore the effect of 0.01% atropine eye drops on myopia progression. Patients and Methods: Healthy children aged 6-12 years with cycloplegic spherical equivalent (SE) from -0.5 D to -5.0 D and astigmatism ≤1.5 D were included. Myopia progression was assessed by changes in SE and axial length (AL) over 1 year and SE changes 1 year before the study enrollment and during the 1-year follow-up. Adverse events were evaluated based on complaints reported by either parents or the children themselves during follow-up visits. Results: The analysis involved 55 patients in the 0.01% atropine eye drops group and 66 in the control group. After the 1-year follow-up, the change in SE was -0.50 (-2.25-0.50) D in the control group compared to -0.50 (-1.50-0.50) D in the 0.01% atropine group (p = 0.935); AL change was 0.31 (0.18) mm in the control group and 0.29 (0.18) mm in the 0.01% atropine group (p = 0.480). The change in SE was -0.68 (-2.0--0.25) D/year before the study and remained similar -0.50 (-2.25-0.25) D over the 1-year follow-up in the control group (p = 0.111); SE change was reduced from -1.01 (-2.0--0.25) D/year before the study to -0.50 (-1.5-0.5) D over the 1-year follow-up in the 0.01% atropine group (p < 0.001). In the 0.01% atropine group, ten (16.4%) children experienced mild adverse events, including blurred near vision, ocular discomfort, photophobia, dry eyes, and anisocoria. Conclusions: Compared to the control group, the administration of 0.01% atropine eye drops demonstrated no significant effect on changes in SE and AL over a 1-year follow-up. However, children in the 0.01% atropine group initially experienced higher myopia progression, which decreased with treatment over the course of 1 year. Future studies should explore the long-term effects, rebound effects, potential genetic associations, and efficacy of higher doses of atropine in managing myopia progression.

Socioeconomic disparities and green space associated with myopia among Chinese school-aged students: A population-based cohort study.

There is increasing evidence on the link between environmental factors and myopia in children and adolescents, yet with inconsistent conclusions. We investigated the associations between socioeconomic inequalities and green space with myopia in school-aged students participating in the Tianjin Child and Adolescent Research of Eye (TCARE) study. We obtained data from a population-based dynamic cohort study conducted in Tianjin, China, in 2021 and followed up in 2022. We included 1 245 271 participants from 16 districts with an average age of 11.6 years (standard deviation = 3.3) in our analysis. We synthesized their area-level SES through a prediction model that combined economic, educational, and health care variables and assessed the greenness levels surrounding the school using the Normalized Difference Vegetation Index (NDVI) based on data obtained through satellite remote sensing. We performed generalised linear mixed effects analyses for each myopia outcome separately, with adjustments for students' sex, years of education completed, and the school's geographical location. We observed that students living in low SES areas had the highest prevalence of myopia (60.7%) in the last screening in 2022, as well as a higher incidence of one-year myopia (26.4%) compared to those residing in middle SES areas (22.7%). With a 0.1 increase in the 250, 500, and 1000 m buffer NDVI, the prevalence of myopia dropped by 6.3% (odds ratio (OR) = 0.937; 95% confidence interval (CI) = 0.915, 0.960), 7.7% (OR = 0.923; 95% CI = 0.900, 0.946), and 8.7% (OR = 0.913; 95% CI = 0.889, 0.937), respectively. The interaction analysis showed that low SES and low greenness exacerbate the prevalence of myopia. Findings from longitudinal analyses consistently demonstrated a correlation between higher values of NDVI and a slower progression of myopia. These findings remained robust across sensitivity analyses, including for variables on parental myopia and students' behaviors. Exposure to green spaces could play a crucial role in slowing the progression of myopia among school-aged students. Myopia control policies should prioritise young populations residing in low SES areas with limited access to green spaces, as they face the highest potential risks.

A new look at the myopia control efficacy of orthokeratology

PurposeTo evaluate the efficacy of orthokeratology contact lens wear in slowing the axial elongation of the eye in myopic children. MethodsData from three prospective studies, which evaluated the use of orthokeratology for slowing myopia progression in children in comparison to a parallel control group of distance, single-vision spectacle lens wearers over a 2-year period, were pooled together for analysis. ResultsCollectively, data from 125 orthokeratology and 118 control subjects were analyzed in this study. Of these, 101 (81 %) and 88 (75 %) orthokeratology and control subjects completed the 2-year follow-up period, respectively. Statistically significant differences in the change in axial length from baseline were found over time, between groups and for the time*group interaction (all p < 0.001), indicating that the rate of increase in axial length over time was significantly lower in the orthokeratology versus the control group. The lower axial elongation of the orthokeratology versus the control group was statistically significant at all time points (all p < 0.001), with significant differences being also present between each of the different pairs of time points (all p < 0.001). The interactions of group with age, gender, mean spherical refractive error and ethnicity at baseline were not significant (p > 0.05). The change in axial length at the 2-year visit in comparison to baseline for the orthokeratology and control groups were 0.41 ± 0.25 and 0.65 ± 0.30 mm, respectively, thus providing a treatment effect following 2-years of lens wear of 0.24 mm (95 % confidence intervals: 0.15 to 0.34 mm). About 40 % and 25 % of the orthokeratology subjects experienced remarkably low and high levels of myopia progression, respectively (2-years axial elongation: ≤0.30 mm and >0.59 mm, respectively). ConclusionsOrthokeratology lens wear slows the axial elongation of the eye in comparison to spectacle lens wear in myopic children. The use of these lenses for slowing myopia progression appears to be very effective and not effective at all in 40% and 25% of orthokeratology lens wearers, respectively.