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AIM: To compare the changes in axial length of myopic patients of different ages after wearing orthokeratology lenses with increased compression factor(ICF)or conventional compression factor(CCF)for 2 a.METHODS: Retrospective study. A total of 141 myopia patients(141 right eyes)aged 8 to 15 years who fitted with orthokeratology lenses in the General Hospital of Foshan Aier Eye Hospital from July 2020 to July 2021 were continuously included. They were divided into the CCF group(70 cases, 70 eyes)and the ICF group(71 cases, 71 eyes). The patients in the CCF group were fitted with orthokeratology lens of 0.75 DS CCF, while patients in the ICF group were fitted with orthokeratology lens of 1.25 D ICF. Taking 12 years old as a boundary, these two groups were divided into 8-11 years old and 12-15 years old group. The uncorrected visual acuity(UCVA), horizontal corneal curvature(K1)and corneal staining were recorded for all subjects after wearing lenses for 1 d, 1 wk, 1, 6 mo, 1 and 2 a. The axial length(AL)was recorded after wearing lenses for 6 mo, 1 and 2 a, and the complication and corneal epithelial staining were observed during lens wearing.RESULTS:The improvement of UCVA in the ICF group was faster than that in the CCF group, which were statistical significant after wearing lenses for 1 d, 1 wk and 1 mo, respectively(all P<0.001); however, there was no statistical significance between the two groups after 6 mo, 1 and 2 a(all P>0.05); K1 of the ICF group decreased faster than that of the CCF group, and there were statistical significance at 1 d, 1 wk, and 1 mo after wearing lenses(all P<0.05); there was no statistical significance at 6 mo, 1 and 2 a(all P>0.05). The axial length growth of patients aged 8-11 years old in the ICF group and CCF group was 0.35±0.17 and 0.48±0.26 mm, respectively(P=0.010), after wearing lenses for 2 a, and the axial length growth of patients aged 12-15 years old in the ICF group and CCF group was 0.16±0.15 and 0.31±0.29 mm, respectively(P=0.011). During the follow-up period, corneal spotting occurred in 6 eyes(8.5%)in the ICF group, and 7 eyes(10%)in the CCF group(P>0.05), all of which were grade 1 spotting.CONCLUSION:Wearing ICF orthokeratology lens is more effective than wearing CCF lenses in controlling the growth of axial length, with faster shaping and more obvious improvement in UCVA, especially for the prevention of high myopia in children under 12 years. Therefore, young children can give priority to wearing lenses that increase the compression factor, and for children over 12 years old, the compression factor of the lens can be selectively increased according to the wearer's eye habits, health status of ocular surface and visual function.
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AIM:To investigate the effect of diquafosol sodium(SD)eye drops combined with sodium hyaluronate eye drops on improving tear film stability after wearing orthokeratology lenses.METHODS:Prospective study. A total of 82 patients(82 right eyes)who were recruited from the outpatient department of Anhui Aier Eye Hospital from March to August 2022. Participants were assigned to three groups: sodium hyaluronate(SH)group(30 eyes), SD group(24 eyes), and sodium diquafosol combined with sodium hyaluronate(CG)group(28 eyes)according to random number table method. All groups wore the same brand of orthokeratology lens. Non-invasive tear breakup time(NIBUT), non-invasive tear meniscus height(NITMH)and lipid layer thickness were examined before treatment, and after wearing orthokeratology lens for 1 d, 1 wk, and 1 mo. Corneal spot staining was also recorded.RESULTS:The NITMH and NIBUT of CG group and the SD group at 1 mo after treatment were higher than those before wearing lenses(both P<0.05), and the NIBUT and NITMH of the CG group were 19.74±3.29 s and 0.30±0.05 mm, respectively, which were better than those of the SD group(NIBUT: 16.09±2.98 s, NITMH: 0.22±0.08 mm)and the SH group(NIBUT: 15.67±3.90 s, NITMH: 0.22±0.04 mm; all P<0.01). There were no significant differences in lipid layer thickness between the groups(all P>0.05). The incidence of corneal staining did not differ significantly among the groups(P>0.05).CONCLUSION:The combination of diquafosol sodium and sodium hyaluronate eye drops demonstrates a superior effect in improving NIBUT and NITMH after wearing orthokeratology lenses for 1 mo, effectively enhancing tear film stability in patients wearing orthokeratology lenses.
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AIM: To compare the clinical effectiveness of using multifocal defocus spectacle lenses, orthokeratology lenses, and single-vision spectacle lenses in patients with myopia and small-angle intermittent exotropia.METHODS: This retrospective study included 150 patients aged 8-15 years with basic intermittent exotropia, strabismus of -10△ to -20△ prism diopters(D)(block lenses), and spherical equivalents of -1.00 to -5.50 D, who visited our hospital from June 2021 to September 2022. They were selected and divided into three groups on a voluntary basis: the HAL group(50 patients with multifocal myopia defocus spectacle lenses), the OK lens group(50 patients with nighttime orthokeratology lenses), and the SVL group(50 patients with regular single-vision spectacle lenses). After wearing the lenses consistently, changes in axial length, prism diopters with the naked eye and lenses(prism at 33 cm), positive fusional vergence of blurred points, and near stereopsis were observed and compared among groups before intervention and after 1 a. The Newcastle control score(NCS)was used to evaluate the eye position control ability of the patients in the three groups.RESULTS: Before the intervention, the axial lengths of the HAL, OK lens, and SVL groups were 24.83±0.91, 24.93±0.97, and 24.98±0.68 mm, respectively(P>0.05). After 1 a, the axial lengths of the three groups were 25.02±0.90, 25.18±0.97, and 25.45±0.65, respectively(P<0.05). Compared with an increase of 0.47±0.30 mm in the SVL group after 1 a, the axial length of the HAL and OK lens groups increased by 0.19±0.06 and 0.25±0.21 mm, respectively(both P<0.05). Before intervention, the prism diopters of the HAL, OK lens, and SVL groups measured using the prism were -15.00△±3.12△, -14.34△±3.00△ and -14.06△±3.22△, respectively. After 1 a, the prism diopters of the three groups with lenses were -9.34△±3.84△, -18.42△±4.41△, and -19.58△±5.21△, respectively, which increased by 5.66△±2.13△, -4.08△±3.34△, and -5.52△±3.70△, respectively, compared with the preintervention values(P<0.05). Before intervention, the near stereopsis in the HAL, OK lens, and SVL groups were 89.20″±54.65″, 93.00″±52.54″, and 88.40″±55.31″, respectively(P>0.05). After 1 year, near stereopsis in the groups were 76.00″±20.40″, 81.20″±18.91″, and 100.60″±51.41″, respectively(P<0.05). The positive fusional vergence(fuzzy point)of the three groups was 15.04±1.97, 15.14±1.67, and 14.62±1.47, respectively, before intervention(P>0.05), and it was 17.10±2.02, 13.12±1.41, and 13.26±2.45, respectively, after 1 a(P<0.05). In addition, the eye position control in the HAL group was significantly better than that in the OK lens and SVL groups after wearing lenses for 1 a(P<0.05).CONCLUSION: For patients with myopia and small-angle intermittent exotropia, wearing HAL can effectively control changes in strabismus and axial length compared with OK lenses and SVL, particularly for better control of strabismus, whereas wearing OK lenses or SVL would result in exotropic drifts. Stereopsis and positive fusional vergence were significantly improved in the HAL group.
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Objective To investigate the effect and safety of orthokeratology lens on myopia control in adolescents and children with different diopters.Methods Ninety-three patients(171 eyes)with myopia who received orthokeratology lens treatment in the Affiliated Jiangning Hospital of Nanjing Medical University from February to August 2021 were selected for the study.They were divided into a low degree group(88 eyes,-0.5D to-3.0D)and medium degree group(83 eyes,-3.0D to-6.0D)according to the equivalent spherical lens degree.The naked eye distant vision,diopter,optic axis,breakup time of tear film(BUT),corneal endothelial cell count and complications were compared between two groups.Results After 1 year of lens wear,growth of optic axis in low degree group was significantly greater than that in medium degree group(Z=-2.035,P=0.042).After 1 year of lens wear,naked eye distant vision of both groups was significantly higher than that before lens wear(P<0.05),and increase of visual acuity in medium degree group was significantly greater than that in low degree group(P<0.05).The equivalent spherical degree of two groups was significantly lower than that before lens wear(P<0.05),and reduction of equivalent spherical lens degree in medium degree group was significantly greater than that in low degree group(P<0.05).After 1 year of lens wear,BUT in both groups was significantly shorter than that before lens wear,and corneal endothelial cell count was lower than that before lens wear(P<0.05),but there were no significant differences in BUT and corneal endothelial cell count between two groups(P>0.05).There was no statistically significant difference in complication rate between two groups(χ2=2.000,P=0.157).Conclusion Orthokeratology lens has good control effect and safety for adolescents and children with different diopters,and the effect is more prominent for moderate myopia.
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AIM: To assess the gap between the peak of the base curve to the surface of the cornea, as well as examines the correlation between the thickness of the tear film and the fitting of the orthokeratology lens through optical coherence tomography(OCT), providing an intuitive and quantitative clinical evaluation method for the fitting of the orthokeratology lens.METHODS: Myopia patients who fitted orthokeratology at our hospital from January to December 2023 were included. Examinations, including naked vision, slit lamp, non-contact intraocular pressure, ocular fundus, eye position, corneal diameter, corneal topography, tear film rupture time, optometry, etc., were performed on all patients before fitting. The trial lens parameter was selected according to the examination results, and fluorescein staining was performed to evaluate lens fitting state after patients adapted to wearing glasses. According to the performance of fluorescein staining, the inspected eyes are divided into three groups: lens loose group, lens fitting group, and lens tight group. In addition, the tear film thickness of three groups of subjects was measured by OCT, and the differences between the three groups of data were evaluated.RESULTS: A total of 49 myopic patients(77 eyes)were included. The average sphere degree was -3.10±1.25 D, the average cylinder degree was -0.43(-0.75, 0)D, the average horizontal keratometry(HK)was 42.48±0.81 D, and vertical keratometry(VK)was 42.98(42.25, 43.50)D. There were 21 cases(34 eyes)in the lens fitting group, with 13 cases of bilateral eyes, 8 cases of one eye, 14 cases(22 eyes)in the lens loose group, with 8 cases of bilateral eyes, 6 cases of one eye, and 14 cases(21 eyes)in the lens tight group, with 7 cases of bilateral eyes, 7 cases of one eye. There was no statistical difference in the main basic data of the subjects in the three groups(all P>0.05). OCT showed that the tear film thickness of the lens fitting group, the lens loose group, and the lens tight group was 231.18(219.0, 243.0), 220.41(214.0, 224.3), and 249.00(241.5, 258.0)μm, respectively, and there was statistical significance in the thickness among the three groups(P<0.05).CONCLUSION: OCT can serve as a safe and reliable method for measuring the tear film thickness, which can help evaluate the suitability of orthokeratology and provide a non-invasive, more intuitive, and quantitative evaluation method for the fitting and evaluation of orthokeratology.
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AIM: To observe and analyze the effectiveness and safety of wearing corneal refractive therapy(CRT)and vision shaping treatment(VST)designed orthokeratology in controlling myopic progression in adolescents with low E-value corneal morphology.METHODS: This prospective study involved 100 cases(100 eyes)of adolescent myopia patients fitted with orthokeratology at our optometry clinic from January 2020 to December 2021. The data of right eye were collected for research, and they were divided into low myopia group(-1.00 to -3.00 D)and moderate myopia group(-3.25 to -5.00 D)according to spherical equivalent, with 50 cases in each group. Each group of patients was further randomly divided into the CRT group and the VST group, with 25 cases in each group. Uncorrected visual acuity, refractive error, axial length(AL), tear film break-up time(BUT), corneal endothelial cell density, corneal staining grading, lens decentration, and refractive power at 15°-30° were measured before and after wearing orthokeratology, with a follow-up duration of 1.5 a.RESULTS: The uncorrected visual acuity of CRT and VST subgroups in the low myopia group showed no statistical significance at any time point after wearing orthokeratology. However, in the moderate myopia group, CRT subgroup showed better uncorrected visual acuity than the VST subgroup, with significant differences at 1 d and 1 wk(t=-9.474, -12.067, both P<0.01); no significant differences were noted at other time points. After wearing lens for 6 mo and 1.5 a, the AL growth for the CRT subgroup in low and moderate myopia was less than the VST subgroup, with no statistically significant differences. There were no statistically significant differences in binocular BUT and corneal endothelial cell density after wearing lens for 6 mo and 1.5 a. Corneal injury was lower in the CRT subgroup than that in the VST subgroup, but the difference was not statistically significant(Z=-1.803, P=0.071). Lens decentration was significantly better in the CRT subgroup than in the VST subgroup(Z=-4.629, P<0.001). In the periphery of the retina at 15°-30°, there were no significant differences in the amount of myopic defocus between the two groups, while it was statistically significant at 1, 3, and 6 mo in the moderate myopia subgroup(t=-3.949, P=0.008; t=-5.833, P<0.001; t=-6.231, P<0.001), indicating that CRT subgroup could produce a greater amount of myopic defocus.CONCLUSION: For patients with low E-value corneal morphology, CRT, using the vector height at 8 mm on the cornea for fitting, is not limited to the corneal E-value. It shapes faster and improves uncorrected visual acuity after shaping, especially for moderate myopia, achieving better daytime vision. In terms of controlling myopia, CRT fitting elevates return zone depth(RZD), creating a small central optical zone to produce more peripheral myopic defocus. However, there was no significant difference between the two groups in controlling AL growth. Both groups showed minimal corneal damage, indicating consistent safety in myopia control.
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As a highly prevalent global condition, myopia significantly impacts the ocular health of young individuals in China. Orthokeratology lens, as a rigid corneal contact lens, has demonstrated effective control over the progression of myopia; however, its mechanism of action remains incompletely elucidated. As one of the factors influencing visual acuity, higher-order aberrations will undergo marked changes after orthokeratology, with particular emphasis on the alterations in spherical aberrations and coma. The changes in corneal morphology induced by orthokeratology lead to significant positive increase in both spherical aberration and coma. Furthermore, the elevation of spherical aberration and coma demonstrates a negative correlation with the rate of axial length growth following orthokeratology. The interplay among spherical aberration, coma, defocus, accommodation, astigmatism, and pseudo-accommodation may constitute the underlying mechanism governing the control of myopia through orthokeratology.
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AIM: To observe the effectiveness, safety and ethnic differences of 0.005% atropine eye drops combined with orthokeratology in controlling adolescents' low myopia between different ethnic groups.METHODS:A total of 246 Han and Hani patients(246 eyes)with low myopia treated in our hospital from January to October 2021 were selected, with 120 patients(120 eyes)treated with 0.005% atropine eye drops combined with orthokeratology in experimental group, and 126 patients(126 eyes)treated with orthokeratology in control group. The uncorrected visual acuity, spherical equivalent(SE), axial length(AL), intraocular pressure, tear film break-up time(BUT), corneal curvature and corneal thickness of the two groups before and 1 a after wearing lenses were observed, and the incidence of complications were recorded.RESULTS:At 1 a after wearing lenses, the changes of AL and SE in the experimental group(0.16±0.35 mm, -0.39±0.47 D)were lower than those in the control group(0.22±0.89 mm, -0.48±0.54 D), uncorrected visual acuity(LogMAR)was better than the control group(0.11±0.25 vs 0.14±0.19; P&#x003C;0.05), there were differences in BUT, anterior chamber depth, corneal curvature and corneal thickness(P&#x003C;0.05), but there were no differences in intraocular pressure of the two groups(P&#x003E;0.05). In the Han and Hani groups, there were no differences in the changes of uncorrected visual acuity, AL and SE(P&#x003E;0.05). During the follow-up period, no significant local or systemic adverse reactions occurred in the two groups, and there was no difference in the incidence of ocular complications between the two groups of patients(P&#x003E;0.05).CONCLUSION: The 0.005% atropine eye drops combined with orthokeratology can effectively delay the progression of low myopia in adolescents without significant adverse reactions and ethnic differences.
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Objective To investigate the effect of orthokeratology(OK)lens decentration on peripheral retinal defo-cus in myopic eyes.Methods Totally 154 patients(234 eyes)continuously wearing OK lenses for one month or more were recruited in this study.According to the location of defocus rings in corneal topography,these eyes were divided into the centration group(118 eyes)and the decentration group(116 eyes).Peripheral retinal defocus data of each patient was collected by multispectral refraction topography,including total refraction difference value(TRDV),refraction difference value at 15°(RDV-15),refraction difference value at 30°(RDV-30),refraction difference value at 45°(RDV-45),superior refraction difference value(RDV-S),inferior refraction difference value(RDV-I),temporal refraction difference value(RDV-T)and nasal refraction difference value(RDV-N).An independent sample t-test was used to compare the differ-ences in these parameters between the two groups,and multivariate correlation analysis(generalized estimating equation,GEE)was conducted to analyze the relationship between clinical parameters and the amount of peripheral retinal defocus within the group.Results The RDV-N of patients in the decentration group was significantly lower than that in the cen-tration group(t=2.668,P=0.008),and there were no significant differences in other parameters(all P＞0.05).GEE showed that age was the determinant of RDV-S,and they were positively correlated;steep K was the determinant of RDV-I,and they were negatively correlated;gender was the determinant of RDV-T,and female OK lens wearers showed less RDV-T;the determinants of RDV-N include the alignment of OK lens,eye distribution and age,among which,RDV-N was positively corrected with age,and RDV-N of the left eyes was significantly superior to that of the right eyes.Conclusion Subclinical decentration of the OK lens may result in better RDV-N of myopia patients.The peripheral retinal defocus is influenced by factors such as age,gender,steep K,amount of decentration and eye distribution of OK lens wearers.
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Objective To explore the effect of the orthokeratology lenses on the control of different types of aniso-metropia in myopic children.Methods A total of 99 myopic children aged 8 to 16 years who got the orthokeratology len-ses at the Department of Ophthalmology,Heping Hospital Affiliated to Changzhi Medical College from September 2020 to November 2022 with complete data were included.These children were divided into the simple myopic anisometropia group(monocular myopia,binocular diopter difference ≥ 1.00 D,n=39)and the compound myopic anisometropia group(binoc-ular myopia,binocular diopter difference ≥ 1.00 D,n=60).The children with higher anisometropia(binocular diopter difference ≥ 2.50 D)in the two groups were set as the high anisometropia subgroup(n=18 and 29,respectively),and chil-dren with lower anisometropia(1.00 D≤ binocular diopter difference＜2.50 D)were set as the low anisometropia subgroup(n=21 and 31,respectively).In each group,eyes with a higher diopter were set as the high diopter eyes,and the contra-lateral eyes with a lower diopter were set as the low diopter eyes.Diopter,corneal topography,intraocular pressure,cor-neal endothelium and axial length of children in the two groups were examined and recorded.The changes in axial length before and after wearing orthokeratology lenses for 1 year were compared between the two groups,analyzing the correla-tion between the degree of anisometropia and changes in the binocular axial length.Results After wearing orthokeratolo-gy lenses for 1 year,children in both groups had an increase in the axial length with a lower increase in the axial length of the high diopter eyes compared to the low diopter eyes;before and 1 year after wearing orthokeratology lenses,the axial length of high diopter eyes was greater than that of the low diopter eyes in both groups,and the differences were statistical-ly significant(all P＜0.05).Both groups of children showed a decrease in the binocular axial length difference after wear-ing the orthokeratology lenses for 1 year;before and 1 year after wearing orthokeratology lenses,the binocular axial length difference of children in the simple myopic anisometropia group was greater than that in the compound myopic anisometro-pia group,and the differences were statistically significant(t=4.903 and 2.670;both P＜0.05).The changes in binocular axial length difference before and after wearing the orthokeratology lenses of children in the high anisometropia subgroup and low anisometropia subgroup of the simple myopic anisometropia group were greater than those in the high anisometro-pia subgroup and low anisometropia subgroup of the compound myopic anisometropia group,respectively,and the differ-ences were statistically significant(both P＜0.05).In the simple myopic anisometropia and compound myopic anisometro-pia groups,the degree of anisometropia was positively correlated with the binocular axial length changes before and 1 year after wearing the orthokeratology lenses(r=0.423 and 0.510,both P＜0.05).Conclusion Orthokeratology lenses can effectively reduce the difference in binocular axial length of children with myopic anisometropia,and their control effect on simple myopic anisometropia is better than that of compound myopic anisometropia.
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Objective To systematically evaluate the changes in axial length and treatment zone diameter among my-opic patients wearing orthokeratology lenses with different back optic zone diameters.Methods A comprehensive litera-ture search was conducted on PubMed,Embase,the Cochrane Library,Web of Science,Wangfang Med Online and CNKI databases in both Chinese and English to identify randomized controlled trials or controlled trials investigating orthokeratol-ogy lenses with varying back optical zone diameters.The literature was thoroughly reviewed by two researchers,who ex-tracted relevant data and conducted a methodological quality evaluation.Finally,meta-analysis was performed using Rev-Man 5.3 software.In all the included studies,orthokeratology lenses with a conventional back optic zone diameter were taken as the control group,while orthokeratology lenses with a reduced back optic zone diameter were utilized as the ex-perimental group.Results Eight studies involving 437 patients(459 eyes)with myopia were included.The results of me-ta-analysis showed that the axial length changes in the experimental group were significantly lower than those of the control group after wearing orthokeratology lenses for 6 months and 12 months(6 months:MD=-0.09,95％CI:-0.10 to-0.07,Z=10.50,P＜0.05;12 months:MD=-0.11,95％CI:-0.13 to-0.09,Z=12.19,P＜0.05);significant differ-ences in treatment zone diameter were observed between the experimental and control groups at various time points follow-ing orthokeratology lens wearing(MD=-0.82,95％CI:-1.04 to-0.59,Z=7.03,P＜0.05).Conclusion Orthoker-atology lenses designed with smaller back optical zone diameters can effectively delay axial length growth in myopic pa-tients,but their long-term efficacy needs to be confirmed.
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Objective:To compare the effect of delaying progression of myopia in children between defocus incorporated multiple segments (DIMS) spectacle lens and orthokeratology.Methods:A nonrandomized controlled clinical study was conducted.A total of 390 children (390 eyes) with myopia who were treated in the First Affiliated Hospital of Zhengzhou University from January 2018 to December 2020 were included, with the spherical equivalent (SER) of -0.75 to -6.00 D. According to the willingness of patients and patients' guardians, the subjects were divided into DIMS group, orthokeratology group and single-vision spectacle lens group, with 130 cases (130 eyes) in each group, wearing DIMS spectacle lenses, standard or astigmatic design orthokeratology and conventional single-vision full-correction aspheric spectacle lenses, respectively.The SER of the eyes was measured using an automatic computerized refractometer in combination with subjective refraction before and one year after lens wear, and the axial length (AL) of the eyes was measured using IOLMaster.A total of 327 patients in the three groups met the inclusion and exclusion criteria, including 107 in the DIMS group, 112 in the orthokeratology group, and 104 in the single-vision spectacle lens group.All the right eyes were included in this study.The changes in SER and AL before and after wearing lenses for 1 year were compared among the three groups.The relationship between AL and SER changes and baseline data in the DIMS group was evaluated by Pearson linear correlation analysis.The study followed the Declaration of Helsinki, and the study protocol was reviewed and approved by the Ethics Committee of the First Affiliated Hospital of Zhengzhou University (No.2023-KY-0174-002). The subjects and their guardians were fully aware of the purpose and methodology of the study, and voluntarily signed an informed consent form.Results:There were statistically significant overall differences in SER and AL at different time points among the three groups (SER: Fgroup=7.065, P=0.009; Ftime=183.730, P<0.001.AL: Fgroup=6.151, P=0.014; Ftime=175.290, P<0.001). One year later, the differences in SER and AL changes among the three groups were statistically significant ( F=7.065, P=0.009; F=6.151, P=0.014). The SER and AL of each group after 1 year was greater than the baseline, with the SER and AL and their changes significantly smaller in orthokeratology group and DIMS group than in single-vision spectacle lens group and greater in DIMS group than in orthokeratology group, showing statistically significant differences (all at P<0.05). Compared with single-vision spectacle lenses, wearing orthokeratology for 1 year can inhibit SER and AL progression by 58.3% and 59.0%, and wearing DIMS frame glasses for 1 year can inhibit SER and AL progression by 46.9% and 43.6%.The percentage of eyes with no change in SER was 5.77%(6/104), 24.11%(27/112) and 17.76%(19/107) in the single-vision spectacle lens group, orthokeratology group and DIMS group, respectively, and the percentage of AL was 0.00%(0/104), 8.93%(10/112) and 7.48%(8/107), respectively, showing statistically significant differences among the three groups ( χ2=9.316, 8.676; both at P<0.001). The AL change in the DIMS group was weakly negatively correlated with age ( r=-0.252, P=0.006). Conclusions:Wearing DIMS spectacle lenses is not as effective as orthokeratology in delaying myopia in children, but it is significantly better than wearing conventional single-vision spectacle lenses.
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Objective To compare the prevention and control effects of binocular myopia after wearing orthokeratology lenses or glasses for correction in adolescents with low-to-moderate unilateral myopia.Methods The clinical data of 46 adolescents with unilateral myopia treated in First Affiliated Hospital of Army Medical University were retrospectively analyzed,the patients were divided into the orthokeratology lenses group and spectacles group according to the correction methods,with 23 cases in each group.The axial length(AL),changes in spherical diopter(SD)and anisometropia between the myopic eye and the control eye with orthokeratology lenses spectacles for unilateral myopia correction,and orthokeratology lenses for unilateral and binocular myopia were compared.Results There was no significant difference in baseline AL,SD or anisometropia between the two groups(P>0.05).One year after unilateral myopia correction,the increase of SD for the myopic eye in the orthokeratology lenses group was less than that in the spectacles group(P<0.05),and there was no significant difference in the AL elongation of myopic eyes between the two groups(P>0.05);the elongation of AL for the control eyes in the orthokeratology lenses group was more than that in the spectacles group;the increase of SD for the myopic eyes in the orthokeratology lens group was lower than that in the spectacles group(P<0.05),and there was no significant difference in the increase of SD for the control eyes between the two groups(P>0.05);the anisometropia of patients in the orthokeratology lenses group was less than that in the spectacles group(P<0.05).The biological parameters of the eyes before and after wearing orthokeratology lenses in the patients with monocular and binocular myopia in the orthokeratology lens group were compared,the elongation of AL for the myopic eyes with lens in one eye was less than that with lenses in both eyes(P<0.05),and the elongation of AL for the control eye was more than that with lenses in both eyes(P<0.05),the increases of SD in both myopic eyes and control eyes were more than those with lenses in both eyes(P<0.05),and the anisotropia was more than that with lenses in both eyes(P<0.05).Conclusion Orthokeratology lenses is better than spectacles in controlling the increase of myopia in low-to-moderate unilateral myopia,which can reduce anisometropia between eyes.However,the AL of the emmetropic eye increases rapidly during unilateral myopia correction by orthokeratology lenses,and the progression of binocular myopia can be significantly delayed after wearing orthokeratology lenses.
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Purpose: The coronavirus disease 2019 (COVID?19) pandemic profoundly impacts lifestyle habits and myopia control in children worldwide. This study investigated the changes in eyecare habits, orthokeratology compliance, axial length, and time interval of follow?up visits during home confinement in the COVID?19 pandemic in Taiwan. Methods: This investigation was part of a prospective study undertaken to evaluate the effectiveness of a mobile application. A semi?structured telephone interview was conducted with parents retrospectively to document eyecare habits and myopia control during the COVID?19 home confinement. Results: Thirty?three children with myopia participated in the follow?up of orthokeratology lenses for 2 years. The children’s time viewing digital devices such as tablets and televisions significantly increased during the COVID?19 pandemic (P < 0.05). An analysis using McNemar’s test found that the proportional growth of axial length <0.2 mm in 2021 was significantly higher than that in 2020 (77.42% vs. 58.06%, P < 0.05). In the multivariate logistic regression analysis, onset <10 years of age (P = 0.001) and parents with high myopia (P < 0.001) were independent risk factors for the growth of axial length ?0.2 mm in 2021. Conclusion: The suspension of face?to?face classes and after?school tutorials benefited myopic axial elongation in children during COVID?19 home confinement. The use of digital devices and staying indoors may not be the exclusive reasons for myopia progression. Educating parents about the influence of extra learning classes after school on myopia progression would be prudent.
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AIM: To investigate the effect of orthokeratology lens on ocular surface and meibomian gland in children and adolescents of different ages.METHODS: A total of 120 cases(240 eyes)of myopic children and adolescents treated in the optometry clinic of our hospital from December 2020 to February 2021 were retrospectively selected, and they were divided into the orthokeratology group(60 cases, 120 eyes)and the frame glasses group(60 cases, 120 eyes)according to the myopia correction methods. The changes in ocular surface and meibomian gland after wearing glasses were analyzed, and those changes in patients of different ages were compared between the two groups.RESULTS: Corneal curvature decreased, non-invasive tear film break-up time(NIBUT)shortened and meibomian gland score increased at 3, 6, 9 and 12mo in the orthokeratology group after wearing lens, while lower tear meniscus height increased at 6, 9 and 12mo compared with that before wearing lens. In the frame glasses group, the lower tear meniscus height was higher at 6 and 9mo than that before wearing glasses(both P<0.05). At the same time point, the corneal curvature of the orthokeratology group was significantly lower than that of the frame glasses group at all time points, the NIBUT at 3, 9 and 12mo after wearing the lens was shorter than that of the frame glasses group and the meibomian gland scores were higher at 6, 9 and 12mo than those at the same time point in the glasses group(all P<0.05). After wearing lens for 12mo, the corneal curvature of the orthokeratology group at all ages was significantly lower than that of the frame glasses group, the NIBUT of the orthokeratology group at 8 to 12 years old and 13 to 15 years old was significantly lower than that of the frame glasses group, and the meibomian gland score was significantly higher than that of the frame glasses group(all P<0.05).CONCLUSION: Orthokeratology lens may affect the ocular surface and meibomian glands function, and the effects on ocular surface are more pronounced in children and adolescents under 12 years old. Therefore, younger children and adolescents could be prioritized for myopia correction with framed glasses, and then wearing orthokeratology lens when they get older.
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AIM: To investigate the bacterial flora and antibiotic susceptibility testing of conjunctival sac in adolescents after wearing orthokeratology(OK)lens.METHODS:A total of 101 adolescents aged 8 to 14 who admitted to outpatient department of Xi'an No.1 Hospital from September 2021 to August 2022 were recruited in this cross-sectional observational study. There were 51 cases wearing OK Lens(wearing group)and 50 patients not wearing contact lens(non-lens group), the right eye of all patients was selected into the group. The culture of bacterial flora in conjunctival sac between the two groups were compared, the species were identified by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry, and the antibiotic susceptibility testing was carried out for the positive strains cultured in the wearing group.RESULTS:The positive rate of conjunctival sac bacterial cultured in the wearing group and the non-lens group was 68.6%(35/51)and 60.0%(30/50), respectively(P>0.05). In both groups, the bacteria with the highest detection rate were staphylococcus epidermidis and staphylococcus aureus. The sensitivity rates of the strains detected in the wearing group to drugs are as follows: Levofloxacin(98%), Moxifloxacin(98%), Gatifloxacin(98%), Cefuroxime(98%), Cefathiamidine(98%), Rifampicin(98%), Chloramphenicol(96%), Cefoxitin(95%), Clindamycin(80%), Gentamicin(74%), Fusidic acid(72%), Tobramycin(64%), Compound sulfamethoxazole(26%), Mezlocillin(10%), Azithromycin(6%), of which the sensitivity rate of Gram-positive cocci was 100% sensitive to Vancomycin.CONCLUSION:Gram-positive cocci are the main bacteria isolated from conjunctival sac of adolescents after wearing OK Lens. Wearing OK Lens will not significantly increase the positive rate of conjunctival sac bacterial flora. Results of antibiotic susceptibility testing may provide guidance for empirical medication in patients wearing OK lens after eye infection.
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AIM: To observe the effect of eccentricity of the optical treatment zone on retinal defocus after wearing orthokeratology lens for 12mo.METHODS: In this case-control study, a total of 120 myopic patients(120 eyes)who completed the fitting in our hospital from March 2021 to September 2021 and insisted on wearing orthokeratology lenses for 12mo were selected. According to the eccentricity after wearing lenses for 12mo, they were divided into the low eccentricity group(<0.5mm, 58 cases, 58 eyes)and the moderate and high eccentricity group(≥0.5mm, 62 cases, 62 eyes). The optical treatment zone diameter(OTZD), eccentricity, axial length(AL), pupil diameter(PD)and refraction difference value(RDV)were evaluated after 12mo of wearing orthokeratology lenses, and the correlation between RDV and eccentricity was analyzed.RESULTS: After wearing orthokeratology lenses for 12mo, AL growth and RDV at 30°～40° and 40°～53° from the fovea were significantly lower in the moderate and high eccentricity group than in the low eccentricity group(all P<0.05). In all patients, RDV at 40°～53° from the fovea was positively correlated with AL growth and OTZD(rs=0.544, 0.333, both P<0.01), and negatively correlated with eccentricity(rs=-0.224, P=0.014).CONCLUSION: Peripheral retinal defocus is related to eccentricity and OTZD after wearing orthokeratology lenses. The greater eccentricity and the smaller OTZD within a certain range can induce more peripheral retinal myopic defocus, leading to a better control of AL growth.
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AIM: To investigate the effect of wearing an orthokeratology lens on postoperative binocular vision rebuilding in patients with intermittent exotropia combined with myopic refractive error.METHODS: Prospective control study. A total of 60 patients(120 eyes)with intermittent exotropia and myopia who underwent surgical treatment in our hospital from June 2019 to December 2020 were selected. Patients who wore orthokeratology lenses or monofocal frame glasses after surgery were divided into a treatment group(group A)and a control group(group B)according to the wishes of patients and their families, with 30 cases(60 eyes)in each group, and they were followed-up for 6mo. The third level visual function and Titmus near stereoscopic visual function of the two groups of patients were observed before and 6mo after surgery.RESULTS: There was no statistical significance in all observation indicators between group A and group B before surgery(P>0.05). After 6mo of surgery, patients with intermittent exotropia achieved significant improvement in binocular visual function and corrected eye position. Group A was superior to group B in terms of fusion range and near stereoscopic visual function(P<0.05). There was no statistical significance between the two groups in terms of simultaneous vision and stereoscopic visual function(P>0.05).CONCLUSION: The binocular visual function of patients with intermittent exotropia after surgery has significantly improved. Wearing orthokeratology lenses can effectively improve binocular visual function in patients with intermittent exotropia combined with myopia after surgery.
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AIM: To evaluate the clinical efficacy of wearing base curve aspheric orthokeratology(OK)lens in the control of myopia.METHODS: A prospective study was conducted. A total of 94 cases(94 eyes)of myopia aged 8～13 years old who were fitted with orthokeratology(OK)lens in our hospital from January 2020 to July 2021 were selected(for patients who received OK lens in one eye, the eye is selected as the observation eye, and for patients who receive OK lens in both eyes, the right eye is used as the observation eye). Patients were divided into two groups according to the design of the OK lens, with 46 cases wearing base curve aspheric OK lens in study group and 48 cases wearing base curve spheric OK lens in control group. The study group and the control group were further divided into low myopia group(-3.00D&#x003C; SE ≤-0.75D)and moderate myopia group(-6.00D&#x003C; SE ≤-3.00D)according to the baseline spherical equivalent(SE), with 52 cases(52 eyes)in the low myopia group and 42 cases(42 eyes)in the moderate myopia group. Uncorrected visual acuity(UCVA)was evaluated at 1d, 1wk, 1, 3, 6 and 9mo after wearing lenses, and axial length were measured at 6mo and 1a after wearing lenses respectively.RESULTS: All patients completed follow-up, and there was no significant differences in UCVA(LogMAR)between the study group(-0.12±0.08)and the control group(-0.17±0.07)after wearing the OK lens for 1mo(P&#x003E;0.05); the mean axial length elongation between the two groups had no significant differences after wearing lenses for 6mo and 1a(all P&#x003E;0.05). In the low myopia group, the axial length elongation of the study group was 0.19±0.17mm after wearing OK lens for 1a, which was significantly lower than that of the control group(0.31±0.18mm; P&#x003C;0.05); while in the moderate myopia group, the axial length elongation was 0.22±0.18mm, and it had no significant differences with that in the control group(0.19±0.12mm; P&#x003E;0.05). There was no significant differences in axial length elongation between the low myopia group and the moderate myopia group in study group after wearing lenses for 6mo and 1a(P&#x003E;0.05), while there was differences in axial length elongation between low myopia group and moderate myopia group in the control group after wearing lenses for 6mo(0.15±0.13 vs. 0.05±0.12mm)and 1a(0.31±0.18 vs. 0.19±0.12mm; all P&#x003C;0.05).CONCLUSION: Wearing base curve aspheric OK lens can effectively improve the UCVA and control the elongation of axial length. For patients with low myopia, base curve aspheric OK lens had a better efficacy in controlling the elongation of axial length than the spheric OK lens.
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The incidence of myopia is gradually on the rise worldwide, which seriously affects the eye health of teenagers and children, causing enormous loss of socioeconomic benefits. As a result, the prevention and control of myopia is crucial and urgent. In recent years, orthokeratology lens have gradually demonstrated its superiority in the field of myopia prevention and control. At present, the principle of controlling the development of myopia by orthokeratology lens is mainly based on the theory of retinal hyperopia optical defocus, which promotes the shift of hyperopic defocus to myopic defocus in myopic patients to curb the growth of the axial length. The effect of controlling the development of myopia is related to various factors, including the total amount of defocusing, pupil diameter, optical zone design, and lens decentration. The widespread use of orthokeratology lenses will effectively reduce the incidence of myopia in teenagers and children. This paper discusses the principle of controlling the development of myopia by the defocus technique of orthokeratology lenses, and the relationship between the amount of defocusing and the position of the defocusing circle and the effect of myopia prevention and control. A specific review was conducted to clarify the research progress on defocus technique of orthokeratology lens in the prevention and control of myopia.