ARVO 2023 latest research updates

The Association for Research in Vision and Ophthalmology (ARVO) 2023 annual conference ran from April 23-27  in New Orleans, Louisiana, USA. Bringing together thousands of eye researchers to share their latest learnings, we brought you the highlights, hot off the press! We selected several for each day of the conference, picked for their relevance to clinical practice.  Click on the abstract links to read more about an individual study.

Authors: Kate Gifford^1,2, Clare Maher^3,4, Paul Gifford⁵

1. School of Optometry and Vision Science, Queensland University of Technology Faculty of Health, Kelvin Grove, Queensland, Australia
2. Myopia Profile Pty Ltd,  Queensland, Australia
3. School of Medicine, University of Notre Dame, Sydney, Chippendale, New South Wales, Australia
4. Intelligent Polymer Research Institute (IPRI), University of Wollongong, Wollongong, New South Wales, Australia
5. School of Optometry and Vision Science, University of New South Wales, Kensington, New South Wales, Australia

This study investigated the characteristics of the'typical' patient that would benefit from myopia control: one whose age, refraction and other characteristics align them with participant characteristics in myopia control research. Thirty-four studies across spectacle, soft contact lens, ortho-k and atropine treatment types found that based on median data, the evidence-base currently supports efficacy for children aged 7 to 12 years at treatment commencement, with -0.75D to -4.50D of myopia, 1.25D or less of astigmatism and 1.00D or less of anisometropia. Atroine has evidence for younger children and high myopia; ortho-k for higher myopia and astigmatism. This helps inform clinical practice and informed consent for those falling outside these criteria.

Link to Abstract

Authors: Kate Gifford^1,2, Clare Maher^3,4, Paul Gifford^5,2

1. School of Optometry and Vision Science, Queensland University of Technology Faculty of Health, Kelvin Grove, Queensland, Australia
2. Myopia Profile Pty Ltd,  Queensland, Australia
3. School of Medicine, University of Notre Dame, Sydney, Chippendale, New South Wales, Australia
4. Intelligent Polymer Research Institute (IPRI), University of Wollongong, Wollongong, New South Wales, Australia
5. School of Optometry and Vision Science, University of New South Wales, Kensington, New South Wales, Australia

This study investigated the characteristics of the ‘typical’ patient that would benefit from myopia control: one whose age, refraction and other characteristics align them with participant characteristics in myopia control research. Thirty-four studies across spectacle, soft contact lens, ortho-k and atropine treatment types found that based on median data, the evidence-base currently supports efficacy for children aged 7 to 12 years at treatment commencement, with -0.75D to -4.50D of myopia, 1.25D or less of astigmatism and 1.00D or less of anisometropia. Atroine has evidence for younger children and high myopia; ortho-k for higher myopia and astigmatism. This helps inform clinical practice and informed consent for those falling outside these criteria.

Link to Abstract

Authors: Sergio Recalde^2,1, Miriam De la Puente^1,2, Maria Hernandez^2,1, Leire Gomez-Arteta³, Jaione Bezunartea^2,3, Jorge Gonzalez-Zamora^1,2, Valentina Bilbao^2,4, Manuel Saenz de Viteri1,², Jesus Barrio-Barrio1, Alfredo Garcia-Layana^1,2, Patricia Fernandez-Robredo^2,1

1. Ophthalmology, Clinica Universidad de Navarra, Pamplona, Navarra, Spain
2.  Retinal Pathologies and New Therapies Group, Experimental Ophthalmology Laboratory, Department of Ophthalmology, Clinica Universidad de Navarra, Pamplona, Navarra, Spain;
3. Facultad de Medicina, Universidad de Navarra, Pamplona, Navarra, Spain; 
4. Ophthalmology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Catalunya, Spain;

Conjunctival autofluorescence area (CUVAF), colloquially called sunspot of the sclera, was compared in myopic (n=213) and non-myopic (n-50) children aged 6-17 years, as well as correlation between outdoor time and CUVAF area. CUVAF, as measured using the Heidelberg Spectralis HRA+OCT, in the non-myopes was significantly higher than in myopes: this was commensurate with degree of myopia too. There was also less hours spent outdoors in the myopic group. CUVAF may be used as a biomarker, and may be used as a more reliable method to assess outdoor activities than questionnaires, and may become an effective tool for monitoring the development of childhood myopia.

Link to Abstract

Authors: Donald O. Mutti¹, Loraine T. Sinnott¹, David A. Berntsen², Lisa Jordan¹, Jeffrey J. Walline¹

1. College of Optometry, The Ohio State University, Columbus, Ohio, United States; 
2. College of Optometry, University of Houston, Houston, Texas, United States;

The BLINK study found that children wearing a centre-distance multifocal contact lens with +2.50D add yielded the most myopia control compared to +1.50D and SV contact lenses; this study analysed this data and found that across different levels of myopia progression and axial elongation, there was uniformity in amount of myopia control yielded by the +2.50D add multifocal contact lenses compared to SV. This means that all children regardless of age can be considered candidates for optical myopia control, rather than prioritizing those at risk for fast progression.

Link to Abstract

Authors: EBENEZER ZAABAAR¹, Xiu Juan Zhang¹, Fangyao Tang¹, Clement C. Tham¹, Calvin C P Pang¹, Li Jia Chen¹, Jason C. Yam¹

1. Ophthalmology and Visual Sciences, The Chinese University of Hong Kong Faculty of Medicine, Hong Kong, Hong Kong;

The myopia control effects of different wavelengths of light were compared in this meta-analysis and it was found that the effect is indeed wavelength-dependent. Axial length was shorter and progression of spherical equivalent refraction slower in the light therapy groups compared to control groups. Red light was ranked as the most effective for myopia control followed by violet light and full spectrum light. This may become a new clinical treatment for myopia control.  

Link to Abstract

Authors: Sylvia Agyekum¹, Xiu Juan Zhang^1,2, Poemen Pui Man Chan^1,2, Yuzhou Zhang^1,2, Zhaohua Huo³, Benjamin HK Yip³, Clement C. Tham^1,2, Li Jia Chen^1,2, Calvin C P Pang¹, Jason C. Yam^1,3 

1. Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, New Territories, Hong Kong; 
2. Hong Kong Eye Hospital, Hong Kong, Kowloon, Hong Kong; 
3. Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, New Territories, Hong Kong;

This study evaluated the cost-effectiveness of atropine concentrations per amount of spherical equivalent reduction. Data from the LAMP study, which included children (n=438) between the ages 4-12 years old, was used; cost included patient out of pocket costs of medical examination and medications which consisted of cost of consultation, follow-up visits, optometric services (refraction), specialized ophthalmic services, spectacles, and loss of productivity. 0.05% atropine was the most cost-effective concentration across all age ranges for controlling myopia progression.  

Link to Abstract

Authors: Ian Flitcroft^5,1, Emmanuel Kobia-Acquah⁵, Gareth Lingham⁵, John Butler², Ekaterina Loskutova⁵, David Mackey^3,4, Samantha Sze-Yee Lee³, James Loughman⁵ 

1. Ophthalmology, Children's Health Ireland at Temple Street, Dublin, Dublin, Ireland; 
2. School of Mathematics and Statistics, Technological University Dublin, Dublin, Dublin, Ireland; 
3. University of Western Australia Centre for Ophthalmology and Visual Science, Perth, Western Australia, Australia;
4. Centre for Eye Research Australia, University of Melbourne, Victoria, Australia;
5. Centre for Eye Research Ireland, Technological University Dublin, Dublin, Dublin, Ireland;

Children of white ethnicity (n=207) and non-white ethnicity (n=43) aged 6-16 years old were randomly allocated 0.01% atropine or placebo eyedrops for 24 months. The MOSAIC study is unique as the first in Europeans; exploring a stable, preservative free atropine formulation; three years placebo controlled; exploring various tolerance, behaviour risk factors and tapering regimes.

It was found that atropine was well tolerated in the European population and slowed down myopia progression by a modest amount, indicating benefits as a form of treatment in the West; previously, it had predominantly been studied in Asian populations. Benefits were strongest for children with blue eyes; green eyes had some effect and there was no benefit of treatment for brown eyes. The twist in the story is that children enrolled pre-COVID lockdown had no effect from the atropine, but children recruited after lockdown had 0.37D and 0.17mm less myopia progression over 2 years.

Link to Abstract

Authors: Jason YAM¹, Xiu Juan Zhang¹, Yuzhou Zhang¹, Ka Wai Kam¹, Fangyao Tang¹, Clement C. Tham¹, Li Jia Chen¹, Calvin C P Pang¹

1. Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong;

This longitudinal study followed boys (n=548) and girls (n=545) with a mean age of 7.53±0.94 years old and spherical equivalent of 0.31±1.47 D over 3 years; parental myopia data was also obtained. It was found that parental myopia had an independent, dose-dependent effect on childhood myopia onset and progression, where any parent with high myopia increased risks for their child. Those with two high myopic parents had a 5.18 times higher risk of myopia onset, and progressed 1D faster over 3 years, compared to children who had parents with no or mild myopia. This indicates that children with high risk can be identified based on parental myopia data, and this should become a key clinical question for targeted myopia management.  

Link to Abstract

Authors: Mingguang He^1,2, Wei Wang², Yu Jiang², Zhuoting Zhu^2,1, Junwen Zeng²

1. Centre for Eye Research Australia Ltd, East Melbourne, Victoria, Australia; 
2. Sun Yat-Sen University Zhongshan Ophthalmic Center State Key Laboratory of Ophthalmology, Guangzhou, Guangdong, China;

Myopic children (n=264) aged 8-13 years old obtained repeated low-level red light therapy (RLRL) or single vision glasses as the control. The treatment was highly controlled: 650nm (red) laser diodes viewed for 3 minutes, separated by at least 4 hours, twice per day, 5 days per week. The myopia control results are impressive, with axial length shortening of at least 0.05mm observed in around 20% of the myopic children that received RLRL - only 28% of this was explained by choroidal thickening, indicating some other mechanism is involved. Children with higher myopia and a thinner choroid at baseline seemed to get the best effect. While this instrument has been classified as safe according to various regulatory standards, the risk of copycat instruments, longer exposure times and/or susceptibility factors to retinal health was a concern raised by the audience, as this has the potential to gain popularity for myopia control treatment.

Link to Abstract

Authors: Willem Tideman^1,2, Sander Kneepkens¹, Jan Roelof Polling¹, Caroline C W Klaver¹

1. Ophthalmology, Erasmus MC, Rotterdam, Zuid-Holland, Netherlands;
2. Ophthalmology, Martini Ziekenhuis, Groningen, Groningen, Netherlands;

The Generation R study followed around 5,000 children from age 6 to 9 to 13 years, with repeated cycloplegic refraction data for around 3,000 children. Children spent an average of 1.6 hours per day outdoors at age 6 and 1.2 hours at age 9. With over 22% prevalence of myopia by age 13, those who had spent more time outdoors had less myopia onset and slower myopia progression. Early outdoor time (eg from 6-9 years) seemed to have the biggest impact on lowering myopia risk by age 13.

Link to Abstract

Authors: Laura Batres¹, Gonzalo Carracedo¹, Julia Bodas¹

1. Optometry and Vision, University Complutense of Madrid, Madrid, Madrid, Spain;

Children (n=47) with a mean age of 12 +/-2.50 years wore orthokeratology (OK) for 12 months, and accommodation lag reduced from a mean 0.53D before OK to 0.15D after 12 months, which is a finding in line with previous studies. This decrease (improvement) was greatest in those who had a higher accommodative lag before OK. After 1 month of ceasing OK wear, accommodation lag returned to baseline levels - there was no persistent effect. Large changes in spherical aberration during OK wear were measured, which is the likely source of the improved accommodation response. This could point to kids who could benefit most from OK.

Link to Abstract

Authors: Yee Ling Wong^1,2, Yingying Huang^3,4, Li Xue^3,4, Yimin Yuan^3,4, Ying Ying Ye^3,4, Ee Woon Lim^1,2, Adeline Yang^1,2, Daniel P. Spiegel^1,2, Bjorn Drobe^1,2, Hao Chen^3,2, Jinhua Bao^3,4

1. R&D Singapore, Essilor International, Singapore, , Singapore; 
2. Wenzhou Medical University–Essilor International Research Center (WEIRC), Wenzhou Medical University, Wenzhou, China; 
3. National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, China;
4. National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China;

Data from the aspherical lenslet spectacle lens study (HAL and SAL lenses) was compared to large-scale emmetropic eye growth data from China to characterise slow, normal and fast eye growth, being below 25th, within 25th and 75th, and above 75th percentiles, respectively. After two years of wearing HAL lenses, 35% of children had slow, 35% normal and 30% fast eye growth. This was compared to 2% slow, 12% normal and 86% fast eye growth in SV. Check the abstract for the growth criteria, which were categorised for children aged 7-10 and 11-13 years.

Link to Abstract

Authors: Karla Zadnik¹, Erica Schulman², Daniel Ian Flitcroft³, Jennifer Swingle Fogt¹, Louis C. Blumenfeld⁴, Tung Fong⁵, Eric Lang⁵, Houman D. Hemmati⁵, Simon Chandler⁵

1. The Ohio State University College of Optometry, Columbus, Ohio, United States; 
2. SUNY College of Optometry, New York, New York, United States; 
3. Centre for Eye Research, Dublin, Ireland; 
4. Eye Physicians of Central Florida, Maitland, Florida, United States;
5. Vyluma, Inc., Bridgewater, New Jersey, United States;

European and US children (n=576) aged 3-17 years old with -0.50D to -6.00D myopia were given a placebo, 0.01% atropine or 0.02% atropine for 36 months. It was shown that 0.01% atropine was efficacious in myopia control as compared to the placebo, with 28% of children progressing by less than 0.50D over 3 years compared to only 17% of the placebo group. Absolute differences were -0.13mm and 0.24D across the entire study group, with sub-group analyses showing benefits for younger children and/or lower myopes: stay tuned for more data on this. Side effects were similar between treatment and control groups, being most commonly photophobia (4.5%), allergic conjunctivitis (3.3%), eye irritation (1.6%), and mydriasis (1.0%). Atropine 0.01% could be set to become the first approved pharmacological treatment option for myopia in the US and Europe.

Link to Abstract

Authors: Raquel Gil-Cazorla¹, Affiong Iyire¹, Alfredo Desiato¹, Syeda Sanyana Kifayat¹, Nicola S. Logan¹

1. Aston University College of Health and Life Sciences, Birmingham, Birmingham, United Kingdom;

The cytotoxic effect of differing concentrations of benzalkonium chloride (BAK) and atropine was explored by examining the penetration of atropine through cultured human corneal cells. BAK-preserved solutions showed higher permeability of 0.01% atropine than non-preserved solutions and more than 60% of cells survived 3 consecutive days of exposure to 0.01% atropine + 0.004% BAK (similar to marketed eyedrops). BAK was shown to be ineffective as a preservative at 0.0005% concentration, suggesting it is inappropriate to prepare low-concentration multi-dose atropine by diluting 1% commercial atropine. Corneal epithelial penetration of 0.01% atropine varied depending on BAK concentration, without causing significant cytotoxicity on short-term exposure.

Link to Abstract

Authors: Kin Ho Chan¹, Tsz Wing Leung^1,2, Chea-Su Kee^1,2

1. School of Optometry, The Hong Kong Polytechnic University, Hong Kong, Hong Kong;
2. Centre for Myopia Research, The Hong Kong Polytechnic University School of Optometry, Kowloon, Hong Kong;

Topographic maps of children aged 6-11 years who had completed at least 1 year of orthokeratology (OK) treatment were analysed to summate Relative Corneal Refractive Power Shift (RCPRS), taking in tangential, axial, and refractive RCRPS within various corneal radii up to 4mm in 0.1mm steps. Only tangential data within 2.2mm predicted axial elongation; higher age and higher initial axial length predicted less axial elongation. As a more complex measure of corneal power than just apical corneal change, this could point to greater central flattening over larger areas, or more aspheric shapes, being linked with slower myopia progression in OK wearers.

Link to Abstract

Authors: Bjorn Drobe^1,2, Li Xue^3,4, Yingying Huang^3,4, Ee Woon Lim^1,2, Jinhua Bao^3,4

1. R&D Singapore, Essilor International, Singapore, Singapore; 
2. Wenzhou Medical University–Essilor International Research Center (WEIRC), Wenzhou, Zhejiang, China;
3. National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, China; 
4. National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China; 

Children participating in the Highly Aspherical Lenslets (HAL) clinical trial (n = 43, mean age 13.7±1.1yrs) wore the lenses for a 4th year. Modelling for the control group predicted 4-yr changes of -2.46D for spherical equivalent refraction (SER) and 1.20mm for axial length (AL). The 4-yr changes with HAL lenses were -1.23D for SER and 0.58mm for AL. HAL lenses provided a sustained 50% saving on SER and AL progression over 4yrs for older children aged 11 to 15yrs.

Link to Abstract

AuthorBlock: Harmin Chima¹

1. West Point Optical Group LLC, Ohio, United States;

Children with mean age 12yrs started myopia management at an optometric practice (0.025% atropine n = 36, 0.05% atropine n = 3 and dual focus MiSight n = 11) and were followed for 12mths. Mean initial spherical equivalent refraction was -3.97D with changes of -0.02D at 6mths and -0.21D at 12mths. Axial length data was unavailable in this practice setting. The intent of this study was to characterize uptake and outcomes for myopia management in a retail style practice, with 70% of patients commenced their treatment on the day of their comprehensive eye exam. Being a case series there was no control group, however these 1-year results are similar to those expected from peer-reviewed studies, and these outcomes are reflective of everyday practice.

Link to Abstract

Authors: Rigmor C. Baraas², Nickolai Godtfred Nilsen², Lene A. Hagen², Hilde Rogeberg Pedersen², Stuart J. Gilson¹

1. National Centre for Optics, Vision & Eye Care, Universitetet i Sorost-Norge, Kongsberg, Buskerud, Norway; 
2. National centre for Optics, Vision and Eye Care, University of South-Eastern Norway, , Norway;

Ocular biometry data was collected from Norwegian schoolchildren in 2nd grade (n = 49, 7-8yrs) and 5th grade (n= 43, 10-11yrs) across two winter seasons (6.5-7.4hrs daylight) and one summer (18.4hrs daylight). Mean refraction was mild hyperopia, as the incidence of myopia in Norway is low. Axial length was similar between sexes in the 2nd grade but boys had longer eyes by 5th grade. Younger children had more positive spherical equivalent refraction, and increased AL changes for all ages were more apparent in the time period of winter-to-summer than across summer-to-winter.  Rigmor explained a recent paper published by her research group which showed both seasonal and diurnal variations in axial length, indicating the importance of gathering repeated data, and ideally at similar times of day. Here's a link to that paper.

The volume of evidence on seasonal variation indicates that faster myopia progression observed across the winter season may be expected, and may not necessarily indicate failure of myopia control treatment.

Link to Abstract  

Authors: Emmanuel Kobia-Acquah¹, Daniel Ian Flitcroft^1,2, Gareth Lingham¹, James Loughman¹

1. Centre for Eye Research Ireland, Technological University Dublin, Dublin, Dublin, Ireland; 
2. Department of Ophthalmology, Children’s Health Ireland at Temple Street Hospital, Dublin, Ireland;

Children aged 3-17 years enrolled in the MOSAIC clinical trial of 0.01% atropine had their choroidal thickness (ChT) measured at subfoveal, parafoveal, and perifoveal regions at baseline and after 1 and 2 years. The ability of ChT to predict axial length change is equivocal in the literature; here, temporal perifoveal thinning in both treatment and control groups was correlated with changes in refraction and axial length. Subfoveal ChT thinning was also correlated with axial length progression. Interestingly, the atropine 0.01% treated children showed effective stability in ChT over 2 years, whereas the placebo group showed thinning. As we learn more on this topic, clinical OCT measurement could potentially support targeted myopia treatment and gauging responses.

Link to Abstract

Authors: Debbie Laughton¹, Jennifer Hill¹, Vanessa Tasso¹, Jay Neitz², Maureen Neitz², Kellie Hogan³, Thomas Chalberg¹

1. SightGlass Vision Inc, Los Altos, California, United States; 
2. University of Washington, Seattle, Washington, United States; 
3. Phoenix Feather Stats, Georgia, United States;

Myopic children (n=181) aged 6 to 10 years were randomised to wear Diffusion Optics Technology (DOT) lenses or single vision (SV) lenses. 3 year data shows that children wearing DOT lenses full-time had significantly less axial length (AL) elongation, with 83% reduction in pathological AL growth after 2 years and 73% after 3 years. This method of analysis subtracts physiological AL growth, calculated based on age-matched emmetropic eye growth data from a previous longitudinal study, from the myopic eye growth observed in the treatment and control groups. For younger children (<10.5 yrs), physiological (normal) AL growth accounted for over 50% of observed eye growth, so this 'correction' helps to understand efficacy in a new way. This study is the first to investigate myopia controlling spectacles in the 6-10 year age range, a group well known to be at risk of fast progression.

Link to Abstract

Authors: Alex Nixon¹, Jie Xu¹, Noel A. Brennan¹, Robert Morlock², Xu Cheng¹

1. Johnson and Johnson Vision, Jacksonville, Florida, United States; 
2. Henry Ford Health System, Detroit, Michigan, United States;

Though myopic progression can occur through the teenage years, most soft contact lens myopia control studies have been on children younger than 12 years old. The authors compared the subjective visual experiences between two groups of children: 7-12 years old and 13-17 years old. Three test lenses were two prototype MC SCLs with noncoaxial ring-focus designs (for enhancing efficacy [EE] and enhancing vision [EV]) and one dual-focus (DF) design. They found that older children were more judgemental of the quality of vision in the early periods of wear, noticing a difference on survey in both EE and DF designs, but not the EV design. Read about efficacy of these designs in THIS review. The designs were not directly compared to each other. The authors concluded that extra thought should be given when considering myopia control in older children who tend to be more critical of their vision quality and are less likely to progress rapidly.

Link to Abstract

Authors: Raman Prasad Sah¹, Dawn Meyer¹, Nitya Murthy¹, Pete S. Kollbaum¹

1. School of Optometry, Indiana University Bloomington, Bloomington, Indiana, United States;

An hypothesis for myopia is that prolonged near work can place individuals in a hyperopic defocus state, driving myopia. Inaccurate accommodative behaviour has been observed in myopes such as higher near work induced transient myopia (NITM) and lower tonic accommodation (TA, also known as dark focus). The authors used an open-field autorefractor to monitor the refractive state of 7 subjects comprising myopic and non-myopic young adults after 20 min of using an iPhone at 25cm. Though the sample size was small, they found that the accommodative lag of both myopic and non-myopic young adults was similar, with most accommodative lags <1.00D. They have taken measures of NITM and TA which will be next on the analysis agenda, to understand how dynamic accommodative behaviour may vary between myopes and non-myopes.

Link to Abstract

Authors: Gines Martinez¹, Rosa María Salmerón-Campillo¹, Mateusz Tomasz Jaskulski², Andres Gonzalez-Diaz⁴, David Zarzoso-Fernandez³, Norberto Lopez-Gil¹

1. Universidad de Murcia, Murcia, Murcia, Spain; 
2. Indiana University, Bloomington, Indiana, United States; 
3. Aix-Marseille Universite, Marseille, Provence-Alpes-Côte d'Azu, France; 
4. Global Incubator, , Spain;

Near work is hypothesised to have an association with myopic development and progression. The authors studied the effectiveness of an app (myopia.app by VisionApp Solutions) in increasing the viewing distance of users, to reduce dioptric demand on the near vision system. The app warned users when the face-device distance was less than 300mm or its brightness less than 100 lux. They found that using the app led to a reduction in proportion of young adults viewing at a distance of less than 300mm from 40% to 10%. This app is available for free to download for practitioners and patients: here's the Apple link. In the image below right you can see the close working distance warning at the bottom of the phone screen.

Link to Abstract

Authors: Jane M. Fulton¹, Tsz Wing Leung^2,3, Sara McCullough¹, Lesley Doyle¹, Nicola S. Logan⁴, Carly S Y Lam^2,3, Kathryn Saunders¹ 

1. Centre for Optometry & Vision Research, Ulster University, Coleraine, Londonderry, United Kingdom;
2. School of Optometry, The Hong Kong Polytechnic University, Hong Kong, Hong Kong; 
3. Research Centre for SHARP Vision (RCSV), The Hong Kong Polytechnic University, Hong Kong, Hong Kong; 
4. School of Optometry, Aston University, Birmingham, Birmingham, United Kingdom;

The authors investigate the sensitivity and specificity of the Predicting Myopia Onset and Progression Risk indicator (PreMO) in stratifying risk for future myopia based on cycloplegic spherical refraction, axial length and parental myopia. The prospective study used data from children 6-8 years old in the UK and Hong Kong. They found that a PreMO risk score of ≥4 at 6-8 years old was highly sensitive for predicting future myopia. It was also highly specific for UK children but less so for HK children.  This sensitivity and specificity reduces in data obtained at 9-10 years old. This tool can be used now in a PDF format and further development of an app is underway.

Link to Abstract

Authors: Zhenghua Lin^1,2, Xiaoyun Xi^2,3, Longbo wen^2,3, Zhiwei Luo^2,3, Weizhong Lan^2,3, Zhikuan Yang^2,3, Pablo Artal^1,2

1. Laboratorio de Óptica, Universidad de Murcia, Murcia, Murcia, Spain; 
2. Aier School of Ophthalmology, Central South University, Changsha, Hunan, China; 
3. Aier School of Optometry and Vision Science, Hubei University, Wuhan, Hubei, China;

Peripheral optics is known to be involved in myopia progression in animal models, but it is unsure whether peripheral refraction status is a cause or consequence of myopia in humans. The authors compared peripheral refraction maps of 3 groups of Chinese children aged 9-16 years over a two-year period. The children were divided into those who remained emmetropic throughout the study, those who developed myopia and those who were already myopic when the study commenced. They found that all subjects displayed similar peripheral refraction patterns and suggest that this shows that peripheral refraction changes as a consequence of myopia progression and not a cause.

Link to Abstract

Authors: Zachary Zlatin¹, Sandra Wagner², Xiaoying Zhu¹, David Troilo¹ 

1. Vision Science, SUNY College of Optometry, New York, New York, United States; 
2. Institute for Ophthalmic Research, Eberhard Karls Universitat Tubingen, Tubingen, Baden-Württemberg, Germany;

Multifocal contact lens (MFCL) wearing children showed a reduced accommodative response, compared to single vision CL wear, which improved after a single 200 second session of auditory biofeedback training. The effect was greater at closer viewing distances and was maintained after 1 week. Accurate accommodation in MFCL appears to be important in maximising efficacy so this could become a potential adjunct therapy.

Link to Abstract

Authors: Jens Ellrich¹, Hosein Hoseini-Yazdi², Scott A. Read², Michael J. Collins², Hamed Bahmani³, Tim Schilling³

1. Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany; 
2. Queensland University of Technology, Brisbane, Queensland, Australia; 
3. Dopavision, Berlin, Germany;

This is super interesting, given the new interest in red light therapy for myopia. In this study, adults underwent 1-minute flickering light stimulation with a virtual reality headset to the optic nerve head region using red light (Day 1), no light (Day 2) then blue light (Days 3-8). In response to the blue light, myopes showed a 20 micron shortening of axial length while emmetropes were unaffected. Red light did not have a measurable effect. Yet to see if this innovative technology could be applied to children.

Link to Abstract

Authors: Thomas Chalberg¹, Deborah Laughton¹, Jennifer Hill¹, Vanessa Tasso¹, Graeme Young², Christopher Hunt², Jay Neitz³, Maureen Neitz³

1. SightGlass Vision Inc, Los Altos, California, United States; 
2. Visioncare Research Limited, Farnham, United Kingdom; 
3. University of Washington, Seattle, Washington, United States;

The clinical trial of Diffusion Optics Technology (DOT) lenses recruited 6-10 year olds across multiple USA sites. Three-year outcomes showed that DOT 0.2 lenses (Test 1 in the abstract) reduced myopia progression by 0.13mm (~20%) and 0.33D (~30%) compared to SV controls. Most of this effect was found in year 1, with around 50% efficacy for axial length observed, with years 2 and 3 affected by COVID changes in lifestyle, schooling and potentially wearing time. The MOSAIC 0.01% atropine trial also observed this minimal myopia control effect during COVID, which increased again to expected levels post-COVID (see #ARVO2023 Update 7 on our Facebook or LinkedIn coverage, or the Summary Day 2 newsletter). Interestingly, children aged 6-7 years showed 0.84D and 0.32mm less myopia over 36 months, a group for which progression is typically faster and less treatment efficacy data exists than for older kids.

Link to Abstract

Authors: Li Lian Foo^1,2, Gilbert Lim^3,2, Daniel SW Ting^1,2, Seang-Mei Saw³, Marcus Ang^1,2

1. Singapore National Eye Centre, Singapore, Singapore, Singapore; 
2. Duke-NUS Medical School, Singapore, Singapore; 
3. Singapore Eye Research Institute, Singapore, Singapore;

Retinal fundus images for almost 1000 children aged 6-12 years in Singapore were used to train a deep learning system, including external validation. Using imaging alone, clinical data (eg. age, gender, ethnicity, parental myopia and baseline refraction) or a combination could all be used to predict risk of developing high myopia 5 years later (11-17 years). Adding 1 year progression data didn't do much to improve the already robust modelling. This system could be used in future as a clinical decision support tool to identify kids at risk of high myopia.  

Link to Abstract

Authors: Quan V. Hoang^1,2, Thanadet Chuangsuwanich³, Tin A. Tun^1,3, Tin Aung¹, Michael J A Girard^1,3

1. Singapore Eye Research Institute, Singapore National Eye Centre, Duke-NUS Medical School, Singapore, Singapore;
2. Ophthalmology, Columbia University, New York, New York, United States; 
3. Ophthalmic Engineering & Innovation Laboratory, Department of Biomedical Engineering, National University of Singapore, Singapore, Singapore;

Adult eyes (n=328) who were emmetropic, or with high myopia (>26mm axial length), high myopia and glaucoma or pathological myopia (presence of staphyloma and/or myopic macular degeneration) were imaged with OCT. Acute intraocular pressure risk to >40mmHg was induced through ophthalmodynamometry (pressing on the eyeball!) and macula scans were repeated. Macular curvature increased in eyes with pathology (glaucoma or pathological myopia) and less so in high myopes and emmetropes, who were similar. These 'hypermobility / deformability' changes could potentially be used as a biomarker for eyes at risk of developing other pathologies.

Link to Abstract