Objective: to determine optimal method of progressive myopia optical correction in children and adolescents.Patients and methods. Conducted 5-year prospective clinical and instrumental examination of 494 children with myopia using orthokeratology lenses, soft contact lenses and glasses. 61 children (the average age 11.7 ± 2.36 years) with myopia –2.87 ± 1.1 D and astigmatism –0.58 ± 0.27 D used orthokeratological lens. 92 children (the average age 12.8 ± 1.51 years) with myopia –3.66 ± 1.07 D, astigmatism –0.53 ± 0.18 D wore soft contact lens. 79 children (the average age 11.52 ± 1.78 years) with myopia –1.59 ± 1.08 D, astigmatism –0.71 ± 0.54 D used glasses with monofocal lenses, with full correction. The control group consisted of 249 children (the average age 9.1 ± 1.14 years) with initial emmetropia. Determination of refraction, subjective and objective determination of accommodation, and axial length of the eye (“IOL-master”) was conducted in children.Results. The maximum progression of myopia was observed in younger children (8–9 years). Correction of myopia with orthokeratology lenses (OKLs) was accompanied by the lowest dynamics of changes in axial length (axial elongation 0,44 ± 0,32 mm) compared to the correction with soft contact lenses (SCLs) (axial elongation 0,73 ± 0,36 mm), spectacle correction (axial elongation 1,39 ± 0,47 mm) and the control group (axial elongation 0,6 ± 0,41 mm). In all children with myopia, at the beginning of the study, there were reduced values reserve of relative accommodation and an objective accommodative response. Correction of myopia with OKLs (p = 0,0002) and SCLs (p = 0,036) provides the normalization of subjective and objective reserve indication of relative accommodation in both age group in comparison of spectacles correction.Conclusion. Correction with orthokeratology lens in children with progressive myopia contributes to the minimum growth length of the eye. Correction of myopia OKLs and MKL improves of subjective and objective indicators of relative accommodation reserve.
Purpose: To analyze changes of functional parame¬ters and aberrations before fitting and after using rigid gas-permeable scleral lenses (RGPSCL) in patients with irregular cornea. Material and methods. 21 patients (29 eyes) with irregular astigmatism of various etiology were enrolled in this study. The patients could not achieve good visual aсuity in glasses, standard soft or rigid corneal contact lenses. Complex ophthalmologic examination was per¬formed: autorefractometry, visometry, biomicroscopy, computer corneal topography, aberrometry on “OPD-Scan II” (“Nidek”, Japan) before fitting scleral lenses and during the period of their wearing. Results and discussion. The results demonstrat¬ed significant visual acuity improvement after RGP¬SCL fitting in all observed patients. UCVA amounted to 0.1±0.18, BCVA in glasses amounted to 0.4±0.26, BCVA in RGPSCL amounted to 0.7±0.1. An increase of best-corrected visual acuity in RGPSCL was statistically significant in patients after keratoplasty, after intra-stromal corneal ring segments (ICRS) implantation, af¬ter refractive laser surgery (RLS) and in cases of mixed astigmatism. We have found that the correction of ker¬atoconus with the use of RGPSCL resulted in a decrease of the root mean square value (RMS), measured in the 3 mm and 5 mm zones by 2.5 times and 4 times, re¬spectively. In patients wearing RGPSCL after kerato¬plasty, statistically significant decrease in RMS was observed in the 3 mm zone (by 3.85 times) and in the 5 mm zone (by 2.99 times). In patients wearing RGPSCL after implantation of intrastromal corneal ring segment (ICRS), RMS in the 3 mm zone decreased by 1.5 times. In patients wearing RGPSCL after refractive laser surgery (RLS) RMS was 2.5 times lower in the 3 mm zone and 2.8 times lower in the 5 mm zone. In case of mixed astigmatism correction with RGPSCL, RMS increased by 1.6 times in the 3 mm zone and practically did not change in the 5 mm zone. Conclusion. The results obtained demonstrated significant visual acuity improvement in all observed patients. The sub-lens-space filled with tear forms a unified “cornea-tear-scleral contact lens” optic system that corrects unevenness of cornea, decreases amount of high-order aberrations (HOA) and provides a clear stable vision.
Purpose. To evaluate changes of anatomical and functional parameters of the eye in children with initial emmetropia and to assess their impact on the occurrence of myopia. Patients and methods. 189 children: 85 boys (44.97 %) and 104 girls (55.03 %) aged 7–11 years (mean 8.5 ± 1.01 years) with emmetropia were examined. Ophthalmic examination consisted of refractometry, keratometry with registration of the radius of corneal curvature (CR) on the RC-5000 autorefractometer (Tomey), visual acuity testing with and without correction, positive relative accommodation (PRA), optical biometry with axial length (AL) measurement were performed with a IOL-master biometer (Carl Zeiss). Results. 87 schoolchildren (56 girls (64.4 %) and 31 boys (35.6 %)) of the 189 healthy children had myopia (p = 0.017) by the end of 5-year observation period. Myopia was more prevalent in girls (53.8 %) than boys (36.5 %). There was a statistically significant difference in the values of the ratio of the axial length to the CR in children with stable emmetropia and developing myopia: 2.9 ± 0.06 and 2.95 ± 0.07 (p < 0.001). PRA at the beginning of the study was lower in children with subsequent myopia in comparison with children with stable emmetropia (3.76 ± 0.72 diopters and 4.1 ± 0.7 diopters, p = 0.002). Change of AL was 0.58 ± 0.39 mm in healthy young children (7–8 years old) and 0.44 ± 0.29 mm — the oldest (9–10 years old) (p = 0.021). Increase of AL in case of myopia was 1.55 ± 0.67 mm in children of the younger age group and 1.13 ± 0.32 mm in the older one (p = 0.011). Conclusion. Higher ratio of the axial length to the radius of curvature of the anterior corneal surface was noted in children with developing myopia compared with stable emmetropia. Decline in positive relative accommodation before clinical manifestation of myopia was revealed. A greater increase of axial length was noted in children of 7–8 years of age compared with children of 9–10 years of age in groups with stable emmetropia and with developing myopia.
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