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Brennan NA, Cheng X, Jong M, Bullimore MA. Commonly Held Beliefs About Myopia That Lack a Robust Evidence Base: 2025 Update. Eye Contact Lens 2025:00140068-990000000-00287. [PMID: 40397787 DOI: 10.1097/icl.0000000000001191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2025] [Indexed: 05/23/2025]
Abstract
PURPOSE To subject a number of areas of contention in the myopia field to evidence-based scrutiny. METHOD The 10 topics from our previous review were revisited, and nine new topics were also critiqued with emphasis on the recent peer-reviewed literature. RESULTS The following observations were made: 0.01% atropine should not be considered a frontline myopia control treatment; the role of relative peripheral hyperopia in myopia development and progression remains unclear; undercorrection probably does not slow myopia progression; treatment efficacy diminishes with time; percentage is a misleading metric of efficacy; handheld digital devices have not been proven to be myopiagenic; more time outdoors may slow myopic shift to a similar extent in children with and without myopia; daylight is responsible for only part of the impact of outdoor time; all myopia, not just high myopia, carries the risk of visually threatening complications; premyopia is a real condition. Furthermore, myopia may be considered a disease; accommodation lag may be a measurement artifact; adult myopia progression is significant; past progression is a flawed indicator to initiate myopia control; fast progression does not mean nonresponse to treatment; single vision soft contact lenses are not myopiagenic; red light therapy may not be safe; contact lens wear in children may be considered safe; rebound cannot be assessed by comparing progression during and following treatment. CONCLUSIONS The myopia field continues to evolve with some conflicts resolved, ongoing areas of confusion, and new uncertainties emerging.
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Affiliation(s)
- Noel A Brennan
- Freelance (N.A.B.), Department of Optometry and Vision Sciences, The University of Melbourne, Melbourne, Australia; Johnson & Johnson (X.C., M.J.); School of Optometry & Vision Science (M.J.), University of New South Wales, Kensington, Australia; and College of Optometry (M.A.B.), University of Houston, Houston, TX
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Lawrenson JG, Huntjens B, Virgili G, Ng S, Dhakal R, Downie LE, Verkicharla PK, Kernohan A, Li T, Walline JJ. Interventions for myopia control in children: a living systematic review and network meta-analysis. Cochrane Database Syst Rev 2025; 2:CD014758. [PMID: 39945354 PMCID: PMC11822883 DOI: 10.1002/14651858.cd014758.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2025]
Abstract
RATIONALE The increasing prevalence of myopia is a growing global public health problem, in terms of rates of uncorrected refractive error and significantly, an increased risk of visual impairment due to myopia-related ocular morbidity. Interventions to slow its progression are needed in childhood, when myopia progression is most rapid. This is a review update, conducted as part of a living systematic review. OBJECTIVES To assess the comparative efficacy and safety of interventions for slowing myopia progression in children using network meta-analysis (NMA). To generate a relative ranking of interventions according to their efficacy. To produce a brief economic commentary, summarising economic evaluations. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, and three trial registers. The latest search date was 19 February 2024. ELIGIBILITY CRITERIA We included randomised controlled trials (RCTs) of optical, pharmacological, light therapy and behavioural interventions for slowing myopia progression in children, up to 18 years old. OUTCOMES Critical outcomes were progression of myopia (mean difference (MD) in the change in spherical equivalent refraction (SER, dioptres (D)), and axial length (AL, mm) in the intervention and control groups at one year or longer), and difference in the change in SER and AL following cessation of treatment (rebound). RISK OF BIAS We assessed the risk of bias (RoB) for SER and AL using the Cochrane RoB 2 tool. SYNTHESIS METHODS We followed standard Cochrane methods. We rated the certainty of evidence using the GRADE approach for change in SER and AL at one and two years. We used the surface under the cumulative ranking curve (SUCRA) to rank the interventions for all available outcomes. INCLUDED STUDIES We included 104 studies (40 new for this update) that randomised 17,509 children, aged 4 years to 18 years. Most studies were conducted in China or other Asian countries (66.3%), and North America (14.4%). Eighty-four studies (80.8%) compared myopia control interventions against inactive controls. Study durations ranged from 12 months to 48 months. SYNTHESIS OF RESULTS Since most of the networks in the NMA were poorly connected, our estimates are based on direct (pairwise) comparisons, unless stated otherwise. The median change in SER for controls was -0.65 D (55 studies, 4888 participants; one-year follow-up). These interventions may reduce SER progression compared to controls: repeated low intensity red light (RLRL: MD 0.80 D, 95% confidence interval (CI) 0.71 to 0.89; SUCRA = 93.8%; very low-certainty evidence); high-dose atropine (HDA (≥ 0.5%): MD 0.90 D, 95% CI 0.62 to 1.18; SUCRA = 93.3%; moderate-certainty evidence); medium-dose atropine (MDA (0.1% to < 0.5%): MD 0.55 D, 95% CI 0.17 to 0.93; NMA estimate SUCRA = 75.5%; low-certainty evidence); low dose atropine (LDA (< 0.1%): MD 0.25 D, 95% CI 0.16 to 0.35; SUCRA = 53.2%; very low-certainty evidence); peripheral plus spectacle lenses (PPSL: MD 0.45 D, 95% CI 0.16 to 0.74; SUCRA = 50.2%; very low-certainty evidence); multifocal soft contact lenses (MFSCL: MD 0.27 D, 95% CI 0.18 to 0.35; SUCRA = 49.9%; very low-certainty evidence); and multifocal spectacle lenses (MFSL: MD 0.14 D, 95% CI 0.08 to 0.21; SUCRA = 30.8%; low-certainty evidence). The median change in AL for controls was 0.33 mm (58 studies, 9085 participants; one-year follow-up). These interventions may reduce axial elongation compared to controls: RLRL (MD -0.33 mm, 95% CI -0.37 to -0.29; SUCRA = 98.6%; very low-certainty evidence); HDA (MD -0.33 mm, 95% CI -0.35 to -0.30; SUCRA = 88.4%; moderate-certainty evidence); MDA (MD -0.24 mm, 95% CI -0.34 to -0.15; NMA estimate SUCRA = 75.8%; low-certainty evidence); LDA (MD -0.10 mm, 95% CI -0.13 to -0.07; SUCRA = 36.1%; very low-certainty evidence); orthokeratology (ortho-K: MD -0.18 mm, 95% CI -0.21 to -0.14; SUCRA = 79%; moderate-certainty evidence); PPSL (MD -0.13 mm, 95% CI -0.21 to -0.05; SUCRA = 52.6%; very low-certainty evidence); MFSCL (MD -0.11 mm, 95% CI -0.13 to -0.09; SUCRA = 45.6%; low-certainty evidence); and MFSL (MD -0.06 mm, 95% CI -0.09 to -0.04; SUCRA = 26.3%; low-certainty evidence). Ortho-K plus LDA probably reduces axial elongation more than ortho-K monotherapy (MD -0.12 mm, 95% CI -0.15 to -0.09; SUCRA = 81.8%; moderate-certainty evidence). At two-year follow-up, change in SER was reported in 34 studies (3556 participants). The median change in SER for controls was -1.01 D. The ranking of interventions to reduce SER progression was close to that observed at one year; there were insufficient data to draw conclusions on cumulative effects. The highest-ranking interventions were: HAD (SUCRA = 97%); MDA (NMA estimate SUCRA = 69.8%); and PPSL (SUCRA = 69.1%). At two-year follow-up, change in AL was reported in 33 studies (3334 participants). The median change in AL for controls was 0.56 mm. The ranking of interventions to reduce axial elongation was similar to that observed at one year; there were insufficient data to draw conclusions on cumulative effects. The highest-ranking interventions were: ortho-K plus LDA (SUCRA = 94.2%); HAD (SUCRA = 96.8%); and MDA (NMA estimate SUCRA = 88.4%). There was limited evidence on whether cessation of myopia control therapy increases progression beyond the expected rate of progression with age. Adverse events and treatment adherence were not consistently reported. Two studies reported quality of life, showing little to no difference between intervention and control groups. We were unable to draw firm conclusions regarding the relative costs or efficiency of different myopia control strategies in children. AUTHORS' CONCLUSIONS Most studies compared pharmacological and optical treatments to slow the progression of myopia with an inactive comparator. These interventions may slow refractive change and reduce axial elongation, although results were often heterogeneous. Less evidence is available for two years and beyond; uncertainty remains about the sustained effect of these interventions. Longer term and better quality studies comparing myopia control interventions alone or in combination are needed, with improved methods for monitoring and reporting adverse effects. FUNDING Cochrane Eyes and Vision US Project is supported by grant UG1EY020522, National Eye Institute, National Institutes of Health. REGISTRATION The previous version of this living systematic review is available at doi: 10.1002/14651858.CD014758.pub2.
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Affiliation(s)
- John G Lawrenson
- Centre for Applied Vision Research, School of Health & Medical Sciences, City St George's, University of London, London, UK
| | - Byki Huntjens
- Centre for Applied Vision Research, School of Health & Medical Sciences, City St George's, University of London, London, UK
| | - Gianni Virgili
- Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Sueko Ng
- Department of Ophthalmology, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA
| | - Rohit Dhakal
- Department of Optometry and Vision Science, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Laura E Downie
- Department of Optometry and Vision Sciences, The University of Melbourne, Melbourne, Australia
| | - Pavan K Verkicharla
- Myopia Research Lab, Prof. Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, India
| | - Ashleigh Kernohan
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Tianjing Li
- Department of Ophthalmology, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA
| | - Jeffrey J Walline
- College of Optometry, The Ohio State University, Columbus, Ohio, USA
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Santodomingo-Rubido J, Cheung SW, Villa-Collar C. The safety of orthokeratology contact lens wear in slowing the axial elongation of the eye in children. Cont Lens Anterior Eye 2025; 48:102258. [PMID: 39003152 DOI: 10.1016/j.clae.2024.102258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Revised: 06/27/2024] [Accepted: 06/27/2024] [Indexed: 07/15/2024]
Abstract
PURPOSE To evaluate the safety of orthokeratology contact lens wear in slowing the axial elongation of the eye in myopic children. METHODS Safety data from three prospective studies, which evaluated the use of orthokeratology for slowing myopia progression in children in comparison to a parallel control group of single-vision spectacle lens wearers over a 2-year period, were pooled together for analysis. The primary and secondary safety endpoints are the comparisons of adverse events and slit-lamp findings grades ≥ 2 between orthokeratology and control groups, respectively. RESULTS Collectively, 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. Nineteen orthokeratology subjects experienced 28 adverse events, of which 6 were significant, whereas just one adverse event was found in the control group; this difference was statistically significant (p < 0.001). Most adverse events found in the orthokeratology group were corneal in nature, primarily corneal abrasion/staining, accounting for around 40 % of all adverse events. Of the 28 adverse events, only 18 (3 significant) are likely to be contact lens-related, leading to incidence rates of total and device-related adverse events per 100 patient years of lens wear (95 % confidence intervals) of 13.1 (9.2-18.2) and 8.4 (5.4-10.7), respectively. No significant differences were found between groups in the total number of silt-lamps findings with grades ≥ 2 (p > 0.05). CONCLUSION Around 13% of eyes wearing overnight orthokeratology contact lenses are likely to experience an adverse event over one year of lens wear, with this figure being lower when considering device-related adverse events alone. No serious adverse events were found, with most being non-significant. These results inform eye care practitioners on the safety of orthokeratology lenses when prescribed for slowing myopia progression to myopic children.
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Affiliation(s)
| | - Sin-Wan Cheung
- School of Optometry, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, China
| | - César Villa-Collar
- Faculty of Biomedical and Health Sciences, Universidad Europea, Madrid, Spain
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Hiraoka T, Matsumura S, Hori Y, Kamiya K, Miyata K, Oshika T. Incidence of microbial keratitis associated with overnight orthokeratology: a multicenter collaborative study. Jpn J Ophthalmol 2025; 69:139-143. [PMID: 39549214 DOI: 10.1007/s10384-024-01137-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Accepted: 09/26/2024] [Indexed: 11/18/2024]
Abstract
PURPOSE To investigate the incidence of microbial keratitis among Japanese patients wearing orthokeratology (ortho-k) lenses STUDY DESIGN: Retrospective multicenter study METHOD: This study was conducted at 4 hospitals in Japan and involved 1438 patients who had been prescribed ortho-k lenses and had worn them for at least 3 months. Data on patient demographics, lens characteristics, lens care systems, and presence of microbial keratitis were extracted from the medical records. Duration of ortho-k lens wear was calculated from the original fitting date to the patient's last visit, with the total years of lens wear used as person-years of lens wear. The incidence of microbial keratitis was calculated by dividing the number of infected cases by the total person-years of lens wear for all enrolled participants. RESULTS Among the 1438 patients, 753 were male and 685 were female, with a mean age of 12.7 ± 5.4 years. The mean duration of ortho-k lens wear was 5.2 ± 4.5 years, and the mean lens power was -3.52 ± 1.41 D. The total person-years of lens wear for all enrolled patients was 7415. Four cases of microbial keratitis were identified, resulting in an overall incidence of microbial keratitis of 5.4 (95% CI: 1.0-9.8) per 10,000 patient-years among ortho-k lens wearers. CONCLUSION This study represents the largest sample size to date for estimating the incidence of microbial keratitis associated with ortho-k lenses. The incidence was similar to or slightly lower than that of previous studies on ortho-k-related microbial keratitis and also comparable to that of daily wear soft contact lenses.
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Affiliation(s)
- Takahiro Hiraoka
- Department of Ophthalmology, Institute of Medicine, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, Ibaraki, 305-8575, Japan.
| | - Saiko Matsumura
- Department of Ophthalmology, Toho University Faculty of Medicine, Tokyo, Japan
| | - Yuichi Hori
- Department of Ophthalmology, Toho University Faculty of Medicine, Tokyo, Japan
| | - Kazutaka Kamiya
- Visual Physiology, School of Allied Health Sciences, Kitasato University, Kanagawa, Japan
| | - Kazunori Miyata
- Department of Ophthalmology, Miyata Eye Hospital, Miyazaki, Japan
| | - Tetsuro Oshika
- Department of Ophthalmology, Institute of Medicine, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, Ibaraki, 305-8575, Japan
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Lipson MJ, Koffler BH. The History and Impact of Prescribing Orthokeratology for Slowing Myopia Progression. Eye Contact Lens 2024; 50:517-521. [PMID: 39252199 DOI: 10.1097/icl.0000000000001123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2024] [Indexed: 09/11/2024]
Abstract
ABSTRACT This paper discusses the history and impact of orthokeratology on slowing the progression of myopia. It discusses the origins and evolution of orthokeratology from polymethymethaccrylate lenses worn during the day to its current prescribing of highly permeable, innovative reverse-geometry designs worn only while sleeping. Technological advances in corneal topography, lens design, lens materials, and manufacturing have facilitated growth of orthokeratology to a precise and predictable procedure. More recently, significant interest in orthokeratology has been stimulated by its efficacy in slowing axial elongation in myopic children. Safety of children wearing contact lenses while sleeping has been an ongoing concern. The potential of serious complications exists, but long-term studies and clinical experience have shown that risks of those events can be minimized with strict compliance with lens cleaning, disinfection, and hand hygiene. Because no correction is required during waking hours, patients using orthokeratology report higher vision-related quality of life, less activity restrictions, and more comfortable eyes compared with spectacles or contact lenses worn during the day. The future growth of orthokeratology will be fueled by the prescribing of orthokeratology as a modality to slow axial elongation and an alternative modality to spectacles, traditional contact lenses, and refractive surgery to correct refractive error.
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Affiliation(s)
- Michael J Lipson
- Department of Ophthalmology and Visual Science, University of Michigan, Northville, MI
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Surico PL, Parmar UPS, Singh RB, Farsi Y, Musa M, Maniaci A, Lavalle S, D’Esposito F, Gagliano C, Zeppieri M. Myopia in Children: Epidemiology, Genetics, and Emerging Therapies for Treatment and Prevention. CHILDREN (BASEL, SWITZERLAND) 2024; 11:1446. [PMID: 39767875 PMCID: PMC11674392 DOI: 10.3390/children11121446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/20/2024] [Revised: 11/18/2024] [Accepted: 11/26/2024] [Indexed: 01/11/2025]
Abstract
Refractive errors, particularly myopia, are among the most prevalent visual impairments globally, with rising incidence in children and adolescents. This review explores the epidemiology and risk factors associated with the development of refractive errors, focusing on the environmental and lifestyle factors contributing to the current surge in myopia. We provide an overview of key genetic factors and molecular pathways driving the pathogenesis of myopia and other refractive errors, emphasizing the complex interplay between genetic predisposition and environmental triggers. Understanding the underlying mechanisms is crucial for identifying new strategies for intervention. We discuss current approaches to slow myopia progression in pediatric populations, including pharmacological treatment regimens (low-dose atropine), optical interventions, and lifestyle modifications. In addition to established therapies, we highlight emerging innovations, including new pharmacological agents and advanced optical devices, and insights into potential future treatments. Cutting-edge research into gene therapy, molecular inhibitors, and neuroprotective strategies may yield novel therapeutic targets that address the root causes of refractive errors. This comprehensive review underscores the importance of early intervention and highlights promising avenues for future research, aiming to provide pediatricians with guidance to ultimately improve clinical outcomes in managing and preventing myopia progression in children and young adults.
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Affiliation(s)
- Pier Luigi Surico
- Schepens Eye Research Institute of Mass Eye and Ear, Harvard Medical School, Boston, MA 02114, USA or (P.L.S.)
- Department of Ophthalmology, Campus Bio-Medico University, 00128 Rome, Italy
| | - Uday Pratap Singh Parmar
- Schepens Eye Research Institute of Mass Eye and Ear, Harvard Medical School, Boston, MA 02114, USA or (P.L.S.)
- Department of Ophthalmology, Government Medical College and Hospital, Chandigarh 160030, India
| | - Rohan Bir Singh
- Schepens Eye Research Institute of Mass Eye and Ear, Harvard Medical School, Boston, MA 02114, USA or (P.L.S.)
| | - Yeganeh Farsi
- Schepens Eye Research Institute of Mass Eye and Ear, Harvard Medical School, Boston, MA 02114, USA or (P.L.S.)
| | - Mutali Musa
- Department of Optometry, University of Benin, Benin City 300238, Nigeria
- Africa Eye Laser Centre, Km 7, Benin City 300105, Nigeria
| | - Antonino Maniaci
- Department of Medicine and Surgery, University of Enna “Kore”, Piazza dell’Università, 94100 Enna, Italy
| | - Salvatore Lavalle
- Department of Medicine and Surgery, University of Enna “Kore”, Piazza dell’Università, 94100 Enna, Italy
| | - Fabiana D’Esposito
- Imperial College Ophthalmic Research Group (ICORG) Unit, Imperial College, 153-173 Marylebone Rd, London NW15QH, UK
- Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples Federico II, Via Pansini 5, 80131 Napoli, Italy
| | - Caterina Gagliano
- Department of Medicine and Surgery, University of Enna “Kore”, Piazza dell’Università, 94100 Enna, Italy
- Mediterranean Foundation “G.B. Morgagni”, 95125 Catania, Italy
| | - Marco Zeppieri
- Department of Ophthalmology, University Hospital of Udine, 33100 Udine, Italy
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Fogt JS, Roth M, Gardner HP. How Can We Better Inform Patients of the Importance of Contact Lens Compliance?: Current Perspectives. CLINICAL OPTOMETRY 2024; 16:267-286. [PMID: 39507399 PMCID: PMC11539749 DOI: 10.2147/opto.s405204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/02/2024] [Accepted: 10/15/2024] [Indexed: 11/08/2024]
Abstract
Compliance with contact lens care is important for successful contact lens wear and for minimizing the risk of complications related to lens wear. There are many components of overall lens care guidelines that may potentially be disregarded, forgotten, or misunderstood. Literature has reported copious data on rates of poor compliance for separate lens care recommendations. Knowing the areas of contact lens care where lens wearers perform poorly is helpful when creating strategies for improving patient education. As science evolves and new best-practices are determined, eye care providers must be engaged in educating new lens wearers and reeducating existing wearers. It is vital to make wearers mindful of proper lens care and why proper lens care should be important to them. Various educational strategies can help practitioners to communicate with their patients more effectively. The purpose of this narrative review is to discuss studies of noncompliance with contact lens wear; consequences of these noncompliant behaviors; and studies of lens care education which were found with a literature search. The resulting discussion also includes strategies to improve compliance with patient contact lens wear.
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Affiliation(s)
| | - Madison Roth
- Ohio State University College of Optometry, Columbus, OH, USA
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Chen Y, Xiong R, Yang S, Zhu Z, Li H, Xiang K, Congdon N, Wang W, He M. Safety of repeated low-level red-light therapy for myopia: A systematic review. Asia Pac J Ophthalmol (Phila) 2024; 13:100124. [PMID: 39672511 DOI: 10.1016/j.apjo.2024.100124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2024] [Revised: 11/17/2024] [Accepted: 12/06/2024] [Indexed: 12/15/2024] Open
Abstract
PURPOSE Establishing the safety profile of repeated low-level red-light (RLRL) therapy is necessary prior to its widespread clinical implementation. METHODS We conducted a systematic review (International Prospective Register of Systematic Reviews, CRD42024516676) of articles across seven databases from inception through February 10, 2024, with keywords related to myopia and RLRL therapy. Pooled safety outcomes and risk-to-benefit ratios were reported, and incidence of side effects was compared with other antimyopia interventions. RESULTS Among 689 screened articles, 20 studies (2.90 %; median duration 9 months, longest 24 months) were analysed, encompassing 2380 participants aged 3-18 years and 1436 individuals undergoing RLRL therapy. Two case reports described an identical patient with reversible decline in visual acuity and optical coherence tomography (OCT) abnormalities, completely resolved 4 months after treatment cessation. No cases of permanent vision loss were reported. Temporary afterimage was the most common ocular symptom following treatment, resolving within 6 minutes in reported studies. The number needed to harm outweighed the number needed to treat by a ratio of 12.7-21.4 for a person with -3D to -8D myopia treated with RLRL therapy. Incidence of side effects from RLRL was 0.088 per 100 patient-years (95 % confidence interval, 0.02-0.50). CONCLUSIONS No irreversible visual function loss or ocular structural damage was identified with RLRL. Fundus photography and OCT before and during therapy, alongside home monitoring of visual acuity and duration of afterimages, are necessary to identify side effects. Further adequately powered studies of longer duration are needed to evaluate long-term safety of RLRL.
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Affiliation(s)
- Yanping Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou 510060, China
| | - Ruilin Xiong
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou 510060, China
| | - Shaopeng Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou 510060, China
| | - Ziyu Zhu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou 510060, China
| | - Huangdong Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou 510060, China
| | - Kaidi Xiang
- Department of Clinical Research, Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai Vision Health Center and Shanghai Children Myopia Institute, Shanghai, China; Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai Eye Research Institute, Shanghai, China; Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China; Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai, China; Shanghai Key Clinical Specialty, Shanghai, China; Shanghai Clinical Research Center for Eye Diseases, Shanghai, China; National Clinical Research Center for Eye Diseases, Shanghai, China; Department of Ophthalmology, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University School of Medicine, Shanghai, China, Shanghai Eye Research Institute, Shanghai, China
| | - Nathan Congdon
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou 510060, China; Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom; Orbis International, New York, NY, USA.
| | - Wei Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou 510060, China.
| | - Mingguang He
- Center for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, VIC, Australia; Research Centre for SHARP Vision (RCSV), The Hong Kong Polytechnic University, Kowloon, Hong Kong, China.
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Chen X, Li M, Li J, Wu M, Liu X, Yu C, Guo X, Wang Y, Wang Y, Lu W, Li L, Wang Y. One-year efficacy of myopia control by the defocus distributed multipoint lens: a multicentric randomised controlled trial. Br J Ophthalmol 2024; 108:1583-1589. [PMID: 38503477 DOI: 10.1136/bjo-2023-324243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 02/29/2024] [Indexed: 03/21/2024]
Abstract
AIMS To report the 1-year results of the efficacy of a defocus distributed multipoint (DDM) lens in controlling myopia progression in a multicentre, randomised controlled trial. METHODS Overall, 168 children aged 6-13 years were recruited and randomly assigned to wear a DDM lens (n=84) or single-vision (SV) lens (n=84) in three centres. Cycloplegic autorefraction (spherical equivalent refraction (SER)) and axial length (AL) were measured. Linear mixed model analysis was performed to compare between-group SER and AL changes. Logistic regression analysis was used to analyse the between-group difference in rapid myopia progression (SER increase≥0.75 D per year or AL growth≥0.40 mm per year). RESULTS After 1 year, mean changes in SER were significantly lower in the DDM group (-0.47±0.37 D) than in the SV group (-0.71±0.42 D) (p<0.001). Similarly, mean changes in AL were significantly lower in the DDM group (0.21±0.17 mm) than in the SV group (0.34±0.16 mm) (p<0.001). After adjusting for age, sex, daily wearing time and parental myopia, rapid myopia progression risk was higher in the SV group than in the DDM group (OR=3.51, 95% CI: 1.77 to 6.99), especially for children who wore a lens for >12 hours per day, boys and younger children (6-9 years) with ORs (95% CIs) of 10.82 (3.22 to 36.37), 5.34 (1.93 to 14.78) and 8.73 (2.6 to 29.33), respectively. CONCLUSIONS After 1 year, DDM lenses effectively retarded myopia progression in children. Longer daily wearing time of DDM lens improved the efficacy of myopia control. Future long-term studies are needed for validation. TRIAL REGISTRATION NUMBER NCT05340699.
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Affiliation(s)
- Xiaoqin Chen
- Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China
- Tianjin Eye Hospital, Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin Eye Institute, Nankai University affiliated Eye Institute, Tianjin, China
- Tianjin Eye Hospital Optometric Center, Tianjin, China
| | - Mengdi Li
- Tianjin Eye Hospital Optometric Center, Tianjin, China
| | - Jun Li
- Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China
- Tianjin Eye Hospital Optometric Center, Tianjin, China
| | - Min Wu
- Tongren Eye Care Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | | | - Cui Yu
- He Eye Specialist Hospital, Shenyang, China
| | - Xingyi Guo
- Tianjin Eye Hospital Optometric Center, Tianjin, China
| | - Yanbo Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Tianjin Medical University, Tianjin, China
| | | | - Wenli Lu
- Department of Epidemiology and Health Statistics, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Lihua Li
- Tianjin Eye Hospital, Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin Eye Institute, Nankai University affiliated Eye Institute, Tianjin, China
- Tianjin Eye Hospital Optometric Center, Tianjin, China
| | - Yan Wang
- Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China
- Tianjin Eye Hospital, Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin Eye Institute, Nankai University affiliated Eye Institute, Tianjin, China
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10
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Jung S, Eom Y, Song JS, Hyon JY, Jeon HS. Clinical Features and Visual Outcome of Infectious Keratitis Associated with Orthokeratology Lens in Korean Pediatric Patients. KOREAN JOURNAL OF OPHTHALMOLOGY 2024; 38:399-412. [PMID: 39174012 PMCID: PMC11491801 DOI: 10.3341/kjo.2024.0101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2024] [Revised: 08/15/2024] [Accepted: 08/22/2024] [Indexed: 08/24/2024] Open
Abstract
PURPOSE To investigate the clinical features and visual outcome of infectious keratitis associated with orthokeratology (Ortho-K) lens in Korean pediatric patients. METHODS We retrospectively reviewed medical records of patients diagnosed with Ortho-K lens-related infectious keratitis from June 2005 to April 2020 at a tertiary referral hospital. Patients' demographics, clinical features, microbiological evaluation, and treatment methods were assessed, and factors related to final visual outcomes were analyzed. RESULTS The study included 26 eyes from 26 patients (19 female and 7 male patients; mean age, 11.9 years), with an average Ortho-K lens wear duration of 33.7 ± 21.2 months. The highest number of cases occurred in summer (11 of 26 cases, 42.3%). Central or paracentral corneal lesions were observed in 25 cases (96.2%), with a mean corneal epithelial defect size of 5.13 mm2. Pseudomonas aeruginosa was the most commonly isolated organism (n = 5), followed by Serratia marcescens (n = 4). All patients responded to medical treatment without needing surgical intervention. 72% of cases achieved favorable visual outcomes (Snellen best-corrected visual acuity [BCVA] >6 / 12), while 8% experienced severe visual impairment (Snellen BCVA ≤6 / 60) due to residual central corneal opacities. Multivariable analysis showed that non-summer seasons (p = 0.043), duration from symptom onset to presentation (p = 0.040), and corneal epithelial defect size (p = 0.002) were significantly associated with final logarithm of the minimum angle of resolution BCVA. Failed autorefraction at presentation due to an Ortho-K-related infectious keratitis lesion was a significant predictor of poor final visual outcome (Snellen BCVA ≤6 / 12; odds ratio, 38.995; p = 0.030). CONCLUSIONS Ortho-K lens-related infectious keratitis can lead to permanent corneal opacities and potentially devastating visual outcomes in children. Delayed time to presentation, large corneal lesions, failure of autorefraction, and non-summer seasons were associated with poorer outcomes. Proper education and early detection would be key to safe use of orthokeratology lenses in pediatric patients.
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Affiliation(s)
- Sangwon Jung
- Department of Ophthalmology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul,
Korea
| | - Youngsub Eom
- Department of Ophthalmology, Korea University Ansan Hospital, Korean University College of Medicine, Ansan,
Korea
| | - Jong Suk Song
- Department of Ophthalmology, Korea University Guro Hospital, Korean University College of Medicine, Seoul,
Korea
| | - Joon Young Hyon
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam,
Korea
| | - Hyun Sun Jeon
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam,
Korea
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11
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Sánchez-García A, Molina-Martin A, Ariza-Gracia MÁ, Piñero DP. Analysis of Treatment Discontinuation in Orthokeratology: Studying Efficacy, Safety, and Patient Adherence Over Six Months. Eye Contact Lens 2024; 50:395-400. [PMID: 38886923 DOI: 10.1097/icl.0000000000001110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Abstract
PURPOSE This study aimed to evaluate the efficacy, safety, and participant compliance of orthokeratology treatment for the correction of myopic refractive errors over a six-month prospective study and to define the potential reasons for early treatment discontinuation. METHODS A total of 32 participants with low-to-moderate myopia were fitted with the spherical model of corneal refractive therapy (CRT) orthokeratology lenses (Paragon Vision Sciences) and followed over six months, with specific attention to alterations in refractive error, corneal topography, and epithelial thickness. Concurrently, participant feedback and reasons for any treatment discontinuation were documented. RESULTS Significant changes in refractive error and in corneal topography were observed, with approximately 50% of the refractive error being corrected on the first night of use and 100% by the first two weeks ( P <0.001). Central epithelial thickness experienced substantial thinning, reducing to 15.65±4.49 μm (67.38%) ( P <0.001) after 6 months of lens use. Six participants withdrew from this study for varied reasons, including unmet visual expectations and difficulty adhering to the lens-wearing regimen. Notably, the dropout group exhibited higher baseline low-order aberrations and less prolate corneas than those who persisted with the treatment ( P <0.05). CONCLUSIONS Orthokeratology with CRT is efficacious and safe for the correction of low-to-moderate myopia in adults, but a portion of patients discontinue the treatment in the first 6 months of contact lens wear. Special care should be taken when recommending orthokeratology in patients with higher levels of myopia and corneas with less prolate shape, providing more realistic expectations and even changing to dual axis or more sophisticated designs.
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Affiliation(s)
- Alicia Sánchez-García
- Department of Optics (A.S.-G., A.M.-M., D.P.P.), Pharmacology and Anatomy, University of Alicante, Alicante, Spain; ARTORG Center for Biomedical Engineering Research (M.Á.A.-G), University of Bern, Bern, Switzerland; and Department of Ophthalmology (IMQO-Oftalmar) (D.P.P.), Vithas Medimar International Hospital, Alicante, Spain
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12
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Tomiyama ES, Kobia-Acquah E, Ansari SM, Logan AK, Gialousakis J, Ng S, Wagner H. Scoping review: Reporting characteristics for the safety of contact lenses in the pediatric population. Optom Vis Sci 2024; 101:556-562. [PMID: 38950144 PMCID: PMC11560738 DOI: 10.1097/opx.0000000000002156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/03/2024] Open
Abstract
SIGNIFICANCE Contact lenses are an increasingly popular option for correcting pediatric refractive error due to increased awareness of interventions to slow myopia progression. With limited information on the safety profiles of contact lenses in children, it is important to characterize the current understanding and promote this device's safe and effective use. PURPOSE This scoping review evaluates characteristics of the current literature that have examined the safety of contact lenses in pediatric patients. It provides future directions for systematic reviews and identifies any gaps in the current literature or areas for future research. METHODS Literature searches in MEDLINE via PubMed, EMBASE, The Cochrane Library, trial registries, and U.S. Food and Drug Administration clinical trial documentation were performed. Included studies (i.e., experimental and quasi-experimental studies; observational studies including prospective and retrospective cohort, case-control, and analytical cross-sectional studies, and case series of 30 or more participants) reported safety and/or complications of the use of any contact lens for correcting refractive error in children (0 to 18 years). Two independent reviewers first screened the titles and abstracts, and then full-text reports for eligibility. Conflicts in eligibility were resolved by discussions with a third reviewer. Two independent reviewers extracted data, including details about the participants, context, study methods, and key findings relevant to the review question. RESULTS This scoping review included 73 studies from 10 countries using different contact lens modalities, primarily orthokeratology and soft contact lenses, in children (6 to 18 years). The most common adverse event reported by the studies was corneal staining (60% orthokeratology, 45% soft contact lens). CONCLUSIONS The need for uniform reporting standards for adverse events poses challenges for comprehensive data synthesis. However, this scoping review identified a sufficient number of studies for a future systematic review to quantify the risks associated with orthokeratology and soft contact lens use in children.
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Affiliation(s)
| | | | - Shora M Ansari
- Southern California College of Optometry, Marshall B. Ketchum University, Fullerton, California
| | | | - John Gialousakis
- Midwestern University Chicago College of Optometry, Downers Grove, IL
| | - Sueko Ng
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Heidi Wagner
- Southern California College of Optometry, Marshall B. Ketchum University, Fullerton, California
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13
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Craig JP, Barsam A, Chen C, Chukwuemeka O, Ghorbani-Mojarrad N, Kretz F, Michaud L, Moore J, Pelosini L, Turnbull AMJ, Vincent SJ, Wang MTM, Ziaei M, Wolffsohn JS. BCLA CLEAR Presbyopia: Management with corneal techniques. Cont Lens Anterior Eye 2024; 47:102190. [PMID: 38851946 DOI: 10.1016/j.clae.2024.102190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2024]
Abstract
Corneal techniques for enhancing near and intermediate vision to correct presbyopia include surgical and contact lens treatment modalities. Broad approaches used independently or in combination include correcting one eye for distant and the other for near or intermediate vision, (termed monovision or mini-monovision depending on the degree of anisometropia) and/or extending the eye's depth of focus [1]. This report reviews the evidence for the treatment profile, safety, and efficacy of the current range of corneal techniques for managing presbyopia. The visual needs and expectations of the patient, their ocular characteristics, and prior history of surgery are critical considerations for patient selection and preoperative evaluation. Contraindications to refractive surgery include unstable refraction, corneal abnormalities, inadequate corneal thickness for the proposed ablation depth, ocular and systemic co-morbidities, uncontrolled mental health issues and unrealistic patient expectations. Laser refractive options for monovision include surface/stromal ablation techniques and keratorefractive lenticule extraction. Alteration of spherical aberration and multifocal ablation profiles are the primary means for increasing ocular depth of focus, using surface and non-surface laser refractive techniques. Corneal inlays use either small aperture optics to increase depth of field or modify the anterior corneal curvature to induce corneal multifocality. In presbyopia correction by conductive keratoplasty, radiofrequency energy is applied to the mid-peripheral corneal stroma, leading to mid-peripheral corneal shrinkage and central corneal steepening. Hyperopic orthokeratology lens fitting can induce spherical aberration and correct some level of presbyopia. Postoperative management, and consideration of potential complications, varies according to technique applied and the time to restore corneal stability, but a minimum of 3 months of follow-up is recommended after corneal refractive procedures. Ongoing follow-up is important in orthokeratology and longer-term follow-up may be required in the event of late complications following corneal inlay surgery.
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Affiliation(s)
- Jennifer P Craig
- Department of Ophthalmology, Aotearoa New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand; College of Health & Life Sciences, Aston University, Birmingham, UK.
| | | | - Connie Chen
- Department of Optometry, Chung Shan Medical University, Taichung City, Taiwan
| | - Obinwanne Chukwuemeka
- Cornea, Contact Lens and Myopia Management Unit, De-Lens Ophthalmics Family and Vision Care Centre, Abuja, Nigeria
| | - Neema Ghorbani-Mojarrad
- School of Optometry and Vision Science, University of Bradford, Bradford, UK; Wolfson Centre for Applied Health Research, Bradford Royal Infirmary, Bradford, UK
| | | | | | | | | | - Andrew M J Turnbull
- Royal Bournemouth Hospital, University Hospitals Dorset, UK; Faculty of Life and Health Sciences, Ulster University, UK
| | - Stephen J Vincent
- Optometry and Vision Science, Centre for Vision and Eye Research, Queensland University of Technology, Brisbane, Australia
| | - Michael T M Wang
- Department of Ophthalmology, Aotearoa New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand
| | - Mohammed Ziaei
- Department of Ophthalmology, Aotearoa New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand
| | - James S Wolffsohn
- Department of Ophthalmology, Aotearoa New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand; College of Health & Life Sciences, Aston University, Birmingham, UK
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14
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Sartor L, Hunter DS, Vo ML, Samarawickrama C. Benefits and risks of orthokeratology treatment: a systematic review and meta-analysis. Int Ophthalmol 2024; 44:239. [PMID: 38904856 PMCID: PMC11192849 DOI: 10.1007/s10792-024-03175-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 06/15/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND This meta-analysis reviews the evidence for the risks and benefits associated with orthokeratology (OK) treatment compared with other methods of myopia control in children and adults. METHODS A systematic search of Cochrane Central Register of Controlled Trials, Pubmed, Embase and Ovid was conducted from database inception to 22nd August 2021. Studies that reported on risks, visual and ocular biometric effects of OK in patients > 5 years of age with myopia (- 0.75 to - 6.00D) were included. Main outcomes are change in axial length and any adverse event. RESULTS Fourty-five papers were included in this systematic review and meta-analysis. The quality of data was variable and of moderate certainty, and selection bias likely skewed the results towards a relative benefit for OK. The rate of axial elongation in children was lower for OK treatment compared to other treatment modalities at one year (MD - 0.16 mm, 95% CI - 0.25 to - 0.07). Rate of change in axial length in children rebounded after OK discontinuation compared to participants who continued treatment (MD 0.10 mm, 95% CI 0.06 to 0.14). Adults and children wearing OK were up to 3.79 times more likely to experience an adverse event when compared with conventional contact lenses (OR 3.79, 95% CI 1.24 to ll.), though this evidence base is underdeveloped and requires additional well-designed studies for substantial conclusions to be drawn. CONCLUSIONS OK arrests myopia progression while in use, however, there remain unanswered questions about the optimal duration of treatment, discontinuation effects and long-term risk for adverse events.
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Affiliation(s)
- Lauren Sartor
- Centre for Vision Research, Westmead Institute of Medical Research, Sydney, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Department of Ophthalmology, Westmead Hospital, Sydney, NSW, Australia
| | - Damien S Hunter
- Centre for Vision Research, Westmead Institute of Medical Research, Sydney, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Mai Linh Vo
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Chameen Samarawickrama
- Centre for Vision Research, Westmead Institute of Medical Research, Sydney, Australia.
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
- Department of Ophthalmology, Westmead Hospital, Sydney, NSW, Australia.
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15
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Yamasaki K, Dantam J, Sasanuma K, Hisamura R, Mizuno Y, Hui A, Jones L. Impact of in vitro lens deposition and removal on bacterial adhesion to orthokeratology contact lenses. Cont Lens Anterior Eye 2024; 47:102104. [PMID: 38161140 DOI: 10.1016/j.clae.2023.102104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 11/22/2023] [Accepted: 12/11/2023] [Indexed: 01/03/2024]
Abstract
PURPOSE The purpose of this study was to explore the impact of several contact lens (CL) care solutions on the removal of proteins and lipids, and how deposit removal impacts bacterial adhesion and solution disinfection. METHODS Lysozyme and lipid deposition on three ortho-k (rigid) and two soft CL materials were evaluated using an ELISA kit and gas chromatography respectively. Bacterial adhesion to a fluorosilicone acrylate material using Pseudomonas aeruginosa with various compositions of artificial tear solutions (ATS), including with denatured proteins, was also investigated. The impact of deposition of the different formulations of ATS on biofilm formation was explored using cover slips. Finally, the lysozyme and lipid cleaning efficacy and disinfection efficacy against P. aeruginosa and Staphylococcus aureus of four different contact lens care solutions were studied using qualitative analysis. RESULTS While maximum lysozyme deposition was observed with the fluorosilicone acrylate material (327.25 ± 54.25 µg/lens), the highest amount of lipid deposition was recorded with a fluoro-siloxanyl styrene material (134.71 ± 19.87 µg/lens). Adhesion of P. aeruginosa to fluorosilicone acrylate lenses and biofilm formation on cover slips were significantly greater with the addition of denatured proteins and lipids. Of the four contact lens care solutions investigated, the solution based on povidone-iodine removed both denatured lysozyme and lipid deposits and could effectively disinfect against P. aeruginosa and S. aureus when contaminated with denatured proteins and lipids. In contrast, the peroxide-based solution was able to inhibit P. aeruginosa growth only, while the two multipurpose solutions were unable to disinfect lenses contaminated with denatured proteins and lipids. CONCLUSION Bacterial adhesion and biofilm formation is influenced by components within artificial tear solutions depositing on lenses, including denatured proteins and lipids, which also affects disinfection. The ability of different solutions to remove these deposits should be considered when selecting systems to clean and disinfect ortho-k lenses.
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Affiliation(s)
| | - Jaya Dantam
- Centre for Ocular Research & Education (CORE), School of Optometry and Vision Science, University of Waterloo, Ontario, Canada
| | | | | | - Yohei Mizuno
- Kobe Research Center, OPHTECS Corporation, Kobe, Japan
| | - Alex Hui
- Centre for Ocular Research & Education (CORE), School of Optometry and Vision Science, University of Waterloo, Ontario, Canada; School of Optometry and Vision Science, Faculty of Medicine and Health, UNSW Sydney, Australia.
| | - Lyndon Jones
- Centre for Ocular Research & Education (CORE), School of Optometry and Vision Science, University of Waterloo, Ontario, Canada; Centre for Eye and Vision Research (CEVR), Hong Kong Special Administrative Region, Hong Kong
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16
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Abstract
SIGNIFICANCE The availability of a range of effective myopia control modalities enables the clinician to exercise judgment when discussing the treatment plan with the patient and their parents. This article outlines important considerations beyond efficacy.Clinically meaningful myopia control may be attained with some spectacle lenses, select soft contact lenses, some concentrations of atropine, and overnight orthokeratology. Given that satisfactory efficacy can be achieved with a range of modalities, other factors should be considered when deciding upon the best intervention for a given child. Four key factors-compliance, quality of vision, quality of life, and safety-are discussed in this review. Compliance directly impacts efficacy regardless of the modality and is the most important consideration, as it is influenced by quality of vision and comfort. Daily disposal myopia control contact lenses and overnight orthokeratology are generally associated with high compliance, provide better vision-related quality of life than spectacles, and carry a very low risk when used appropriately. A further benefit of overnight orthokeratology is the elimination of a need for optical correction during the day.
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Hansen NC, Hvid-Hansen A, Møller F, Bek T, Larsen DA, Jacobsen N, Kessel L. Two-Year Results of 0.01% Atropine Eye Drops and 0.1% Loading Dose for Myopia Progression Reduction in Danish Children: A Placebo-Controlled, Randomized Clinical Trial. J Pers Med 2024; 14:175. [PMID: 38392608 PMCID: PMC10890135 DOI: 10.3390/jpm14020175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 01/27/2024] [Accepted: 01/31/2024] [Indexed: 02/24/2024] Open
Abstract
We investigated the two-year safety and efficacy of 0.1% loading dose and 0.01% low-dose atropine eye drops in Danish children for reduction in myopia progression in an investigator-initiated, placebo-controlled, double-masked, randomized clinical trial. Ninety-seven six- to twelve-year old myopic participants were randomized to 0.1% loading dose for six months and then 0.01% for eighteen months (loading dose group, N = 33), 0.01% for two years (0.01% group, N = 32) or placebo for two years (placebo, N = 32). Axial length (AL) and spherical equivalent refraction (SER) were primary outcomes. Secondary outcomes included adverse events and reactions, choroidal thickness, and other ocular biometrical measures. Outcomes were measured from baseline and at six-month intervals. Individual eyes nested by participant ID were analyzed with linear-mixed model analysis. Data were analyzed with intention-to-treat. Mean AL was 0.08 mm less (95% confidence interval (CI): -0.01; 0.17, p-value = 0.08) in the 0.1% loading dose and 0.10 mm less (95% CI: 0.01; 0.19, p-value = 0.02) in the 0.01% group after two years of treatment compared to placebo. Mean SER progression was 0.12 D (95% CI: -0.10; 0.33) less in the loading dose and 0.26 D (95% CI: 0.04; 0.48) less in the 0.01% groups after two years of treatment compared to placebo (p-value = 0.30 and 0.02, respectively). In total, 17 adverse events were reported in the second-year follow-up, and all were rated as mild. Adjusting for iris color did not affect treatment effect estimates. Intra-ocular pressure increased over two years comparably between all groups but remained within normal limits. Two-year treatment with 0.01% low-dose atropine eye drops is a safe and moderately efficacious intervention in Danish children for reducing myopia progression.
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Affiliation(s)
- Niklas Cyril Hansen
- Department of Ophthalmology, Copenhagen University Hospital-Rigshospitalet-Glostrup, DK-2600 Glostrup, Denmark
| | - Anders Hvid-Hansen
- Department of Ophthalmology, Copenhagen University Hospital-Rigshospitalet-Glostrup, DK-2600 Glostrup, Denmark
| | - Flemming Møller
- Department of Ophthalmology, University Hospital of Southern Denmark-Vejle Hospital, DK-7100 Vejle, Denmark
| | - Toke Bek
- Department of Ophthalmology, Aarhus University Hospital, DK-8200 Aarhus N, Denmark
| | - Dorte Ancher Larsen
- Department of Ophthalmology, Aarhus University Hospital, DK-8200 Aarhus N, Denmark
| | - Nina Jacobsen
- Department of Ophthalmology, Copenhagen University Hospital-Rigshospitalet-Glostrup, DK-2600 Glostrup, Denmark
| | - Line Kessel
- Department of Ophthalmology, Copenhagen University Hospital-Rigshospitalet-Glostrup, DK-2600 Glostrup, Denmark
- Department of Clinical Medicine, University of Copenhagen, DK-2200 København N, Denmark
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18
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Logan NS, Bullimore MA. Optical interventions for myopia control. Eye (Lond) 2024; 38:455-463. [PMID: 37740053 PMCID: PMC10858277 DOI: 10.1038/s41433-023-02723-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 07/26/2023] [Accepted: 08/25/2023] [Indexed: 09/24/2023] Open
Abstract
A range of optical interventions have been developed to slow the progression of myopia. This review summarizes key studies and their outcomes. Peer-reviewed, randomized controlled clinical trials of at least 18 months duration were identified. Randomized clinical trials were identified and summarised: 13 for spectacles, 5 for overnight orthokeratology, 5 for soft contact lenses, and 3 for orthokeratology combined with low concentration atropine. Overnight orthokeratology trials were the most consistent with 2-year slowing of axial elongation between 0.24 and 0.32 mm. Other modalities were more variable due to the wide range of optical designs. Among spectacle interventions, progressive addition lenses were the least effective, slowing axial elongation and myopia progression by no more than 0.11 mm and 0.31 D, respectively. In contrast, novel designs with peripheral lenslets slow 2-year elongation and progression by up to 0.35 mm and 0.80 D. Among soft contact lens interventions, medium add concentric bifocals slow 3-year elongation and progression by only 0.07 mm and 0.16 D, while a dual-focus design slows 3-year elongation and progression by 0.28 mm and 0.67 D. In summary, all three optical interventions have the potential to significantly slow myopia progression. Quality of vision is largely unaffected, and safety is satisfactory. Areas of uncertainty include the potential for post-treatment acceleration of progression and the benefit of adding atropine to optical interventions.
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19
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Zhang J, Lu X, Cheng Z, Zou D, Shi W, Wang T. Alterations of conjunctival microbiota associated with orthokeratology lens wearing in myopic children. BMC Microbiol 2023; 23:397. [PMID: 38087200 PMCID: PMC10717905 DOI: 10.1186/s12866-023-03042-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 10/03/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Orthokeratology (OK) lens wear increases the risk of bacterial infection, but little is known about the microbiota of the conjunctival sac in myopic children wearing OK lenses. This study aimed to investigate the changes of conjunctival microbiota in children after treatment with OK lenses using 16 S rDNA sequencing. METHODS Twenty-eight myopic children who had been continuously wearing OK lenses for 12 to 13 months were enrolled in this prospective study. Twenty-two gender- and age-matched myopic children who had not worn OK lenses or discontinued OK lens wear at least 1 year ago were recruited as controls. Conjunctival swabs from each participant were collected for exploration of the microbiota profiles, targeting the V3-V4 regions of the 16 S rRNA gene by MiSeq sequencing. The differences in the microbial community structure and diversity were also compared between groups. RESULTS The bacterial alpha diversity indices in the OK lens group were not different from those in the non-wearer group (P > 0.05, Wilcoxon test), while beta diversity examined using principle coordinate analysis of unweighted UniFrac divided the two groups into different clusters. Proteobacteria, Bacteroidetes, and Firmicutes were the abundant phyla in the conjunctival sac microbiota in both groups (P < 0.05, Mann-Whitney U test). Among children in the OK lens group, the Linear discriminant analysis Effect Size identified the compositional changes in OK lens-associated bacteria. Key functional genera such as Blautia, Parasutterella, and Muribaculum were enriched, whereas Brevundimonas, Acinetobacter, Proteus, and Agathobacter decreased significantly (P < 0.05, Mann-Whitney U test). Phylogenetic investigation of communities by reconstruction of unobserved states also showed altered bacterial metabolic pathways in OK lens-associated microbiota. Moreover, using receiver operating characteristic curves, Brevundimonas, Acinetobacter, Proteus, and Agathobacter alone (the area under the curve was all > 0.7500) or in combination (the area under the curve was 0.9058) were revealed to discriminate OK lens wearers from controls. CONCLUSIONS The relative abundance of the microbial community in the conjunctival sac of myopic children can alter after OK lens wear. Brevundimonas, Acinetobacter, Proteus, and Agathobacter may be candidate biomarkers to distinguish between OK lens wearers and non-wearers.
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Affiliation(s)
- Ju Zhang
- Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
- Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), 372 Jingsi Road, Jinan, 250021, China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Qingdao, China
| | - Xiuhai Lu
- Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), 372 Jingsi Road, Jinan, 250021, China
| | - Zhiwei Cheng
- Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), 372 Jingsi Road, Jinan, 250021, China
| | - Dulei Zou
- Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), 372 Jingsi Road, Jinan, 250021, China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Qingdao, China
- Medical College, Qingdao University, Qingdao, China
| | - Weiyun Shi
- Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), 372 Jingsi Road, Jinan, 250021, China.
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Qingdao, China.
| | - Ting Wang
- Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), 372 Jingsi Road, Jinan, 250021, China.
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Qingdao, China.
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Hansen NC, Hvid-Hansen A, Møller F, Bek T, Larsen DA, Jacobsen N, Kessel L. Safety and efficacy of 0.01% and 0.1% low-dose atropine eye drop regimens for reduction of myopia progression in Danish children: a randomized clinical trial examining one-year effect and safety. BMC Ophthalmol 2023; 23:438. [PMID: 37904082 PMCID: PMC10614417 DOI: 10.1186/s12886-023-03177-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 10/14/2023] [Indexed: 11/01/2023] Open
Abstract
BACKGROUND To investigate the efficacy and safety of 0.1% and 0.01% low-dose atropine eye drops in reducing myopia progression in Danish children. METHODS Investigator-initiated, placebo-controlled, double-masked, randomized clinical trial. Ninety-seven six- to twelve-year old myopic participants were randomized to 0.1% loading dose for six months followed by 0.01% for six months (loading dose group, Number (N) = 33), 0.01% for twelve months (0.01% group, N = 32) or vehicle for twelve months (placebo, N = 32). Primary outcomes were axial length and spherical equivalent refraction. Secondary outcomes included adverse events and reactions, choroidal thickness and ocular biometry. Outcomes were measured at baseline and three-month intervals. Data was analyzed with linear-mixed model analysis according to intention-to-treat. RESULTS Mean axial elongation was 0.10 mm less (95% confidence interval (CI): 0.17; 0.02, adjusted-p = 0.06) in the 0.1% loading dose and 0.07 mm less (95% CI: 0.15; 0.00, adjusted-p = 0.16) in the 0.01% group at twelve months compared to placebo. Mean spherical equivalent refraction progression was 0.24 D (95% CI: 0.05; 0.42) less in the loading dose and 0.19 D (95% CI: 0.00; 0.38) less in the 0.01% groups at twelve months, compared to placebo (adjusted-p = 0.06 and 0.14, respectively). A total of 108 adverse events were reported during the initial six-month loading dose period, primarily in the loading dose group, and 14 were reported in the six months following dose switching, all deemed mild except two serious adverse events, unrelated to the intervention. CONCLUSIONS Low-dose atropine eye drops are safe over twelve months in otherwise healthy children. There may be a modest but clinically relevant reduction in myopia progression in Danish children after twelve months treatment, but the effect was statistically non-significant after multiple comparisons adjustment. After dose-switching at six months the loading dose group approached the 0.01% group, potentially indicating an early "rebound-effect". TRIAL REGISTRATION this study was registered in the European Clinical Trials Database (EudraCT, number: 2018-001286-16) 05/11/2018 and first posted at www. CLINICALTRIALS gov (NCT03911271) 11/04/2019, prior to initiation.
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Affiliation(s)
- Niklas Cyril Hansen
- Department of Ophthalmology, Copenhagen University Hospital - Rigshospitalet-Glostrup, Valdemar Hansens Vej 1-23, DK-2600, Glostrup, Denmark.
| | - Anders Hvid-Hansen
- Department of Ophthalmology, Copenhagen University Hospital - Rigshospitalet-Glostrup, Valdemar Hansens Vej 1-23, DK-2600, Glostrup, Denmark
| | - Flemming Møller
- Department of Ophthalmology, University Hospital of Southern Denmark - Vejle Hospital, Beriderbakken 4, DK-7100, Vejle, Denmark
| | - Toke Bek
- Department of Ophthalmology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 167, DK-8200, Aarhus, Denmark
| | - Dorte Ancher Larsen
- Department of Ophthalmology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 167, DK-8200, Aarhus, Denmark
| | - Nina Jacobsen
- Department of Ophthalmology, Copenhagen University Hospital - Rigshospitalet-Glostrup, Valdemar Hansens Vej 1-23, DK-2600, Glostrup, Denmark
| | - Line Kessel
- Department of Ophthalmology, Copenhagen University Hospital - Rigshospitalet-Glostrup, Valdemar Hansens Vej 1-23, DK-2600, Glostrup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3b 33.5, DK-2200, Copenhagen, Denmark
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21
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Bullimore MA, Liu M. Efficacy of the Euclid orthokeratology lens in slowing axial elongation. Cont Lens Anterior Eye 2023; 46:101875. [PMID: 37365049 DOI: 10.1016/j.clae.2023.101875] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 06/19/2023] [Indexed: 06/28/2023]
Abstract
PURPOSE The Euclid Emerald lens designs for orthokeratology have been available in global markets for over 20 years and is used extensively by clinicians for slowing myopia progression in children. This paper comprehensively reviews data from published studies of the efficacy of this lens. METHODS A comprehensive systematic search was performed in March 2023 using Medline with the following search terms: orthokeratology AND myopi* AND (axial or elong*) NOT (review or meta). RESULTS The original search identified 189 articles, of which 140 reported axial elongation. Of those, 49 reported data on the Euclid Emerald design. Unique axial elongation data could be extracted from 37 papers-14 of which included an untreated control group. Among these, the mean 12-month efficacy-the difference in axial elongation between orthokeratology wearers and controls-was 0.18 mm (range: 0.05-0.29 mm), and the mean 24-month efficacy was 0.28 mm (range: 0.17-0.38 mm). The orthokeratology wearers in 23 studies without an untreated comparison group showed similar axial elongation to those in the 14 studies with a control group. For example, the mean 12-month axial elongation for the studies with controls was 0.20 ± 0.06 mm compared with 0.20 ± 0.07 mm for the studies without controls. CONCLUSIONS This extensive body of literature on a single device for myopia control is unique and demonstrates the efficacy of this design in slowing axial elongation in myopic children.
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Affiliation(s)
- Mark A Bullimore
- University of Houston, College of Optometry, 4901 Calhoun Rd., Houston, TX 77204, United States.
| | - Maria Liu
- Herbert Wertheim School of Optometry and Vision Science, University of California, Berkeley, Berkeley, CA 94720, United States.
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22
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Zadnik K, Schulman E, Flitcroft I, Fogt JS, Blumenfeld LC, Fong TM, Lang E, Hemmati HD, Chandler SP. Efficacy and Safety of 0.01% and 0.02% Atropine for the Treatment of Pediatric Myopia Progression Over 3 Years: A Randomized Clinical Trial. JAMA Ophthalmol 2023; 141:990-999. [PMID: 37261839 PMCID: PMC10236322 DOI: 10.1001/jamaophthalmol.2023.2097] [Citation(s) in RCA: 58] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 03/30/2023] [Indexed: 06/02/2023]
Abstract
Importance The global prevalence of myopia is predicted to approach 50% by 2050, increasing the risk of visual impairment later in life. No pharmacologic therapy is approved for treating childhood myopia progression. Objective To assess the safety and efficacy of NVK002 (Vyluma), a novel, preservative-free, 0.01% and 0.02% low-dose atropine formulation for treating myopia progression. Design, Setting, and Participants This was a double-masked, placebo-controlled, parallel-group, randomized phase 3 clinical trial conducted from November 20, 2017, through August 22, 2022, of placebo vs low-dose atropine, 0.01% and 0.02% (2:2:3 ratio). Participants were recruited from 26 clinical sites in North America and 5 countries in Europe. Enrolled participants were 3 to 16 years of age with -0.50 diopter (D) to -6.00 D spherical equivalent refractive error (SER) and no worse than -1.50 D astigmatism. Interventions Once-daily placebo, low-dose atropine, 0.01%, or low-dose atropine, 0.02%, eye drops for 36 months. Main Outcomes and Measures The primary, prespecified end point was the proportion of participants' eyes responding to 0.02% atropine vs placebo therapy (<0.50 D myopia progression at 36 months [responder analysis]). Secondary efficacy end points included responder analysis for atropine, 0.01%, and mean change from baseline in SER and axial length at month 36 in a modified intention-to-treat population (mITT; participants 6-10 years of age at baseline). Safety measurements for treated participants (3-16 years of age) were reported. Results A total of 576 participants were randomly assigned to treatment groups. Of these, 573 participants (99.5%; mean [SD] age, 8.9 [2.0] years; 315 female [54.7%]) received trial treatment (3 participants who were randomized did not receive trial drug) and were included in the safety set. The 489 participants (84.9%) who were 6 to 10 years of age at randomization composed the mITT set. At month 36, compared with placebo, low-dose atropine, 0.02%, did not significantly increase the responder proportion (odds ratio [OR], 1.77; 95% CI, 0.50-6.26; P = .37) or slow mean SER progression (least squares mean [LSM] difference, 0.10 D; 95% CI, -0.02 D to 0.22 D; P = .10) but did slow mean axial elongation (LSM difference, -0.08 mm; 95% CI, -0.13 mm to -0.02 mm; P = .005); however, at month 36, compared with placebo, low-dose atropine, 0.01%, significantly increased the responder proportion (OR, 4.54; 95% CI, 1.15-17.97; P = .03), slowed mean SER progression (LSM difference, 0.24 D; 95% CI, 0.11 D-0.37 D; P < .001), and slowed axial elongation (LSM difference, -0.13 mm; 95% CI, -0.19 mm to -0.07 mm; P < .001). There were no serious ocular adverse events and few serious nonocular events; none was judged as associated with atropine. Conclusions and Relevance This randomized clinical trial found that 0.02% atropine did not significantly increase the proportion of participants' eyes responding to therapy but suggested efficacy for 0.01% atropine across all 3 main end points compared with placebo. The efficacy and safety observed suggest that low-dose atropine may provide a treatment option for childhood myopia progression. Trial Registration ClinicalTrials.gov Identifier: NCT03350620.
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Affiliation(s)
- Karla Zadnik
- The Ohio State University College of Optometry, Columbus
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23
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Singh V, Lallu J, Ramachandran N, Kim BZ, McKelvie J. Orthokeratology-related Acanthamoeba keratitis in a 13-year-old. Clin Exp Optom 2023; 106:800-802. [PMID: 35999057 DOI: 10.1080/08164622.2022.2111203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 07/15/2022] [Accepted: 08/04/2022] [Indexed: 10/15/2022] Open
Affiliation(s)
- Vidit Singh
- Department of Ophthalmology, Waikato DHB Hospital, Hamilton, New Zealand
| | - Jagrut Lallu
- Department of Optometry, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Department of Optometry, School of Medicine, Faculty of Health, Deakin University, Geelong, Australia
| | | | - Bia Z Kim
- Department of Ophthalmology, Waikato DHB Hospital, Hamilton, New Zealand
| | - James McKelvie
- Department of Ophthalmology, Waikato DHB Hospital, Hamilton, New Zealand
- Department of Ophthalmology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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24
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Tariq F, Mobeen R, Wang X, Lin X, Bao Q, Liu J, Gao H. Advances in myopia prevention strategies for school-aged children: a comprehensive review. Front Public Health 2023; 11:1226438. [PMID: 37655278 PMCID: PMC10466414 DOI: 10.3389/fpubh.2023.1226438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 07/24/2023] [Indexed: 09/02/2023] Open
Abstract
Myopia has significantly risen in East and Southeast Asia, and the pathological outcomes of this condition, such as myopic maculopathy and optic neuropathy linked to high myopia, have emerged as leading causes of irreversible vision loss. Addressing this issue requires strategies to reduce myopia prevalence and prevent progression to high myopia. Encouraging outdoor activities for schoolchildren and reducing near-work and screen time can effectively prevent myopia development, offering a safe intervention that promotes healthier habits. Several clinical approaches can be employed to decelerate myopia progression, such as administering low-dose atropine eye drops (0.05%), utilizing orthokeratology lenses, implementing soft contact lenses equipped with myopia control features, and incorporating spectacle lenses with aspherical lenslets. When choosing an appropriate strategy, factors such as age, ethnicity, and the rate of myopia progression should be considered. However, some treatments may encounter obstacles such as adverse side effects, high costs, complex procedures, or limited effectiveness. Presently, low-dose atropine (0.05%), soft contact lenses with myopia control features, and orthokeratology lenses appear as promising options for managing myopia. The measures mentioned above are not necessarily mutually exclusive, and researchers are increasingly exploring their combined effects. By advocating for a personalized approach based on individual risk factors and the unique needs of each child, this review aims to contribute to the development of targeted and effective myopia prevention strategies, thereby minimizing the impact of myopia and its related complications among school-aged children in affected regions.
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Affiliation(s)
- Farheen Tariq
- Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
- Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), Jinan, China
- School of Ophthalmology, Shandong First Medical University, Jinan, China
| | - Rabia Mobeen
- School of Optometry and Vision Science, UNSW Sydney, Sydney, NSW, Australia
| | - Xinhai Wang
- Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), Jinan, China
- School of Ophthalmology, Shandong First Medical University, Jinan, China
| | - Xiao Lin
- Shandong University of Traditional Chinese Medicine, Affiliated Eye Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Qingdong Bao
- Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), Jinan, China
- School of Ophthalmology, Shandong First Medical University, Jinan, China
| | - Jinhui Liu
- Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), Jinan, China
- School of Ophthalmology, Shandong First Medical University, Jinan, China
| | - Hua Gao
- Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), Jinan, China
- School of Ophthalmology, Shandong First Medical University, Jinan, China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Eye Institute of Shandong First Medical University, Qingdao, China
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25
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Jones L, Efron N, Bandamwar K, Barnett M, Jacobs DS, Jalbert I, Pult H, Rhee MK, Sheardown H, Shovlin JP, Stahl U, Stanila A, Tan J, Tavazzi S, Ucakhan OO, Willcox MDP, Downie LE. TFOS Lifestyle: Impact of contact lenses on the ocular surface. Ocul Surf 2023; 29:175-219. [PMID: 37149139 DOI: 10.1016/j.jtos.2023.04.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 04/10/2023] [Indexed: 05/08/2023]
Abstract
Several lifestyle choices made by contact lens wearers can have adverse consequences on ocular health. These include being non-adherent to contact lens care, sleeping in lenses, ill-advised purchasing options, not seeing an eyecare professional for regular aftercare visits, wearing lenses when feeling unwell, wearing lenses too soon after various forms of ophthalmic surgery, and wearing lenses when engaged in risky behaviors (e.g., when using tobacco, alcohol or recreational drugs). Those with a pre-existing compromised ocular surface may find that contact lens wear exacerbates ocular disease morbidity. Conversely, contact lenses may have various therapeutic benefits. The coronavirus disease-2019 (COVID-19) pandemic impinged upon the lifestyle of contact lens wearers, introducing challenges such as mask-associated dry eye, contact lens discomfort with increased use of digital devices, inadvertent exposure to hand sanitizers, and reduced use of lenses. Wearing contact lenses in challenging environments, such as in the presence of dust and noxious chemicals, or where there is the possibility of ocular trauma (e.g., sport or working with tools) can be problematic, although in some instances lenses can be protective. Contact lenses can be worn for sport, theatre, at high altitude, driving at night, in the military and in space, and special considerations are required when prescribing in such situations to ensure successful outcomes. A systematic review and meta-analysis, incorporated within the review, identified that the influence of lifestyle factors on soft contact lens dropout remains poorly understood, and is an area in need of further research. Overall, this report investigated lifestyle-related choices made by clinicians and contact lens wearers and discovered that when appropriate lifestyle choices are made, contact lens wear can enhance the quality of life of wearers.
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Affiliation(s)
- Lyndon Jones
- Centre for Ocular Research & Education (CORE), School of Optometry and Vision Science, University of Waterloo, Waterloo, ON, Canada.
| | - Nathan Efron
- School of Optometry and Vision Science, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Kalika Bandamwar
- Department of Ophthalmology, New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand
| | - Melissa Barnett
- University of California, Davis Eye Center, Sacramento, CA, USA
| | - Deborah S Jacobs
- Massachusetts Eye & Ear, Harvard Medical School, Boston, MA, USA
| | - Isabelle Jalbert
- School of Optometry and Vision Science, UNSW Sydney, NSW, Australia
| | - Heiko Pult
- Dr Heiko Pult Optometry & Vision Research, Weinheim, Germany
| | | | - Heather Sheardown
- Department of Chemical Engineering, McMaster University, Hamilton, Ontario, Canada
| | | | - Ulli Stahl
- Centre for Ocular Research & Education (CORE), School of Optometry and Vision Science, University of Waterloo, Waterloo, ON, Canada
| | | | - Jacqueline Tan
- School of Optometry and Vision Science, UNSW Sydney, NSW, Australia
| | - Silvia Tavazzi
- Department of Materials Science, University of Milano-Bicocca, Milan, Italy
| | | | - Mark D P Willcox
- School of Optometry and Vision Science, UNSW Sydney, NSW, Australia
| | - Laura E Downie
- Department of Optometry and Vision Sciences, The University of Melbourne, Parkville, Victoria, Australia
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26
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Sankaridurg P, Berntsen DA, Bullimore MA, Cho P, Flitcroft I, Gawne TJ, Gifford KL, Jong M, Kang P, Ostrin LA, Santodomingo-Rubido J, Wildsoet C, Wolffsohn JS. IMI 2023 Digest. Invest Ophthalmol Vis Sci 2023; 64:7. [PMID: 37126356 PMCID: PMC10155872 DOI: 10.1167/iovs.64.6.7] [Citation(s) in RCA: 47] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
Abstract
Myopia is a dynamic and rapidly moving field, with ongoing research providing a better understanding of the etiology leading to novel myopia control strategies. In 2019, the International Myopia Institute (IMI) assembled and published a series of white papers across relevant topics and updated the evidence with a digest in 2021. Here, we summarize findings across key topics from the previous 2 years. Studies in animal models have continued to explore how wavelength and intensity of light influence eye growth and have examined new pharmacologic agents and scleral cross-linking as potential strategies for slowing myopia. In children, the term premyopia is gaining interest with increased attention to early implementation of myopia control. Most studies use the IMI definitions of ≤-0.5 diopters (D) for myopia and ≤-6.0 D for high myopia, although categorization and definitions for structural consequences of high myopia remain an issue. Clinical trials have demonstrated that newer spectacle lens designs incorporating multiple segments, lenslets, or diffusion optics exhibit good efficacy. Clinical considerations and factors influencing efficacy for soft multifocal contact lenses and orthokeratology are discussed. Topical atropine remains the only widely accessible pharmacologic treatment. Rebound observed with higher concentration of atropine is not evident with lower concentrations or optical interventions. Overall, myopia control treatments show little adverse effect on visual function and appear generally safe, with longer wear times and combination therapies maximizing outcomes. An emerging category of light-based therapies for children requires comprehensive safety data to enable risk versus benefit analysis. Given the success of myopia control strategies, the ethics of including a control arm in clinical trials is heavily debated. IMI recommendations for clinical trial protocols are discussed.
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Affiliation(s)
- Padmaja Sankaridurg
- Brien Holden Vision Institute, Sydney, Australia
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - David A Berntsen
- University of Houston, College of Optometry, Houston, Texas, United States
| | - Mark A Bullimore
- University of Houston, College of Optometry, Houston, Texas, United States
| | - Pauline Cho
- West China Hospital, Sichuan University, Sichuan, China
- Eye & ENT Hospital of Fudan University, Shanghai, China
- Affiliated Eye Hospital of Wenzhou Medical University, Wenzhou, China
| | - Ian Flitcroft
- Centre for Eye Research Ireland, School of Physics and Clinical and Optometric Sciences, Technological University Dublin, Dublin, Ireland
- Department of Ophthalmology, Children's Health Ireland at Temple Street Hospital, Dublin, Ireland
| | - Timothy J Gawne
- Department of Optometry and Vision Science, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Kate L Gifford
- Queensland University of Technology, Brisbane, Australia
| | - Monica Jong
- Johnson & Johnson Vision, Jacksonville, Florida, United States
| | - Pauline Kang
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Lisa A Ostrin
- University of Houston, College of Optometry, Houston, Texas, United States
| | | | - Christine Wildsoet
- UC Berkeley Wertheim School Optometry & Vision Science, Berkeley, California, United States
| | - James S Wolffsohn
- College of Health & Life Sciences, Aston University, Birmingham, United Kingdom
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27
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Bullimore MA, Richdale K. Incidence of Corneal Adverse Events in Children Wearing Soft Contact Lenses. Eye Contact Lens 2023; 49:204-211. [PMID: 36877990 PMCID: PMC10503544 DOI: 10.1097/icl.0000000000000976] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2023] [Indexed: 03/08/2023]
Abstract
OBJECTIVES There is increasing interest in fitting children with soft contact lenses, in part due to the increase in prescribing of designs to slow the progression of myopia. This literature review summarizes large prospective and retrospective studies that include data on the incidence of microbial keratitis and corneal infiltrative events (CIEs) in children wearing soft contact lenses. METHODS Peer-reviewed prospective and retrospective studies that report contact lens-related complications in children with at least one year of wear and at least 100 patient years of wear were identified. RESULTS Seven prospective studies published between 2004 and 2022 were identified representing 3,752 patient years of wear in 1,756 children, nearly all of whom were fitted at age 12 years or younger. Collectively, they report one case of microbial keratitis and 53 CIEs, of which 16 were classified as symptomatic. The overall incidence of microbial keratitis was 2.7 per 10,000 patient years (95% CI: 0.5-15), and the incidence of symptomatic CIEs was 42 per 10,000 patient years (95% CI: 26-69). Two retrospective studies were identified representing 2,545 patient years of wear in 1,025 children, fitted at age 12 years or younger. One study reports two cases of microbial keratitis giving an incidence of 9.4 per 10,000 patient years (95% CI: 0.5-15). CONCLUSIONS Accurate classification of CIEs is challenging, particularly in retrospective studies. The incidence of microbial keratitis in children wearing soft lenses is no higher than in adults, and the incidence of CIEs seems to be markedly lower.
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Choi KY, Cheung JKW, Wong GTK, Li PH, Chan SSH, Lam TC, Chan HHL. Myopia Control Efficacy and Long-Term Safety of a Novel Orthokeratology Lens (MESOK Study)-A Randomized Controlled Clinical Trial Combining Clinical and Tear Proteomics Data. J Clin Med 2023; 12:jcm12093210. [PMID: 37176650 PMCID: PMC10179394 DOI: 10.3390/jcm12093210] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 03/31/2023] [Accepted: 04/28/2023] [Indexed: 05/15/2023] Open
Abstract
Myopia control efficacy and long-term safety of the Breath-O-Correct orthokeratology (OK) lens was evaluated in a 2-year randomized, single vision (SV) spectacle lens-controlled, single-blind clinical trial combining clinical and tear proteomics data. A total of 71 children (43 OK, 9.8 ± 1.3 years; 28 SV, 9.5 ± 1.4 years) completed the 2-year study. Axial length (AL), cycloplegic refraction, clinical safety parameters (best-corrected visual acuity, central cornea thickness, corneal endothelial health, ocular surface disease index), and quantitative tear proteomics were evaluated by masked examiners. Mean 2-year-normalized AL elongations in the OK and SV groups differed significantly (p = 0.03) and were 0.37 ± 0.37 mm and 0.60 ± 0.41 mm, respectively. OK-mediated myopia control efficacy was 37.1%. No significant difference was found in clinical safety parameters of both groups (p > 0.10), except for a thinner central corneal thickness in the OK group (p = 0.01). Proteomics revealed modest OK lens-mediated effects on immune response proteins, including an increased abundance of haptoglobin at 6 and 12 months and a decreased abundance of two proteins (neutrophil defensin 3 and histone 4) at 6 months. The changes were further validated using a high-resolution multiple-reaction monitoring (MRMHR) mass spectrometry. In summary, the Breath-O-Correct OK lens significantly reduced AL elongation in schoolchildren without adverse clinical effects or subclinical inflammatory responses.
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Affiliation(s)
- Kai Yip Choi
- Centre for Myopia Research, School of Optometry, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Jimmy K W Cheung
- Centre for Eye and Vision Research (CEVR), 17W Hong Kong Science Park, Hong Kong SAR, China
| | - Gigi T K Wong
- Centre for Myopia Research, School of Optometry, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Peter H Li
- Centre for Eye and Vision Research (CEVR), 17W Hong Kong Science Park, Hong Kong SAR, China
| | - Sonia S H Chan
- Centre for Myopia Research, School of Optometry, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Thomas C Lam
- Centre for Myopia Research, School of Optometry, The Hong Kong Polytechnic University, Hong Kong SAR, China
- Centre for Eye and Vision Research (CEVR), 17W Hong Kong Science Park, Hong Kong SAR, China
- Research Centre for SHARP Vision (RCSV), The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Henry H L Chan
- Centre for Myopia Research, School of Optometry, The Hong Kong Polytechnic University, Hong Kong SAR, China
- Centre for Eye and Vision Research (CEVR), 17W Hong Kong Science Park, Hong Kong SAR, China
- Research Centre for SHARP Vision (RCSV), The Hong Kong Polytechnic University, Hong Kong SAR, China
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Lattery LJ, Chao C, Walline JJ, Bullimore MA, Ritchey ER, Skidmore K, Richdale K. Patient and parent perceptions of myopia modalities. Cont Lens Anterior Eye 2023; 46:101772. [PMID: 39101460 DOI: 10.1016/j.clae.2022.101772] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 09/15/2022] [Accepted: 10/18/2022] [Indexed: 11/22/2022]
Abstract
PURPOSE This study compared quality of life (QoL) of myopic adults and children who were established spectacle, soft contact lens (SCL), or orthokeratology (OK) wearers as well as parent/child responses using Pediatric Refractive Error Profile 2 (PREP2). METHODS Forty-eight adults (aged 18-26 years), 49 children (aged 9-17 years), and the children's parent, completed PREP2, with 7 subscales (symptoms, vision, activities, appearance, peer perception, handling, and overall). Adults and children must have worn their correction for at least three years. Parents were asked to answer how they thought their child would answer. Scores were compared between age groups, among correction groups, and between children and their parents using non-parametric ANOVA, Mann-Whitney U and Wilcoxon Signed-Rank tests, as appropriate. Post-hoc pairwise comparisons among correction groups were conducted with Bonferroni adjustment. RESULTS Average age of adults was 22 ± 2 and children was 14 ± 2 years, and duration of correction use was 8 ± 3 for adults and 5 ± 2 years for children (both p < 0.01). Adult OK wearers were more satisfied with vision (p = 0.04), activities (p < 0.001) and overall (p = 0.03) compared to spectacle wearers. Children OK wearers reported higher scores for activities than SCL (p = 0.048) and spectacle wearers (p < 0.001). Parents of contact lens wearers reported higher perceived QoL for activities (OK p < 0.001; SCL p = 0.02), handling (OK p = 0.02; SCL p < 0.001), appearance (SCL p = 0.001), and overall (OK p = 0.001; SCL p < 0.001) subscales than parents of child spectacle wearers. CONCLUSION Activity-driven children and adults perceive significant benefits from OK over spectacles. Parents' perceptions did not align with their children's perceptions of their correction.
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Affiliation(s)
- Lauren J Lattery
- University of Houston College of Optometry, Houston, TX, United States
| | - Cecilia Chao
- University of Houston College of Optometry, Houston, TX, United States; School of Optometry and Vision Science, University of New South Wales Sydney, Australia
| | - Jeffrey J Walline
- The Ohio State University College of Optometry, Columbus, OH, United States
| | - Mark A Bullimore
- University of Houston College of Optometry, Houston, TX, United States
| | - Eric R Ritchey
- University of Houston College of Optometry, Houston, TX, United States
| | - Kelsea Skidmore
- University of Houston College of Optometry, Houston, TX, United States
| | - Kathryn Richdale
- University of Houston College of Optometry, Houston, TX, United States.
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Lawrenson JG, Shah R, Huntjens B, Downie LE, Virgili G, Dhakal R, Verkicharla PK, Li D, Mavi S, Kernohan A, Li T, Walline JJ. Interventions for myopia control in children: a living systematic review and network meta-analysis. Cochrane Database Syst Rev 2023; 2:CD014758. [PMID: 36809645 PMCID: PMC9933422 DOI: 10.1002/14651858.cd014758.pub2] [Citation(s) in RCA: 52] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
BACKGROUND Myopia is a common refractive error, where elongation of the eyeball causes distant objects to appear blurred. The increasing prevalence of myopia is a growing global public health problem, in terms of rates of uncorrected refractive error and significantly, an increased risk of visual impairment due to myopia-related ocular morbidity. Since myopia is usually detected in children before 10 years of age and can progress rapidly, interventions to slow its progression need to be delivered in childhood. OBJECTIVES To assess the comparative efficacy of optical, pharmacological and environmental interventions for slowing myopia progression in children using network meta-analysis (NMA). To generate a relative ranking of myopia control interventions according to their efficacy. To produce a brief economic commentary, summarising the economic evaluations assessing myopia control interventions in children. To maintain the currency of the evidence using a living systematic review approach. SEARCH METHODS: We searched CENTRAL (which contains the Cochrane Eyes and Vision Trials Register), MEDLINE; Embase; and three trials registers. The search date was 26 February 2022. SELECTION CRITERIA: We included randomised controlled trials (RCTs) of optical, pharmacological and environmental interventions for slowing myopia progression in children aged 18 years or younger. Critical outcomes were progression of myopia (defined as the difference in the change in spherical equivalent refraction (SER, dioptres (D)) and axial length (mm) in the intervention and control groups at one year or longer) and difference in the change in SER and axial length following cessation of treatment ('rebound'). DATA COLLECTION AND ANALYSIS: We followed standard Cochrane methods. We assessed bias using RoB 2 for parallel RCTs. We rated the certainty of evidence using the GRADE approach for the outcomes: change in SER and axial length at one and two years. Most comparisons were with inactive controls. MAIN RESULTS We included 64 studies that randomised 11,617 children, aged 4 to 18 years. Studies were mostly conducted in China or other Asian countries (39 studies, 60.9%) and North America (13 studies, 20.3%). Fifty-seven studies (89%) compared myopia control interventions (multifocal spectacles, peripheral plus spectacles (PPSL), undercorrected single vision spectacles (SVLs), multifocal soft contact lenses (MFSCL), orthokeratology, rigid gas-permeable contact lenses (RGP); or pharmacological interventions (including high- (HDA), moderate- (MDA) and low-dose (LDA) atropine, pirenzipine or 7-methylxanthine) against an inactive control. Study duration was 12 to 36 months. The overall certainty of the evidence ranged from very low to moderate. Since the networks in the NMA were poorly connected, most estimates versus control were as, or more, imprecise than the corresponding direct estimates. Consequently, we mostly report estimates based on direct (pairwise) comparisons below. At one year, in 38 studies (6525 participants analysed), the median change in SER for controls was -0.65 D. The following interventions may reduce SER progression compared to controls: HDA (mean difference (MD) 0.90 D, 95% confidence interval (CI) 0.62 to 1.18), MDA (MD 0.65 D, 95% CI 0.27 to 1.03), LDA (MD 0.38 D, 95% CI 0.10 to 0.66), pirenzipine (MD 0.32 D, 95% CI 0.15 to 0.49), MFSCL (MD 0.26 D, 95% CI 0.17 to 0.35), PPSLs (MD 0.51 D, 95% CI 0.19 to 0.82), and multifocal spectacles (MD 0.14 D, 95% CI 0.08 to 0.21). By contrast, there was little or no evidence that RGP (MD 0.02 D, 95% CI -0.05 to 0.10), 7-methylxanthine (MD 0.07 D, 95% CI -0.09 to 0.24) or undercorrected SVLs (MD -0.15 D, 95% CI -0.29 to 0.00) reduce progression. At two years, in 26 studies (4949 participants), the median change in SER for controls was -1.02 D. The following interventions may reduce SER progression compared to controls: HDA (MD 1.26 D, 95% CI 1.17 to 1.36), MDA (MD 0.45 D, 95% CI 0.08 to 0.83), LDA (MD 0.24 D, 95% CI 0.17 to 0.31), pirenzipine (MD 0.41 D, 95% CI 0.13 to 0.69), MFSCL (MD 0.30 D, 95% CI 0.19 to 0.41), and multifocal spectacles (MD 0.19 D, 95% CI 0.08 to 0.30). PPSLs (MD 0.34 D, 95% CI -0.08 to 0.76) may also reduce progression, but the results were inconsistent. For RGP, one study found a benefit and another found no difference with control. We found no difference in SER change for undercorrected SVLs (MD 0.02 D, 95% CI -0.05 to 0.09). At one year, in 36 studies (6263 participants), the median change in axial length for controls was 0.31 mm. The following interventions may reduce axial elongation compared to controls: HDA (MD -0.33 mm, 95% CI -0.35 to 0.30), MDA (MD -0.28 mm, 95% CI -0.38 to -0.17), LDA (MD -0.13 mm, 95% CI -0.21 to -0.05), orthokeratology (MD -0.19 mm, 95% CI -0.23 to -0.15), MFSCL (MD -0.11 mm, 95% CI -0.13 to -0.09), pirenzipine (MD -0.10 mm, 95% CI -0.18 to -0.02), PPSLs (MD -0.13 mm, 95% CI -0.24 to -0.03), and multifocal spectacles (MD -0.06 mm, 95% CI -0.09 to -0.04). We found little or no evidence that RGP (MD 0.02 mm, 95% CI -0.05 to 0.10), 7-methylxanthine (MD 0.03 mm, 95% CI -0.10 to 0.03) or undercorrected SVLs (MD 0.05 mm, 95% CI -0.01 to 0.11) reduce axial length. At two years, in 21 studies (4169 participants), the median change in axial length for controls was 0.56 mm. The following interventions may reduce axial elongation compared to controls: HDA (MD -0.47mm, 95% CI -0.61 to -0.34), MDA (MD -0.33 mm, 95% CI -0.46 to -0.20), orthokeratology (MD -0.28 mm, (95% CI -0.38 to -0.19), LDA (MD -0.16 mm, 95% CI -0.20 to -0.12), MFSCL (MD -0.15 mm, 95% CI -0.19 to -0.12), and multifocal spectacles (MD -0.07 mm, 95% CI -0.12 to -0.03). PPSL may reduce progression (MD -0.20 mm, 95% CI -0.45 to 0.05) but results were inconsistent. We found little or no evidence that undercorrected SVLs (MD -0.01 mm, 95% CI -0.06 to 0.03) or RGP (MD 0.03 mm, 95% CI -0.05 to 0.12) reduce axial length. There was inconclusive evidence on whether treatment cessation increases myopia progression. Adverse events and treatment adherence were not consistently reported, and only one study reported quality of life. No studies reported environmental interventions reporting progression in children with myopia, and no economic evaluations assessed interventions for myopia control in children. AUTHORS' CONCLUSIONS Studies mostly compared pharmacological and optical treatments to slow the progression of myopia with an inactive comparator. Effects at one year provided evidence that these interventions may slow refractive change and reduce axial elongation, although results were often heterogeneous. A smaller body of evidence is available at two or three years, and uncertainty remains about the sustained effect of these interventions. Longer-term and better-quality studies comparing myopia control interventions used alone or in combination are needed, and improved methods for monitoring and reporting adverse effects.
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Affiliation(s)
- John G Lawrenson
- Centre for Applied Vision Research, School of Health & Psychological Sciences , City, University of London, London, UK
| | - Rakhee Shah
- Centre for Applied Vision Research, School of Health & Psychological Sciences , City, University of London, London, UK
| | - Byki Huntjens
- Centre for Applied Vision Research, School of Health & Psychological Sciences , City, University of London, London, UK
| | - Laura E Downie
- Department of Optometry and Vision Sciences, The University of Melbourne, Melbourne, Australia
| | - Gianni Virgili
- Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Rohit Dhakal
- Myopia Research Lab, Prof. Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, India
| | - Pavan K Verkicharla
- Myopia Research Lab, Prof. Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, India
| | - Dongfeng Li
- Centre for Public Health, Queen's University Belfast, Belfast, UK
- Department of Ophthalmology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Sonia Mavi
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Ashleigh Kernohan
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Tianjing Li
- Department of Ophthalmology, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA
| | - Jeffrey J Walline
- College of Optometry, The Ohio State University, Columbus, Ohio, USA
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Defining Daily Disposable Contact Lens Wear in a Clinical Study. Optom Vis Sci 2023; 100:145-150. [PMID: 36728687 DOI: 10.1097/opx.0000000000001985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
SIGNIFICANCE The U.S. Food and Drug Administration regulates contact lenses as prescription medical devices and defines daily disposable lenses for single use; however, safety comparisons between daily disposable and reusable lenses rely on the lens-wearing regimen. When inappropriately discerned, studies may erroneously report replacement regimen, resulting in inaccurate risk rates. PURPOSE This study aimed to explore different measures for defining daily disposable wearers in the context of a clinical study. METHODS A secondary analysis of data from five multisite fieldings (n = 1059) from the Contact Lens Risk Survey was performed. Descriptive statistics were used to examine self-reported lens replacement, use of lens case, and manufacturer's recommended replacement frequency as defined by the participants' selection of their habitual lenses using a photographic aide. Daily disposable wearers were identified as reporting daily replacement (by self-report and lens identification) and not using a lens case. If there was a discrepancy among these three factors, the lens assignment was assessed as a majority response (two of three) or as missing if conflicting information was reported. RESULTS The cohort was approximately two-thirds (68.7%) female and ranged from 12 to 33 years of age. A total of 154 participants (14.5%) were classified as daily disposable wearers and 896 (84.6%) as reusable wearers. Congruence was observed among all three daily disposable assignment factors for only 106 wearers (68.8%). The greatest discrepancy among daily disposable wearers was the report of using a lens case (n = 32 [20.8%]). In contrast, reusable lens wearers were more likely to report agreement across all three factors (n = 798 [89.1%], P < .001). CONCLUSIONS This analysis suggests that the report of not using a lens case is a more conservative surrogate for true single-use lens wear, as one in five may be storing and reusing their daily disposable lenses.
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Santodomingo-Rubido J. Foreword - Orthokeratology for Myopia Control in everyday practice. Cont Lens Anterior Eye 2023; 46:101798. [PMID: 36539314 DOI: 10.1016/j.clae.2022.101798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Qin G, Chao C, Lattery LJ, Lin H, Fu W, Richdale K, Cai C. Tear proteomic analysis of young glasses, orthokeratology, and soft contact lens wearers. J Proteomics 2023; 270:104738. [PMID: 36191803 DOI: 10.1016/j.jprot.2022.104738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 09/01/2022] [Accepted: 09/06/2022] [Indexed: 02/01/2023]
Abstract
Contact lens-related ocular surface complications occur more often in teenagers and young adults. The purpose of this study was to determine changes in tear proteome of young patients wearing glasses (GL), orthokeratology lenses (OK), and soft contact lenses (SCL). Twenty-two young subjects (10-26 years of age) who were established GL, OK, and SCL wearers were recruited. Proteomic data were collected using a data-independent acquisition-parallel accumulation serial fragmentation workflow. In total, 3406 protein groups were identified, the highest number of proteins identified in Schirmer strip tears to date. Eight protein groups showed higher abundance, and 11 protein groups showed lower abundance in the SCL group compared to the OK group. In addition, the abundance of 82 proteins significantly differed in children compared to young adult GL wearers, among which 67 proteins were higher, and 15 proteins were lower in children. These 82 proteins were involved in inflammation, immune, and glycoprotein metabolic biological processes. In summary, this work identified over 3000 proteins in Schirmer Strip tears. The results indicated that tear proteomes were altered by orthokeratology and soft contact wear and age, which warrants further larger-scale study on the ocular surface responses of teenagers and young adults separately to contact lens wear. SIGNIFICANCE: In this work, we examined the tear proteomes of young patients wearing glasses, orthokeratology lenses, and soft contact lenses using a data-independent acquisition-parallel accumulation serial fragmentation (diaPASEF) workflow and identified 3406 protein groups in Schirmer strip tears. Nineteen protein groups showed significant abundance changes between orthokeratology and soft contact lens wearers. Moreover, eighty-two protein groups significantly differed in abundance in children and young adult glasses wearers. As a pilot study, this work provides a deep coverage of tear proteome and suggests the need to investigate ocular responses to contact lens wear separately for children and young adults.
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Affiliation(s)
- Guoting Qin
- College of Optometry, University of Houston, Houston, TX 77204, United States of America; Mass Spectrometry Laboratory, Department of Chemistry, University of Houston, Houston, TX 77204, United States of America.
| | - Cecilia Chao
- College of Optometry, University of Houston, Houston, TX 77204, United States of America; School of Optometry and Vision Science, University of New South Wales, Sydney, NSW 2023, Australia
| | - Lauren J Lattery
- College of Optometry, University of Houston, Houston, TX 77204, United States of America
| | - Hong Lin
- Department of Computer Science & Engineering Technology, University of Houston - Downtown, Houston, TX 77002, United States of America
| | - Wenjiang Fu
- Department of Mathematics, University of Houston, Houston, TX 77204, United States of America
| | - Kathryn Richdale
- College of Optometry, University of Houston, Houston, TX 77204, United States of America
| | - Chengzhi Cai
- Mass Spectrometry Laboratory, Department of Chemistry, University of Houston, Houston, TX 77204, United States of America.
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Abstract
ABSTRACT Contact lenses are a safe and effective method for correction of refractive error and worn by an estimated 45 million Americans. Because of the widespread availability and commercial popularity of contact lenses, it is not well appreciated by the public that contact lenses are U.S. Food and Drug Administration (FDA)-regulated medical devices. Contact lenses are marketed in numerous hard and soft materials that have been improved over decades, worn in daily or extended wear, and replaced in range of schedules from daily to yearly or longer. Lens materials and wear and care regimens have impact on the risks of contact lens-related corneal inflammatory events and microbial keratitis. This article reviews contact lens safety, with specific focus on the correction of refractive error in healthy eyes.
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Ma L, Xu M, Wang J, Niu X. Analysis of the Reasons for the Discontinuation of Orthokeratology Lens Use: A 4-Year Retrospective Study. Eye Contact Lens 2022; 48:335-339. [PMID: 35877184 PMCID: PMC9298146 DOI: 10.1097/icl.0000000000000910] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE Although orthokeratology has a positive effect on myopia control, some patients discontinue orthokeratology lens use. This study analyzed the data of all patients who had been fitted with an orthokeratology lens in the past 4 years and the reasons for discontinued lens use, with the aim of improving the prevention and control of myopia. METHODS This retrospective study analyzed the data of patients, aged 8 to 18 years, fitted with orthokeratology lenses from 2017 to 2020. The ametropic spherical lens powers ranged from -6.00 D to -0.75 D, and the cylindrical lens powers were all more than -1.50 D. The reasons for discontinuation of lens wear were analyzed and compared. The period of lens wear (median [range]) was 24 (13.5-34.5) months. RESULTS A total of 2,499 patients' files were retrieved. The duration of lens wear was 24 (13.5-34.5) months. A total of 50 patients discontinued lens use, including 25 patients (50.0%) who could not adhere to lens use for various reasons, nine patients (18.0%) with a short sleep time, eight patients (16.0%) with economic difficulties, and five patients (10.0%) who experienced a poor effect after wearing the lenses. Corneal infiltrates affected lens use in three patients (6.0%). In addition, 30 patients underwent surgical correction when they reached adulthood. CONCLUSION Although orthokeratology lenses are effective and safe, there are still a small number of patients who discontinued lens use for various reasons. Adherence and precautions should be emphasized during the process.
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Affiliation(s)
- Lina Ma
- Aier Eye Hospital of Wuhan University (L.M., M.X., J.W., X.N.), Wuhan, China; and Hanyang Aier Eye Hospital (L.M., M.X., X.N.), Wuhan, China
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Wu SY, Wang JH, Chiu CJ. Assessment of Satisfaction, Compliance and Side Effects among Long-Term Orthokeratology Wearers. J Clin Med 2022; 11:4126. [PMID: 35887890 PMCID: PMC9321806 DOI: 10.3390/jcm11144126] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 07/12/2022] [Accepted: 07/14/2022] [Indexed: 02/04/2023] Open
Abstract
Purpose: This study aims to assess the satisfaction, compliance, and side effects among the long-term orthokeratology (Ortho-K) users in a tertiary hospital in Taiwan and analyze the side effects and related risk factors. Methods: Children and their guardians were assessed using a structured and validated questionnaire inquiring about background information, wear and care behaviors, daily activities, satisfaction, and related concerns. Clinical information, including refractive data and side effects, was obtained through patient medical files. Results: Three hundred and five school-aged patients were enrolled, and the average age was 13.13 ± 3.39 years, with an average wearing period of 17.1 ± 8.1 months. Over 83% of the subjects had clear daytime vision all day, around 88% felt satisfied or very satisfied with the results, and 98% exhibited a willingness to continue wearing the Ortho-K lenses. Most guardians (83%) were pleased with the controlling effect of myopic progression. Initial spherical equivalent and regular cleaning of the lens protein significantly correlated with clear day vision. Wearing >6 days/week correlated with less risk of lens binding. Based on the questionnaire, the main reasons for using Ortho-K were effectiveness, safety, and practicality, while the major concerns were discomfort, harmful to the eyes, and no effect. Conclusion: With a comprehensive care program from practitioners and good compliance of users, Ortho-K could be the most effective and satisfactory option for myopic children in Taiwan.
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Affiliation(s)
- Shang-Yen Wu
- Department of Ophthalmology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970, Taiwan;
| | - Jen-Hung Wang
- Department of Medical Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970, Taiwan;
| | - Cheng-Jen Chiu
- Department of Ophthalmology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970, Taiwan;
- Department of Ophthalmology and Visual Science, Tzu Chi University, Hualien 970, Taiwan
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Yang B, Liu L, Cho P. Comparison of compliance with care procedures performed by orthokeratology wearers and their parents and factors affecting compliance. Ophthalmic Physiol Opt 2022; 42:1044-1061. [PMID: 35656798 DOI: 10.1111/opo.13009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 04/29/2022] [Accepted: 05/02/2022] [Indexed: 02/05/2023]
Abstract
PURPOSE To compare the levels of compliance with care routines of orthokeratology (ortho-k) wearers and their parents and to identify factors affecting compliance in a hospital setting in Chengdu, China. METHODS Patients who had worn ortho-k lenses for at least one month were invited to participate in a survey on compliance. Wearers or their parents were required to complete a questionnaire to determine their compliance with hand hygiene, ortho-k lenses and accessory care procedures. RESULTS A total of 200 wearers, 78 male wearers and 122 female wearers, median age 12 (range 8-18) years were enrolled. Except for use of lens solution, the percentage of participants reporting total compliance with all procedures did not differ significantly between lens wearers and their parents. However, compliance for some items was significantly higher when performed by parents p < 0.001-0.01). 'Eye care practitioner provided instructions' was a significant protective factor for most procedures (p < 0.001-0.04). Age and sex were significant risk factors for some items (p < 0.001-0.04; p = 0.03-0.04, respectively), with girls having higher compliance than boys. 'Parental supervision' was a significant protective factor for some items (p = 0.02-0.04) when wearers performed the procedures themselves. When parents performed lens care procedures, only 'eye care practitioner provided instructions' was a significant variable (p = 0.001-0.04). CONCLUSION Some degree of non-compliance was noted in the majority of ortho-k wearers, particularly for the care of the lens case and suction holder. Compliance with care of some items was higher when performed by parents. Regular reinforcement of care procedures by practitioners is important, especially for older and male lens wearers. Parental supervision is necessary when children perform lens care procedures themselves, even for older wearers.
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Affiliation(s)
- Bi Yang
- Department of Optometry and Vision Sciences, West China School of Medicine, Sichuan University, Sichuan, China.,Laboratory of Optometry and Vision Sciences, West China Hospital, Sichuan University, Sichuan, China
| | - Longqian Liu
- Department of Optometry and Vision Sciences, West China School of Medicine, Sichuan University, Sichuan, China.,Laboratory of Optometry and Vision Sciences, West China Hospital, Sichuan University, Sichuan, China
| | - Pauline Cho
- School of Optometry, The Hong Kong Polytechnic University, Hong Kong, China
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Fitting of Orthokeratology in the United States: A Survey of the Current State of Orthokeratology. Optom Vis Sci 2022; 99:568-579. [PMID: 35657355 DOI: 10.1097/opx.0000000000001911] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
SIGNIFICANCE The Fitting of Orthokeratology in the United States (FOKUS) survey provides information about the United States (US) OrthoK market. This independent survey is the first to attain detailed assessment of the OrthoK market. PURPOSE Develop and administer a survey to eye care providers (ECP's) in the US who are managing orthokeratology patients and those who are not to determine a profile of prescribers, patients and overall market. METHODS The FOKUS survey was administered and distributed online. Outcome measures of the FOKUS survey involved general categories of 1) practice and practitioner profiles, 2) clinical prescribing patterns, 3) patient profile, 4) products and marketing, 5) fees and 6) market size and growth. RESULTS The number of ECP's who are actively fitting and managing OrthoK patients in the US is approximately 3,000. 545 responded to the survey, 283 reported they were actively fitting orthokeratology. Orthokeratology is prescribed with the intent of managing myopia by 68% of respondents, 53% monitor axial length, and 61% start OrthoK patients at age 13 years old or under. The mean number of years a patient wears OrthoK is 7.8. A commonly reported complication with orthokeratology is corneal staining. Microbial keratitis (MK) is rarely or never seen by 86% of respondents. Of those currently fitting, 56% anticipate growth of orthokeratology fitting over the next twelve months. Of those not currently fitting orthokeratology, 46% plan to start within two years. CONCLUSIONS Orthokeratology represents a small but growing segment of the US contact lens market. The number of practitioners actively prescribing and fitting orthokeratology in the US is approximately 3,000 with high potential for growth within the next two years. Results of the FOKUS survey are relevant to practitioners currently fitting or considering orthokeratology, manufacturers, educators and researchers as baseline for future orthokeratology market assessment.
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Cardona G, Alonso S, Yela S. Compliance versus Risk Awareness with Contact Lens Storage Case Hygiene and Replacement. Optom Vis Sci 2022; 99:449-454. [PMID: 35165235 DOI: 10.1097/opx.0000000000001881] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
SIGNIFICANCE Compliance with hygiene and replacement of contact lens (CL) storage cases is key to avoid CL contamination and anterior ocular surface complications. However, compliance levels with these accessories remain low, even in patients with awareness of the risk associated with noncompliance. PURPOSE This study aimed to determine level of compliance with common practices regarding CL storage case hygiene and replacement, type of information provided by practitioners, and risk perception. METHODS An ad hoc self-reported survey was used to collect demographic and CL wear details, compliance with storage case care, type of received information, and risk perception (in a 1-to-5 scale). Inferential statistics explored the relationship of demographic details and type of received information with compliance and risk perception. RESULTS Nondaily disposable wearing participants returned 299 completed surveys, with a median age of 24 years (76.9% females). Monthly replacement silicone hydrogel CLs and multipurpose solutions were predominant. Self-reported compliance with storage case care was poor, with 19.1% of respondents never cleaning their cases, 68.6% exposing them to tap water, and 26.4% failing to replace them within 6 months of acquisition. Two-thirds of respondents received specific information on case maintenance, mainly in oral form. Perceived risk associated with poor-compliance practices was high (median values of 4 and 5), and increased with educational level (P = .02, regarding handwashing; P = .03, regarding case hygiene), with years of CL wear experience (P < .001, regarding handwashing), in those patients provided with specific information on CL case care (P = .01, regarding case replacement). CONCLUSIONS Compliance with CL storage case hygiene and replacement was generally poor, although awareness of risk associated with noncompliance was high and influenced by factors related to demographic details, CL experience, and patient-practitioner communication. Strategies must be explored to increase risk awareness through education because this may lead to better compliance practices.
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Affiliation(s)
| | - Silvia Alonso
- Department of Optics and Optometry, Universitat Politècnica de Catalunya, Terrassa, Spain
| | - Sandra Yela
- Department of Optics and Optometry, Universitat Politècnica de Catalunya, Terrassa, Spain
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Abstract
ABSTRACT Intervention to slow axial elongation and progressing degree of myopia has become an important public health issue. Although orthokeratology (OrthoK) has been prescribed to temporarily reduce or eliminate refractive error, myopic children undergoing OrthoK have shown significant slowing of axial elongation and myopic progression. This review presents data on the efficacy, benefits, and risks of the use of OrthoK to slow axial elongation in myopic children. It also discusses how OrthoK fits into an overall strategy of myopia management in practice compared with alternative prescribed interventions to slow myopic progression. Other factors discussed are patient candidacy, impact on vision-related quality of life, and use of OrthoK in combination with pharmaceutical agents. With precise fitting, careful follow-up, and patient compliance with recommended lens cleaning and disinfection, OrthoK is a safe and effective method to slow axial elongation in children.
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Affiliation(s)
- Michael J Lipson
- Kellogg Eye Center, Department of Ophthalmology and Visual Science, University of Michigan, Commerce Twp, MI
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Overview on Defocus Incorporated Multiple Segments Lenses: A Novel Perspective in Myopia Progression Management. Vision (Basel) 2022; 6:vision6020020. [PMID: 35466272 PMCID: PMC9036268 DOI: 10.3390/vision6020020] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/09/2022] [Accepted: 03/30/2022] [Indexed: 11/16/2022] Open
Abstract
Myopia is becoming more common across the world, affecting approximately two billion people and rising. Different kinds of therapies (optical, pharmaceutical, environmental, or behavioral) have been proposed to decrease myopia progression, but with variable results and a lack of standardization. The evidence that targeted myopic defocus inhibits eye length growth has paved the way for several contact and spectacle lense designs to induce a peripheral defocus, thus slowing myopia progression, but the perfect configuration has yet to be defined. One of the newest and more promising approaches in this field is the use of Defocus Incorporated Multiple Segments (DIMS) lenses. These lenses are built from the assumption that targeted myopic defocus, produced by 396 mid-peripheral lenslets with positive power, inhibits eye length growth. Recent studies have highlighted the effectiveness of these lenses compared to children who had worn single vision spectacle lenses, in terms of myopia control and tolerability. Despite the evidence that these lenses can help slow down the progression of myopia, the occasional mid-peripheral aberrations they can induce, as well as the overall eye strain that comes with wearing them, should not be overlooked. The aim of this review is to give attention to the advantages and the shortfalls of this new approach and to evaluate its effectiveness in clinical practice.
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Chao C, Lattery L, Qin G, Kamat M, Basso K, Lakkis C, Hasan M, Richdale K. Tear Proteomics of Children and Young Adult Soft Contact Lens, Orthokeratology and Spectacle Wearers - A Pilot Study. Curr Eye Res 2022; 47:832-842. [PMID: 35317695 DOI: 10.1080/02713683.2022.2047206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE Contact lens complications occur more often in older teenagers and young adults compared to children. This study explored differences in tear proteomics between children and young adults wearing soft contact lens (SCL), orthokeratology or spectacles for >3 years. METHODS Twelve children and 12 sex- and correction-matched young adults were enrolled. Tears were collected via Schirmer strips for tear proteomic analysis using mass spectrometry. Proteome Discoverer was used for protein identification. Label-Free Quantitation was generated using Scaffold software; Fisher's Exact tests were used to compare proteins by age and correction groups. Generalized linear models were used to assess differences in overall protein levels by age and correction groups. A secondary analysis of proteins presented in >50% of samples of each group was conducted using the R/Bioconductor limma package. RESULTS There were 385 proteins present only in young adults while 183 were unique in children. There were 528 unique proteins to SCL, 96 to orthokeratology and 149 to spectacle wearers. Based on Fisher's Exact analyses, 126 proteins were higher in young adults than children (all P < 0.048). Forty-seven protein levels were higher in SCL compared to orthokeratology (all P < 0.01), 33 protein levels were higher in SCL compared to spectacles (all P < 0.01), 15 protein levels were higher in orthokeratology compared to spectacle wearers (all P < 0.01). Based on generalized linear models, young adults had higher overall protein levels than children (P = 0.001), SCL had higher protein levels than spectacle wearers (P < 0.001) but no differences were found between orthokeratology and spectacle wearers (P = 0.79). Based on the secondary analysis, only Antileukoproteinase was higher in the young adult orthokeratology group compared to other groups (P < 0.01). CONCLUSIONS Tear protein type and abundance differ by age and correction. Further research is needed to understand the effects of contact lens correction in children and young adults on the tear proteome.
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Affiliation(s)
- Cecilia Chao
- College of Optometry, University of Houston, Houston, TX, USA.,School of Optometry and Vision Science, University of New South Wales Sydney, Kensington, Australia
| | - Lauren Lattery
- College of Optometry, University of Houston, Houston, TX, USA
| | - Guoting Qin
- College of Optometry, University of Houston, Houston, TX, USA
| | - Manasi Kamat
- Department of Chemistry, University of Florida, Gainesville, FL, USA
| | - Kari Basso
- Department of Chemistry, University of Florida, Gainesville, FL, USA
| | - Carol Lakkis
- College of Optometry, University of Houston, Houston, TX, USA
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Hsu CC, Kuo YS, Lin PY, Chen KH. Overnight orthokeratology-associated Acanthamoeba keratitis at a tertiary referral hospital in Taiwan: A retrospective case-control study. J Chin Med Assoc 2022; 85:381-387. [PMID: 35259136 DOI: 10.1097/jcma.0000000000000676] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Acanthamoeba keratitis (AK) is a vision-threatening disease, usually associated with contact lens (CL) wear. As overnight orthokeratology (OOK) is increasingly used to control myopia, we have found incidence of OOK-associated AK is increasing. This study aimed to investigate the clinical presentation and visual outcomes of OOK-associated AK. METHODS Demographic characteristics, clinical features, and treatment outcomes were collected by reviewing the medical charts of CL-associated AK patients (n = 35) diagnosed at Taipei Veterans General Hospital from 2001 to 2016. Cases were OOK-associated AK patients (n = 13), and controls were all other CL-associated AK patients (n = 22). Student t tests and chi-square tests were used to compare cases and controls. Linear regression analyses were used to identify factors associated with the final visual outcome in CL-associated AK. RESULTS OOK-associated AK accounted for half of all CL-associated AK after 2010. OOK-associated AK patients and other CL-associated patients had similar best-corrected logarithm of the minimum angle of resolution visual acuity (BCLVA) before treatment (1.10 ± 0.75 vs 1.13 ± 0.76, p = 0.893), but OOK-associated AK patients were younger (17.15 ± 3.21 vs 26.36 ± 12.81 years, p = 0.004), had less severe disease (ring infiltration, 0% vs 31.82%, p = 0.023), and had better post-treatment BCLVA (0.06 ± 0.15 vs 0.51 ± 0.95, p = 0.041). Multiple linear regression analysis showed that better BCLVA after treatment in CL-associated AK was associated with initial presentation without ring infiltration (p = 0.002) but not with OOK use itself (p = 0.793). Twenty-six of 35 CL-associated AK patients had final BCLVA equal to or better than 0.10 (Snellen visual acuity of 6/7.5). All 13 OOK-associated AK cases were treated with chlorhexidine 0.02% ± voriconazole 1% ± oral voriconazole, and 12 of these patients had final BCLVA equal to or better than 0.10. CONCLUSION Most CL-associated AK patients had satisfactory visual outcomes. Half of AK at our hospital is OOK-associated since 2010. Early diagnosis and correct treatment may be the reason why OOK-associated AK patients had better vision prognosis.
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Affiliation(s)
- Chih-Chien Hsu
- Faculty of Medicine, National Yang Ming Chiao Tung University School of Medicine, Taipei, Taiwan, ROC
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Yih-Shiuan Kuo
- Faculty of Medicine, National Yang Ming Chiao Tung University School of Medicine, Taipei, Taiwan, ROC
| | - Pei-Yu Lin
- Faculty of Medicine, National Yang Ming Chiao Tung University School of Medicine, Taipei, Taiwan, ROC
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Ko-Hua Chen
- Faculty of Medicine, National Yang Ming Chiao Tung University School of Medicine, Taipei, Taiwan, ROC
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
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Abstract
ABSTRACT A number of studies regarding the effect of orthokeratology (OK) on myopia progression have been published and shown that it can slow myopia progression in school-aged children. Recently, OK has been considered to be one of the most effective optical treatments for myopia control. This article reviewed the peer-reviewed literature on the efficacy of OK for myopia control. Although it cannot halt myopia progression completely, the inhibitory effect on axial elongation for 2 years has been reported to be from 32% to 63%, as compared with single-vision spectacles and contact lenses. In addition, the efficacy and acceptable safety have been confirmed even in several long-term studies up to 10 years. However, the possibility of a rebound phenomenon in myopia progression after OK discontinuation remains unknown. It is also unclear how long the treatment should be continued to attain the maximum benefit in each patient. In the near future, further research including assessment of rebound phenomenon should be conducted with longer follow-up periods in more diverse populations.
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Affiliation(s)
- Takahiro Hiraoka
- From the Department of Ophthalmology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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Sun L, Li ZX, Chen Y, He ZQ, Song HX. The effect of orthokeratology treatment zone decentration on myopia progression. BMC Ophthalmol 2022; 22:76. [PMID: 35164702 PMCID: PMC8845411 DOI: 10.1186/s12886-022-02310-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 02/10/2022] [Indexed: 12/18/2022] Open
Abstract
Background This study aimed to compare the changes in the axial length (AL) in myopic children that wear centered and decentered orthokeratology (Ortho-K). Methods This retrospective study included 217 subjects who were treated with an Ortho-K lens for >12 months. The subjects were divided into three groups based on the magnitude of the Ortho-K lens treatment zone decentration: mildly, moderately, and severely decentered groups. Distance and direction of treatment zone decentration were calculated using software that was developed in-house. The AL changes in different groups were compared. Results Based on the distance of the treatment zone decentration, 65 children (65 eyes) were included in the mildly decentered group, 114 children (114 eyes) in the moderately decentered group, and 38 children (38 eyes) in the severely decentered group. The mean decentration distance in the three groups was 0.35 ± 0.11 mm, 0.71 ± 0.13 mm, and 1.21 ± 0.22 mm, respectively. The mean AL increase in the three groups after 12 months of Ortho-K lens wear was 0.24 ± 0.21 mm, 0.23 ± 0.18 mm, and 0.19 ± 0.20 mm, respectively. There were no significant differences in AL changes among the three groups. Conclusions Ortho-K lens decentration is common in clinical practice. The AL change after Ortho-K lens wear was not significantly different in subjects with different magnitudes of Ortho-K lens decentration. Fitting the Ortho-K lens in the properly centered zone is recommended to ensure the safety of Ortho-K lens wear and to maintain visual quality.
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Affiliation(s)
- Lu Sun
- Beijing Tongren Eye Center, Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and visual Sciences, National Engineering Research Center for Ophthalmology, #1 Dong Jiao Min Xiang, Beijing, 100730, China
| | - Zheng-Xuan Li
- Beijing Tongren Eye Center, Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and visual Sciences, National Engineering Research Center for Ophthalmology, #1 Dong Jiao Min Xiang, Beijing, 100730, China
| | - Yun Chen
- Key Laboratory of Universal Wireless Communications, Ministry of Education, Beijing University of Posts and Telecommunications, Beijing, 100876, China
| | - Zhi-Qiang He
- Key Laboratory of Universal Wireless Communications, Ministry of Education, Beijing University of Posts and Telecommunications, Beijing, 100876, China
| | - Hong-Xin Song
- Beijing Tongren Eye Center, Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and visual Sciences, National Engineering Research Center for Ophthalmology, #1 Dong Jiao Min Xiang, Beijing, 100730, China.
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The Impact of Antibiotic Usage Guidelines, Developed and Disseminated through Internet, on the Knowledge, Attitude and Prescribing Habits of Orthokeratology Contact Lens Practitioners in China. Antibiotics (Basel) 2022; 11:antibiotics11020179. [PMID: 35203782 PMCID: PMC8868172 DOI: 10.3390/antibiotics11020179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 01/17/2022] [Accepted: 01/24/2022] [Indexed: 01/16/2023] Open
Abstract
It has been previously reported that the improper prescribing of antibiotic eye drops is common among orthokeratology (ortho-k) practitioners. Guidelines have since been developed and disseminated to improve their understanding and implementation of antibiotic prescriptions. This study aimed to investigate the influence of these guidelines on the knowledge, attitude, and prescribing habits of ortho-k practitioners by means of a questionnaire, which was administered nationwide via an official online account to eye care practitioners (ECPs) involved in ortho-k lens fitting, 548 of whom completed the survey. Differences in characteristics before and after the dissemination of the guidelines and between the groups were explored using χ2 tests. The relationship between prescribing habits and demographics was analyzed using stepwise logistic regression models. The implementation of the guidelines significantly improved the overall prescribing habits of ECPs (p < 0.001), especially for prophylactic antibiotic use before and after ortho-k lens wear (p < 0.001). Most ECPs who prescribed antibiotics properly displayed significantly better knowledge of correct antibiotic use, which in turn affected the compliance in their ortho-k patients (p < 0.001). The ECPs’ occupations (professionals other than ophthalmologists and optometrists, including nurses and opticians), clinical setting (distributor fitting centers), and age (younger than 25 years) were risk factors for the misuse of antibiotics. Although the implementation of the antibiotic guidelines significantly improved overall prescribing habits, some practitioners’ prescribing behavior still needs improvement. A limitation of this study was that all questions were mandatory, requiring ECPs to recall information, and therefore was subjected to selection and recall bias.
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Bian Z, Xu X, Chen D, Ni H. Assessment of patient compliance in orthokeratology and analysis of influencing factors: a cross-sectional study. BMC Ophthalmol 2021; 21:396. [PMID: 34784895 PMCID: PMC8594163 DOI: 10.1186/s12886-021-02148-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 10/21/2021] [Indexed: 11/20/2022] Open
Abstract
Background Patient non-compliance, that is, failure to perform standard wear and care orthokeratology (ortho-k) lenses procedures, has been shown to be a major risk factor for contact lens-associated complications. Therefore, this study aimed to investigate the compliance with wear and care behaviors of ortho-k patients and analyze its influencing factors. Methods Patients who were successfully prescribed ortho-k lenses at the Eye Center of the Second Affiliated Hospital of Zhejiang University School of Medicine (ECSAHZU) were enrolled in the study. Patient compliance with wear and care behaviors was examined through a questionnaire. Results This study assessed 238 subjects. The subjects’ ages ranged from 7 to 25 (mean ± SD, 11.3 ± 2.5) years. The compliance with wear and care behaviors was 19.7%, and the subjects’ self-assessment compliance was 96.6%. The compliance rate of subjects wearing lenses for less than 1 year was higher than that of subjects wearing lenses for more than 1 year (p < 0.001). In the first year, the compliance rates of wearing experiences for less than 1 month, 1 month, 3 months, 6 months, and more than 6 months were 45, 29, 21.6, 20, and 27.6%, respectively, and there were no statistically significant differences in compliance among these periods (p = 0.314). No correlation was identified between compliance and age (r = − 0.061, p = 0.527) or sex (r = 0.114, p = 0. 751). There was no correlation between compliance and lens care operator (r = − 0.626, p = 0.151). Conclusions The compliance of ortho-k patients was poor. After wearing ortho-k lenses for more than 1 year, compliance with wear and care behaviors declined. In clinical practice, measures should be taken to solve these problems and improve the safety of wearing ortho-k lenses. Supplementary Information The online version contains supplementary material available at 10.1186/s12886-021-02148-2.
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Affiliation(s)
- Zhiwen Bian
- The Second Affiliated Hospital, Zhejiang University School of Medicine, Eye Center, 88 Jiefang Road, Shangcheng District, Hangzhou, 310009, Zhejiang, China
| | - Xindi Xu
- The Second Affiliated Hospital, Zhejiang University School of Medicine, Eye Center, 88 Jiefang Road, Shangcheng District, Hangzhou, 310009, Zhejiang, China
| | - Duya Chen
- The Second Affiliated Hospital, Zhejiang University School of Medicine, Eye Center, 88 Jiefang Road, Shangcheng District, Hangzhou, 310009, Zhejiang, China
| | - Hailong Ni
- The Second Affiliated Hospital, Zhejiang University School of Medicine, Eye Center, 88 Jiefang Road, Shangcheng District, Hangzhou, 310009, Zhejiang, China.
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Efficacy, predictability and safety of long-term orthokeratology: An 18-year follow-up study. Cont Lens Anterior Eye 2021; 45:101530. [PMID: 34785154 DOI: 10.1016/j.clae.2021.101530] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 10/13/2021] [Accepted: 10/20/2021] [Indexed: 12/31/2022]
Abstract
PURPOSE To determine the efficacy, predictability and safety of long-term orthokeratology in children and adults. METHODS Case histories of 300 orthokeratology patients (596 eyes; 34.3% children; 65.7% adults) were reviewed to collect information on demographics, corneal and refractive parameters, visual acuity, residual refraction and adverse effects. Predictability was defined as the percentage of eyes with absolute values of spherical equivalent refraction ≤ 0.5 D of emmetropia, and efficacy as the ratio of post-orthokeratology uncorrected and pre-orthokeratology corrected distance visual acuity. RESULTS Median duration of treatment was 37 and 28.5 months in children and adults, respectively (p = 0.022). During the first year, 17.2% of children and 33% of adults ceased lens wear (p < 0.001). For children and adults with a successful ortho-k treatment of at least one year of duration, 88.7% and 95.9% of eyes had a predictable refractive outcome, and efficacy was 0.98 and 1.01, respectively. A larger percentage of children (65.7%) were free of complications than of adults (55.4%) (p = 0.015). One event of microbial keratitis occurred in adults (6.8 cases per 10,000 patient-years) and none in children. Corneal staining was the most frequent complication, with a higher incidence in adults (p = 0.007) and in higher myopia (p < 0.001), higher anterior corneal eccentricity (p = 0.019) and smaller anterior horizontal radius (p = 0.027). CONCLUSION Orthokeratology is a safe and predictable long-term procedure in children and adults, with a low incidence of serious adverse effects. Corneal staining episodes are relatively frequent throughout the course of the treatment, thus highlighting the relevance of education of experienced users.
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A novel quantitative evaluation of deposits adhered to worn orthokeratology contact lenses. Jpn J Ophthalmol 2021; 65:855-863. [PMID: 34586527 DOI: 10.1007/s10384-021-00873-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 08/26/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Total deposition and deposition along the reverse curve of heavily deposited worn orthokeratology (OK) lenses were quantitatively evaluated using two novel imaging methods. In addition, the cleaning efficacies of a contact lens cleaning solution for daily use and an intensive cleaner and protein remover solution were evaluated using the same two methods. STUDY DESIGN Experimental study. METHODS Twenty-six worn reverse-geometry OK lenses (MY Emerald, Technopia) were photographed for use in three experiments: (1) total deposition was assessed before and after cleaning with two cleaning solutions; (2) in addition to assessing total lens deposition, the feasibility of measuring the thickness of lens deposits along the reverse curve was assessed; and (3) after confirming it was possible to assess the thickness of lens deposits, the thickness of deposits was assessed before and after cleaning with a daily contact lens cleaning solution (O2 Care®, Menicon Co., Ltd.) and an intensive cleaner and protein remover (Progent®, Menicon Co., Ltd.). Total lens deposition was assessed as the total volume of cloudiness over the lens surface in terms of volume per unit pixel. Cross-sectional images were taken from worn OK lenses to assess the thickness of lens deposits on the reverse curve as the area of deposits/horizontal length. RESULTS Significant differences in total deposition were found between the three cleaning conditions for the twenty worn OK lenses (mean total deposition ± SD for pre-cleaning = 0.209 ± 0.076; post-daily cleaning = 0.124 ± 0.078; and post-intensive cleaning = 0.045 ± 0.046) (p < 0.001). Mean total deposition and thickness of the deposits along the reverse curve for the three lenses from the second experiment were 0.310 and 6.0 mm, respectively. The mean thicknesses of lens deposits found in the third experiment under the 3 conditions were as follows: pre-cleaning = 3.4 µm; post-daily cleaning = 2.3 µm; and post-intensive cleaning = 0.0 µm. CONCLUSION The two novel imaging methods used in this study detected significant amounts of deposits attached to worn OK lenses and were sensitive enough to detect a reduction in deposition following the use of the two cleaning solutions tested. Furthermore, these methods could visualize and quantify the thickness of lens deposits along the reverse curve.
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Chen YX, Liao CM, Tan Z, He MG. Who needs myopia control? Int J Ophthalmol 2021; 14:1297-1301. [PMID: 34540602 DOI: 10.18240/ijo.2021.09.01] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 04/14/2021] [Indexed: 12/16/2022] Open
Abstract
Myopia has become a major visual disorder among school-aged children in East Asia due to its rising prevalence over the past few decades and will continue to be a leading health issue with an annual incidence as high as 20%-30%. Although various interventions have been proposed for myopia control, consensus in treatment strategies has yet to be fully developed. Atropine and orthokeratology stand out for their effectiveness in myopia progression control, but children with rapid progression of myopia require treatment with higher concentrations of atropine that are associated with increased rates of side effects, or with orthokeratology that carries risk of significant complication. Therefore, improved risk assessment for myopia onset and progression in children is critical in clinical decision-making. Besides traditional prediction models based on genetic effects and environmental exposures within populations, individualized prediction using machine learning and data based on age-specific refraction is promising. Although emerging treatments for myopia are promising and some have been incorporated into clinical practice, identifying populations who require and benefit from intervention remains the most important initial step for clinical practice.
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Affiliation(s)
- Yan-Xian Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510000, Guangdong Province, China.,Department of Ophthalmology, Peking University Shenzhen Hospital, Shenzhen Peking University-The Hong Kong University of Science and Technology Medical Center, Shenzhen 518000, Guangdong Province, China
| | - Chi-Mei Liao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510000, Guangdong Province, China
| | - Zachary Tan
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, Melbourne 3010, Australia
| | - Ming-Guang He
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510000, Guangdong Province, China.,Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, Melbourne 3010, Australia
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