Myopia progression

Summary of Evidence

Low-dose atropine for myopic control

At 2 years, atropine 1% was effective in slowing the progression of low to moderate myopia. (ATOM I, 2006){Chua WH, Balakrishnan V, Chan YH, Tong L, Ling Y, Quah BL, Tan D. Atropine for the treatment of childhood myopia. Ophthalmology. 2006 Dec;113(12):2285-91.}

At 2 years, atropine 0.01% had minimal side effects and similar efficacy with 0.1% and 0.5% in controlling myopia progression. (ATOM II, 2012){Chia A, Chua WH, Cheung YB, Wong WL, Lingham A, Fong A, Tan D. Atropine for the treatment of childhood myopia: safety and efficacy of 0.5%, 0.1%, and 0.01% doses (Atropine for the Treatment of Myopia 2). Ophthalmology. 2012 Feb;119(2):347-54. }

At 1 and 2 years, 0.05% atropine was the most effective in controlling spherical equivalent progression and axial length elongation in myopia. (LAMP, 2019){Yam JC, Jiang Y, Tang SM, Law AKP, Chan JJ, Wong E, Ko ST, Young AL, Tham CC, Chen LJ, Pang CP. Low-Concentration Atropine for Myopia Progression (LAMP) Study: A Randomized, Double-Blinded, Placebo-Controlled Trial of 0.05%, 0.025%, and 0.01% Atropine Eye Drops in Myopia Control. Ophthalmology. 2019 Jan;126(1):113-124.}

Evidence

1. Atropine eyedrops

Clinical trial

2019 Yam et.al. (LAMP)

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2019
Clinical trial

At 1 and 2 years, 0.05% atropine was the most effective in controlling spherical equivalent progression and axial length elongation in myopia.{Yam JC, Jiang Y, Tang SM, Law AKP, Chan JJ, Wong E, Ko ST, Young AL, Tham CC, Chen LJ, Pang CP. Low-Concentration Atropine for Myopia Progression (LAMP) Study: A Randomized, Double-Blinded, Placebo-Controlled Trial of 0.05%, 0.025%, and 0.01% Atropine Eye Drops in Myopia Control. Ophthalmology. 2019 Jan;126(1):113-124.}

Clinical trial

2012 Chia et.al. (ATOM II)

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2012
Clinical trial

At 2 years, atropine 0.01% had minimal side effects and similar efficacy with 0.1% and 0.5% in controlling myopia progression.{Chia A, Chua WH, Cheung YB, Wong WL, Lingham A, Fong A, Tan D. Atropine for the treatment of childhood myopia: safety and efficacy of 0.5%, 0.1%, and 0.01% doses (Atropine for the Treatment of Myopia 2). Ophthalmology. 2012 Feb;119(2):347-54. }

Clinical trial

2006 Chua et.al. (ATOM I)

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2006
Clinical trial

2. Orthokeratology lenses (OK)

Clinical trial

2022 Jakobsen and Moller

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2022
Clinical trial

Orthokeratology lenses reduced AL elongation in myopic Scandinavian children by 59%, with no treatment-requiring or vision-threatening adverse events.{Jakobsen TM, Møller F. Control of myopia using orthokeratology lenses in Scandinavian children aged 6 to 12 years. Eighteen-month data from the Danish Randomized Study: Clinical study Of Near-sightedness; TReatment with Orthokeratology Lenses (CONTROL study). Acta Ophthalmol. 2022 Mar;100(2):175-182. }

Sixty Danish children aged 6-12 years with myopia ranging from 0.5 to 4.75 dioptres (D) spherical component and refractive astigmatism ≤2.5 D in both eyes were randomly assigned to either OKL or single-vision spectacles (SVS).
Nineteen participants completed the 18-month follow-up in the OKL group and 28 in the SVS group. The average AL elongation in the OKL group was 0.24 mm smaller as compared to the SVS group.

Clinical trial

2012 Cho et.al.

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2012
Clinical trial

On average, subjects wearing ortho-k lenses had a slower increase in axial elongation by 43% compared with that of subjects wearing single-vision glasses.{Cho P, Cheung SW. Retardation of myopia in Orthokeratology (ROMIO) study: a 2-year randomized clinical trial. Invest Ophthalmol Vis Sci. 2012 Oct 11;53(11):7077-85. }

This single-masked randomized clinical trial aimed to evaluate the effectiveness of orthokeratology (ortho-k) for myopic control.78 subjects (37 in ortho-k group and 41 in control group) completed the study.
The average axial elongation, at the end of 2 years, were 0.36 ± 0.24 and 0.63 ± 0.26 mm in the ortho-k and control groups, respectively, and were significantly slower in the ortho-k group (P < 0.01).

Prospective study

2012 Hiraoka et.al.

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2012
Prospective study

The current 5-year follow-up study indicated that OK can suppress axial length elongation in childhood myopia.{Hiraoka T, Kakita T, Okamoto F, Takahashi H, Oshika T. Long-term effect of overnight orthokeratology on axial length elongation in childhood myopia: a 5-year follow-up study. Invest Ophthalmol Vis Sci. 2012 Jun 22;53(7):3913-9.}

A total of 43 subjects (22 and 21 in the OK and control groups, respectively) completed the 5-year follow-up examinations.
The increase in axial length during the 5-year study period was 0.99 ± 0.47 and 1.41 ± 0.68 mm for the OK and control groups, respectively, and the difference was statistically significant (P = 0.0236, unpaired t-test).
There were no severe complications throughout the study period.

3. Defocus incorporated multiple segments (DIMS) lenses

Clinical trial

2021 Lam et.al.

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2021
Clinical trial

Myopia control effect was sustained in the third year in children who had used the DIMS spectacles in the previous 2 years and was also shown in the children switching from SV to DIMS lenses.{Lam CS, Tang WC, Lee PH, Zhang HY, Qi H, Hasegawa K, To CH. Myopia control effect of defocus incorporated multiple segments (DIMS) spectacle lens in Chinese children: results of a 3-year follow-up study. Br J Ophthalmol. 2021 Mar 17:bjophthalmol-2020-317664.}

Clinical trial

2020 Lam et.al.

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2020
Clinical trial

Daily wear of the DIMS lens significantly retarded myopia progression and axial elongation in myopic children.{Lam CSY, Tang WC, Tse DY, Lee RPK, Chun RKM, Hasegawa K, Qi H, Hatanaka T, To CH. Defocus Incorporated Multiple Segments (DIMS) spectacle lenses slow myopia progression: a 2-year randomised clinical trial. Br J Ophthalmol. 2020 Mar;104(3):363-368.}

2-year double-masked randomised controlled trial of DIMS vs single vision (SV) spectacles was carried out in 183 Chinese children aged 8-13 years, with myopia between -1.00 and -5.00 D and astigmatism ≤1.50 D.
Average (SE) myopic progressions over 2 years were -0.41±0.06 D in the DIMS group and -0.85±0.08 D in the SV group. Mean (SE) axial elongation was 0.21±0.02 mm and 0.55±0.02 mm in the DIMS and SV groups, respectively.

4. MiSight soft contact lens

Clinical trial

2022 Chamberlain et.al.

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2022
Clinical trial

Dual-focus soft contact lenses continue to slow the progression of myopia in children over a 6-year period revealing an accumulation of treatment effect. Eye growth of the initial control cohort with dual-focus soft contact lens (DFCL; MiSight 1 day) was slowed by 71% over the subsequent 3-year treatment period.{Chamberlain P, Bradley A, Arumugam B, Hammond D, McNally J, Logan NS, Jones D, Ngo C, Peixoto-de-Matos SC, Hunt C, Young G. Long-term Effect of Dual-focus Contact Lenses on Myopia Progression in Children: A 6-year Multicenter Clinical Trial. Optom Vis Sci. 2022 Mar 1;99(3):204-212. }

Clinical trial

2019 Chamberlain et.al.

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2019
Clinical trial

Results of this clinical trial demonstrate the effectiveness of the MiSight daily disposable soft contact lens in slowing change in spherical equivalent refraction and axial length.{Chamberlain P, Peixoto-de-Matos SC, Logan NS, Ngo C, Jones D, Young G. A 3-year Randomized Clinical Trial of MiSight Lenses for Myopia Control. Optom Vis Sci. 2019 Aug;96(8):556-567.}

Myopic children (spherical equivalent refraction, -0.75 to -4.00 D; astigmatism, <1.00 D) aged 8 to 12 years with no prior contact lens experience were enrolled in a 3-year, double-masked, randomized clinical trial
Unadjusted change in spherical equivalent refraction was -0.73 D (59%) less in the test group than in the control group (-0.51 ± 0.64 vs. -1.24 ± 0.61 D, P < .001). Mean change in axial length was 0.32 mm (52%) less in the test group than in the control group (0.30 ± 0.27 vs. 0.62 ± 0.30 mm, P < .001).

References

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Summary of Evidence

Evidence

1. Atropine eyedrops

2. Orthokeratology lenses (OK)

Details

Details

Details

3. Defocus incorporated multiple segments (DIMS) lenses

Details

4. MiSight soft contact lens

Details

References

Comments