Evaluation of an Optical Defocus Treatment for Myopia Progression Among Schoolchildren During the COVID-19 Pandemic

Abstract Atropine eye drops and myopic retinal defocus each slow progression of myopia (short-sight). They also cause thickening of the choroid, and it has been suggested that the thickening is a precursor for reduced eye growth and slowed myopia progression. We investigated whether choroidal thickening due to optical defocus would add to thickening due to atropine when both were applied simultaneously. Addition would suggest that combining the two clinical treatments may improve efficacy of myopia control. We studied 20 children receiving 0.3% atropine daily for myopia control, over a period of 6 months. We imposed short periods of retinal defocus (1 h of myopic or hyperopic defocus (± 2.00D)) both before, and after 1 week and 3 and 6 months of atropine treatment. Prior to atropine, myopic or hyperopic defocus caused significantly thicker or thinner choroids respectively (± 12 µm, p < 0.001). After one week of atropine alone, thickness had increased (+ 21 µm; SD 17 µm; p < 0.001), and it increased further (by + 13 µm; SD 6 µm; p < 0.001) when exposed to myopic defocus. Atropine abolished choroidal thinning in response to hyperopic defocus. These effects remained the same after 3 and 6 months of atropine treatment. Our results show that additive effects of atropine and optical defocus are present at the level of the choroid, and suggest that combining optical and pharmaceutical treatments is likely to enhance efficacy of clinical myopia control.

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Optimum spatial filter for optical defocus sensing

Electrical Engineering in Japan ◽

10.1002/ecja.4400640915 ◽

1981 ◽

Vol 64 (9) ◽

pp. 113-120

Author(s):

Kohji Takemura ◽

Suteo Tsutsumi

Keyword(s):

Spatial Filter ◽

Optical Defocus

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Atropine for Children Myopia Progression Study

Case Medical Research ◽

10.31525/ct1-nct03949101 ◽

2019 ◽

Author(s):

Keyword(s):

Myopia Progression

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Eye Exercise, Transcutaneous Electrical Nerve Stimulation on Prevention of Myopia Progression

Case Medical Research ◽

10.31525/ct1-nct04017234 ◽

2019 ◽

Author(s):

Keyword(s):

Nerve Stimulation ◽

Transcutaneous Electrical Nerve Stimulation ◽

Myopia Progression ◽

Electrical Nerve Stimulation

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Update and guidance on management of myopia. European Society of Ophthalmology in cooperation with International Myopia Institute

European Journal of Ophthalmology ◽

10.1177/1120672121998960 ◽

2021 ◽

pp. 112067212199896

Author(s):

János Németh ◽

Beáta Tapasztó ◽

Wagih A Aclimandos ◽

Philippe Kestelyn ◽

Jost B Jonas ◽

...

Keyword(s):

European Society ◽

High Myopia ◽

Treatment Options ◽

Vision Impairment ◽

Pathological Myopia ◽

Myopia Progression ◽

Preventive Actions ◽

Prevalence Estimates ◽

Number Of Individuals ◽

Myopia Control

The prevalence of myopia is increasing extensively worldwide. The number of people with myopia in 2020 is predicted to be 2.6 billion globally, which is expected to rise up to 4.9 billion by 2050, unless preventive actions and interventions are taken. The number of individuals with high myopia is also increasing substantially and pathological myopia is predicted to become the most common cause of irreversible vision impairment and blindness worldwide and also in Europe. These prevalence estimates indicate the importance of reducing the burden of myopia by means of myopia control interventions to prevent myopia onset and to slow down myopia progression. Due to the urgency of the situation, the European Society of Ophthalmology decided to publish this update of the current information and guidance on management of myopia. The pathogenesis and genetics of myopia are also summarized and epidemiology, risk factors, preventive and treatment options are discussed in details.

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The Effect of Long-Term Low-Dose Atropine on Refractive Progression in Myopic Australian School Children

Journal of Clinical Medicine ◽

10.3390/jcm10071444 ◽

2021 ◽

Vol 10 (7) ◽

pp. 1444

Author(s):

William Myles ◽

Catherine Dunlop ◽

Sally A. McFadden

Keyword(s):

Low Dose ◽

High Dose ◽

Eye Drops ◽

Myopia Progression ◽

At Risk Children ◽

Slow Group ◽

Blue Eyes ◽

Global Population ◽

Axial Growth

Myopia will affect half the global population by 2050 and is a leading cause of vision impairment. High-dose atropine slows myopia progression but with undesirable side-effects. Low-dose atropine is an alternative. We report the effects of 0.01% or 0.005% atropine eye drops on myopia progression in 13 Australian children aged between 2 and 18 years and observed for 2 years without and up to 5 years (mean 2.8 years) with treatment. Prior to treatment, myopia progression was either ‘slow’ (more positive than −0.5D/year; mean −0.19D/year) or ‘fast’ (more negative than −0.5D/year; mean −1.01D/year). Atropine reduced myopic progression rates (slow: −0.07D/year, fast: −0.25D/year, combined: before: −0.74, during: −0.18D/year, p = 0.03). Rebound occurred in 3/4 eyes that ceased atropine. Atropine halved axial growth in the ‘Slow’ group relative to an age-matched model of untreated myopes (0.098 vs. 0.196mm/year, p < 0.001) but was double that in emmetropes (0.051mm/year, p < 0.01). Atropine did not slow axial growth in ‘fast’ progressors compared to the age-matched untreated myope model (0.265 vs. 0.245mm/year, p = 0.754, Power = 0.8). Adverse effects (69% of patients) included dilated pupils (6/13) more common in children with blue eyes (5/7, p = 0.04). Low-dose atropine could not remove initial myopia offsets suggesting treatment should commence in at-risk children as young as possible.

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Myopia control effect of defocus incorporated multiple segments (DIMS) spectacle lens in Chinese children: results of a 3-year follow-up study

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2020-317664 ◽

2021 ◽

pp. bjophthalmol-2020-317664

Author(s):

Carly SY Lam ◽

Wing Chun Tang ◽

Paul H Lee ◽

Han Yu Zhang ◽

Hua Qi ◽

...

Keyword(s):

Repeated Measures ◽

Mean Difference ◽

Historical Control ◽

Control Group ◽

Control Effect ◽

Myopia Progression ◽

The Third ◽

Spherical Equivalent Refraction ◽

Mean Differences ◽

Myopia Control

AimsTo determine myopia progression in children who continued to wear the defocus incorporated multiple segments (DIMS) lenses or switched from single vision (SV) to DIMS lenses for a 1-year period following a 2-year myopia control trial.Methods128 children participated in this study. The children who had worn DIMS lenses continued to wear DIMS lenses (DIMS group), and children who had worn SV lenses switched to wear DIMS lenses (Control-to-DIMS group). Cycloplegic spherical equivalent refraction (SER) and axial length (AL) were measured at 6-month interval. Historical controls were age matched to the DIMS group at 24 months and used for comparing the third-year changes.ResultsOver 3 years, SER and AL changes in the DIMS group (n=65) were −0.52±0.69D and 0.31±0.26 mm; these changes were not statistically significant over time (repeated measures analysis of variance, p>0.05).SER (−0.04±0. 38D) and AL (0.08±0.12 mm) changes in the Control-to-DIMS group (n=55) in the third year were less compared with the first (mean difference=0.45 ± 0.30D, 0.21±0.11 mm, p<0.001) and second (0.34±0.30D, 0.12±0.10 mm, p<0.001) years.Changes in SER and AL in both groups over that period were significantly less than in the historical control group (DIMS vs historical control: mean difference=−0.18±0.42D, p=0.012; 0.08±0.15 mm, p=0.001; Control-to-DIMS versus historical control: adjusted mean differences=−0.30±0.42D, p<0.001; 0.12±0.16 mm, p<0.001).ConclusionsMyopia control effect was sustained in the third year in children who had used the DIMS spectacles in the previous 2 years and was also shown in the children switching from SV to DIMS lenses.

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Intravitreal brimonidine inhibits form-deprivation myopia in guinea pigs

Eye and Vision ◽

10.1186/s40662-021-00248-0 ◽

2021 ◽

Vol 8 (1) ◽

Author(s):

Yifang Yang ◽

Junshu Wu ◽

Defu Wu ◽

Qi Wei ◽

Tan Zhong ◽

...

Keyword(s):

Guinea Pig ◽

Intravitreal Injection ◽

Guinea Pigs ◽

Intravitreal Injections ◽

Eye Drops ◽

Rna Seq ◽

Myopia Progression ◽

Expression Levels ◽

Guinea Pig Model ◽

Administration Methods

Abstract Background The use of ocular hypotensive drugs has been reported to attenuate myopia progression. This study explores whether brimonidine can slow myopia progression in the guinea pig form-deprivation (FD) model. Methods Three-week-old pigmented male guinea pigs (Cavia porcellus) underwent monocular FD and were treated with 3 different methods of brimonidine administration (eye drops, subconjunctival or intravitreal injections). Four different concentrations of brimonidine were tested for intravitreal injection (2 μg/μL, 4 μg/μL, 20 μg/μL, 40 μg/μL). All treatments continued for a period of 21 days. Tonometry, retinoscopy, and A-scan ultrasonography were used to monitor intraocular pressure (IOP), refractive error and axial length (AL), respectively. On day 21, guinea pigs were sacrificed for RNA sequencing (RNA-seq) to screen for associated transcriptomic changes. Results The myopia model was successfully established in FD animals (control eye vs. FD eye, respectively: refraction at day 20, 0.97 ± 0.18 D vs. − 0.13 ± 0.38 D, F = 6.921, P = 0.02; AL difference between day 0 and day 21, 0.29 ± 0.04 mm vs. 0.45 ± 0.03 mm, F = 11.655, P = 0.004). Among the 3 different brimonidine administration methods, intravitreal injection was the most effective in slowing myopia progression, and 4 μg/μL was the most effective among the four different concentrations of brimonidine intravitreal injection tested. The AL and the refraction of the brimonidine intravitreal injection group was significantly shorter or more hyperopic than those of other 2 groups. Four μg/μL produced the smallest difference in AL and spherical equivalent difference values. FD treatment significantly increased the IOP. IOP was significantly lower at 1 day after intravitreal injections which was the lowest in FD eye of intravitreal injection of brimonidine. At day 21, gene expression analyses using RNA-seq showed upregulation of Col1a1 and Mmp2 expression levels by intravitreal brimonidine. Conclusions Among the 3 different administration methods, intravitreal injection of brimonidine was the most effective in slowing myopia progression in the FD guinea pig model. Intravitreal brimonidine at 4 μg/μL significantly reduced the development of FD myopia in guinea pigs. Expression levels of the Col1a1 and Mmp2 genes were significantly increased in the retinal tissues of the FD-Inj-Br group.

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Myopia Control with Combination Low-Dose Atropine and Peripheral Defocus Soft Contact Lenses: A Case Series

Case Reports in Ophthalmology ◽

10.1159/000515568 ◽

2021 ◽

pp. 548-554

Author(s):

Nir Erdinest ◽

Naomi London ◽

Nadav Levinger ◽

Yair Morad

Keyword(s):

Low Dose ◽

Contact Lenses ◽

Case Series ◽

Concentric Circle ◽

Retrospective Case ◽

Soft Contact ◽

Myopia Progression ◽

Soft Contact Lenses ◽

Center Distance ◽

Myopia Control

The goal of this retrospective case series is to demonstrate the effectivity of combination low-dose atropine therapy with peripheral defocus, double concentric circle design with a center distance soft contact lenses at controlling myopia progression over 1 year of treatment. Included in this series are 3 female children aged 8–10 years with progressing myopia averaging −4.37 ± 0.88 D at the beginning of treatment. Their average annual myopic progression during the 3 years prior to therapy was 1.12 ± 0.75 D. They had not attempted any myopia control treatments prior to this therapy. The children were treated with a combination of 0.01% atropine therapy with spherical peripheral defocus daily replacement soft lenses MiSight<sup>®</sup> 1 day (Cooper Vision, Phoenix, AZ, USA). They underwent cycloplegic refraction, and a slit-lamp evaluation every 6 months which confirmed no adverse reactions or staining was present. Each of the 3 children exhibited an average of 0.25 ± 0.25 D of myopia progression at the end of 1 year of treatment. To the best of the authors’ knowledge, this is the first published study exhibiting that combining low-dose atropine and peripheral defocus soft contact lenses is effective at controlling children’s moderate to severe myopia progression during 1 year of therapy.

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