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BackgroundThe myopia control effect of orthokeratology (OK) varies among individuals. The variation might relate to the proposed ‘areal summation effect’ of lens-induced visual signals. The current study evaluated the areal summed corneal power shift (ASCPS) in myopic children treated with OK lenses and assessed whether the ASCPS achieved at early post-OK visit can predict the lens long-term effect on the axial length (AL) elongation.MethodsStudy participants were 130 myopic children treated with OK lenses (age range, 8 to 15 years) in a prospective study. Corneal topography and AL were measured at baseline and 1, 3, 6, 9 and 12 months after OK lens wear. The ASCPS was derived from corneal topographic measurements and defined as the change in the areal summed corneal relative refraction at the follow-up visit from baseline. The impact of the ASCPS achieved at the 1 month post-OK visit on the 12 months AL elongation was examined using multivariate linear regression analysis.ResultsBaseline age of the study participants was 11.8 ± 1.8 years and their mean spherical equivalent was −3.00±0.92 D. The ASCPS was 6.90±6.09 D*mm at the 1 month visit and remained stable throughout the follow-up period (p=0.5508, repeated-measures analysis of variance). Greater 1 month ASCPS was associated with slower AL elongation at the 12 months visit (β=−0.007, p=0.001).ConclusionsThe ASCPS achieved at early post-OK visit is predictive for the lens long-term effect on the myopic AL elongation. The parameter is potential in guiding the OK lens practice to slow down axial growth in myopic children.

To evaluate the features of the choroidal structures in the eyes of myopic children obtained by enhanced depth imaging optical coherence tomography (EDI-OCT). METHODS. Ninety-six myopic children with low to moderate myopia (spherical equivalent refractive error [SER],-5.75 to-1.00 diopter) were included in this cross-sectional study. Ocular biometrics were measured using an optical low-coherence reflectometry device. Data of the choroidal structures extracted from a 7500-μm cross-sectional arc of the choroid extending from the temporal optic disc margin, including the total choroidal area, luminal area, stromal area, and choroidal vascularity index, were determined by image binarization of the EDI-OCT. Associations between demographic factors, ocular parameters, and choroidal structures were evaluated using univariate and multiple linear regression analyses. RESULTS. The study participants (mean age, 11.02 ± 1.70 years) had a mean axial length (AL) of 24.94 ± 0.70 mm. The mean total choroidal area was 2.64 ± 0.49 mm 2 (luminal area, 1.68 ± 0.32 mm 2 ; stromal area, 0.95 ± 0.19 mm 2), and the choroidal vascularity index was 0.64 ± 0.03. Multiple regression analysis showed that the luminal area was significantly associated with the AL (standard β =-0.24, P = 0.022) after adjusting for sex and corneal radius (CR), whereas the stromal area (standard β =-0.30, P = 0.003) and choroidal vascularity index (standard β = 0.36, P = 0.001) were significantly associated with age after adjusting for sex, CR, and lens thickness (LT). Sex, CR, LT, and SER showed no significant association with choroidal structures after adjusting for age and AL (all P > 0.05). CONCLUSIONS. The luminal area of the choroid tends to decrease with a longer AL, whereas the stromal area tends to decrease with increasing age in myopic children. These findings require further exploration in a longitudinal study.

Purpose: To investigate the characteristics of corneal biomechanics in Chinese preschool children with different refractive status. Methods: Study participants were 108 Chinese children (216 eyes) aged 4 to 6 years with a spherical equivalent refraction between −9.00 and +9.00 diopters (D). Cycloplegic refraction was measured using an autorefractor, axial length using an IOL Master (Zeiss, Oberkochen, Germany), and corneal biomechanical metrics and corneal power using an ultra-high-speed camera (Corvis ST; Oculus, Wetzlar, Germany) and Pentacam (Oculus; Menlo Park, CA). Differences in corneal biometry and biomechanical characteristics among myopia, emmetropia, and hyperopia eyes were analyzed by SPSS 17.0. Results: The spherical equivalent refraction was significantly positively correlated with the stiffness parameter at the first applanation (SP-A1, r = 0.22, P < 0.01) and corneal velocity at the second applanation (A2 velocity, r = 0.25, P < 0.001), whereas it was negatively correlated with the peak distance (r = −0.32, P < 0.001) and deformation amplitude ratio (DA ratio, r = −0.34, P < 0.001). In the hyperopia, emmetropia, and myopia groups, the SP-A1 successively decreased (108.70 ± 22.93 vs. 100.50 ± 18.98 vs. 97.97 ± 18.91, P < 0.01), whereas the peak distance progressively increased (4.39 ± 0.32 vs. 4.56 ± 0.30 vs. 4.63 ± 0.34 mm, P < 0.001). In the same order of groups, an increasing trend was found for the axial length (21.11 ± 0.76 vs. 22.39 ± 0.72 vs. 24.09 ± 1.37 mm, P < 0.001), central anterior chamber depth (CACD, 3.04 ± 0.41 vs. 3.21 ± 0.33 vs. 3.37 ± 0.40 mm, P < 0.001) and flat meridian keratometry (K1, 41.92 ± 1.59 vs. 42.73 ± 1.39 vs. 42.98 ± 1.60 D, P < 0.001). Central corneal thickness significantly decreased in the same order of groups (565.46 ± 33.22 vs. 551.97 ± 24.66 vs. 543.36 ± 37.74 µm, P < 0.001). Conclusions: Corneal stiffness is reduced in myopia and increased in hyperopia compared with emmetropia in children aged 4 to 6 years. Corneal biometry and biomechanical characteristics in preschool children seem to depend on refractive status.

PurposeTo investigate the 2-year efficacy of atropine, orthokeratology (ortho-k) and combined treatment on myopia. To explore the factors influencing the efficacy.MethodsAn age-stratified randomised controlled trial. Children (n=164) aged 8–12 years with spherical equivalent refraction of −1.00 to −6.00 D were stratified into two age subgroups and randomly assigned to receive placebo drops+spectacles (control), 0.01% atropine+spectacles (atropine), ortho-k+placebo (ortho-k) or combined treatment. Axial length was measured at baseline and visits at 6, 12, 18 and 24 months. The primary analysis was done following the criteria of intention to treat, which included all randomised subjects.ResultsAll interventions can significantly reduce axial elongation at all visits (all p<0.05). Overall, the 2-year axial elongation was significantly reduced in combined treatment than in monotherapies (all p<0.05). After stratification by age, in the subgroup aged 8–10, the difference between combined treatment and ortho-k became insignificant (p=0.106), while in the subgroup aged 10–12, the difference between combined treatment and atropine became insignificant (p=0.121). A significant age-dependent effect existed in the ortho-k group versus the control group (p for interaction=0.013), and a significant age-dependent effect existed in the ortho-k group versus the atropine group (p for interaction=0.035), which indicated that ortho-k can achieve better efficacy in younger children.ConclusionsAtropine combined with ortho-k treatment can improve the efficacy of myopia control compared with monotherapy in children aged 8–12. Younger children might benefit more from ortho-k.Trial registration numberChiCTR1800015541.

Purpose To develop and validate a standardized prediction model aiming at 1‐year axial length elongation and to guide the orthokeratology lens practice. Methods This retrospective study was based on medical records of myopic children treated with orthokeratology. Individuals aged 8–15 years (n = 1261) were included and divided into the primary cohort (n = 757) and validation cohort (n = 504). Feature selection was primarily performed to sort out influential predictors by high‐throughput extraction. Then, the prediction model was developed using multivariable linear regression analysis completed by backward stepwise selection. Finally, the validation of the prediction model was performed by evaluation metrics (mean‐square error, root‐mean‐square error, mean absolute error and Rad2). Results No significant difference was found between primary and validation cohort (all p > 0.05). After the feature selection, the crude model was adjusted by demographic information in multivariable linear regression analysis, and five final predictors were identified (all p < 0.01). The interaction effect of age with 1‐month change of zone‐3 mm flat K was detected (p < 0.01); hence, two final prediction models were developed based on two age subgroups. The validation proved an acceptable performance. Conclusion An effective multivariable prediction model aiming at 1‐year axial length elongation was developed and validated. It can potentially help clinicians to predict orthokeratology efficacy and make valid adjustments. The influential variables revealed in this model can also provide designers directions to optimize the design of lens to improve the efficacy of myopia control.

Near work has been considered to be a potential risk factor for the onset of myopia, but with inadequate evidence. Chinese adolescents use digital devices for near work, such as study and entertainment purposes, especially during the COVID-19 pandemic. In this study, we investigated the influence of prolonged periods of near work on accommodative response, accommodative microfluctuations (AMFs), and pupil diameter between juvenile subjects of myopia and emmetropia. Sixty juveniles (30 myopes and 30 emmetropes) were recruited for the study. Participants were instructed to play a video game on a tablet PC at a distance of 33.3 cm for 40 min. Accommodative response and pupil diameter were measured with an open-field infrared refractometer in High-speed mode. Parameters of the subjects were measured once every 10 min, and analyzed by one-way repeated measure ANOVA for variation tendency. There were no significant differences between emmetropia and myopia groups with respect to age and sex (p > 0.05). The low-frequency component (LFC) of myopia gradually increased with time, reached a peak at 30 min, and then declined (p = 0.043). The high-frequency component (HFC) of myopia also reached a peak at 30 min (p = 0.036). Nevertheless, there was no significant difference in the LFC (p = 0.171) or HFC (p = 0.278) of the emmetropia group at each time point. There was no significant difference in the mean and standard deviation of the accommodative response and pupil diameter both in emmetropic and myopic juveniles. Compared with juvenile emmetropes, myopes exhibit an unstable tendency in their accommodation system for prolonged near work at a certain time point. Accommodative microfluctuations may be a sensitive, objective indicator of fatigue under sustained near work in juvenile myopes.

PurposeTo determine how orthokeratology (ortho‐k) affects corneal biomechanical properties in myopia control and whether corneal biomechanical parameters can predict clinical efficacy of ortho‐k.MethodsA total of 125 children 7–15 years of age using ortho‐k lenses were followed in this clinical practice and data of their right eyes were analysed. Corneal biomechanical parameters and most ocular biometry were measured at baseline, 1 week, and at 1, 3, 6, 12, 18 and 24 months. Axial length (AL) was collected every 6 months after baseline measurements.ResultsDuring the 2‐year follow up, nine corneal biomechanical parameters, including deformation amplitude maximum (DA), varied between baseline and 1 week (p < 0.05) and stabilized during the rest of wearing period (p > 0.05). The mean AL increased from 25.02 ± 0.84 mm to 25.38 ± 0.81 mm and baseline DA strongly correlated with AL progression (Pearson r = 0.37). In the multiple regression models, baseline age, AL and DA were the independent factors for AL progression (R2: 0.7849, 0.2180 in low and moderate myopes). The area under the receiver operating characteristic curves using the three variables for predicting excessive AL progression (>0.35 mm during 2 years) in low and moderate myopes was 0.902 and 0.698.ConclusionsCorneal biomechanics firstly fluctuated before becoming stable with long‐term ortho‐k use. Corneal biomechanics was associated with AL progression in children wearing ortho‐k lenses. DA combined with age and AL at baseline could predict AL progression in low myopes using ortho‐k.