Myopia control: Seeing beyond efficacy.

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.

Myopia: An ounce of prevention is worth a pound of cure.

PURPOSE: Myopia severity has a profound impact on visual impairment in later life. A patient's final level of myopia may be lowered by myopia control, but also by delaying onset. Here, we evaluate the influence of the age of onset on the final recorded level of myopia. METHODS: Data were extracted from: (1) Three prospective cohort studies of myopia progression in East Asia and the United States where the final recorded level of myopia is presented as a function of the established age of onset. (2) Four retrospective studies of myopia progression in Finland, India, the Netherlands and China and two cross-sectional studies in Argentina and the UK where the age of onset was based on self-report of age at first spectacle prescription. (3) A cohort study of Finnish subjects originally recruited for a clinical trial and followed into adulthood. Subjects were divided into five groups according to age at recruitment that was used as a surrogate for the age of onset. RESULTS: Final recorded level of myopia was plotted as a function of age of onset for all studies. Among the three East Asian studies, the slopes are between 0.68 and 0.97 D/year, meaning that each later year of onset is associated with between 0.68 and 0.97 less myopia at the final recorded refraction. For six of the seven non-East Asian studies, the slopes are substantially flatter, with slopes between 0.23 and 0.50 D/year. By contrast, the slope for the Finnish study was 0.87 D/year. Increasing age of final recorded refraction tended to be associated with higher levels of myopia. CONCLUSION: Among East Asians, delaying the onset of myopia by 1 year has the potential to lower the final myopia level by 0.75 D or more-equivalent to 2-3 years of myopia control with existing modalities. The benefit is lower, but meaningful, among non-East Asians.

The future of clinical trials of myopia control.

In the field of myopia control, effective optical or pharmaceutical therapies are now available to patients in many markets. This creates challenges for the conduct of placebo-controlled, randomised clinical trials, including ethics, recruitment, retention, selective loss of faster progressors and non-protocol treatments: Ethics: It is valid to question whether withholding treatment in control subjects is ethical. Recruitment: Availability of treatments is making recruitment into clinical trials more difficult. Retention: If masking is not possible, parents may immediately withdraw their child if randomised to no treatment. Selective loss: Withdrawal of fast progressors in the control group leading to a control group biased towards low progression. Non-protocol treatment: Parents may access other myopia treatments in addition to those within the trial. We propose that future trials may adopt one of the following designs: Non-inferiority trials using an approved drug or device as the control. The choice will depend on whether a regulatory agency has approved the drug or device. Short conventional efficacy trials where data are subsequently entered into a model created from previous clinical trials, which allows robust prediction of long-term treatment efficacy from the initial efficacy. Virtual control group trials based on data relating to axial elongation, myopia progression or both, accounting for subject's age and race. Short-term control data from a cohort, for example, 1 year or less, and applying an appropriate, proportional annual reduction in axial elongation to that population and extrapolating to subsequent years. Time-to-treatment-failure trials using survival analysis; once a treated or control subject progresses or elongates by a given amount, they exit the study and can be offered treatment. In summary, the future development of new treatments in myopia control will be hampered if significant changes are not made to the design of clinical trials in this area.

Impact of zone geometry on the introduction of myopic defocus in young adult eyes wearing multi-zone lenses.

PURPOSE: Multizone contact lenses control myopia progression by proposed introduction of myopic defocus. This project investigated how much of the pupil area and how many dioptres of myopic defocus are introduced by different lens zone geometries with near- and off-axis viewing. METHODS: Ten young myopic adults (18-25 years) binocularly wore four soft contact lenses including a single vision (SV), concentric-ring dual-focus (DF), centre-distance multifocal (MF) and a RingBoost™ (RB) multi-zone design containing a combination of coaxial and non-coaxial zones. A modified aberrometer captured aberrations and pupil sizes at four target vergences between -0.25 and -4.00 D (on-axis) and across the central ±30° of the horizontal retina (off-axis). Defocus was quantified as the difference between the measured refractive state and the target vergence within each zone of a multi-zone design within the pupil and compared with that of equivalent zone areas of the SV lens. The percentage of the pupil containing myopic defocused light for each lens was calculated. RESULTS: Defocus within the distance correction zones of multi-zone lenses was similar to that of the SV lens. When viewing on-axis at -0.25 D target vergence, on average 11% of the pupil was myopic with SV, whereas 62%, 84% and 50% of the pupil was myopic for the DF, MF and RB designs, respectively. At -4.00 D target vergence, all lenses exhibited a systematic decrease in the percentage of pupil area having myopic defocus (SV: 3%; DF: 18%; MF: 5% and RB: 26%). The off-axis proportions were similar across multi-zone lenses; however, multi-zone lenses retained approximately 1.25-3.0× more myopic defocus than the SV lens. CONCLUSIONS: Subjects accommodated using the distance-correction zones of multi-zone lenses. Multi-zone contact lenses introduced significant myopic defocus on-axis and across the central ±30° retina. However, the magnitude and proportion of defocus were influenced by zone geometry, add power and pupil size.

The Limited Value of Prior Change in Predicting Future Progression of Juvenile-onset Myopia.

SIGNIFICANCE: Identifying children at highest risk for rapid myopia progression and/or rapid axial elongation could help prioritize who should receive clinical treatment or be enrolled in randomized clinical trials. Our models suggest that these goals are difficult to accomplish. PURPOSE: This study aimed to develop models predicting future refractive error and axial length using children's baseline data and history of myopia progression and axial elongation. METHODS: Models predicting refractive error and axial length were created using randomly assigned training and test data sets from 916 myopic participants in the Collaborative Longitudinal Evaluation of Ethnicity and Refractive Error Study. Subjects were 7 to 14 years of age at study entry with three consecutive annual visits that included cycloplegic A-scan ultrasound and autorefraction. The effect of adding prior change in axial length and refractive error was evaluated for each model. RESULTS: Age, ethnicity, and greater myopia were significant predictors of future refractive error and axial length, whereas prior progression or elongation, near work, time outdoors, and parental myopia were not. The 95% limits for the difference between actual and predicted change were ±0.22 D and ±0.14 mm without prior change data compared with ±0.26 D and ±0.16 mm with prior change data. Sensitivity and specificity for identifying fast progressors were between 60.8 and 63.2%, respectively, when the cut points were close to the sample average. Positive predictive value and sample yield were even lower when the cut points were more extreme. CONCLUSIONS: Young, more myopic Asian American children in the Collaborative Longitudinal Evaluation of Ethnicity and Refractive Error Study were the most likely to progress rapidly. Clinical trials should expect average progression rates that reflect sample demographics and may have difficulty recruiting generalizable samples that progress faster than that average. Knowing progression or elongation history does not seem to help the clinical decision regarding initiating myopia control.

Myopia Control: Why Each Diopter Matters.

SIGNIFICANCE: Reducing the incidence or prevalence of any disease by 40% is of huge public health significance. Slowing myopia by 1 diopter may do just that for myopic maculopathy-the most common and serious sight-threatening complication of myopia. There is a growing interest in slowing the progression of myopia due to its increasing prevalence around the world, the sight-threatening consequences of higher levels of myopia, and the growing evidence-based literature supporting a variety of therapies for its control. We apply data from five large population-based studies of the prevalence of myopic maculopathy on 21,000 patients. We show that a 1-diopter increase in myopia is associated with a 67% increase in the prevalence of myopic maculopathy. Restated, slowing myopia by 1 diopter should reduce the likelihood of a patient developing myopic maculopathy by 40%. Furthermore, this treatment benefit accrues regardless of the level of myopia. Thus, while the overall risk of myopic maculopathy is higher in a -6-diopter myope than in a -3-diopter myope, slowing their myopic progression by 1 diopter during childhood should lower the risk by 40% in both.

Accommodation and its role in myopia progression and control with soft contact lenses.

PURPOSE: To examine the impact of contact lens optical design on accommodative behaviour of children and the correlation between myopia progression and the accommodative response of the eye while wearing a contact lens designed for myopia control. METHODS: A post-hoc analysis was conducted on data from a previously published myopia control trial. A total of 109 subjects (aged 8 to 11 years, myopia: -0.75 to -4.00 D) wore either a Control (single-vision, n = 57) or a Test (with positive spherical aberration, +SA, n = 52) soft contact lens, binocularly for 1 year. Accommodative response was measured as the subject observed targets at -1.00 to -4.00 D vergence using the Grand Seiko WAM-5500 open-field autorefractor (www.grandseiko.com). Slope of accommodative response (SAR) as well as distance and near phoria and stimulus accommodative convergence/accommodation (AC/A) were compared between each group at baseline without study lenses and at 1-week and 1-year visits with study lenses. The SAR was also compared to changes in axial length (AL) and spherical equivalent cycloplegic auto refraction (SECAR). RESULTS: At baseline, there was no significant difference in SAR between the two study groups (ΔSAR = -0.039, p = 0.84). At 1 week, mean SAR of the Test group was significantly less than for the Control group (ΔSAR = -0.203, p < 0.0001), an effect that persisted to 1 year (ΔSAR = -0.129, p < 0.0001). In the Test group, greater SAR was associated with less change in AL (regression coefficient: -0.59 mm, p < 0.0001) and SECAR (regression coefficient: 1.12 D, p = 0.006) at 1 year. In the Control group, associations between SAR and change in AL and SECAR were not statistically significant. Compared to the Control group, eyes of the Test group appeared to be more exophoric with study lenses, however, the difference between the two groups was only significant at 1 week for distance phoria and 1 year for near phoria. CONCLUSION: The soft contact lens with +SA for controlling myopia progression resulted in an apparent decrease in mean accommodation. Within the Test group, reduced accommodative response correlated with greater myopia progression, suggesting some subjects in the Test group utilised the +SA for near viewing, inducing hyperopic defocus at the retina. Accordingly, the potential impact of a lens optics on accommodative function should be considered during design of myopia control lenses.

Commonly Held Beliefs About Myopia That Lack a Robust Evidence Base.

PURPOSE: To subject a number of commonly held beliefs or areas of confusion in the myopia field to scientific scrutiny. METHOD: A collection of statements about myopia are provided with references to demonstrate that a section of the research or clinical community supports the statement. The topics under discussion are reviewed critically with reference to the literature. RESULTS: The following statements are considered to lack sufficient supporting data to be considered as evidence-based: low-dose (0.01%) atropine slows myopia progression; relative peripheral hyperopia leads to myopia development and progression in children; undercorrection slows myopia progression; percentage treatment effect remains constant with continuing treatment; percentage treatment effect applies across the progression range; hand-held digital devices contribute to the myopia epidemic; more time outdoors slows myopia progression; the impact of outdoor activity on myopia incidence is due to daylight; subclassifications for myopia are effective; and myopia is a condition with a negative dioptric number. CONCLUSION: There are many hypotheses proposed to explain phenomena in the myopia field. Caution should be exercised in adopting conjecture until a robust evidence base is provided in support.

Daily Wear Contact Lenses Manufactured in Etafilcon A Are Noninferior to Two Silicone Hydrogel Lens Types With Respect to Hypoxic Stress.

PURPOSE: This study hypothesized that a traditional high-water contact lens of moderate oxygen transmissibility (Dk/t) is noninferior to common silicone hydrogel (SH) lenses worn for daily wear with respect to measures of hypoxic stress. METHODS: Thirty-six habitual contact lens wearers completed wear of three lens types worn in a randomized order: etafilcon A (ACUVUE 2, control), lotrafilcon B (Air Optix Aqua), and comfilcon A (Biofinity). Central corneal thickness (CT) and limbal hyperemia were measured >2 hr after waking and after 6 to 8 hr of wear on days 1 and 7. Endothelial bleb formation was measured on day 1 of each lens type. Noninferiority of etafilcon A, with respect to the other two lens types, was assumed if the following difference margins of equivalence were met: <1.5% for corneal swelling, <0.5 grade for limbal hyperemia, and <1% area of endothelial blebs. Outcomes were modeled using generalized linear mixed modeling techniques. RESULTS: All lenses showed reductions in least-square mean estimates of CT on both days: etafilcon A -0.26% at day 1 and -0.31% at day 7; lotrafilcon B -1.11% at day 1 and -1.06% at day 7; comfilcon A -0.63% at day 1 and -0.84% at day 7. The difference in mean swelling between etafilcon A and lotrafilcon B was 0.85% at day 1 (95% confidence interval [0.4%-1.3%]) and 0.75% at day 7 (0.3%-1.2%). The difference in mean swelling between etafilcon A and comfilcon A was 0.37% at day 1 (-0.1% to 0.8%) and 0.53% at day 7 (0.1%-1.0%). For limbal redness, etafilcon A fell within 0.1 grade of lotrafilcon B and 0.18 grade of comfilcon A. For endothelial bleb formation, etafilcon A fell within 0.45% of lotrafilcon B and 0.23% of comfilcon A. CONCLUSION: The etafilcon A control lens resulted in corneal deswelling throughout the day as did the SH lens types. Limbal hyperemia and endothelial bleb formation with all lenses were negligible, and noninferiority assumptions were met between the lens types for all outcomes. Equivalence of etafilcon A with respect to the two SH lenses for three measures of hypoxic stress was demonstrated.

Soft Contact Lenses with Positive Spherical Aberration for Myopia Control.

PURPOSE: To determine whether soft contact lenses with positive spherical aberration (+SA) can slow myopia progression. METHODS: Eligible subjects (N = 127, primarily Asian) aged 8 to 11 years were randomized to wear either control (spherical design) or test (with +SA) soft daily disposable contact lenses for a minimum of 1 and up to 2 years (treatment phase). Subjects from the initial cohorts (N = 82) were then followed for an additional 1.5 years while wearing a marketed spherical daily disposable contact lens (withdrawal phase). Axial length and spherical equivalent cycloplegic autorefraction (SECAR) were measured at baseline and every 6 months in both phases. RESULTS: During the first year of treatment, lens type (test vs. control) had a statistically significant impact on axial elongation (p = 0.0409). Eyes wearing test lenses increased in length by 0.11 (65.3%) and 0.14 (38.6%) mm less than eyes wearing control soft lenses at 6 and 12 months, respectively (p < 0.05 at both time points). The principal control of axial elongation occurred during the first 6 months. Spherical equivalent cycloplegic autorefraction change from baseline was significantly less in the test cohort than the control cohort by 0.21D (54.0%) at 6 months (p < 0.05) but not at 12 months (0.14D, p > 0.05). Lens type was not overall a significant factor affecting refractive error change (p = 0.0677). After ceasing treatment, neither the rate of axial elongation nor change in SECAR was significantly different between the initial two cohorts. CONCLUSIONS: The soft contact lens with +SA slowed axial growth of the eye, although this did not translate into a sustained statistically significant effect on SECAR. The majority of the treatment effect occurred in the initial 6 months of wear. No evidence of rebound effect was observed after ceasing treatment.

Comparative evaluation of Asian and white ocular topography.

PURPOSE: To provide comparative ocular topography data from a substantial population of East Asian and white eyes. METHODS: This study evaluated 675 subjects from three ethnic groups: white (n = 255), Chinese (n = 299), and Japanese (n = 121) at investigational sites in four locations: Wenzhou, China; Melbourne, Australia; Tokyo, Japan; and Jacksonville, USA. Subjects underwent the same measurements of ocular topography using identical equipment and protocols. A videokeratoscope (Medmont E300) was used to measure apical corneal radius, simulated K-reading (K), corneal shape factor (CSF), and corneal sagittal height at 10 mm in the two principal meridians. Digital photography was also used to measure ocular parameters including horizontal visible iris diameter (HVID), vertical palpebral aperture (PA), the intercanthal angle (ICA), and upper and lower lid angles. RESULTS: Mean HVID measurements were significantly smaller for the Chinese and Japanese groups than whites: 11.26, 11.10, and 11.75 mm, respectively. Horizontal K was significantly steeper for the white than the Chinese and Japanese groups: 7.79, 7.86, and 7.92 mm, respectively. The Chinese eyes showed significantly higher mean vertical CSF (i.e., more prolate) than the other two groups. The Chinese group had significantly narrower PA and steeper ICA than the other two groups: the mean PA and ICA values were 9.71, 10.31, and 10.58 mm and 7.56, 6.32, and 6.27 degrees, for the Chinese, Japanese, and white groups, respectively. One-third of the Chinese (32%) and 31% of the Japanese subjects showed no apparent supratarsal fold ("single eyelid"). There were also significant differences between groups for corneal sagittal height at 10 mm and upper and lower lid angles, but no significant differences for vertical K and horizontal CSF. CONCLUSIONS: This study has highlighted some differences in ocular topography between Chinese, Japanese, and white ethnic groups that may be relevant to soft contact lens fit.

Juvenile-onset myopia-who to treat and how to evaluate success.

The risk of eye diseases such as myopic macular degeneration increases with the level of myopia, but there is no safe level of myopia and the burden of lower degrees of myopia remains considerable. Effective treatments are available that slow progression and thus limit the final degree of myopia. In this review, the rationale for slowing progression is summarized, and a case made for treating all myopic children. Measurement of refractive error and axial length is reviewed, stressing the precision of optical biometry, but also the need for cycloplegic autorefraction. The factors influencing progression are considered and the available tools for interpretation of progression rate are discussed. Finally, the need to set attainable treatment goals is emphasized.

Comparison of manual and artificial intelligence-automated choroidal thickness segmentation of optical coherence tomography imaging in myopic adults.

BACKGROUND: Myopia affects 1.4 billion individuals worldwide. Notably, there is increasing evidence that choroidal thickness plays an important role in myopia and risk of developing myopia-related conditions. With the advancements in artificial intelligence (AI), choroidal thickness segmentation can now be automated, offering inherent advantages such as better repeatability, reduced grader variability, and less reliance for manpower. Hence, we aimed to evaluate the agreement between AI-automated and manual segmented measurements of subfoveal choroidal thickness (SFCT) using two swept-source optical coherence tomography (OCT) systems. METHODS: Subjects aged ≥ 16 years, with myopia of ≥ 0.50 diopters in both eyes, were recruited from the Prospective Myopia Cohort Study in Singapore (PROMYSE). OCT scans were acquired using Triton DRI-OCT and PLEX Elite 9000. OCT images were segmented both automatically with an established SA-Net architecture and manually using a standard technique with adjudication by two independent graders. SFCT was subsequently determined based on the segmentation. The Bland-Altman plot and intraclass correlation coefficient (ICC) were used to evaluate the agreement. RESULTS: A total of 229 subjects (456 eyes) with mean [± standard deviation (SD)] age of 34.1 (10.4) years were included. The overall SFCT (mean ± SD) based on manual segmentation was 216.9 ± 82.7 µm with Triton DRI-OCT and 239.3 ± 84.3 µm with PLEX Elite 9000. ICC values demonstrated excellent agreement between AI-automated and manual segmented SFCT measurements (PLEX Elite 9000: ICC = 0.937, 95% CI: 0.922 to 0.949, P < 0.001; Triton DRI-OCT: ICC = 0.887, 95% CI: 0.608 to 0.950, P < 0.001). For PLEX Elite 9000, manual segmented measurements were generally thicker when compared to AI-automated segmented measurements, with a fixed bias of 6.3 µm (95% CI: 3.8 to 8.9, P < 0.001) and proportional bias of 0.120 (P < 0.001). On the other hand, manual segmented measurements were comparatively thinner than AI-automated segmented measurements for Triton DRI-OCT, with a fixed bias of - 26.7 µm (95% CI: - 29.7 to - 23.7, P < 0.001) and proportional bias of - 0.090 (P < 0.001). CONCLUSION: We observed an excellent agreement in choroidal segmentation measurements when comparing manual with AI-automated techniques, using images from two SS-OCT systems. Given its edge over manual segmentation, automated segmentation may potentially emerge as the primary method of choroidal thickness measurement in the future.

The underestimated role of myopia in uncorrectable visual impairment in the United States.

We estimate the US prevalence of uncorrectable visual impairment in 2050 accounting for the changing distribution of both age and myopia. Age projections of the US population (from an estimated total of 379 million in 2050), were taken from the US census website. The distribution of myopia, by severity, was calculated from literature-derived prevalence estimates of 58.4% (≤ - 0.50 D, 2050 projection) and 33.1% (≤ - 1.00 D, 1999-2004 estimate) to provide predicted and conservative estimates, respectively. Uncorrectable visual impairment as a function of age and refractive error was modelled by multiple linear regression. Finally, the likely number of individuals in the US with visual impairment in 2050 was calculated. For a projected myopia prevalence of 58.4%, 222 million are projected to be myopic and 48 million will have high myopia (- 5 D or worse). The projected total number with uncorrectable visual impairment is 11.4 million of which 4.9 million cases (43%) of visual impairment will be directly attributed to increased risk of eye disease associated with myopia. For a projected myopia prevalence of 33.1%, 8.9 million are projected to have uncorrectable visual impairment of which 2.4 million cases (27%) will be directly attributed to myopia. It is predicted that between 27 and 43% of uncorrectable visual impairment in the US population in 2050 will be directly attributable to myopia. Failure to account for the increasing prevalence of myopia among the aging population leads to a substantial underestimate of the prevalence of visual impairment.

Randomized Trial of Soft Contact Lenses with Novel Ring Focus for Controlling Myopia Progression.

Purpose: To evaluate efficacy and vision with 2 prototype myopia control soft contact lenses with noncoaxial ring-focus designs (for enhancing efficacy [EE] and enhancing vision [EV]) compared with dual-focus (DF) and single-vision (SV) designs. Design: Multicenter, 6-month, randomized, controlled, double-masked clinical trial. Participants: One hundred ninety-nine myopic (-0.75 diopters [D] to -4.50 D) children aged 7 to 12 years. Methods: Participants were randomized with stratification into myopia control (EE, EV, or DF) or SV arms at 9 clinical sites in 3 countries. Postcycloplegia axial length (AL) and spherical equivalent autorefraction (SECAR) were measured at baseline and 26 weeks. Axial length was also measured without cycloplegia at baseline, 1, 4, 13, and 26 weeks. Progression was analyzed using linear mixed models by intention-to-treat population. Visual acuity (VA) and vision quality were monitored. Main Outcome Measures: Axial elongation, change in SECAR. Results: A total of 185 subjects completed the study (n = 44, 49, 45, and 47 for EE, EV, DF, and SV, respectively). There were no serious/significant ocular adverse events. After 26 weeks, EE, EV, and DF all had statistically significantly less axial elongation than SV (unadjusted mean [standard deviation]: EE, 0.079 [0.125]; EV, 0.119 [0.101]; DF, 0.135 [0.117]; SV; 0.189 [0.121] mm). The estimated least-square mean (LSM) differences (adjusted 95% confidence interval) compared with SV were -0.105 (-0.149, -0.062), -0.063 (-0.106, -0.020), and -0.056 (-0.100, -0.013) mm for EE, EV, and DF, respectively. Enhancing efficacy alone had statistically significantly less progression of SECAR than SV (EE: -0.12 [0.27] D vs. SV: -0.35 [0.33] D; LSM difference: 0.22 D [0.09, 0.35]). Enhancing efficacy also had statistically significantly less axial elongation than DF (-0.049 mm [-0.093, -0.004]). Changes in AL and SECAR of EV and DF were not statistically different. All 3 myopia control lenses had mean VA close to 0.00 logarithm of the minimum angle of resolution (logMAR) with estimated 95% upper confidence limits <0.10 logMAR. Enhancing efficacy and DF produced similar reports of halos but more than EV and SV. Conclusions: The prototype contact lenses met the design intent; EE was more efficacious in slowing axial elongation than DF with comparable vision performance, whereas EV produced comparable efficacy to DF with similar vision performance to SV.

Applications of Genomics and Transcriptomics in Precision Medicine for Myopia Control or Prevention.

Myopia is a globally emerging concern accompanied by multiple medical and socio-economic burdens with no well-established causal treatment to control thus far. The study of the genomics and transcriptomics of myopia treatment is crucial to delineate disease pathways and provide valuable insights for the design of precise and effective therapeutics. A strong understanding of altered biochemical pathways and underlying pathogenesis leading to myopia may facilitate early diagnosis and treatment of myopia, ultimately leading to the development of more effective preventive and therapeutic measures. In this review, we summarize current data about the genomics and transcriptomics of myopia in human and animal models. We also discuss the potential applicability of these findings to precision medicine for myopia treatment.

A Duration-Dependent Interaction Between High-Intensity Light and Unrestricted Vision in the Drive for Myopia Control.

Purpose: To evaluate the duration-dependent and synergetic impact of high-intensity light (HL) and unrestricted vision (UnV) on lens-induced myopia (LIM) development in chickens. Methods: Myopia was induced in one eye in chicks (10 groups, n = 126) from day 1 posthatching (D1) until day 8 (D8) using -10 diopter (D) lenses. Fellow eyes remained uncovered as controls. Nine groups were exposed daily to 2, 4, or 6 hours of HL (15,000 lux), UnV (removal of -10 D lens), or both (HL + UnV). One group served as the LIM group without any interventions. Ocular axial length (AL), refractive error, and choroidal thickness were measured on D1, D4, and D8. Outcome measures are expressed as interocular difference (IOD = experimental eye - control eye) ± SEM. Results: By D8, LIM increased AL (0.36 ± 0.04 mm), myopic refraction (-9.02 ± 0.37 D), and choroidal thinning (-90.27 ± 16.44 µm) in the LIM group (all, P < 0.001). Compared to the LIM group, exposure to 2, 4, or 6 hours of HL, UnV, or HL + UnV reduced myopic refraction in a duration-dependent manner, with UnV being more effective than HL (P < 0.05). Only 6 hours of HL + UnV (not 2 or 4 hours) prevented LIM and was more effective than UnV (P = 0.004) or HL (P < 0.001) in reducing myopic refraction and more effective than HL (P < 0.001) in reducing axial elongation. Conclusions: Daily exposure to 2, 4, or 6 hours of HL, UnV, or HL + UnV reduced lens-induced myopic refraction in a duration-dependent manner in chickens. Only 6 hours of HL + UnV completely stopped LIM development. The synergetic effect of HL and UnV is dependent on the duration of the interventions.

Citation analysis of the contact lens field.

PURPOSE: To identify, analyze, and celebrate the most highly cited articles relating to contact lenses and the leading authors, journals, institutions, and countries associated with these publications. METHODS: To capture all contact lens articles published since 1900, a search equation targeting specific contact lens-related terms in the titles of articles was derived and entered into "Web of Science." A rank order list of the 1000 most highly cited articles was assembled, each having received at least eight citations. The most prominent articles, authors, journals, institutions, and countries were identified from this list by simple counts. RESULTS: The most highly cited article relating to contact lenses (although cited exclusively in the physical sciences literature) is that of Phillip and Schmidt (J Non Cryst Solids 1984;63:288-92), reporting the application of the sol-gel process for the fabrication of rigid contact lenses. Eight of the top 10 articles ranked according to average number of citations/year relate to contact lens-associated microbial keratitis. Of the top eight authors, six have spent all, or a substantial proportion, of their academic careers in Australia and seven have worked in optometric research environments. Optometry and Vision Science is the leading journal. The top-ranked institution is The University of New South Wales, Sydney, Australia. The United States is the most prominent publishing country in the field, and Australia ranks highest when the numbers of highly cited articles are considered per head of population. CONCLUSIONS: This work provides a unique snapshot of significant articles relating to contact lenses.