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PURPOSE: To investigate the myopia control efficacy of novel Lenslet-ARray-Integrated (LARI) spectacle lenses with positive power lenslets (PLARI) and negative power lenslets (NLARI) worn for 1 year in myopic children. DESIGN: Randomized, double-masked, controlled clinical trial. PARTICIPANTS: A total of 240 children 6 to 12 years of age with spherical equivalent refraction (SER) between -4.00 and -1.00 diopters (D), astigmatism of ≤ 1.50 D, and anisometropia of ≤ 1.00 D. METHODS: Participants were assigned randomly in a 1:1:1 ratio to PLARI, NLARI, and control (single-vision [SV]) groups. Cycloplegic autorefraction and axial length were measured at baseline and 6-month intervals after lens wear. MAIN OUTCOME MEASURES: Changes in SER, axial elongation (AE), and differences between groups. RESULTS: After 1 year, SER changes and AE in the PLARI and NLARI groups were significantly less than those in the SV group (SER: -0.30 ± 0.48 D, -0.21 ± 0.35 D, and -0.66 ± 0.40 D, respectively; AE: 0.19 ± 0.20 mm, 0.17 ± 0.14 mm, 0.34 ± 0.18 mm, respectively; all P < 0.001). No significant differences were found in SER changes and AE between PLARI and NLARI groups (P = 0.54 and P = 1.00, respectively). Younger age was associated with more rapid SER increase and larger AE in the SV group (r = 0.40 [P < 0.001] and r = -0.59 [P < 0.001], respectively) and PLARI group (r = 0.46 [P < 0.001] and r = -0.52 [P < 0.001], respectively), but not in the NLARI group (r = -0.002 [P = 0.98] and r = -0.08 [P = 0.48], respectively). CONCLUSIONS: Compared with the SV group, both PLARI and NARI groups showed significantly slower myopia progression in terms of SER and AE. Faster myopia progression, in terms of both SER and AE, was associated with younger age in the SV and PLARI groups but not the NLARI group. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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PURPOSE: To determine how the position of the centre of rotation of the eyeball is related to axial length and refractive error when horizontal and vertical eye movements are performed. METHODS: A custom-built eye tracker was used that determined the centre of rotation of the eye (COR) from lateral displacements of the pupil centre. Horizontal and vertical eye movements were studied in the right eyes, and each measurement performed five times in 59 subjects (32 females) with an average age of 36.6 ± 9.1 years. Spherical equivalent refractive errors ranged from -9.7 to +6.8 D with an average error of -1.5 ± 2.9 D. Axial lengths were measured with the ZEISS IOL Master 500. RESULTS: The mean horizontal centre of rotation (COR) of the right eye for a saccade from 0° to ±11.9° was 15.3 ± 1.5 mm behind the corneal apex, while the average vertical COR for the same angle of eccentricity was 12.5 ± 1.4 mm, indicating that the horizontal COR was 2.8 ± 1.7 mm behind the vertical COR. In right eyes, horizontal COR was significantly correlated with axial length (r = 0.28, p = 0.02) but not with the spherical equivalent refractive error (r = 0.39, p = 0.90). Similarly, vertical COR was significantly correlated with axial length (r = 0.25, p = 0.03) but not with the spherical equivalent refractive error (r = 0.17, p = 0.90). CONCLUSIONS: While it might be expected that the COR is dependent on axial length, the correlation was not strong. Interestingly, the location of the COR was substantially different for horizontal and vertical eye movements which may relate to the flatter curvature of the eyeball in the vertical meridian, compared to the horizontal, as described in previous studies.
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Erros de Refração , Adulto , Córnea , Movimentos Oculares , Feminino , Humanos , Pessoa de Meia-Idade , Pupila , Refração Ocular , Erros de Refração/diagnóstico , RotaçãoRESUMO
BACKGROUND: Myopia is one of the most common eye diseases causing visual impairment and blindness, and the high prevalence in adolescents remains a major public health concern. Based on clinical studies using optical defocus to regulate ocular growth and refractive changes through visual feedback, we hypothesize that early wearing of peripheral myopic defocusing spectacles in children with high risk of myopia may slow the process of emmetropization and even prevent the onset of myopia by inducing more peripheral myopic defocus. The aim of this study is to investigate whether the wearing of peripheral focus-out glasses can be effective in delaying emmetropization in non-myopic children aged 6-8 years. METHODS: The study is a 2-year randomized controlled trial. A total of 160 subjects will be randomized into the experimental group or the control group. The experimental group will be fitted with direct emmetropia with focus-out glasses (DEFOG) to guide the emmetropization process. The control group will not receive any treatment and will serve as a blank control group. The primary aim is to determine whether non-myopic children wearing DEFOG lenses are superior to those who do not receive any intervention on the progression of cycloplegic objective refraction over 2 years. DISCUSSION: This is the first randomized controlled trial aiming at myopic prevention by non-invasive intervention in non-myopic children. This study aims to initially investigate whether wearing peripheral focus-out glasses can effectively delay the process of emmetropization in children aged 6-8 years with high risk of myopia, which might give potential clues for further exploration on early prevention of myopia. TRIAL REGISTRATION: ClinicalTrials.gov NCT05689567. Registered on 10 January 2023.
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Óculos , Miopia , Criança , Humanos , População do Leste Asiático , Olho , Miopia/diagnóstico , Miopia/prevenção & controle , Ensaios Clínicos Controlados Aleatórios como Assunto , Refração Ocular , Visão OcularRESUMO
Myopia is becoming more common across the world, affecting approximately two billion people and rising. Different kinds of therapies (optical, pharmaceutical, environmental, or behavioral) have been proposed to decrease myopia progression, but with variable results and a lack of standardization. The evidence that targeted myopic defocus inhibits eye length growth has paved the way for several contact and spectacle lense designs to induce a peripheral defocus, thus slowing myopia progression, but the perfect configuration has yet to be defined. One of the newest and more promising approaches in this field is the use of Defocus Incorporated Multiple Segments (DIMS) lenses. These lenses are built from the assumption that targeted myopic defocus, produced by 396 mid-peripheral lenslets with positive power, inhibits eye length growth. Recent studies have highlighted the effectiveness of these lenses compared to children who had worn single vision spectacle lenses, in terms of myopia control and tolerability. Despite the evidence that these lenses can help slow down the progression of myopia, the occasional mid-peripheral aberrations they can induce, as well as the overall eye strain that comes with wearing them, should not be overlooked. The aim of this review is to give attention to the advantages and the shortfalls of this new approach and to evaluate its effectiveness in clinical practice.
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Purpose: To compare visual function of myopic children who had worn either defocus incorporated multiple segment (DIMS) spectacle lenses or single vision (SV) spectacle lenses over two years. Methods: We included 160 Chinese myopic (-1 diopter [D] to -5 D) children aged 8 to 13 years in a randomized clinical trial; they wore either DIMS lenses (DIMS; n = 79) or regular SV spectacles lenses (n = 81) full time for 2 years. Visual function, including high-contrast visual acuity (VA) and low-contrast VA at distance and near, binocular functions, and accommodation, before, during, and after 2 years of spectacle wear were assessed when both groups wore SV corrections. Changes of visual function between the two groups and within groups were compared. Results: There were no statistically significant differences in the 2-year visual function changes between DIMS and SV groups (repeated measures analysis of variance with group as factor; P > 0.05). Statistically significant improvement in the best-corrected distance high-contrast VA (P < 0.001) and stereoacuity score (P < 0.001) were found after DIMS lens wear over 2 years. Similar findings were observed after SV spectacle lens wear. For both the DIMS and SV groups, there were statistically significant decreases in accommodative lag, monocular and binocular amplitude of accommodation after two years (P < 0.01), but not in the changes in distance low-contrast VA, near high-contrast VA, near low-contrast VA, or phoria. Conclusions: Although changes in some visual function were shown during 2 years of DIMS lens wear, similar changes were found with SV lens wear. Wear of DIMS spectacle lenses for 2 years does not adversely affect major visual function when children return to SV corrections. Translational Relevance: DIMS spectacle lenses did not cause any adverse effects on visual function.
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Óculos , Miopia , Acomodação Ocular , Adolescente , Criança , China , Humanos , Miopia/terapia , Visão OcularRESUMO
BACKGROUND: Myopia is increasing in prevalence and is currently recognized as a significant public health issue worldwide, particularly in China. Once myopia develops, appropriate clinical interventions need to be prescribed to slow its progression. Currently, several publications indicate that myopic defocus (MD) retards eye growth and myopia progression. However, no clinical trials have compared the outcomes of different MD spectacle lenses in the same observational group, especially in mainland China. The aim of the present study is to compare the myopia control efficiency of two different MD spectacle lenses: defocus incorporated multiple segments (DIMS) lenses and Apollo progressive addition lenses (PALs). METHODS: The trial is designed as a 3-year, prospective, randomized, multicenter clinical trial of schoolchildren treated with DIMS lenses and PALs. A total of 600 Chinese primary school children aged 6-12 years will be recruited, and each group is intended to include 300 subjects. The inclusion criteria are myopia between - 1.00 and - 5.00 diopters and astigmatism ≤ 1.50 diopters. The follow-up time points will be 1 month (m), 3 m, 6 m, 12 m, 18 m, 24 m, 30 m, and 36 m. The primary outcome will be determined by the difference between the two groups in cycloplegic spherical equivalent refraction between baseline and the last follow-up visit. The secondary outcome is the axial length, and the exploratory outcomes include ocular biometric measures, peripheral refraction, binocular vision, accommodation, compliance, and the results of questionnaires related to wearing experiences. DISCUSSION: The present study will be the first randomized controlled trial in myopic primary school children treated with DIMS lenses and PALs in China. The results will indicate whether and how much different MD mechanisms retard myopia progression and axial elongation. In addition, the comparison will provide information on the clinical efficacy and safety of DIMS lenses and PALs, including information related to wearing experiences and visual function. TRIAL REGISTRATION: Chinese Clinical Trial Registry (ChiCTR), ChiCTR1900025645. Registered on 3 September 2019. http://www.chictr.org.cn/showproj.aspx?proj=42927.
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Progressão da Doença , Óculos/classificação , Miopia/terapia , Acomodação Ocular , Criança , China/epidemiologia , Olho/fisiopatologia , Óculos/efeitos adversos , Feminino , Seguimentos , Humanos , Masculino , Estudos Multicêntricos como Assunto , Miopia/epidemiologia , Miopia/patologia , Prevalência , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Refração Ocular , Resultado do Tratamento , Visão BinocularRESUMO
AIM: To determine if 'Defocus Incorporated Multiple Segments' (DIMS) spectacle lenses slow childhood myopia progression. METHODS: A 2-year double-masked randomised controlled trial was carried out in 183 Chinese children aged 8-13 years, with myopia between -1.00 and -5.00 D and astigmatism ≤1.50 D. Children were randomly assigned to wear DIMS (n=93) or single vision (SV) spectacle lenses (n=90). DIMS lens incorporated multiple segments with myopic defocus of +3.50 D. Refractive error (cycloplegic autorefraction) and axial length were measured at 6month intervals. RESULTS: 160 children completed the study, n=79 in the DIMS group and n=81 in the SV group. Average (SE) myopic progressions over 2 years were -0.41±0.06 D in the DIMS group and -0.85±0.08 D in the SV group. Mean (SE) axial elongation was 0.21±0.02 mm and 0.55±0.02 mm in the DIMS and SV groups, respectively. Myopia progressed 52% more slowly for children in the DIMS group compared with those in the SV group (mean difference -0.44±0.09 D, 95% CI -0.73 to -0.37, p<0.0001). Likewise, children in the DIMS group had less axial elongation by 62% than those in the SV group (mean difference 0.34±0.04 mm, 95% CI 0.22 to 0.37, p<0.0001). 21.5% children who wore DIMS lenses had no myopia progression over 2 years, but only 7.4% for those who wore SV lenses. CONCLUSIONS: Daily wear of the DIMS lens significantly retarded myopia progression and axial elongation in myopic children. Our results demonstrated simultaneous clear vision with constant myopic defocus can slow myopia progression. TRIAL REGISTRATION NUMBER: NCT02206217.
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Óculos , Miopia Degenerativa/terapia , Refração Ocular/fisiologia , Adolescente , Criança , Progressão da Doença , Método Duplo-Cego , Desenho de Equipamento , Feminino , Seguimentos , Humanos , Masculino , Miopia Degenerativa/fisiopatologia , Estudos Prospectivos , Fatores de Tempo , Resultado do TratamentoRESUMO
Lenses used in vision correction have evolved from the initial glass reading stone of the 10th century to the currently anticipated planar metalens made from "nanopillars" of titanium dioxide. With ideas from early scientific minds being translated into reality, and military commissioned concepts adapted for civilian use, spectacle lens and contact lens materials have progressed significantly over the last century, with the expectation of further lens material innovations ahead. The purpose of this article is a review of literature on the historical developments and advances in spectacle lens and contact lens materials.
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INTRODUCTION: Digital eye strain (DES; computer vision syndrome) is a common cause of symptoms when viewing digital devices. Low-powered convex lenses (adds) have been recommended for the condition and "accommodative support" designs developed on this premise. The present research reports the extent to which dry eye is present in this population and the effect of convex lenses on symptoms and visual performance. METHODS: The CVS-Q instrument was used to select pre-presbyopic adults with the symptoms of DES. Participants received a full eye examination including an assessment of dry eye with a modified SANDE questionnaire and using DEWS I criteria. The immediate effect of low-powered convex lenses (low adds: +0.50D, +0.75D, +1.25D) was investigated using subjective preference and a double-masked comparison with plano lenses with the Wilkins Rate of Reading Test (WRRT). Throughout this testing, participants wore their full distance refractive correction, based on non-cycloplegic retinoscopy and subjective refraction. RESULTS: The signs and symptoms of dry eye were frequently present. Most participants reported a subjective preference for low adds, with +0.75D the most commonly preferred lens. Low adds (+0.50D and +0.75D; but not +1.25D) were associated with significantly improved performance at the WRRT. One quarter of participants read more than 10% faster with these additional convex lenses. CONCLUSIONS: The study population was aged 20-40y and mostly worked on desktop computers. It is possible that +1.25D add may be more advantageous for people who are older or work more at closer viewing distances. Many symptomatic users of digital devices report a preference for low adds and use of these lenses is often associated with an improvement in reading performance.
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Astenopia/terapia , Computadores , Óculos , Acomodação Ocular/fisiologia , Adulto , Astenopia/etiologia , Astenopia/fisiopatologia , Estudos Transversais , Método Duplo-Cego , Síndromes do Olho Seco/diagnóstico , Síndromes do Olho Seco/etiologia , Síndromes do Olho Seco/fisiopatologia , Feminino , Humanos , Masculino , Óptica e Fotônica , Exame Físico , Leitura , Inquéritos e Questionários , Testes Visuais , Acuidade Visual/fisiologia , Adulto JovemRESUMO
PURPOSE: Eye growth compensates in opposite directions to single vision (SV) negative and positive lenses. We evaluated the response of the guinea pig eye to Fresnel-type lenses incorporating two different powers. METHODS: A total of 114 guinea pigs (10 groups with 9-14 in each) wore a lens over one eye and interocular differences in refractive error and ocular dimensions were measured in each of three experiments. First, the effects of three Fresnel designs with various diopter (D) combinations (-5D/0D; +5D/0D or -5D/+5D dual power) were compared to three SV lenses (-5D, +5D, or 0D). Second, the ratio of -5D and +5D power in a Fresnel lens was varied (50:50 compared with 60:40). Third, myopia was induced by 4 days of exposure to a SV -5D lens, which was then exchanged for a Fresnel lens (-5D/+5D) or one of two SV lenses (+5D or -5D) and ocular parameters tracked for a further 3 weeks. RESULTS: Dual power lenses induced an intermediate response between that to the two constituent powers (lenses +5D, +5D/0D, 0D, -5D/+5D, -5D/0D and -5D induced +2.1 D, +0.7 D, +0.1 D, -0.3 D, -1.6 D and -5.1 D in mean intraocular differences in refractive error, respectively), and changing the ratio of powers induced responses equal to their weighted average. In already myopic animals, continued treatment with SV negative lenses increased their myopia (from -3.3 D to -4.2 D), while switching to SV positive lenses or -5D/+5D Fresnel lenses reduced their myopia (by 2.9 D and 2.3 D, respectively). CONCLUSIONS: The mammalian eye integrates competing defocus to guide its refractive development and eye growth. Fresnel lenses, incorporating positive or plano power with negative power, can slow ocular growth, suggesting that such designs may control myopia progression in humans.