Optical treatment strategies to slow myopia progression: effects of the visual extent of the optical treatment zone

Earl L Smith 3rd, Earl L Smith 3rd

Abstract

In order to develop effective optical treatment strategies for myopia, it is important to understand how visual experience influences refractive development. Beginning with the discovery of the phenomenon of form deprivation myopia, research involving many animal species has demonstrated that refractive development is regulated by visual feedback. In particular, animal studies have shown that optically imposed myopic defocus slows axial elongation, that the effects of vision are dominated by local retinal mechanisms, and that peripheral vision can dominate central refractive development. In this review, the results obtained from clinical trials of traditional optical treatment strategies employed in efforts to slow myopia progression in children are interpreted in light of the results from animal studies and are compared to the emerging results from preliminary clinical studies of optical treatment strategies that manipulate the effective focus of the peripheral retina. Overall, the results suggest that imposed myopic defocus can slow myopia progression in children and that the effectiveness of an optical treatment strategy in reducing myopia progression is influenced by the extent of the visual field that is manipulated.

Keywords: bifocals; contact lenses; hyperopia; myopia; orthokeratology; peripheral refractive error; progressive addition lens.

Conflict of interest statement

Conflict of Interest: The Author is a co-author on patents for lens designs to reduce myopia progression that involve manipulating peripheral refractive errors.

Copyright © 2012 Elsevier Ltd. All rights reserved.

Figures

Figure 1
Figure 1
A. Average relative changes in refractive error obtained at the end of the treatment period in undercorrected myopic subjects and control subjects prescribed traditional full myopic corrections (percentage: treated – control/control). Positive values indicate that the treated, undercorrected subjects exhibited larger myopic shifts than the controls subjects. B. Average differences in refractive error (diopters: control group – treated group) plotted as a function of time from the onset of treatment. The first symbol for each study reflects the average age of the subjects in the treated group. All of the subjects wore single vision lenses. The data were replotted from Adler and Millodot (2006) and Chung et al. (2002).
Figure 2
Figure 2
A. Average relative changes in refractive error obtained over 18- or 24-month treatment periods in control subjects wearing single-vision spectacles and treated subjects wearing multifocal spectacle lenses (percentage: treated – control/control). Negative values indicate that myopia progression was lower in the treated subjects wearing the multifocal lenses. BFs = D-segment bifocals; PALs = progressive addition lenses; E-type = executive or franklin bifocals. B. Average differences in refractive error (diopters: control group – treated group) plotted as a function of time from the onset of treatment. The first symbol for each study reflects the average age of the subjects in the treated group. The cross-hatched bars in panel A and the open and half open symbols in panel B indicate studies that employed inclusion criteria related to the near heterophoria (studies 1 & 7), the magnitude of the accommodative lag at near (studies 7 & STAMP), or the rate of myopia progression prior to the onset of treatment (studies 8 & 9). The data were replotted from Berntsen et al. (2012b), Cheng et al. (2010a), Edwards et al. (2002), Fulk et al. (2000), Gwiazda et al. (2011), Gwiazda et al. (2003), Hasebe et al. (2008), Shih et al. (2001), and Yang et al. (2009).
Figure 3
Figure 3
A. Average relative changes in refractive error obtained at the end of the treatment period in control subjects (wearing either single-vision spectacles or single-vision soft contact lenses) and treated subjects wearing treatment lenses that induced relative myopic defocus selectively in the periphery or over a large part of the central and peripheral retina (percentage: treated – control/control). Negative values indicate that myopia progression was lower in the treated subjects wearing the peripheral and wide-field treatment lenses. Specs = spectacle lenses; CLs = contact lenses. B. Average differences in refractive error (diopters: control group – treated group) plotted as a function of time from the onset of treatment. The first symbol for each study reflects the average age of the subjects in the treated group. The cross-hatched bars in panel A and the open and half open symbols in panel B indicate studies that employed inclusion criteria related to the near heterophoria (study 7) or subject age and parental myopia status (study 2). The data were replotted from Aller et al. (2006), Anstice and Phillips (2011), Holden et al. (2012), Sankaridurg et al. (2010), Sankaridurg et al. (2011), and Walline et al. (2011a). Note that the results from Sankaridurg et al. (2010) refer only to the type III spectacle lenses.
Figure 4
Figure 4
Average relative changes in axial length obtained at the end of a two-year treatment period in control subjects (treated with either single vision spectacles or contact lenses) and treated subjects undergoing overnight orthokeratology to correct central myopia (percentage: treated – control/control). Negative values indicate that axial elongation was smaller in the treated subjects undergoing orthokeratology. B Average differences in axial length (mm: treated group - control group) plotted as a function of time from the onset of treatment. The first symbol for each study reflects the average age of the subjects in the treated group. The data were replotted from Cho and Cheung (2012), Cho et al. (2005), Hiraoka et al. (2012), Kakita et al. (2011), Santodomingo-Rubido et al. (2012), and Walline et al. (2009).
Figure 5
Figure 5
Relative changes in axial length obtained over a two-year treatment period for individual control (filled symbols; single-vision spectacles) and treated eyes (open symbols; overnight orthokeratology for to correct central myopia) plotted as a function of the baseline ametropia. The dashed and solid red lines represent the regression functions for the control and treated subjects, respectively. The data were replotted from Cho and Cheung (2012), Cho et al. (2005), and Kakita et al. (2011).

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