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Carlà, M.M.; Boselli, F.; Giannuzzi, F.; Gambini, G.; Caporossi, T.; , .; Kilian, R.; Rizzo, S. Approaches for Myopia Management. Encyclopedia. Available online: https://encyclopedia.pub/entry/21813 (accessed on 27 July 2024).
Carlà MM, Boselli F, Giannuzzi F, Gambini G, Caporossi T,  , et al. Approaches for Myopia Management. Encyclopedia. Available at: https://encyclopedia.pub/entry/21813. Accessed July 27, 2024.
Carlà, Matteo Mario, Francesco Boselli, Federico Giannuzzi, Gloria Gambini, Tomaso Caporossi,  , Raphael Kilian, Stanislao Rizzo. "Approaches for Myopia Management" Encyclopedia, https://encyclopedia.pub/entry/21813 (accessed July 27, 2024).
Carlà, M.M., Boselli, F., Giannuzzi, F., Gambini, G., Caporossi, T., , ., Kilian, R., & Rizzo, S. (2022, April 15). Approaches for Myopia Management. In Encyclopedia. https://encyclopedia.pub/entry/21813
Carlà, Matteo Mario, et al. "Approaches for Myopia Management." Encyclopedia. Web. 15 April, 2022.
Approaches for Myopia Management
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This entry is adapted from the peer-reviewed paper 10.3390/vision6020020

Different kinds of therapies (optical, pharmaceutical, environmental, or behavioral) have been researched to prevent or postpone the beginning of myopia and to decrease its progression in order to minimize the associated ocular diseases connected to myopia. Regarding environmental approaches, several meta-analyses have shown that spending more time outside is associated with a lower incidence of myopia.

myopia myopia control myopic defocus spectacle lens defocus incorporated multiple segments

1. Pharmacological Treatment

Pharmacological treatment with low-dose 0.01% atropine has been shown to be the most effective strategy for decreasing myopic development in different studies, with successful rates varying from 45 to 77% regarding refractive error reduction, but no impact on axial length [1][2][3]. Although functionally successful, this approach displayed long-term adverse effects including photophobia, glare, and accommodation loss [2][4][5].

2. Ortho-Keratology

The research for alternatives has led to an increase in orthokeratology, or ortho-K (OK), which exploits specially designed and fitted contact lenses to temporarily reshape the cornea [6]. Orthokeratology has shown beneficial effects against myopia progression and axial elongation by 30 to 55 percent [7][8]. The most common complication of ortho-K treatment was corneal staining, with other clinically significant side effects including epithelial iron deposit, prominent fibrillary lines, and transient changes of corneal biomechanical properties, but no long-term effects on the corneal endothelium were observed [9]. In contrast, those contact lenses needed careful maintenance for eye health, because improper handling or cleaning increases the risk of infection, although the risk of microbial keratitis reported in a systematic review was found to be similar to other overnight corneal reshaping lenses [10][11].

3. Contact Lenses

Over time, bifocal (BFSCL) or multifocal soft contact lenses (MFSCL), peripheral gradient lenses, extended depth of focus (EDOF) contact lenses, and progressive addition lenses have all been explored to manage myopic development [12][13][14][15][16][17][18][19][20]. The first generation of bifocal or dual-focus lenses used a concentric zone of rings with plus power addition, resulting in a peripheral myopic defocus. These designs adopted a gradual increase in the positive power toward the periphery (progressive design) or featured discrete zones (concentric ring design), with the peripheral area of the lens having a considerably higher positive power. Concentric ring designs allow stronger axial elongation control than progressive ring designs, but refraction alterations are comparable [1]. Globally, these bifocal soft contact lenses reported a 30–38% reduction in myopia development regarding refraction, and a 31–51% reduction in axial length [21]. Moreover, other research studies have reported that the efficacy of bifocal contact lenses may improve in particular settings: increased usage time, high-rate myopic progression, structural designs with a greater hyperopic power in the mid-periphery [14]. MiSight is an example of a multizone design contact lens which has demonstrated decreased myopia progression (59%) and axial development of the eye (52%) during a three-year follow up [12][13].
Among these approaches, To Chi-ho and Carly Lam from the Centre for Myopia Research under PolyU’s School of Optometry have developed Defocus Incorporated Soft Contact (DISC) lenses [16], which consist of a central correction zone and a series of alternating defocusing and correction zones spreading to the perimeter in a 50:50 ratio, with the defocusing zones at +2.5 D, whereas the corrective zones match the distance prescription. As a result, the daily wearing of DISC lenses significantly slowed axial elongation and myopia progression by 25% when compared to controls [16]. A recent update in the contact lens approach for myopia control was reported by Walline et al. who conducted the BLINK clinical trial, in which children wearing high add power (+2.50 D) MFSCL had significantly less myopia progression and axial elongation over three years, when compared to SV lenses [22].
Similar to ortho-K, the contact lenses approach carries several management problems, linked with infections, corneal traumatism, and long-term biocompatibility.

4. Spectacle Lenses

In comparison to contact lenses and pharmaceutical therapies, intervention with spectacle lenses is a straightforward and less intrusive way for children and their parents, particularly for children under the age of eight [23]. The best prescription must be validated according to associated risk factors, taking into account several patient-specific characteristics connected to myopia development and progression [24]. Single-vision (SV) spectacle lenses have been found to provide less than a 14% decrease in myopia progression. In contrast to SV spectacle lenses, multiple articles have suggested that myopic defocus (MD) slows eye development and progression, whereas hyperopic defocus enhances eye growth [25][26][27]. Nevertheless, differently from previously thought, a recent systematic review reported that under-correction of myopia is not recommended as it did not slow myopia progression [28].
Many investigations have analyzed several kinds of new spectacle lens with relative peripheral defocus, with conflicting initial results [15][29]. Bifocals or progressive additional lenses (PALs) were introduced, allowing the user to see well at distances and up close, reducing accommodative strain and lag during prolonged near work [30]. In many investigations, these lenses showed therapeutic improvements ranging from 6% to 50% as compared to SV spectacles. A stronger impact was found in children with a higher degree of myopia (>3.0 D), accommodative lag, or near esophoria [30][31]. However, in comparison to single vision lenses (SVLs), bifocal spectacles or PALs had little impact in delaying myopia development during meta-analysis, with moderate-certainty evidence. Furthermore, the same meta-analysis highlighted that previously designed peripheral defocus-correcting lenses had mixed results in terms of refractive error and axial length, offering a low level of evidence regarding clinical results [32][33][34].
Since April 2021, a new variety of spectacle lenses with peripheral defocusing capability, known as Defocus Incorporated Multiple Segments (DIMS) technology, have been marketed from Hoya in Germany, Austria, and Switzerland under the trade name “MiYOSMART” (Hoya Lens Thailand Ltd., Bangkok, Thailand) [35]. This dual-focus spectacle lens, similarly to DISC contact lens, has a zonal structure with tiny, circular (≈1 mm diameter) lenslets in the mid-periphery, each with add power (+3.50 D). The novelty of this technology relies on the fact that images from each lenslet do not converge to generate a single image in the focal plane corresponding to the add power, but rather numerous distinct images. DIMS lenses have been reported to substantially delay myopia development when compared to single vision (SV) lenses in a recent clinical trial, while showing an absence of the negative effects of pharmaceutical therapies and a reduction in maintenance level when compared to contact lenses [35]. Several issues, however, remain to be investigated, including the quality of vision, which refers to the comfort and frequency of visual symptoms after wearing added-power spectral lenses and the efficacy of myopia control in long-term follow-ups [36].

References

  1. Wildsoet, C.F.; Chia, A.; Cho, P.; Guggenheim, J.A.; Polling, J.R.; Read, S.; Sankaridurg, P.; Saw, S.-M.; Trier, K.; Walline, J.J. IMI–interventions for controlling myopia onset and progression report. Investig. Ophthalmol. Vis. Sci. 2019, 60, M106–M131.
  2. Huang, J.; Wen, D.; Wang, Q.; McAlinden, C.; Flitcroft, I.; Chen, H.; Saw, S.M.; Chen, H.; Bao, F.; Zhao, Y.; et al. Efficacy Comparison of 16 Interventions for Myopia Control in Children: A Network Meta-analysis. Ophthalmology 2016, 123, 697–708.
  3. Yam, J.C.; Jiang, Y.; Tang, S.M.; Law, A.K.P.; Chan, J.J.; Wong, E.; Ko, S.T.; Young, A.L.; Tham, C.C.; Chen, L.J.; et al. Low-Concentration Atropine for Myopia Progression (LAMP) Study: A Randomized, Double-Blinded, Placebo-Controlled Trial of 0.05%, 0.025%, and 0.01% Atropine Eye Drops in Myopia Control. Ophthalmology 2019, 126, 113–124.
  4. Wu, P.-C.; Chuang, M.-N.; Choi, J.; Chen, H.; Wu, G.; Ohno-Matsui, K.; Jonas, J.B.; Cheung, C.M.G. Update in myopia and treatment strategy of atropine use in myopia control. Eye 2019, 33, 3–13.
  5. Tran, H.D.M.; Tran, Y.H.; Tran, T.D.; Jong, M.; Coroneo, M.; Sankaridurg, P. A Review of Myopia Control with Atropine. J. Ocul. Pharmacol. Ther. 2018, 34, 374–379.
  6. Choo, J.D.; Caroline, P.J.; Harlin, D.D.; Papas, E.B.; Holden, B.A. Morphologic changes in cat epithelium following continuous wear of orthokeratology lenses: A pilot study. Cont. Lens. Anterior Eye 2008, 31, 29–37.
  7. Hiraoka, T.; Kakita, T.; Okamoto, F.; Takahashi, H.; Oshika, T. Long-term effect of overnight orthokeratology on axial length elongation in childhood myopia: A 5-year follow-up study. Investig. Ophthalmol. Vis. Sci. 2012, 53, 3913–3919.
  8. Walline, J.J.; Jones, L.A.; Sinnott, L.T. Corneal reshaping and myopia progression. Br. J. Ophthalmol. 2009, 93, 1181–1185.
  9. Liu, Y.M.; Xie, P. The safety of orthokeratology—a systematic review. Eye Contact Lens. 2016, 42, 35.
  10. Bullimore, M.A.; Johnson, L.A. Overnight orthokeratology. Cont. Lens Anterior Eye 2020, 43, 322–332.
  11. Bullimore, M.A.; Sinnott, L.T.; Jones-Jordan, L.A. The risk of microbial keratitis with overnight corneal reshaping lenses. Optom. Vis. Sci. 2013, 90, 937–944.
  12. Chamberlain, P.; Peixoto-de-Matos, S.C.; Logan, N.S.; Ngo, C.; Jones, D.; Young, G. A 3-year Randomized Clinical Trial of MiSight Lenses for Myopia Control. Optom. Vis. Sci. 2019, 96, 556–567.
  13. Ruiz-Pomeda, A.; Perez-Sanchez, B.; Valls, I.; Prieto-Garrido, F.L.; Gutierrez-Ortega, R.; Villa-Collar, C. MiSight Assessment Study Spain (MASS). A 2-year randomized clinical trial. Graefes Arch. Clin. Exp. Ophthalmol. 2018, 256, 1011–1021.
  14. Aller, T.A.; Liu, M.; Wildsoet, C.F. Myopia Control with Bifocal Contact Lenses: A Randomized Clinical Trial. Optom. Vis. Sci. 2016, 93, 344–352.
  15. Anstice, N.S.; Phillips, J.R. Effect of dual-focus soft contact lens wear on axial myopia progression in children. Ophthalmology 2011, 118, 1152–1161.
  16. Lam, C.S.; Tang, W.C.; Tse, D.Y.; Tang, Y.Y.; To, C.H. Defocus Incorporated Soft Contact (DISC) lens slows myopia progression in Hong Kong Chinese schoolchildren: A 2-year randomised clinical trial. Br. J. Ophthalmol. 2014, 98, 40–45.
  17. Sankaridurg, P.; Bakaraju, R.C.; Naduvilath, T.; Chen, X.; Weng, R.; Tilia, D.; Xu, P.; Li, W.; Conrad, F.; Smith, E.L., 3rd; et al. Myopia control with novel central and peripheral plus contact lenses and extended depth of focus contact lenses: 2 year results from a randomised clinical trial. Ophthalmic Physiol. Opt. 2019, 39, 294–307.
  18. Sankaridurg, P.; Holden, B.; Smith, E., 3rd; Naduvilath, T.; Chen, X.; de la Jara, P.L.; Martinez, A.; Kwan, J.; Ho, A.; Frick, K.; et al. Decrease in rate of myopia progression with a contact lens designed to reduce relative peripheral hyperopia: One-year results. Investig. Ophthalmol. Vis. Sci. 2011, 52, 9362–9367.
  19. Paune, J.; Morales, H.; Armengol, J.; Quevedo, L.; Faria-Ribeiro, M.; Gonzalez-Meijome, J.M. Myopia Control with a Novel Peripheral Gradient Soft Lens and Orthokeratology: A 2-Year Clinical Trial. BioMed Res. Int. 2015, 2015, 507572.
  20. Fujikado, T.; Ninomiya, S.; Kobayashi, T.; Suzaki, A.; Nakada, M.; Nishida, K. Effect of low-addition soft contact lenses with decentered optical design on myopia progression in children: A pilot study. Clin. Ophthalmol. 2014, 8, 1947–1956.
  21. Li, S.M.; Kang, M.T.; Wu, S.S.; Meng, B.; Sun, Y.Y.; Wei, S.F.; Liu, L.; Peng, X.; Chen, Z.; Zhang, F. Studies using concentric ring bifocal and peripheral add multifocal contact lenses to slow myopia progression in school-aged children: A meta-analysis. Ophthalmic Physiol. Opt. 2017, 37, 51–59.
  22. Walline, J.J.; Walker, M.K.; Mutti, D.O.; Jones-Jordan, L.A.; Sinnott, L.T.; Giannoni, A.G.; Bickle, K.M.; Schulle, K.L.; Nixon, A.; Pierce, G.E.; et al. Effect of High Add Power, Medium Add Power, or Single-Vision Contact Lenses on Myopia Progression in Children: The BLINK Randomized Clinical Trial. JAMA 2020, 324, 571–580.
  23. Gifford, K.L.; Richdale, K.; Kang, P.; Aller, T.A.; Lam, C.S.; Liu, Y.M.; Michaud, L.; Mulder, J.; Orr, J.B.; Rose, K.A. IMI–clinical management guidelines report. Investig. Ophthalmol. Vis. Sci. 2019, 60, M184–M203.
  24. Morgan, I.G.; French, A.N.; Ashby, R.S.; Guo, X.; Ding, X.; He, M.; Rose, K.A. The epidemics of myopia: Aetiology and prevention. Prog. Retin. Eye Res. 2018, 62, 134–149.
  25. Wallman, J.; Winawer, J. Homeostasis of eye growth and the question of myopia. Neuron 2004, 43, 447–468.
  26. Tay, S.A.; Farzavandi, S.; Tan, D. Interventions to Reduce Myopia Progression in Children. Strabismus 2017, 25, 23–32.
  27. Troilo, D.; Smith, E.L.; Nickla, D.L.; Ashby, R.; Tkatchenko, A.V.; Ostrin, L.A.; Gawne, T.J.; Pardue, M.T.; Summers, J.A.; Kee, C.-s. IMI–Report on experimental models of emmetropization and myopia. Investig. Ophthalmol. Vis. Sci. 2019, 60, M31–M88.
  28. Walline, J.J.; Lindsley, K.B.; Vedula, S.S.; Cotter, S.A.; Mutti, D.O.; Ng, S.M.; Twelker, J.D. Interventions to slow progression of myopia in children. Cochrane Database Syst. Rev. 2020, 1, CD004916.
  29. Kanda, H.; Oshika, T.; Hiraoka, T.; Hasebe, S.; Ohno-Matsui, K.; Ishiko, S.; Hieda, O.; Torii, H.; Varnas, S.R.; Fujikado, T. Effect of spectacle lenses designed to reduce relative peripheral hyperopia on myopia progression in Japanese children: A 2-year multicenter randomized controlled trial. Jpn. J. Ophthalmol. 2018, 62, 537–543.
  30. Gwiazda, J.E.; Hyman, L.; Norton, T.T.; Hussein, M.E.; Marsh-Tootle, W.; Manny, R.; Wang, Y.; Everett, D. Accommodation and related risk factors associated with myopia progression and their interaction with treatment in COMET children. Investig. Ophthalmol. Vis. Sci. 2004, 45, 2143–2151.
  31. Correction of Myopia Evaluation Trial 2 Study Group for the Pediatric Eye Disease Investigator Group. Progressive-addition lenses versus single-vision lenses for slowing progression of myopia in children with high accommodative lag and near esophoria. Investig. Ophthalmol. Vis. Sci. 2011, 52, 2749–2757.
  32. Gwiazda, J.; Hyman, L.; Hussein, M.; Everett, D.; Norton, T.T.; Kurtz, D.; Leske, M.C.; Manny, R.; Marsh-Tootle, W.; Scheiman, M. A randomized clinical trial of progressive addition lenses versus single vision lenses on the progression of myopia in children. Investig. Ophthalmol. Vis. Sci. 2003, 44, 1492–1500.
  33. Hasebe, S.; Jun, J.; Varnas, S.R. Myopia control with positively aspherized progressive addition lenses: A 2-year, multicenter, randomized, controlled trial. Investig. Ophthalmol. Vis. Sci. 2014, 55, 7177–7188.
  34. Hasebe, S.; Ohtsuki, H.; Nonaka, T.; Nakatsuka, C.; Miyata, M.; Hamasaki, I.; Kimura, S. Effect of progressive addition lenses on myopia progression in Japanese children: A prospective, randomized, double-masked, crossover trial. Investig. Ophthalmol. Vis. Sci 2008, 49, 2781–2789.
  35. Lam, C.S.Y.; Tang, W.C.; Tse, D.Y.; Lee, R.P.K.; Chun, R.K.M.; Hasegawa, K.; Qi, H.; Hatanaka, T.; To, C.H. Defocus Incorporated Multiple Segments (DIMS) spectacle lenses slow myopia progression: A 2-year randomised clinical trial. Br. J. Ophthalmol. 2020, 104, 363–368.
  36. Li, Y.; Fu, Y.; Wang, K.; Liu, Z.; Shi, X.; Zhao, M. Evaluating the myopia progression control efficacy of defocus incorporated multiple segments (DIMS) lenses and Apollo progressive addition spectacle lenses (PALs) in 6- to 12-year-old children: Study protocol for a prospective, multicenter, randomized controlled trial. Trials 2020, 21, 279.
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Subjects: Ophthalmology
Contributors MDPI registered users' name will be linked to their SciProfiles pages. To register with us, please refer to https://encyclopedia.pub/register :
Matteo Mario Carlà
,
Francesco Boselli
,
Federico Giannuzzi
,
Gloria Gambini
,
Tomaso Caporossi
,
,
Raphael Kilian
,
Stanislao Rizzo
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Update Date: 18 Apr 2022
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