Case Report: Modified Piggyback System to Treat Peripheral Iridotomies and Degenerative Myopia.

SIGNIFICANCE: This report details how a case with degenerative myopia and symptoms secondary to laser peripheral iridotomies is managed with a modified piggyback contact lens system. The benefits of using a system with tinted and gas-permeable (GP) lenses are discussed. PURPOSE: This study aimed to report the positive outcome of a modified piggyback system in the treatment of degenerative myopia and iris abnormalities. CASE REPORT: A patient with degenerative myopia presented with visual disturbances secondary to laser peripheral iridotomies in both eyes. A modified piggyback system was trialed using a corneal GP lens overlaying a tinted soft contact lens to provide optimal vision and visual comfort in both eyes. After optimizing the fit, there was a reduction in glare and improved vision. CONCLUSIONS: Hard contact lenses often provide superior optics and vision compared with soft lenses, especially to patients with high refractive errors. Patients who require hard lenses and also have visual disturbances secondary to iris abnormalities could be managed with a modified piggyback contact lens systems using a corneal GP lens and tinted soft lens.

Interventions to slow progression of myopia in children.

BACKGROUND: Nearsightedness (myopia) causes blurry vision when one is looking at distant objects. Interventions to slow the progression of myopia in children include multifocal spectacles, contact lenses, and pharmaceutical agents. OBJECTIVES: To assess the effects of interventions, including spectacles, contact lenses, and pharmaceutical agents in slowing myopia progression in children. SEARCH METHODS: We searched CENTRAL; Ovid MEDLINE; Embase.com; PubMed; the LILACS Database; and two trial registrations up to February 2018. A top up search was done in February 2019. SELECTION CRITERIA: We included randomized controlled trials (RCTs). We excluded studies when most participants were older than 18 years at baseline. We also excluded studies when participants had less than -0.25 diopters (D) spherical equivalent myopia. DATA COLLECTION AND ANALYSIS: We followed standard Cochrane methods. MAIN RESULTS: We included 41 studies (6772 participants). Twenty-one studies contributed data to at least one meta-analysis. Interventions included spectacles, contact lenses, pharmaceutical agents, and combination treatments. Most studies were conducted in Asia or in the United States. Except one, all studies included children 18 years or younger. Many studies were at high risk of performance and attrition bias. Spectacle lenses: undercorrection of myopia increased myopia progression slightly in two studies; children whose vision was undercorrected progressed on average -0.15 D (95% confidence interval [CI] -0.29 to 0.00; n = 142; low-certainty evidence) more than those wearing fully corrected single vision lenses (SVLs). In one study, axial length increased 0.05 mm (95% CI -0.01 to 0.11) more in the undercorrected group than in the fully corrected group (n = 94; low-certainty evidence). Multifocal lenses (bifocal spectacles or progressive addition lenses) yielded small effect in slowing myopia progression; children wearing multifocal lenses progressed on average 0.14 D (95% CI 0.08 to 0.21; n = 1463; moderate-certainty evidence) less than children wearing SVLs. In four studies, axial elongation was less for multifocal lens wearers than for SVL wearers (-0.06 mm, 95% CI -0.09 to -0.04; n = 896; moderate-certainty evidence). Three studies evaluating different peripheral plus spectacle lenses versus SVLs reported inconsistent results for refractive error and axial length outcomes (n = 597; low-certainty evidence). Contact lenses: there may be little or no difference between vision of children wearing bifocal soft contact lenses (SCLs) and children wearing single vision SCLs (mean difference (MD) 0.20D, 95% CI -0.06 to 0.47; n = 300; low-certainty evidence). Axial elongation was less for bifocal SCL wearers than for single vision SCL wearers (MD -0.11 mm, 95% CI -0.14 to -0.08; n = 300; low-certainty evidence). Two studies investigating rigid gas permeable contact lenses (RGPCLs) showed inconsistent results in myopia progression; these two studies also found no evidence of difference in axial elongation (MD 0.02mm, 95% CI -0.05 to 0.10; n = 415; very low-certainty evidence). Orthokeratology contact lenses were more effective than SVLs in slowing axial elongation (MD -0.28 mm, 95% CI -0.38 to -0.19; n = 106; moderate-certainty evidence). Two studies comparing spherical aberration SCLs with single vision SCLs reported no difference in myopia progression nor in axial length (n = 209; low-certainty evidence). Pharmaceutical agents: at one year, children receiving atropine eye drops (3 studies; n = 629), pirenzepine gel (2 studies; n = 326), or cyclopentolate eye drops (1 study; n = 64) showed significantly less myopic progression compared with children receiving placebo: MD 1.00 D (95% CI 0.93 to 1.07), 0.31 D (95% CI 0.17 to 0.44), and 0.34 (95% CI 0.08 to 0.60), respectively (moderate-certainty evidence). Axial elongation was less for children treated with atropine (MD -0.35 mm, 95% CI -0.38 to -0.31; n = 502) and pirenzepine (MD -0.13 mm, 95% CI -0.14 to -0.12; n = 326) than for those treated with placebo (moderate-certainty evidence) in two studies. Another study showed favorable results for three different doses of atropine eye drops compared with tropicamide eye drops (MD 0.78 D, 95% CI 0.49 to 1.07 for 0.1% atropine; MD 0.81 D, 95% CI 0.57 to 1.05 for 0.25% atropine; and MD 1.01 D, 95% CI 0.74 to 1.28 for 0.5% atropine; n = 196; low-certainty evidence) but did not report axial length. Systemic 7-methylxanthine had little to no effect on myopic progression (MD 0.07 D, 95% CI -0.09 to 0.24) nor on axial elongation (MD -0.03 mm, 95% CI -0.10 to 0.03) compared with placebo in one study (n = 77; moderate-certainty evidence). One study did not find slowed myopia progression when comparing timolol eye drops with no drops (MD -0.05 D, 95% CI -0.21 to 0.11; n = 95; low-certainty evidence). Combinations of interventions: two studies found that children treated with atropine plus multifocal spectacles progressed 0.78 D (95% CI 0.54 to 1.02) less than children treated with placebo plus SVLs (n = 191; moderate-certainty evidence). One study reported -0.37 mm (95% CI -0.47 to -0.27) axial elongation for atropine and multifocal spectacles when compared with placebo plus SVLs (n = 127; moderate-certainty evidence). Compared with children treated with cyclopentolate plus SVLs, those treated with atropine plus multifocal spectacles progressed 0.36 D less (95% CI 0.11 to 0.61; n = 64; moderate-certainty evidence). Bifocal spectacles showed small or negligible effect compared with SVLs plus timolol drops in one study (MD 0.19 D, 95% CI 0.06 to 0.32; n = 97; moderate-certainty evidence). One study comparing tropicamide plus bifocal spectacles versus SVLs reported no statistically significant differences between groups without quantitative results. No serious adverse events were reported across all interventions. Participants receiving antimuscarinic topical medications were more likely to experience accommodation difficulties (Risk Ratio [RR] 9.05, 95% CI 4.09 to 20.01) and papillae and follicles (RR 3.22, 95% CI 2.11 to 4.90) than participants receiving placebo (n=387; moderate-certainty evidence). AUTHORS' CONCLUSIONS: Antimuscarinic topical medication is effective in slowing myopia progression in children. Multifocal lenses, either spectacles or contact lenses, may also confer a small benefit. Orthokeratology contact lenses, although not intended to modify refractive error, were more effective than SVLs in slowing axial elongation. We found only low or very low-certainty evidence to support RGPCLs and sperical aberration SCLs.

The diversified defocus profile of the near-work environment and myopia development.

PURPOSE: To quantify the defocus characteristics in the near-work environment at home and investigate the relationship with subsequent myopia progression. METHODS: Fifty subjects (aged 7-12 years) were recruited and followed for 1 year. The home near-work environment (writing desk) was measured at a baseline home-visit using the Kinect-for-Windows to capture a 3-dimensional image. The depth values of the image were then converted into scene defocus with respect to the subject's viewpoint. The defocus characteristics were quantified as the dioptric volume (the total amount of net defocus, or DV) and standard deviation of the defocus values (SDD ). Information on home size, time spent outdoors, and in front of a desk were also obtained. Univariate correlation, and multivariate regression were used to assess the association between myopia progression, defocus characteristics, and other co-variates. RESULTS: The baseline spherical equivalent refraction (M) and refraction change over 1 year (∆M) were - 1.51 ± 2.02 D and - 0.56 ± 0.45 D respectively. DV was not significantly correlated with ∆M (Spearman's ρ = -0.25, p = 0.08), while SDD was negatively correlated to ∆M (Spearman's ρ = -0.42, p = 0.003). Although SDD was not a significant predictor in multivariate analysis, the regional DV at 15°-20° eccentricity was significant (p = 0.001). Home size (F2,50  = 7.01, p = 0.002) and time spent outdoors (Independent t = -2.13, p = 0.04) were also associated with ∆M, but not time spent in front of desk (Independent t = 0.78, p = 0.44). CONCLUSION: The defocus profile in the home environment within the para-central field of view is associated with childhood refractive error development.

Myopia management in the Netherlands.

PURPOSE: A trend that myopia is becoming gradually more common is shown in studies worldwide. Highest frequencies have been found in East Asian urban populations (96.5%) but also a study in Europe shows that nearly half of the 25-29 year olds has myopia. With the increase in prevalence, high myopia, i.e. a spherical equivalent of -6 or more and an axial length of 26 mm or more is also on the rise. High myopia particularly carries a significant risk of ocular pathology related to the long axial length. This highlights the need for myopia management in children with progressive myopia, in particular progression to high myopia. RECENT FINDINGS: During the last decade, many intervention studies for myopia progression have emerged. Although lifestyle adjustments are effective, pharmacological and optical interventions have shown the highest efficacy on reduction of eye growth. High concentration atropine (0.5%-1.0%) shows the most reduction in axial length progression, but has drawbacks of light sensitivity and loss of accommodation. Nevertheless, when these side effects are mitigated by multifocal photochromatic glasses, the long-term adherence to high dose atropine is high. Lower concentrations of atropine are less effective, but have less side effects. Studies on optical interventions have reported reduction of progression for Ortho-K and multifocal contact lenses, but are in need for replication in larger studies with longer duration. SUMMARY: The field of myopia management is rapidly evolving, and a position on the best approach for daily clinics is desirable. Over the last 10 years, our team of clinical researchers has developed a strategy which involves decision-making based on age, axial length, position on the axial length growth chart, progression rate, risk of high myopia, risk profile based on lifestyle and familial risk, side effects, and individual preference. This personalised approach ensures the most optimal long-term myopia control, and helps fight against visual impairment and blindness in the next generations of elderly.

Regimen Study of High Myopia-Partial Reduction Orthokeratology.

OBJECTIVE: This study aims to compare the increase in refractive error and axial length, variation of endothelium cells, and ratio of corneal staining between two regimens of high myopia-partial reduction orthokeratology (ortho-k) in children. METHODS: The present clinical prospective study recruited 102 high-myopia subjects (204 eyes). These subjects were randomly divided into three groups: (1) ortho-k group 1, subjects with a target myopia reduction of 6.00 D; (2) ortho-k group 2, subjects with a target myopia reduction of 4.00 D; and (3) control group, the refractive error of subjects was corrected using a pair of single-vision spectacles. Vision acuity, refractive error, and the cornea were examined at baseline, and at 2 days, 1 week, 1, 3, 6, and 12 months after commencing lens wear. The measurement of the axial length of the eyeball and a corneal endothelium examination were performed at baseline and at 12 months. RESULTS: The uncorrected vision acuities improved in subjects in these groups after treatment with ortho-k. Furthermore, the diopters of myopia and corneal curvature significantly decreased at 1 month, and the values continuously improved at 12 months, when compared with subjects at 1 month (P<0.05). Subjects in the control group had a significant increase in refractive error (0.565±0.313 D) and axial length (0.294±0.136 mm), when compared with subjects in the ortho-k-treated groups (P<0.05). However, there were no significant differences in changes in refractive error and axial length between ortho-k groups 1 (0.101±0.176 mm) and 2 (0.123±0.193 mm) at 12 months (P>0.05). Furthermore, subjects in group 1 (28.97%) had a higher rate of corneal staining, when compared with subjects in group 2 (13.06%) (P<0.05). CONCLUSION: The two ortho-k regimens, target reduction of 6.00 D and target of 4.00 D, had similar effects in controlling the increase in axial length and refractive error in high-myopia children. However, subjects with a target myopia reduction of 6.00 D had a higher rate of corneal staining than in subjects with a target myopia reduction of 4.00 D.

Changes in axial length after orthokeratology lens treatment for myopia: a meta-analysis.

PURPOSE: Orthokeratology (OK) lens is a popular optical method to control myopia progression. This study aimed to assess the effect of OK lens on axial length change compared with glasses. METHODS: PubMed, Web of Science, and Embase were searched to retrieve the related articles. Then, the articles were selected according to predefined criteria. Standardized mean difference (SMD) and 95% confidence interval (CI) were selected as effect size for combining and analyzing the change in axial length. RESULTS: A total of 13 articles were included in the present study. Different models were selected according to the heterogeneity of each analysis. The axial length change in OKs group was significantly smaller than control group; SMD (95% CI) of change in axial length was - 0.857 (- 1.146, - 0.568), p < 0.001 at the end of 1 year and - 0.701 (- 1.675, 0.272), p < 0.001 at the end of 2 years or longer time. CONCLUSIONS: OK lens treatment appears more effective in slowing axial elongation than glasses during the early treatment of myopia in children.

Case Report: Adaptation of a Telescope with a Minus Lens Cap for Highly Myopic Patient.

SIGNIFICANCE: This case report demonstrates a novel approach of using the optical principle of vergence amplification to correct for a visually impaired patient's ametropia while using a telescope system. This approach is easy to apply clinically. PURPOSE: The purpose of this study was to present a novel approach of correcting high myopia for a patient with visual impairment using a spectacle-mounted telescope. CASE REPORT: A 51-year-old man desired improved distance vision for television viewing and facial recognition. His refractive error was -18.00 diopter sphere in each eye with best-corrected acuities of 5/225 (20/900 Snellen equivalent) for the right eye and 10/225 (20/450) for the left eye. Over the years, multiple attempts at contact lens use were unsuccessful, and the patient used spectacle prescription. After evaluating telescope systems, the patient was successful with a 7 × 30 Beecher Mirage Keplerian telescope system. This system cannot be worn over glasses. To correct his ametropia, a -0.25-diopter minus lens cap was applied in front of the objective lens of the telescope, capitalizing on the property of vergence amplification. In addition, the tube length was adjusted. Adding lenses in front of the telescope and focusing the telescope can both affect the angular magnification of the system. Depending on the lenses used, type of telescope, and refractive error, there can be an increase or decrease in angular magnification. In this case, the minus lens at the front of the telescope decreased the power of the objective lens, and the focusing for the remaining uncorrected myopia increased the power of the ocular lens. Both of these factors contributed to increased resultant angular magnification for this patient. The patient achieved 10/30 (20/60) vision and reported success with his distance vision. CONCLUSIONS: Minus-powered lens caps over the objective lens are a viable option for highly myopic individuals who wish to use premanufactured spectacle-mounted telescopes.

Effects of Optical Correction Method on the Magnitude and Variability of Accommodative Response: A Test-retest Study.

SIGNIFICANCE: The present study addresses the accommodative response and its dependence on the type of optical correction used. The results are discussed relative to their possible implications for myopia progression and visual fatigue. PURPOSE: The accommodative response has been investigated owing to its possible relationship with the onset and progression of myopia and visual fatigue. This study explored the influence of wearing soft contact lenses in comparison with spectacles in terms of magnitude and variability of accommodation. In addition, we analyzed the intersession and intermethod repeatability. METHODS: Dynamic accommodative response was recorded during 30-second epochs, at five different distances (50, 40, 33, 25, and 20 cm), in 21 individuals (mean refractive error ± SD, -0.79 ± 1.39 D) while wearing either soft contact lenses or spectacles on two different days. To assess repeatability, a second identical intervention was conducted. RESULTS: Higher lags of accommodation were obtained with the use of soft contact lenses in comparison with the spectacle condition (P = .04, partial η [ηp] = 0.204), and similarly, a higher variability of accommodation at near distances was found during the soft contact lens measurement (P < .001, ηp = 0.647). There was a strong intersession repeatability at all the distances tested for both optical correction methods. CONCLUSIONS: The higher accommodative lag and fluctuations found while wearing soft contact lenses in comparison with spectacles may help to understand the mechanisms underlying myopia progression and asthenopia. These findings may be also considered when testing the accommodative response in research settings. Our test-retest design confirmed that there is a very good intersession repeatability for all the distances in both optical correction methods.

Myopia control with novel central and peripheral plus contact lenses and extended depth of focus contact lenses: 2 year results from a randomised clinical trial.

PURPOSE: We aimed to determine myopia control efficacy with novel contact lenses (CL) that (1) reduced both central and peripheral defocus, and (2) provided extended depth of focus with better global retinal image quality for points on, and anterior to, the retina and degraded for points posterior to the retina. METHODS: Children (n = 508, 8-13 years) with cycloplegic spherical equivalent (SE) -0.75 to -3.50D were enrolled in a prospective, double blind trial and randomised to one of five groups: (1) single vision, silicone hydrogel (SH) CL; (2) two groups wearing SH CL that imposed myopic defocus across peripheral and central retina (test CL I and II; +1.00D centrally and +2.50 and +1.50 for CL I and II at 3 mm semi-chord respectively); and (3) two groups wearing extended depth of focus (EDOF) hydrogel CL incorporating higher order aberrations to modulate retinal image quality (test CL III and IV; extended depth of focus of up to +1.75D and +2.50D respectively). Cycloplegic autorefraction and axial length (AL) measurements were conducted at six monthly intervals. Compliance to lens wear was assessed with a diary and collected at each visit. Additionally, subjective responses to various aspects of lens wear were assessed. The trial commenced in February 2014 and was terminated in January 2017 due to site closure. Myopia progression over time between groups was compared using linear mixed models and where needed post hoc analysis with Bonferroni corrections conducted. RESULTS: Myopia progressed with control CL -1.12 ± 0.51D/0.58 ± 0.27 mm for SE/AL at 24 months. In comparison, all test CL had reduced progression with SE/AL ranging from -0.78D to -0.87D/0.41-0.46 mm at 24 months (AL: p < 0.05 for all test CL; SE p < 0.05 for test CL III and IV) and represented a reduction in axial length elongation of about 22% to 32% and reduction in spherical equivalent of 24% to 32%. With test CL, a greater slowing ranging from 26% to 43% was observed in compliant wearers (≥6 days per week; Control CL: -0.64D/0.30 mm and -1.14D/0.58 mm vs test CL: -0.42D to -0.47D/0.12-0.18 mm and -0.70 to -0.81D/0.19-0.25 mm at 12 and 24 months respectively). CONCLUSIONS: Contact lenses that either imposed myopic defocus at the retina or modulated retinal image quality resulted in a slower progression of myopia with greater efficacy seen in compliant wearers. Importantly, there was no difference in the myopia control provided by either of these strategies.

[Correcting progressive myopia with bifocal contact lenses with central zone for distant vision: changes in accommodation and axial length (a preliminary report)]. / Korrektsiia progressiruiushchei miopii bifokal'nymi kontaktnymi linzami s tsentral'noi zonoi dlia dali: izmeneniia akkomodatsii i perednezadnei osi (predvaritel'noe soobshchenie).

PURPOSE: To assess the state of accommodation and the dynamics of changes of ocular axial length in patients with progressive myopia who use bifocal soft contact lenses (BFSCLs). MATERIAL AND METHODS: The main and control groups consisted of 50 children (100 eyes) each. Patients of the main group used BFSCLs with distance-oriented central zone and added power of 4 D on the periphery. Patients of the control group were corrected with spherical soft contact lenses (SSCLs). Baseline measurements included amplitude of accommodation (AA), positive relative accommodation (PRA) and the length of anterior-posterior axis of the eye. All patients were examined before wearing SCLs and every 3 months during the entire period of observation lasting 9 to 12 months. RESULTS: Correction of myopia with contact lenses is accompanied by the increase of AA and RPA. The users of BFSCLs with distance-oriented central zone and added power of 4 D on the periphery, which induces myopic peripheral defocus, had their accommodative function normalize much faster than the patients wearing SSCLs. The average increase in the ocular axial length in the BFSCLs group appeared to be significantly smaller than in the SSCLs group (0.11 and 0.58 D, respectively), which can be attributed to the simultaneous formation of the central focus and induced peripheral myopic defocus.

The Role of Orthokeratology in Myopia Control: A Review.

The prevalence of myopia and high myopia has significantly increased worldwide and in the United States. The serious implications of these trends are being recognized. Myopia is not just a minor inconvenience requiring vision correction with glasses or contact lenses, but a disease process creating significant risk of serious vision-threatening eye disease. Various methods of treatment for myopia and myopic progression have been prescribed and studied in effort to find one that is effective, safe, and that patients will be compliant with. Numerous peer-reviewed studies have shown orthokeratology (OrthoK) is effective in slowing myopic progression. This review article covers the development of OrthoK, its mechanism of action, its evolution, and refinement from a refractive option to its use as a mean of slowing myopic progression. After detailing patterns of myopia progression, a description of theories and studies as to how OrthoK slows myopia progression in children is also explained. The review will focus on progression of myopia and the use of OrthoK to slow myopia progression after myopia has been diagnosed.

Case Series Analysis of Myopic Progression Control With a Unique Extended Depth of Focus Multifocal Contact Lens.

OBJECTIVES: To determine the rate of myopia progression in children fit with a commercially available extended depth of focus (center distance) multifocal soft contact lens with attributes theoretically expected to slow the progression of myopia. METHODS: A retrospective case series analysis of 32 patients (ages 6-19 years, mean 10.98±2.95) from 10 practice locations was performed. At initial presentation, 44% wore spectacles, 37.5% spherical soft contact lenses, 15.6% a different soft multifocal contact lens, and 3% orthokeratology lenses. All participants showed progression of at least -0.50 diopter with current corrections and were fit with an extended depth of focus (center distance) multifocal soft contact lens (NaturalVue Multifocal 1 Day Contact Lenses; Visioneering Technologies, Inc., Alpharetta, GA). Follow-up time was 6 to 25 months (mean: 10.94±4.76). RESULTS: Reductions in the annualized rate of myopic progression from -0.85 D per year ±0.43 D to -0.04 D per year ±0.18 D (P<0.00000) OD, -0.90 D per year ±0.57 D to -0.03 D per year ±0.17 D (P<0.00000) OS were observed. These data represent a reduction of 95.4% OD and 96.25% OS. Approximately 98.4% of the children showed reduction of annualized myopic progression; 91% showed a decrease of 70% or greater. Overall, 81.25% showed complete halting of myopic progression, including 6.25% demonstrating myopic regression. CONCLUSIONS: This unique extended depth of focus (center distance) daily disposable multifocal contact lens was effective in slowing myopic progression in these children. These findings add to the growing evidence that center distance multifocal soft contact lenses may slow the progression of myopia.

Assessment of Clinical Trials for Devices Intended to Control Myopia Progression in Children.

The increased prevalence of myopia in the United States and other regions of the world, and the sight-threatening problems associated with higher levels of myopia have led to great interest in research designed to reduce these rates. As most of the progression of myopia occurs in childhood, these investigations have been directed toward slowing the progression of myopia in children. Treatments described to potentially slow the progression of myopia have included pharmacological interventions, multifocal spectacles, and multifocal correction created by contact lenses. Although some contact lens clinical trials have demonstrated promising results in slowing the progression of myopia, many of these studies have significant limitations, including only short follow-up times, limited randomization, and incomplete masking. Such limitations have underscored the need to develop a more robust clinical study design, so that future studies can demonstrate whether contact lenses, as well as other medical devices, can be used in a safe and effective manner to control myopia progression. We review previous key studies and discuss study design and regulatory issues relevant to future clinical trials.

Treatment Patterns for Myopic Choroidal Neovascularization in the United States: Analysis of the IRIS Registry.

PURPOSE: To characterize treatment patterns and outcomes in eyes with treatment-naïve myopic choroidal neovascularization (mCNV) in the United States. DESIGN: Retrospective cohort study. PARTICIPANTS: Individuals aged 18 years and older seen in clinics participating in the American Academy of Ophthalmology's IRIS (Intelligent Research in Sight) Registry. METHODS: We analyzed data from the IRIS Registry, from January 1, 2012 to December 31, 2014, to identify cases of treatment-naïve mCNV, which was defined as the presence of myopic refractive error worse than -6.0 diopters with the presence of subretinal/choroidal neovascularization as indicated by International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis of "362.16: Retinal Neovascularization NOS." MAIN OUTCOME MEASURES: Type of initial treatment for mCNV was categorized as the administration of 1 of the following within the first 365 days after the diagnosis date: (1) observation (i.e., no treatment); (2) intravitreal anti-VEGF injection; (3) verteporfin photodynamic therapy (vPDT); or (4) laser photocoagulation. We assessed the difference between logarithm of the minimal angle of resolution (logMAR) visual acuity (VA) on the diagnosis date (baseline) and 1 year after the diagnosis date. Anti-VEGF injection frequency per treated eye over a 1-year period was also estimated. RESULTS: We identified 185 patients with treatment-naïve mCNV in 1 or both eyes. Treatment within 1 year of diagnosis was recorded for 73.0% (135/185); the remainder was classified as "observation." Nearly all treatment (134/135; 99.3%) consisted of anti-VEGF injections; 0.7% (1/135) received vPDT. Those treated with anti-VEGF injections showed significant improvement in VA at 1 year (mean logMAR VA improvement of 0.17 units, 95% confidence interval [CI], 0.12-0.20, P < 0.01), whereas those who were not treated showed a significant decline in VA at 1 year (mean logMAR VA decline: 0.03 units, 95% CI, 0.008-0.05, P < 0.01). The mean number of anti-VEGF injections for an eye with mCNV during the first year after diagnosis was 2.8 (standard deviation, 2.5) (median, 2.0; interquartile range, 1.0-4.0). CONCLUSIONS: In the United States, anti-VEGF injection was the most frequently utilized treatment for mCNV. Those treated were observed to gain vision. However, one quarter of patients received no treatment and lost vision. Further studies are needed to understand the sociodemographic and health-systems barriers surrounding the delivery of anti-VEGF injections to patients with mCNV.

Iontophoresis-assisted accelerated riboflavin/ultraviolet A scleral cross-linking: A potential treatment for pathologic myopia.

Scleral collagen cross-linking is one of the most promising treatments to control the pathologic process of myopia. However, the exact procedure and its impact on animal models of myopia are still to be explored. We modified the scleral riboflavin/ultraviolet A (UVA) cross-linking procedure with an iontophoresis-assisted drug delivery system and an accelerated UVA irradiation (10 mW/cm2, 9 min) and applied this treatment to an animal model of myopia. Ninety-six New Zealand White rabbits developed relatively stable myopia by visual deprivation and then underwent the modified scleral cross-linking surgery. All the statistics and sample collection were obtained from 4 postoperative time points (1-day, 10-day, 1-month and 3-month groups). We found that the ultimate stress, Young's modulus and physiological Young's modulus of treated myopia sclera were significantly increased and maintained in 4 groups. The abnormal elongation of the myopic eye was effectively controlled 1 month after the treatment and even almost halted 3 months after the treatment. The histochemical assay revealed no notable post-surgery damage or apoptosis in the retina and choroid. Vigorous collagen synthesis was observed in scleral fibroblasts of the treated samples but were rarely observed in the untreated ones under electron microscopy. Furthermore, the remarkable difference in collagen gene expression and protein content between treated and untreated samples also indicated that an alteration in collagen metabolism may be triggered by the treatment. The effectiveness and safety exploration suggested that the modified scleral cross-linking procedure may be a potential method to control the pathologic process of myopia.

Studies using concentric ring bifocal and peripheral add multifocal contact lenses to slow myopia progression in school-aged children: a meta-analysis.

PURPOSE: To evaluate the effect of soft contact lens with concentric ring bifocal and peripheral add multifocal designs on controlling myopia progression in school-aged children. METHODS: We systematically searched MEDLINE, EMBASE, Cochrane Library and reference lists of included trials. Methodological quality of included trials was assessed using Jadad Scale and Newcastle-Ottawa Quality Assessment Scale items. RESULTS: We identified five randomised controlled trials (RCTs) and three cohort studies with a total of 587 myopic children. Compared with the control group, concentric ring bifocal soft contact lenses showed less myopia progression with a weighted mean difference (WMD) of 0.31 D (95% CI, 0.05~0.57 D, p = 0.02) and less axial elongation with a WMD of -0.12 mm (95% CI, approximately -0.18 to -0.07 mm, p < 0.0001) at 12 months. Relative to the control group, peripheral add multifocal soft contact lenses showed less myopia progression with a WMD of 0.22 D (95% CI 0.14~0.31 D, p < 0.0001) and less axial elongation of -0.10 mm (95% CI -0.13~0.07 mm, p < 0.0001) at 12 months, respectively. The soft contact lenses with concentric ring bifocal and peripheral add multifocal designs produced additional myopia control rates of 30~38% for slowing myopia progression and 31~51% for lessening axial elongation within 24 months. CONCLUSIONS: Both concentric ring bifocal and peripheral add multifocal soft contact lenses are clinically effective for controlling myopia in school-aged children, with an overall myopia control rates of 30~50% over 2 years. Concentric ring bifocal soft contact lenses seem to have greater effect than peripheral add multifocal soft contact lenses.

Relationship between Reduced Accommodative Lag and Myopia Progression.

PURPOSE: To determine the relationship between accommodative lag and rate of myopia progression when Ghanaian myopic school children are either undercorrected or fully corrected with single vision lenses. METHODS: A 2-year single masked randomized control trial was conducted using 150 Ghanaian myopic children aged 10 to 15 years with mean baseline myopia of -1.98 ± 0.50D. The children were randomly assigned to wear either a full correction (n = 75) or +0.50D undercorrection (UC) (n = 75) single vision lenses. Repeated measurements which included refractive error and accommodative response at 33 and 28.6 cm for FC and UC, respectively, were performed using Open-Field Autorefractor whereas ocular biometry results were obtained using A-Scan ultrasonography. Results were based on the right eye and analyzed using STATA 11. RESULTS: After 24 months, the mean myopia progression of children in the FC group (-0.54 ± 0.26D) was not significantly different from that of the children in the UC group (-0.5 ± 0.22D) (p = 0.31). There was no significant difference between the mean values of the initial near lag and the average lag measured 24 months later in both groups (FC: initial lag -0.74 ± 0.17D, average lag -0.72 ± 0.15D, p = 0.44; UC: initial lag -0.57 ± 0.14D, average lag -0.58 ± 0.15D; p = 0.67). Also, there was no significant correlation between refractive change seen in 24 months and either the first near lag for both FC (r = -0.05, p = 0.43) and UC (r = -0.08, p = 0.43) or the average near lag of accommodation for both FC (r = -0.02, p = 0.49) and UC (r = -0.04, p = 0.49). CONCLUSIONS: This study showed no relationship between lag of accommodation and rate of myopia progression in children with progressing myopia. Different ethnic groups may respond differently to the same size of hyperopic blur.

Posterior scleral reinforcement combined with patching therapy for pre-school children with unilateral high myopia.

PURPOSE: Our purpose was to investigate the effect of posterior scleral reinforcement (PSR) combined with patching therapy for pre-school children with unilateral high myopia. METHODS: A total of 32 pre-school children with unilateral high myopia were recruited. They were randomly divided into the PSR and control group, each of which had 16 patients. The patients in the PSR group underwent the simplified PSR surgery followed by rigid gas permeable contact lens wear and traditional patching therapy, while the patients in the control group were only prescribed contact lens wear and patching. Patients were reviewed and the axial length, refraction, best-corrected visual acuity, and stereoscopic vision were respectively examined postoperatively at yearly intervals for three years. RESULTS: The best-corrected visual acuity was significantly higher in the PSR group than that in the control group at any study visit. A statistically significant difference in axial length was found between the PSR group (27.38 ± 1.30 mm) and the control group (28.29 ± 0.74 mm) at the postoperative three-year (p = 0.03) time point. There was a statistical difference in refractive error between the PSR group (-13.13 ± 2.55 D) and the control group (-15.42 ± 1.83 D) at 3-year follow-up. No significant difference was found between the two groups with respect to the stereoscopic vision by the end of follow-up at 3 years (p =0.103). CONCLUSIONS: PSR combined with the patching therapy has the potential to arrest the progression of high myopia and to help the treatment for amblyopia.

High myopia-partial reduction ortho-k: a 2-year randomized study.

PURPOSE: To investigate if the combination of partial reduction (PR) orthokeratology (ortho-k) and spectacles for residual refractive errors in the daytime was effective to slow myopic progression in high myopic children. METHODS: High myopic children (aged 8 to 11 years) with spherical equivalent refraction at least -5.75 diopters (D) and myopia -5.00 D or more myopic were recruited and randomly assigned into PR ortho-k and control groups. Subjects in the PR ortho-k group were fitted with custom made four-zone ortho-k lenses with target reduction of 4.00 D for both eyes, and the residual refractive errors were corrected with single-vision spectacles for clear vision in the daytime. Control subjects were fully corrected with single-vision spectacles. Axial length of each eye of all subjects was measured with the IOLMaster at 6-month intervals by a masked examiner. This study was registered at www.clinicaltrial.gov with the identifier NCT00977236. RESULTS: Fifty-two subjects were recruited and randomized to the PR ortho-k and control groups. Twelve PR ortho-k and 16 control subjects completed the study. Compared with the residual refractive errors at the 1-month visit (after stabilization of ortho-k treatment), the median increase in noncycloplegic residual myopia at the 24-month visit was 0.13 D. In the control group, the median increase in myopia was 1.00 D at the end of the study. The mean ± SD increases in axial length were 0.19 ± 0.21 mm in the PR ortho-k group and 0.51 ± 0.32 mm in the control group (95% confidence interval, -0.55 to -0.12; unpaired t test, p = 0.005). CONCLUSIONS: This single-masked randomized study showed that PR ortho-k effectively slowed myopic progression in high myopes. Axial length elongation was 63% slower in PR ortho-k-treated children compared with children wearing spectacles.