Myopia Progression Research Articles

Multifocal Rigid Gas Permeable Contact Lenses with Multi-Tangential Positioning and Corrected Spherical Aberration for Myopia Control

Slowing the progression of myopia has become an extensive concern for parents of children with myopia. According to research findings in animals, eye growth is primarily influenced by the peripheral retina. Treatment options such as orthokeratology, daytime bifocal or multifocal soft contact lens usage are available because they can induce relative myopia in the periphery. In this work, a new multifocal rigid gas permeable (MFRGP) contact lens for myopia prevention and control in adolescents was designed specifically for preventing and controlling myopia in adolescents. This lens features a multi-tangent alignment curve, smaller spherical aberration, and transition defocus. FocalPoints and UPC 100 Vision were used for lens design and lathing, respectively. The lens structure and power profile were measured using IS830 and CONTEST 2, respectively. The elimination of lens aberrations was achieved through design optimization using ZEMAX with ray tracing. Lens fitting was evaluated using slit-lamp microscopy and corneal topography.

Comparison of different concentrations atropine in controlling children and adolescent myopia: an umbrella review of systematic reviews and meta-analyses

PurposeTo evaluate the myopia control effect of different concentrations atropine in children and adolescent.MethodsMeta-analyses and systematic reviews available in the Pubmed, Embase, and Cochrane Library databases from the databases’ inception to August 2023 were searched to evaluate the efficacy and tolerability of different concentrations’ atropine in controlling myopia progression. Overall effects were performed using random-effects model. AMSTAR 2 tool was used to assess the quality of included studies. Prespecified outcomes were weight mean difference (WMD) with 95% credible interval (95% CI) of annual spherical equivalent refraction (SER) changes and annual axial length (AL) changes.Results19 systematic reviews/meta-analyses of different atropine concentrations were included in the analysis. 14 studies reported SER changes, and 17 reported AL changes. In terms of the studies’ overall methodological quality level (measured using AMSTAR 2), 1 study was rated high, 7 moderate, 7 low, and 4 critically low. The 0.01% atropine was found to have statistically significance (annual SER change WMD 0.27 [95% CI 0.21 - 0.34] D/year; annual AL change WMD -0.09 [95% CI -0.1 to -0.07]) mm/year), 0.05% atropine was preferred considering efficacy and tolerability (annual SER change WMD 0.54 [95% CI 0.49 - 0.58] D/year; annual AL change WMD -0.21 [95% CI -0.12 to -0.02]) mm/year).ConclusionsDifferent atropine concentrations alleviated children and adolescent myopia progression. However, higher-quality evidence and further investigation are needed to clarify the dose–response relationship, and practical guidelines must be developed to determine myopia control efficacy.

Quantitative structural organization of the sclera in chicks after deprivation myopia measured with second harmonic generation microscopy

Visual deprivation causes enhanced eye growth and the development of myopia, which is associated with a change in the arrangement of collagen fibers within the sclera. A second harmonic generation (SHG) microscope has been used to image the collagen fibers of unstained scleral punches from the posterior part of chicken eyes. We aimed to analyze the fibrous scleral tissue and quantify the changes in collagen organization in relation to the extent of induced deprivation myopia. The scleral architecture was assessed with the Radon transform (RT) through the parameter called structural dispersion (SD) that provides an objective tool to quantify the level of organization of the collagen network. We found that final refraction and axial length changes were linearly correlated. However, no significant differences in scleral thickness were found for different amounts of induced myopia. In contrast, a significant correlation between SD and refraction was demonstrated, ranging from a non-organized (in the control sclerae) to a quasi-aligned distribution (with a dominant direction of the fibers, in the sclera of myopic chicks). These findings demonstrate a remodeling process of the scleral collagen associated with myopia progression that can be measured accurately combining SHG imaging microscopy and RT algorithms.

The Effect of Repeated Low-Level Red-Light Therapy on Myopia Control and Choroid.

To investigate the long-term effects of repeated low-level red light (RLRL) therapy on the axial length (AL), spherical equivalent (SE), and choroidal parameters. Two hundred eight myopic eyes were recruited. The RLRL group included 100 eyes, whereas the control group included 108 eyes. Throughout the one-year follow-up period, changes in AL and SE were recorded for both groups. The RLRL group underwent additional choroidal imaging, and changes in choroidal thickness (CT), choroidal vascularity (CV), and choriocapillaris luminal area (CLA) were assessed before and after RLRL therapy. During the follow-up period, the changing trends in AL and SE differed significantly between the RLRL and control groups. In the RLRL group, AL decreased at three and six months (both P < 0.05) and returned to pretreatment values at 12months (P = 0.453). In contrast, AL increased significantly throughout the follow-up period (three, six, and 12months) in the control group (all P < 0.001). The SE increased significantly during the entire follow-up period in the RLRL group (all P < 0.001), whereas it decreased significantly in the control group (all P < 0.05). Regarding choroidal parameters, significant improvements were observed in CT, CV and CLA throughout the follow-up period (all P < 0.05), and changes in most choroidal parameters were significantly correlated with changes in AL and SE during the follow-up period (all P < 0.05). Furthermore, AL, SE, and most choroidal parameters showed significant correlations between changes at three and 12months (all P < 0.05). RLRL therapy significantly improved choroidal blood perfusion and circulation, which may explain the observed slowing or reversal of myopia progression in the RLRL group. Thus RLRL therapy may be a novel and effective method for controlling myopia. Furthermore, the short-term effect of photobiomodulation therapy (i.e., changes at three months) can be used to predict the long-term effects (i.e., changes at 12months). In this study, RLRL therapy showed a significant control effect on the development of axial length and spherical equivalent. RLRL therapy also promoted the choroidal blood perfusion and circulation. RLRL therapy could be a novel and effective method for myopia control.

Effects of atropine on choroidal thickness in myopic children: a meta-analysis

BackgroundAtropine is an effective medicine for myopia prevention and control. This meta-analysis was conducted to investigate the effects of atropine on choroidal thickness (ChT) in children with myopia.MethodsBetween its inception and 1 June 2023, Medline, Embase, and Web of Science were all searched, and only English literature was included. The choroidal thickness was the primary study outcome. Axial length, standardized equivalent refraction were examined as secondary outcomes. STATA 12.0 was used for data extraction and analysis.ResultsA total of 307 eyes were involved in this study to evaluate the effect of atropine on ChT, axial length (AL) and standardized equivalent refraction (SER) in myopic children. Choroidal thickening was significantly higher in the atropine group than in the control group at 1 month (WMD, 6.87 mm, 95% CI, 0.04 to 13.10, P = 0.049), whereas it was significantly higher in the atropine group than in the control group at months 6 (WMD, 10.37 mm, 95% CI, −3.21 to 23.95, P = 0.135), 12 (WMD, 15.10 mm, 95% CI, −5.08 to 35.27, P = 0.143) and at final follow-up (WMD, 11.52 mm, 95% CI, −3.26 to 26.31, P = 0.127), the differences were not statistically significant. At months 1 (WMD, −0.03 mm, 95% CI, −0.04 to −0.01, P = 0.003), 6 (WMD, −0.07 mm, 95% CI, −0.01 to −0.03, P = 0.000), 12 (WMD, −0.13mm, 95% CI, −0.15 to −0.11, P = 0.843), and at final follow-up (WMD, −0.08 mm, 95% CI, −0.16 to −0.01, P = 0.127), atropine treatment was able to delay the axial elongation. At 1-month follow-up, there was no significant difference in the effect of atropine on SER in myopic children compared with the control group (WMD, 0.01D, 95% CI, −0.07 to 26.31, P = 0.127), whereas it was able to control the progression of refractive status at final follow-up (WMD, 11.52 mm, 95% CI, −3.26 to 26.31, P = 0.127).ConclusionLimited evidence suggests that 0.01% atropine causes choroidal thickening in myopic children at 1 month of treatment. In the short term, choroidal thickness may be a predictor of the effectiveness of atropine in controlling myopia in children. 0.01% atropine is effective in controlling myopic progression in terms of SER and AL.Systematic Review Registrationhttp://www.crd.york.ac.uk/prospero, identifier, CRD42022381195.

ATROPINE FOR MYOPIA CONTROL: EFFICACY, CHALLENGES AND FUTURE DIRECTIONS

Myopia, or near-sightedness, is rapidly emerging as a major global health issue, with projections indicating that by 2050, it will affect nearly 50% of the world’s population. This condition arises from excessive elongation of the eyeball, leading to blurred vision at a distance and increasing the risk of severe ocular complications, such as retinal detachment and glaucoma. Effective management strategies are critical to mitigating the public health impact of this growing epidemic. Atropine, a muscarinic antagonist, has gained attention for its potential in myopia control. By inhibiting muscarinic acetylcholine receptors (mAChRs) in the eye, atropine slows down axial elongation, the anatomical hallmark of myopia. Low-dose atropine (0.01%) has demonstrated efficacy in clinical trials, such as the ATOM2 study, which showed a 50% reduction in myopia progression with minimal side effects, including photophobia and blurred vision. Meanwhile, the LAMP study indicates that slightly higher concentrations (0.05%) may further balance efficacy and tolerability, especially in children at high risk of severe myopia. Despite these promising results, critical knowledge gaps persist, particularly concerning atropine’s long-term safety, optimal dosing, and the rebound effect, where myopia progression may accelerate after stopping treatment. Ethnic and genetic variability also calls for a more diverse research focus. Future studies should explore combining atropine with other interventions, such as orthokeratology or multifocal lenses, to optimize outcomes. As leading pharmacological option for myopia management, atropine holds potential for integration into multifaceted treatment strategies to address this pressing public health concern. KEYWORDS: Atropine, Myopia, Pediatric Populations, Muscarinic Acetylcholine Receptors, LAMP.

Age-specific distribution of oculometric parameters and myopia in children aged 8-12y.

To describe the distribution of ocular biometrics and to evaluate its associations with refractive error and to assess the contribution from ocular parameters to refractive error among Chinese myopic children. This cross-sectional study evaluated subjects aged 8-12y. Keratometry, ocular biometry, and cycloplegic autorefraction were performed on each subject. Spherical equivalent refraction (SER) and ocular biometrics were assessed as a function of age and gender. The Pearson correlation analysis between SER and ocular biometrics was carried out. Multiple linear regression was performed to analyze the association between SER and ocular parameters. A total of 689 out of 735 participants (321 boys, 48.1%) were analyzed, with a mean SER of -2.98±1.47 diopter (D). Axial length (AL), anterior chamber depth (ACD), corneal radius of curvature (CR), horizontal visible iris diameter (HVID), central corneal thickness (CCT) and lens power (LP) showed normal distribution. The AL, AL/CR ratio, ACD and CR increased from 8 to 12y of age, while SER and LP decreased, HVID and CCT remained stable. There was no difference in gender. SER decreased by 0.929 D for every 1 mm increase in AL and decreased by 1.144 D for every 0.1 increase in AL/CR ratio. The Pearson correlation coefficient between SER and AL was -0.538 (P<0.01) and -0.747 (P<0.01) between SER and AL/CR ratio. For the SER variance, AL explained 29.0%, AL/CR ratio explained 55.7%, while AL, CR, ACD and LP explained 99.3% after adjusting for age and gender. The AL, CR, ACD and LP are the most important determinants of myopic refractive error during myopia progression.

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.

The Macular Choroidal Thickness in Danish Children with Myopia After Two-Year Low-Dose Atropine and One-Year Wash-Out: A Placebo-Controlled, Randomized Clinical Trial.

Our aim in this work was to investigate the macular choroidal thickness (ChT) changes in 6-12-year-old Danish children with myopia during 2years of low-dose atropine treatment and 1-year wash-out vs. placebo in an investigator-initiated, placebo-controlled, double-blind randomized clinical trial. Ninety-seven participants wererandomized to either 0.01% for 2years, 0.1% loading dose for 6months followed by 0.01% for 18months, or placebo, then a 1-year wash-out. The primary outcome was ChT in the sub-foveal and inner and outer superior, nasal, inferior, and temporal sectors. The secondary outcome was axial length (AL). Outcomes were measured at baseline and 6, 12, 24, and 36 months. One-way analysis of variance was used to detect baseline ChT differences between AL-stratified groups (< 24mm, 24-25mm, or > 25mm). To determine the longitudinal changes in ChT and its effect on AL, all eyes were included in linear mixed modeling with individual eyes nested in the study ID as a random effect. Longer eyes had significantly thinner ChT in all choroidal sectors (adj-P < 0.01) at baseline. There was no statistically significant change in any ChT sector after 3years in the placebo group. Sub-foveal and nasal ChT in the 0.1% loading dose and 0.01% group were not significantly different from placebo after 2-year treatment. In the placebo group, a 1-mm increase in AL was significantly associated with a 47-µmthinner nasal ChT after 3years (95% confidence interval (CI): -55; -38, adj-P < 0.001). A 10-µmthicker nasal choroid at baseline was associated with 0.13 mm (95% CI: 0.009; 0.017, adj-P < 0.001) less 3-year axial elongation. The ChT in Danish children with myopia remained stable over the 3-year follow-up. A thinner choroid at myopia onset might predispose to increased axial elongation. Treatment with 0.01% atropine did not change the ChT. We speculate that low-dose atropine does not primarily reduce myopia progression via a choroidal mechanism. ClinicalTrials.gov identifier, NCT03911271.

Electroacupuncture Slows Experimental Myopia Progression by Improving Retinal Mitochondrial Function: A Study Based on Single-Cell RNA Sequencing.

This study aimed to establish a complete atlas of retinal cells in lens-induced myopia (LIM) and electroacupuncture (EA) intervention by single-cell RNA sequencing (scRNA-seq) and to explore the potential mechanism of EA in improving experimental myopia progression in guinea pigs. scRNA-seq is used to assess changes in individual cellular gene levels in the retina of LIM- and EA-treated guinea pigs. In addition, the role of EA in slowing myopia progression by improving retinal mitochondrial function is further investigated. scRNA-seq identified ten cell clusters in the retina of LIM and EA guinea pigs and mitochondrial respiratory chain-related genes in Cones and Muller-glia cells-Cytochrome oxidase subunit III (COX3), NADH dehydrogenase subunit 4 (ND4), and NADH dehydrogenase subunit 2 (ND2) are closely related to lens-induced myopia. A comprehensive atlas in the retina of LIM and EA guinea pigs at a single-cell level is established, and the positive role of EA in improving retinal mitochondrial function to slow the experimental myopia progression in guinea pigs is revealed.

Proteomic analysis of CD29+ Müller cells reveals metabolic reprogramming in rabbit myopia model

The prevalence of myopia is rapidly increasing, significantly impacting the quality of life of affected individuals. Prior research by our group revealed reactive gliosis in Müller cells within myopic retina, prompting further investigation of their role in myopia, which remains unclear. In this study, we analyzed protein expression changes in CD29+ Müller cells isolated from a form deprivation-induced rabbit model of myopia using magnetic activated cell sorting to investigate the role of these cells in myopia. As the principal glial cells in the retina, Müller cells exhibited significant alterations in the components of metabolic pathways, particularly glycolysis and angiogenesis, including the upregulation of glycolytic enzymes, such as lactate dehydrogenase A and pyruvate kinase, implicated in the adaptation to increased metabolic demands under myopic stress. Additionally, a decrease in the expression of proteins associated with oxygen transport suggested enhanced vulnerability to oxidative stress. These findings highlight the proactive role of CD29+ Müller cells in modifying the retinal environment in response to myopic stress and provide valuable insights into mechanisms that could help mitigate myopia progression.

The relationship between contact lens ultraviolet light transmittance and myopia progression: a large-scale retrospective cohort study.

The prevalence of myopia is increasing dramatically around the world, and many studies have suggested the possibility that ultraviolet (UV) light is effective to prevent the onset and progression of myopia. However, UV is a risk factor for diseases that cause refractive errors such as cataract and pterygium. In this study, we evaluated the relationship between UV exposure and myopia progression. The dataset consisted of a total of 337 396 eyes of patients in the 12-to-29-year age range, who were prescribed soft contact lenses (SCL) for refractive error at Okada Eye Clinic in Japan between 2002 and 2011. They were tracked over a five-year period and did not change the type of SCL. In this retrospective cohort study based on medical records, we divided patients into two groups, one prescribed SCL with UV protection (UV-SCL), and another prescribed SCL without UV protection (UV+SCL). Change in refractive power over five years was measured and results compared. It was -0.413 diopter (D) in the UV-SCL group and -0.462 D in the UV+SCL group. Thus, the progression of myopia was slower in the UV-SCL group. The results were also analyzed separately by gender and degree of myopia at the time of initial prescription, which all showed significant differences (P<0.001). Results suggest that UV exposure may advance myopia. Further research is needed to investigate the underlying mechanisms that could explain this.

A higher shadow ratio of the living environment on the remote sensing digital image is possibly protective for adolescent myopia

This study aims to assess how the construction patterns within residential communities influence the adolescent myopia using general survey. In a private high school from a megacity in mid-west China, a questionnaire gathered data on the 10th-grade students’ level of myopia, home address, and some potential confounding factors. Additionally, satellite digital images were utilized to calculate the proportion of shadow area (PSA) and the proportion of greenness area (PGA) within a 500 m×500 m area centered on each student’s home address. Correlations between myopia levels and PSA, along with other variables, were analyzed. The prevalence of mild, moderate, and high myopia were 39.2%, 32.5%, and 8.3%, respectively. A negative correlation was observed between myopia levels and PSA, albeit marginally significant (r=-0.189*, P = 0.05). Upon dividing the sample into higher and lower PSA groups using a cut-off point of 20%, a significant difference in myopia levels was evident (χ2 = 8.361, P = 0.038), while other confounding factors remained comparable. In conclusion, high-rise apartment constructions, which often cast more shadows on digital satellite maps, may not exacerbate myopia progression. Instead, they could potentially serve as a protective factor against adolescent myopia in densely populated megacities, as they allow for more ground space allocation.

Deep Spectral Library of Mice Retina for Myopia Research: Proteomics Dataset generated by SWATH and DIA-NN

The retina plays a crucial role in processing and decoding visual information, both in normal development and during myopia progression. Recent advancements have introduced a library-independent approach for data-independent acquisition (DIA) analyses. This study demonstrates deep proteome identification and quantification in individual mice retinas during myopia development, with an average of 6,263 ± 86 unique protein groups. We anticipate that the use of a predicted retinal-specific spectral library combined with the robust quantification achieved within this dataset will contribute to a better understanding of the proteome complexity. Furthermore, a comprehensive mice retinal-specific spectral library was generated, encompassing a total identification of 9,401 protein groups, 70,041 peptides, 95,339 precursors, and 761,868 transitions acquired using SWATH-MS acquisition on a ZenoTOF 7600 mass spectrometer. This dataset surpasses the spectral library generated through high-pH reversed-phase fractionation by data-dependent acquisition (DDA). The data is available via ProteomeXchange with the identifier PXD046983. It will also serve as an indispensable reference for investigations in myopia research and other retinal or neurological diseases.

Biomechanical changes occur in myopic choroidal stroma and mirror those in the adjacent sclera

Retina-derived growth signals relayed from the choroid to the sclera cause remodeling of the extracellular scleral matrix, resulting in myopic ocular elongation. However, to the best of our knowledge, no studies have assessed changes in choroidal stromal biomechanical properties during myopia progression. Here we utilized 7 µm-resolution scanning acoustic microscopy (SAM) to assess biomechanical properties (bulk modulus (K) and mass density (rho)) of choroidal stroma from guinea pig eyes with form-deprivation (FD) induced myopia. The choroidal stroma had considerable intrinsic strength arising from its biomechanical properties and these were differentially affected by myopia in central and peripheral regions. Choroidal stromal biomechanical values were also highly correlated with those in adjacent scleral regions, and the choroidal stromal-scleral association was stronger in myopic eyes. Biomechanical changes observed in the choroidal stroma of myopic eyes were mirrored to those observed in the adjacent sclera. These findings suggest that choroidal stromal remodeling may accompany myopia and open the door to the source of the signals that cause scleral remodeling in myopia.

Efficacy in myopia control-The impact of rebound.

When myopia control treatment is discontinued, progression will increase, but does it revert to expected values based on the age and race of the child or does it accelerate further? The latter scenario is considered a rebound. A PubMed search was conducted with the words 'rebound' and 'myopia control', identifying further papers from reviews. Inclusion was limited to prospective studies with ≥6 months of treatment, ≥3 months of data following cessation and with axial length data, which allowed calculation of rebound. Nineteen studies were identified, comprising 24 treatment groups. In 10 studies, untreated control children were followed both throughout the treatment and cessation periods, allowing for a concurrent comparison group. In three studies, a control group was followed for 1 or 2 years and thereafter received the treatment under evaluation. Later, treatment ceased in the originally treated children. Finally, six studies were cross-over designs. For these latter two study designs, initial axial elongation and myopia progression in the control group were extrapolated to the cessation period, accounting for annual slowing. Values from durations of <1 year were annualised. The mean annualised rebound was +0.05 ± 0.10 mm and -0.09 ± 0.24 D for axial length and myopia progression, respectively, and these were correlated (r2 = 0.59, p < 0.001). Rebound was associated with 1-year treatment efficacy (r2 = 0.43, p < 0.001). The mean annualised rebound with optical corrections was -0.01 ± 0.03 mm. Five of the six highest rebound values (≥0.14 mm) were from red light therapy and atropine studies. Rebound ranged from +0.03 to +0.14 mm for overnight orthokeratology. Consistent with previous statements, no evidence for rebound was found for myopia control spectacles and soft contact lenses. Future research should explore the influence of age and magnitude of treatment efficacy on rebound.

Is the Change in Prevalence of High Myopia Compared to That of Myopia Really Disproportionate?

It has been noted that, at higher prevalences, the rate of change in the prevalence of high myopia seems to be disproportionately greater compared with the rate of change in the prevalence of myopia. A simple, evidence-based explanation for this relationship is offered. Using a convenience sample of 41 datasets with prevalence estimates for at least two refractive error thresholds (e.g., -0.50 and -6.00 D) the common slope of the logit vs. refractive threshold was applied to model expected rates of high myopia across the myopia prevalence range and the corresponding ratio of change in high myopia to myopia prevalence. The logit of high myopia is related linearly to the logit of myopia. The ratio of increase in high myopia prevalence to that for myopia prevalence increases with underlying prevalence. For example, an increase in myopia prevalence from 19% to 20% is modelled to be accompanied by a 0.1% increase in the prevalence of high myopia from 1.55% to 1.65%-a ratio of 0.1. Conversely, an increase in myopia prevalence from 79% to 80% is predicted to result in a 1% increase in the prevalence of high myopia from 20.6% to 21.6%-a ratio of 1.0. The increase in the prevalence of high myopia compared with that of myopia as the latter increases is merely a function of the underlying nature of refractive error probability distributions and requires no further investigation as to its origin. This study shows how the prevalence of myopia and high myopia are inter-related. A widespread effort to slow myopia progression will affect the prevalence of high myopia but not myopia in general. In contrast, efforts to delay myopia onset will affect both.

Juvenile Myopia: The Silent Vision Understanding, Preventing, and Managing Childhood Myopia

Juvenile myopia, a significant visual impairment characterized by blurred distance vision, is increasingly prevalent among Indian children. This review explores the multifactorial etiology of myopia, including genetic predisposition, environmental influences, and lifestyle factors such as prolonged near work and limited outdoor activities. The pathophysiology involves abnormal eye elongation driven by genetic and environmental factors, leading to refractive errors. Clinical manifestations include blurry distance vision, squinting, eye strain, and headaches, impacting academic performance and quality of life. Emphasis on early detection, parental awareness, and adherence to treatment protocols is crucial in controlling myopia progression and preventing long-term complications such as retinal detachment, myopic maculopathy, and glaucoma. This review underscores the need for comprehensive public health strategies to address the growing burden of juvenile myopia in India. Juvenile myopia is rapidly becoming a significant public health concern in India, with increasing prevalence driven by lifestyle changes, urbanization, and academic pressures. This systematic review aims to examine the prevalence, risk factors, and interventions for childhood myopia, with a focus on understanding the silent nature of this condition, identifying early prevention strategies, and outlining management techniques to curb its progression.

Abnormalities of the Conjunctiva, Sclera, Cornea, and Anterior Chamber in Pathological Myopia

Pathological myopia is characterized by typical complications in the fundus resulting from the progression of high myopia. These complications include posterior staphyloma, myopic maculopathy, and widespread choroidal atrophy. This review aims to understand the abnormalities of the conjunctiva, sclera, cornea, and anterior chamber associated with pathological myopia.Patients with pathological myopia are found to be more prone to the dry eye syndrome. This condition is explained by increased axial length, increased proptosis, and rapid evaporation of the tear film. Children with allergic conjunctivitis are shown to have a higher risk of developing myopia and that finding is explained with induced retinal inflammation promoting myopia progression. Posterior staphyloma is one of the diagnostic features of pathological myopia, which can lead to the development of myopic maculopathy. It occurs due to changes in the curvature of the sclera. It is challenging to find a direct relationship between pathological myopia and corneal or anterior chamber abnormalities. Besides, searches for components of pathological myopia have not yielded sufficient results. Understanding the anterior segment abnormalities associated with pathological myopia can play a significant role in the treatment and management of the disease. Future researches should focus on the etiology of axial elongation and factors related to the formation of posterior staphyloma. If the pathogenesis of staphylomas can be elucidated, more specific treatment methods may be developed.

Current Treatment of Pathological Myopia and Sclera-Targeted Therapies

Myopia is a refractive error that arises from the interaction of genetic and environmental factors. In recent years, there has been a significant increase in the prevalence of myopia. As the prevalence of myopia increases, so does the frequency of complications leading to vision loss associated with pathological myopia. Therefore, various methods and treatments are being explored to halt and prevent the progression of myopia in children. In myopia control, spending time outdoors, the use of low-dose atropine, and new generation lens technologies are being investigated. Spending more time outdoors appears to be the most reliable strategy. While some new lens designs seem to be quite effective in preventing progression, recent studies have shown that the expected success from atropine has not been achieved. Further research is needed on the long-term effects of combining different methods.