Regulation of scleral metabolism in myopia and the role of transforming growth factor-beta.

Myopia is one of the most prevalent ocular conditions and is the result of a mismatch between the power of the eye and axial length of the eye. In the vast majority of cases the structural cause of myopia is an excessive axial length of the eye, or more specifically the vitreous chamber depth. In about 3% of the general population in Europe, USA and Australia, the degree of myopia is above 6 dioptres and is termed high myopia. In South East Asia the figure is closer to 20% of the general population with high myopia. The prevalence of sight threatening ocular pathology is markedly increased in eyes with high degrees of myopia (>-6 D). This results from the excessive axial elongation of the eye which, by necessity, must involve the outer coat of the eye, the sclera. Current theories of refractive development acknowledge the pivotal role of the sclera in the control of eye size and the development of myopia. This review details the major structural, biochemical and biomechanical changes that underlie abnormal development of the mammalian sclera in myopia. In describing the changes in regulation of sclera metabolism in myopia, the pivotal role of transforming growth factor-ß signalling is highlighted as the responsible factor for certain critical events in myopia development that ultimately result in the scleral pathology observed in high myopia.

How does atropine exert its anti-myopia effects?

In the following point-counterpoint article, internationally-acclaimed myopia researchers were challenged to defend the two opposing sides of the topic defined by the title; their contributions, which appear in the order, Point followed by Counterpoint, were peer-reviewed by both the editorial team and an external reviewer. Independently of the invited authors, the named member of the editorial team provided an Introduction and Summary, both of which were reviewed by the other members of the editorial team. By their nature, views expressed in each section of the Point-Counterpoint article are those of the author concerned and may not reflect the views of all of the authors.

The M4 muscarinic antagonist MT-3 inhibits myopia in chick: evidence for site of action.

PURPOSE: It is well established that the broad-band muscarinic antagonist, atropine is effective at inhibiting the progression of myopia and does so by preventing the elongation of the vitreous chamber of the eye. However, uncertainty remains as to whether this effect occurs through a receptoral mechanism and, if so, which muscarinic receptor subtype mediates this effect. Previous work, in avian and mammalian models of myopia, implicates the M1 and M4 receptors as potential targets. The current study used physiologically relevant concentrations of highly selective muscarinic antagonists (MT-3 and MT-7) to further characterise the role of the M4 receptor in the control of myopia in the chick model of refractive development. METHODS: Nine groups of week-old chicks underwent 5 days of monocular deprivation, with a translucent occluder, to induce myopia. These animals had either no injection, scleral puncture with a needle, or daily intravitreal injections of MT-3 (M4-selective), MT-7 (M1-selective) or vehicle. Three concentrations of each antagonist were delivered (250 nm, 2.5 µm and 10 µm). After the treatment period, keratometry, retinoscopy and A-Scan ultrasound were used to assess ocular biometry. RESULTS: MT-3 treatment produced a significant dose-dependent reduction in relative myopia (treated-control eye) compared to vehicle treatment (vehicle -10.1 ± 1.1 D vs 10 µm MT-3 -4.0 ± 1.5 D, p < 0.01). The majority of this effect was due to reduced relative vitreous chamber elongation in drug treated eyes (vehicle +0.26 ± 0.04 mm, 10 µm MT-3 +0.08 ± 0.07 mm, p < 0.05). In contrast, MT-7 had no significant effect on the development of myopia (MT-7 10 µm: myopia, -12.1 ± 0.8 D and vitreous chamber depth, +0.23 ± 0.07 mm). Calculations indicate that the experimentally achieved concentrations of MT-3 at intraocular receptors necessary to inhibit 50% of myopia development (between 5 and 50 nm) were consistent with published in vitro affinity constants for the M4 receptor and below those for the M1 receptor. Histology demonstrated that MT-3 at the doses used had no gross effects on the retina, indicating a non-toxic mode of action. CONCLUSIONS: In the chick, which lacks a homologue of the mammalian M1 receptor, the above findings represent compelling evidence that muscarinic antagonists prevent myopia progression through an M4-receptor mediated mechanism, most likely located in the retina.

Biomechanics of the sclera in myopia: extracellular and cellular factors.

PURPOSE: Excessive axial elongation of the eye is the principal structural cause of myopia. The increase in eye size results from active remodelling of the sclera, producing a weakened scleral matrix. The present study will detail the biomechanics of the sclera and highlight the matrix and cellular factors important in the control of eye size. METHODS: Scleral elasticity (load vs. tissue extension) and creep rate (tissue extension vs. time) have been measured postmortem in human eyes. Animal models of myopia have allowed the direct relevance of scleral biomechanics to be investigated during myopia development. Recently, data on tissue matrices incorporating scleral fibroblasts have highlighted the role of cellular contraction in scleral biomechanics. RESULTS: Scleral elasticity is increased in eyes developing myopia, with a reduction in the failure load of the tissue. Scleral creep rate is increased in the sclera from eyes developing myopia, and reduced in eyes recovering from myopia. These changes in biomechanical properties of the sclera occur early in the development of myopia (within 24 h). Alterations in scleral biomechanics during myopia development have been attributed to changes in matrix constituents, principally reduced collagen content. Although the biochemical structure of the sclera plays a critical role in defining the mechanical properties, recent studies investigating the cellular mechanics of the sclera, implicate myofibroblasts in scleral biomechanics. Scleral myofibroblasts have the capacity to contract the matrix and are regulated by tissue stress and growth factors such as transforming growth factor-beta. Changes in these regulatory factors have been observed during myopia development, implicating cellular factors in the resultant weakened sclera. CONCLUSIONS: Changes in the biomechanical properties of the sclera are important in facilitating the increase in axial length that results in myopia. Understanding the matrix and cellular factors contributing to the weakened sclera may aid in the development of a clinically appropriate treatment for myopia.

Effects of a head-mounted display on the oculomotor system of children.

PURPOSE: This study evaluated the effects of short term and extended viewing of virtual imagery using the Binocular Viewer (new generation bi-ocular viewer) on the visual system of children, and compared these effects with that of viewing a high definition television (HDTV) display. METHODS: Sixty children aged 5 to 16 years viewed 30 min of virtual imagery using the Binocular Viewer and a HDTV display on two occasions. Sixteen subjects, aged 13 to 16 years, completed a third session of extended viewing (80 min) with the Binocular Viewer. Oculomotor function and symptoms were assessed previewing, immediately postviewing, and 10 min postviewing. RESULTS: Thirty minutes of Binocular Viewer use resulted in symptom increases (p < 0.05) immediately postviewing ("feeling tired," "feeling sleepy," "difficulty concentrating," and "sore/aching eyes") however most symptoms had dissipated by 10-min postviewing. There were no significant symptom differences between viewing with the Binocular Viewer and the HDTV display at either time point. An increase in symptoms (p < 0.05) immediately postviewing was recorded after 80 min of Binocular Viewer use ("feeling tired," "feeling bored," "feeling sleepy," and "tired eyes"), however only "feeling tired" and "feeling bored" remained significantly increased (p < 0.05) 10-min postviewing. Near unaided visual acuity demonstrated a significant and consistent reduction immediately (p < 0.01) and at 10 min (p < 0.05) following 30 min of Binocular Viewer use and immediately following 80 min of use (p < 0.01). Near unaided VA was also significantly reduced (p < 0.01) immediately after 30 min of HDTV display use. CONCLUSIONS: Virtual imagery viewing with the Binocular Viewer in children aged 5 to 16 years had few additional adverse effects when compared to viewing a more conventional HDTV display. The Binocular Viewer was comfortable to wear for up to 80 min of viewing. The consistent reduction in near vision for both viewing durations with the Binocular Viewer requires further investigation.

Developmental eye movement test: what is it really measuring?

PURPOSE: The Developmental Eye Movement (DEM) test is commonly used as a clinical visual-verbal ocular motor assessment tool. However, while the DEM test ratio has been reported to correlate with horizontal saccadic eye movements, there have been no published comparative studies of the DEM test and objective eye movement measures. The aim of this study was to compare DEM test performance with explicit quantification of saccadic eye movements, reading performance, symptomatology and visual processing speed, to assess the validity of the DEM test in clinical practice. METHODS: One hundred fifty-eight children aged 8 to 11 years completed the DEM test and a battery of eye movement tasks, recorded by a Microguide 1000 infrared eye tracker. All subjects completed a symptomatology survey. Reading performance and visual processing data was collected for 77 and 75 children, respectively. RESULTS: One hundred twenty-nine of the 158 subjects (81.65%) passed the DEM test. There was no significant correlation between any component of DEM test performance and quantitative eye movement parameters (gain, latency, asymptotic peak velocity, and number of corrective saccades) or symptomatology. There were significant correlations between DEM test outcome and reading performance, and with visual processing speed. CONCLUSIONS: DEM test performance does not correlate with saccadic eye movement skills or symptomatology. However, it is related to reading performance and visual processing speed. This study suggests that although DEM test times may not correlate directly with eye movement parameters, they do correlate with aspects of reading performance and thus may serve a diagnostic role in clinical practice.

The effect of positive lens defocus on ocular growth and emmetropization in the tree shrew.

Optical defocus influences postnatal ocular development in animal models. Induced negative lens defocus results in accelerated ocular elongation and myopia. Positive lens-induced defocus findings across animal models have been inconsistent. Specifically, in the tree shrew, positive lens-induced defocus has produced equivocal results. This study evaluated the response of the tree shrew to induced positive lens defocus. One treatment group wore positive lenses binocularly, which were increased in power sequentially from +2 to +4, +6, +8, and +9.5 D over 8 weeks. Other groups wore +4, +6, and +9.5 D lenses, respectively, for 8 weeks. Animals wearing zero-powered (plano) lenses served as controls. Refractive error and ocular dimensions were measured at the start of treatment and every week thereafter. Sequentially increasing positive lens power caused a relative hyperopia of +5.6 D (p < 0.01) compared to the plano lens group (+10.9 +/- 1.8 D vs +5.3 +/- 0.5 D). Constant +4 D lens wear produced +6.9 D relative hyperopia, while +6 and +9.5 D lens wear did not induce hyperopia. Lens-induced defocus changes in refractive state were significantly correlated with vitreous chamber depth changes. The threshold for consistent responses to positive lens defocus in tree shrew was between +4 and +6 D. The results will enable targeted investigation of the efficacy of positive lens defocus in inhibiting myopic ocular growth.

Reduced Scleral TIMP-2 Expression Is Associated With Myopia Development: TIMP-2 Supplementation Stabilizes Scleral Biomarkers of Myopia and Limits Myopia Development.

Purpose: The purpose of this study was to determine the endogenous regulation pattern of tissue inhibitor of metalloproteinase-2 (TIMP-2) in the tree shrew sclera during myopia development and investigate the capacity of exogenous TIMP-2 to inhibit matrix metalloproteinase-2 (MMP-2) in vitro and both scleral collagen degradation and myopia development in vivo. Methods: TIMP-2 expression in the sclera during myopia development was assessed using polymerase chain reaction. In vitro TIMP-2 inhibition of MMP-2 was investigated using a gelatinase activity plate assay and zymography. Tree shrews were injected with a collagen precursor before undergoing monocular form deprivation and concurrent daily subconjunctival injections of either TIMP-2 or vehicle to the form-deprived eye. In vivo ocular biometry changes were monitored, and scleral tissue was collected after 12 days and assayed for collagen degradation. Results: The development of myopia was associated with a mean reduction in TIMP-2 mRNA expression after 5 days of form deprivation (P < 0.01). Both activation and activity of MMP-2 were inhibited by TIMP-2 with an IC50 of 10 to 20 and 2 nM, respectively. In vivo exogenous addition of TIMP-2 significantly reduced myopia development (P < 0.01), due to reduced vitreous chamber elongation (P < 0.01). In vivo TIMP-2 treatment also significantly inhibited posterior scleral collagen degradation relative to vehicle-treated eyes (P < 0.01), with levels similar to those in control eyes. Conclusions: Myopia development in mammals is associated with reduced expression of TIMP-2, which contributes to increased degradative activity in the sclera. It follows that replenishment of this TIMP-2 significantly reduced the rate of both scleral collagen degradation and myopia development.

Expression of collagen-binding integrin receptors in the mammalian sclera and their regulation during the development of myopia.

PURPOSE: The sclera has a collagen-rich extracellular matrix that undergoes significant biochemical and biomechanical remodeling during myopic eye growth. The integrin family of cell surface receptors play critical roles in extracellular matrix and biomechanical remodeling in connective tissues. This study identified the major collagen-binding integrin receptors in the mammalian sclera and investigated their mRNA expression during the development of and recovery from experimental myopia. METHODS: The presence of the alpha1, alpha2, and beta1 integrin subunits was examined by using tree-shrew-specific primers and RT-PCR. Scleral expression of alpha1beta1 and alpha2beta1 receptor proteins was further investigated by using Western blot analysis and immunocytochemistry. Myopia was induced monocularly by occluding pattern vision and scleral tissue collected after 24 hours and 5 days. In a subset of the 5-day treatment group, vision was restored for 24 hours before tissue was isolated. Total RNA was extracted, and integrin subunit expression levels were assessed with quantitative real-time PCR. RESULTS: The presence of the major collagen-binding integrin subunits alpha1, alpha2, and beta1 was confirmed by RT-PCR in both scleral tissue and cultured scleral fibroblasts. Both the alpha1 and alpha2 integrin subunit proteins were identified in tree shrew scleral tissues, and integrin receptor expression was localized to scleral fibroblast focal adhesions. After only 24 hours of myopia induction, a time when no structural elongation has occurred, significant decreases were observed in the expression of the alpha1 (-36%) and beta1 (-44%) integrin subunits. After 5 days of myopia induction, alpha1 integrin expression had returned to baseline levels, whereas the alpha2 subunit showed a significant decrease in expression (-52%). The 5-day integrin profiles were maintained during recovery from the induced myopia, with only alpha2 integrin showing a statistically significant relative decrease in expression (-41%). CONCLUSIONS: The mammalian sclera expresses the major collagen-binding integrin subunits. The alpha1 and beta1 subunit expression was decreased early during the development of myopia, whereas the regulation of alpha2 integrin occurred at a later time point. The differential regulation of alpha1beta1 and alpha2beta1 during the development of myopia may reflect specific roles for these receptors in the scleral extracellular matrix and biomechanical remodeling that accompanies myopic eye growth.

Altered visual sensitivity in axial high myopia: a local postreceptoral phenomenon?

PURPOSE: The present study investigated retinal integrity in high myopia using spatial psychophysical tasks. METHODS: Ten axial high myopes (-8.5 to -11.5 D) and 10 age-matched control subjects (+/-1.0 D) were recruited. All participants underwent clinical examination and ocular biometry and demonstrated no visible macular disease with visual acuities better than 6/12. Foveal summation thresholds were determined for white and S-cone-isolating spots of various diameters up to 5.4 degrees and spatial contrast sensitivity to luminance sine wave gratings (0.5-9.7 cyc/deg). Data were analyzed after correction for the magnification induced by eye size and correcting lens power. RESULTS: Spatial summation for both white and S-cone-isolating spots showed a generalized loss of sensitivity at all spot sizes in myopes relative to control subjects (P = 0.01). Critical areas at maximum summation were significantly larger in myopes, for S-cone isolating spots only, after image size correction (P = 0.048). Sensitivity at maximum summation correlated negatively with vitreous chamber depth for both targets (P = 0.005). Sensitivities for S-cone and luminance spots also correlated (P < 0.001), indicating widespread dysfunction. Myopes displayed contrast sensitivity losses at high spatial frequencies (P

Characterization of the integrin receptor subunit profile in the mammalian sclera.

PURPOSE: During the increased eye growth that results in myopia, the sclera undergoes biochemical and biomechanical remodeling. The cell surface integrin receptor family has important roles during tissue remodeling, regulating the extracellular matrix environment and cellular biomechanical properties. As integrin receptors may have a role in remodeling during myopia, this study detailed subunit gene expression in the mammalian sclera. METHODS: Several tissues, including sclera, were isolated from the tree shrew, a mammalian model used in eye growth studies. Total RNA was purified, reverse transcribed and primers for the alpha- and beta-integrin subunits were designed to the published human sequence in areas of high inter-species homology. PCR was used to amplify products of predetermined size and all tree shrew integrin subunits were sequenced to confirm their identity. Multiple PCR conditions were used to identify the scleral integrin subunits, and positive control tissues were included to reduce the possibility of false negative results. RESULTS: Integrin PCR products corresponding to the beta1-, beta4-, beta5-, and beta8-integrin subunits and the alpha-integrin subunits, alpha1-6-, alpha9-11- and alphav-integrin were identified in the sclera and in scleral fibroblast cultures. The respective sequences showed a high identity (>81%) to their human counterparts. The beta2-, beta3-, beta6-, beta7-, alpha7-, and alpha8-integrin subunits were not detected in tree shrew scleral samples, despite being present in the respective positive controls. Association of the 4 beta-integrin subunits with the 10 alpha-integrin subunits suggests that the mammalian sclera is capable of expressing 13 of the 24 identified integrin receptors. CONCLUSIONS: This is the first systematic description of the integrin subunit expression profile in the sclera. Due to the multiple roles of integrin receptors during tissue remodeling, the identification of these scleral integrins is an important preliminary step in determining the role of these receptors during normal eye growth and myopia development.

Role of the sclera in the development and pathological complications of myopia.

Myopia is one of the most prevalent ocular conditions and is the result of a mismatch between the power of the eye and axial length of the eye. As a result images of distant objects are brought to a focus in front of the retina resulting in blurred vision. In the vast majority of cases the structural cause of myopia is an excessive axial length of the eye, or more specifically the vitreous chamber depth. In about 2% of the general population, the degree of myopia is above 6 dioptres (D) and is termed high myopia. The prevalence of sight-threatening ocular pathology is markedly increased in eyes with high degrees of myopia ( > -6 D). This results from the excessive axial elongation of the eye which, by necessity, must involve the outer coat of the eye, the sclera. Consequently, high myopia is reported as a leading cause of registered blindness and partial sight. Current theories of refractive development acknowledge the pivotal role of the sclera in the control of eye size and the development of myopia. This review considers the major biochemical mechanisms that underlie the normal development of the mammalian sclera and how the scleral structure influences the rate of eye growth during development. The review will characterise the aberrant mechanisms of scleral remodelling which underlie the development of myopia. In describing these mechanisms we highlight how certain critical events in both the early and later stages of myopia development lead to scleral thinning, the loss of scleral tissue, the weakening of the scleral mechanical properties and, ultimately, to the development of posterior staphyloma. This review aims to build on existing models to illustrate that the prevention of aberrant scleral remodelling must be the goal of any long-term therapy for the amelioration of the permanent vision loss associated with high myopia.

Pressure-induced changes in axial eye length of chick and tree shrew: significance of myofibroblasts in the sclera.

PURPOSE: To investigate the change in axial eye dimensions resulting from stretching the sclera by acute elevation of intraocular pressure (IOP). METHODS: IOP was increased to 100 mm Hg for 1 hour through an intravitreal cannula, while ocular component dimensions were monitored every 10 minutes with A-scan ultrasound in anesthetized animals (10 chicks and 10 tree shrews). In addition, immunocytochemical detection of alpha-smooth muscle actin (alpha-SMA) using a monoclonal antibody was conducted in the sclera of the tree shrew and the chick. RESULTS: In both species, axial eye length immediately and significantly (P < 0.0001) increased on elevation of IOP to 100 mm Hg: chick to 103.9%, tree shrew to 101.2% (mean percentage of original measured at 15 mm Hg). After 1 hour of maintained pressure, chick eyes showed a further significant increase in axial length (to 108.6%), but axial length of tree shrew eyes decreased (to 100.3%) to the point that it was not significantly different from the original value at 15 mm Hg. Immunocytochemical studies of age-matched tissue demonstrated the presence of alpha-SMA-containing fibroblasts (myofibroblasts) within tree shrew but not chick sclera. CONCLUSIONS: Elevation of IOP caused axial elongation of chick eyes, but a consistent reduction in axial length of tree shrew eyes. The presence of myofibroblasts, demonstrated in tree shrew but not chick sclera, suggests that the reduction in axial length of tree shrew eyes may have been caused by activation of a contractile mechanism involving scleral myofibroblasts. Such a mechanism may play a role in the regulation of eye size and refractive development.

Muscarinic antagonist control of myopia: a molecular search for the M1 receptor in chick.

PURPOSE: Pirenzepine, an M1 selective muscarinic antagonist, is effective in slowing the progression of myopia in both humans and experimental animals, including chick. As an M1 selective antagonist, pirenzepine is considered to mediate its effect through M1 receptors. However, there is currently no report of the M1 receptor in chicken. Therefore, if the mechanism of action of pirenzepine is similar across species, either the drug mediates its effect through a non-M1 mechanism, or M1 muscarinic receptors are present in chicken. The aim of the present study was to determine whether a genetic template for the M1 receptor was expressed, or even present, in chick. METHODS: Polymerase Chain Reaction (PCR), and Southern and northern blotting analyses were used to search for M1 mRNA in chick ocular and brain tissues. PCR and Southern analyses were then used for searching the chick M1 gene and promoter. Appropriate rat positive controls were included throughout the study. RESULTS: Direct mRNA detection by northern analysis showed no evidence of M1 mRNA expression in the chick ocular and brain tissues studied. Identical results were obtained from PCR amplification and were further confirmed by Southern analysis. Similarly, no M1 gene or promoter sequences were detected by PCR or Southern analyses. Our methods were validated in every case by a positive finding in equivalent rat tissue and by detection of M2 and M4 mRNA expression in chick retina. CONCLUSIONS: Findings in this study suggest that the chick does not possess an M1 receptor. This finding is of primary interest to vision researchers in that it suggests pirenzepine is unlikely to mediate its inhibitory effect on the progression of myopia through an M1 receptor in chick. Alternative mechanisms of action are discussed.

Muscarinic receptor protein expression in the ocular tissues of the chick during normal and myopic eye development.

Muscarinic receptor signalling has been implicated in both the embryonic and postnatal development of ocular structures as well as in myopic eye growth. A radioligand binding assay was used to determine whether changes in muscarinic receptor density and/or affinity occurred in the chick retina, choroid and sclera during early post-hatching development or with the induction of myopia. Specific receptor binding sites were saturable with increasing concentrations of the muscarinic receptor ligand [3H]N-methyl-scopolamine in the retina and choroid but not in the sclera. In normal eyes, binding density in the retina was not altered from age P5 to P10 (447+/-14 vs. 411+/-13 fmol/mg of protein, P=0.07). However, in the choroid, the number of receptor binding sites significantly increased between P5 and P10 (637+/-39 vs. 1125+/-121 fmol/mg of protein, P<0.01). Binding affinity (K(D)) was not altered with age in either the retina or choroid. Myopia was induced in chicks by deprivation of form vision, using translucent diffusers, from age P3. Despite the induction of significant degrees of ocular elongation and myopia at P5 (-8.7+/-0.3 D, P<0.01) and P10 (-22.5+/-1.3 D, P<0.01), neither muscarinic receptor density nor affinity were altered in the retina or choroid of myopic eyes. These findings indicate that regulation of muscarinic receptor numbers in the chick choroid is occurring in normal post-hatching development of this tissue. However, myopic eye enlargement was not associated with changes in muscarinic receptor protein expression in the chick retina and choroid.

Expression and cDNA sequence of matrix metalloproteinase-2 (MMP-2) in a mammalian model of human disease processes: Tupaia belangeri.

Matrix metalloproteinase-2 (MMP-2) is one of a family of proteolytic enzymes that are involved in the remodelling of tissue during normal growth processes and is capable of degrading structural components of the extracellular matrix. Increases in MMP-2 expression and activity have been reported in diseases that involve degradation of the extracellular matrix. Reported here for the first time are the relative levels of expression of MMP-2 in tissues of the tree shrew along with 2587 bases of the mRNA sequence. Translation of this sequence predicts a protein 660 amino acids in length, containing all of the features expected of mammalian MMP-2. The tree shrew is a species close to the primate line and is an emerging animal model for a variety of human diseases, including hepatitis and myopia that feature MMP-2 mediated remodelling of the extracellular matrix.

Eyes in various species can shorten to compensate for myopic defocus.

PURPOSE: We demonstrated that eyes of young animals of various species (chick, tree shrew, marmoset, and rhesus macaque) can shorten in the axial dimension in response to myopic defocus. METHODS: Chicks wore positive or negative lenses over one eye for 3 days. Tree shrews were measured during recovery from induced myopia after 5 days of monocular deprivation for 1 to 9 days. Marmosets were measured during recovery from induced myopia after monocular deprivation, or wearing negative lenses over one or both eyes, or from wearing positive lenses over one or both eyes. Rhesus macaques were measured after recovery from induced myopia after monocular deprivation, or wearing negative lenses over one or both eyes. Axial length was measured with ultrasound biometry in all species. RESULTS: Tree shrew eyes showed a strong trend to shorten axially to compensate for myopic defocus. Of 34 eyes that recovered from deprivation-induced myopia for various durations, 30 eyes (88%) shortened, whereas only 7 fellow eyes shortened. In chicks, eyes wearing positive lenses reduced their rate of ocular elongation by two-thirds, including 38.5% of eyes in which the axial length became shorter than before. Evidence of axial shortening in rhesus macaque (40%) and marmoset (6%) eyes also occurred when exposed to myopic defocus, although much less frequently than that in eyes of tree shrews. The axial shortening was caused mostly by the reduction in vitreous chamber depth. CONCLUSIONS: Eyes of chick, tree shrew, marmoset, and rhesus macaque can shorten axially when presented with myopic defocus, whether the myopic defocus is created by wearing positive lenses, or is the result of axial elongation of the eye produced by prior negative lens wear or deprivation. This eye shortening facilitates compensation for the imposed myopia. Implications for human myopia control are significant.

Muscarinic antagonist control of myopia: evidence for M4 and M1 receptor-based pathways in the inhibition of experimentally-induced axial myopia in the tree shrew.

PURPOSE: The broadband muscarinic antagonist atropine is effective in stopping the progression of myopia in animals and humans. The partially selective M(1)/M(4) antagonist pirenzepine also slows progression of myopia, although not as effectively as atropine. Due to the supra maximal doses utilized in these studies, it is unclear if this antimyopia effect occurs through a receptoral-based mechanism, and if so, which receptors are involved. Studies in chicks indicate the involvement of the M(4) muscarinic receptor. The current study investigated the effect of the highly selective muscarinic antagonists Muscarinic Toxin 3 (MT3) (M(4) selective) and Muscarinic Toxin 7 (MT7) (M(1) selective) on experimental myopia in a mammalian model. METHODS: Tree shrews (n = 23) underwent daily intravitreal injections of MT3, MT7, or vehicle (phosphate buffered saline) for five days in the treated eye, combined with deprivation of vision with a translucent occluder (MD). The contralateral eye was unocccluded and underwent intravitreal injections of vehicle for the same period. Two additional groups (n = 10) underwent daily intravitreal injections of MT7 or vehicle for 10 days in the treated eye combined with negative lens (-9.5 diopter [D]) defocus (LIM). The control eye was injected with saline and wore a plano lens. RESULTS: Both MT3 and MT7 treatment reduced the development of deprivation-induced myopia (treated-control eye [T-C]; vehicle-MD; -4.3 ± 0.6 D versus MT3-MD; -0.7 ± 0.2 D and MT7-MD; -0.7 ± 0.4 D; P < 0.001). MT7 treatment was effective at inhibiting lens-induced myopia (T-C; vehicle-LIM; -4.6 ± 0.5 D versus MT7-LIM; 0.2 ± 0.2 D; P < 0.05). CONCLUSIONS: The findings demonstrate that inhibition of form-deprivation myopia by muscarinic antagonists involves both M(4) and M(1) muscarinic receptor signaling pathways in mammals.

The effect of daily transient +4 D positive lens wear on the inhibition of myopia in the tree shrew.

PURPOSE: Negative-lens-induced defocus causes accelerated ocular elongation and myopia, whereas positive-lens-induced defocus produces reduced ocular elongation and hyperopia. Short durations of positive lens wear result in markedly stronger temporal effects than do short periods of negative lens wear in the chick model of refractive development. In mammalian and nonhuman primate models, there have been equivocal results in inhibiting myopia by short periods of positive lens wear when compared with data from the chick model. The purpose of the present study was an evaluation of full-time -9.5 D negative lens wear interrupted by short periods of daily +4 D positive lens wear in preventing experimental myopia in the tree shrew. METHODS: One treatment group wore negative lenses (-9.5 D) binocularly for 23 hours a day (10 hours of which were spent in total darkness), interrupted by 1 hour of wearing positive lenses (+4 D) binocularly for 12 days. Another group of animals wore negative lenses (-9.5 D) binocularly for 23 hours a day, interrupted by two 30-minute periods of positive lens (+4 D) wear daily, again for 12 days. The animals were raised on a 14-hour/10-hour light-dark cycle. Animals wearing -9.5 D lenses binocularly, interrupted by 0-powered lenses for either 1 hour or two 30-minute periods daily for 12 days, acted as controls. RESULTS: Continuous wear of -9.5 D lenses binocularly induced a -10.8 D myopic shift in refraction. Full-time wear of -9.5 D lenses binocularly, interrupted by 1 hour of 0-power lens wear binocularly, caused a myopic shift of 3.6 D over 12 days, whereas wearing -9.5 D lenses, interrupted by 1 hour every day of +4.0 D lens wear binocularly, whether it was continuous or divided into two 30-minute periods, caused a myopic shift of only 0.7 D over 12 days. CONCLUSIONS: Daily intermittent +4 D positive lens wear effectively inhibits experimentally induced myopia and may prove a viable approach for preventing myopia progression in children.