Children aged 6 to 8 years old in China were found to experience a mean -0.30D myopic shift and a significant increase in myopia prevalence during a 5-month long COVID-19 home confinement period. Due to their age and corresponding critical stage in visual development, the change in the children’s environment and lifestyle may have been more responsible for their increased myopia than the increased online learning.
This multi-ethnic study found that parental myopia was a risk factor for myopia development in pre-school age children. The age the parents became myopic themselves had a dose-dependent effect in their children if both parents had onset of myopia before age 12. Eye care practitioners can use this to identify which children may benefit from early myopia treatment intervention.
The risk of microbial keratitis (MK) in orthokeratology-wearing children was shown in a 2013 analysis to be around 14 per 10,000 patient wearing years, but new data indicates that it may be lower. Data gathered from a large group of practices in Russia found MK risk of around 5 per 10,000 patient-wearing years, similar to the risk of daily wear soft lenses. This should increase confidence in fitting orthokeratology to children for myopia control.
This systematic review of 9 studies confirms that under-correction of myopia does not slow progression; rather, at least half of the studies have shown the myopia progression is accelerated. There was no benefit found in overcorrection, and the evidence for un-correction was equivocal. Clinically, this advocates for the full correction of myopia.
The Erasmus Medical Group in the Netherlands set out four steps in their myopia management protocol: providing visual environment advice, identifying high-risk myopes by axial length and treating them with atropine 0.5%, managing other myopes with optical treatments or lower-concentration atropine, and ceasing treatment in the late teens once axial length is stable. The described use of axial length percentile growth charts for diagnosis, choice of treatment, monitoring and cessation is a world-first.
Light-emitting glasses worn by young adults for 1-2 hours reduced axial length and increased choroidal thickness by around 20 microns compared to darkness. The study participants viewed a colour-muted television at 5m while indoors, and the changes regressed within 30 minutes. A future myopia treatment to increase ‘outdoor’ time?
After the 3-year MiSight 1 day clinical trial, the control group children were switched to MiSight. A ‘virtual control group’ mathematical model, previously published, was utilized to demonstrate a continued myopia control effect across six years, plus effectiveness of treatment for children who commenced wear at age 11-15 years.
This study reported that children wearing DIMS spectacle lenses showed increased sub-foveal choroidal thickness than controls at 1 week which increased in the first 6 months and was maintained at 2 years. There was a correlation between more choroidal thickening and less axial elongation, but choroidal thickening only explained around 8% of the variation in axial length.
The BLINK study found that +2.50 Add centre-distance multifocal contact lenses (MFCLs) slowed myopia progression but the +1.50 Add didn’t. Further analysis indicates that increased peripheral defocus created by the +2.50 Add only accounted for around 15% of the myopia control effect, indicating other mechanisms are involved.
A combination of higher baseline myopia, parental myopia and faster 3-year progression in earlier childhood were strongly predictive of teenage high myopia in this study. Young patients with these combination of factors should receive closer clinical monitoring and timely interventions to slow myopia progression.