Journal of Clinical Medicine

Research

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14 pages, 957 KiB

Open AccessArticle

Comparative Outcomes of Amblyopia Treatment in High Astigmatism: Stability and Sustained Improvements

by Chia-Chen Hsu, Lung-Chi Lee, Hsu-Chieh Chang, Chun-Hao Huang and Ke-Hung Chien

J. Clin. Med. 2025, 14(10), 3577; https://doi.org/10.3390/jcm14103577 - 20 May 2025

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Abstract

Background/Objectives: Astigmatism is a major risk factor for amblyopia. While optical correction improves visual acuity (VA), the long-term treatment outcomes, particularly in children with high astigmatism, remain understudied. This study aimed to determine the treatment effects, time course, and visual outcomes in [...] Read more.

Background/Objectives: Astigmatism is a major risk factor for amblyopia. While optical correction improves visual acuity (VA), the long-term treatment outcomes, particularly in children with high astigmatism, remain understudied. This study aimed to determine the treatment effects, time course, and visual outcomes in children aged 3–7 years with high astigmatism and compared their VA improvement with those with low astigmatism. Methods: This retrospective cohort study included 63 children with untreated high with-the-rule astigmatism (≥+2.50 diopters [D]) and 46 with low astigmatism (≤1.50 D). The children with high astigmatism were classified based on their baseline best-corrected VA (BCVA) into good-VA (20/25 or better, n = 24), mild-VA-impairment (20/25–20/40, n = 19), and amblyopia (20/40 or worse, n = 20) groups. The primary outcomes include maximal improvement in mean BCVA post treatment, the cumulative probability of achieving a VA of 20/25 or better, and being within one line of the fellow eye. Results: The amblyopia, mild-VA-impairment, good-VA, and low astigmatism control groups showed mean improvements of logarithm of the minimum angle of resolution of 0.36 ± 0.08, 0.15 ± 0.05, 0.03 ± 0.04, and 0.01 ± 0.04, respectively. Post treatment with optical correction and/or patching over a mean duration of 46.61 ± 35.22 weeks, amblyopia resolved in all affected children. In the mild-VA-impairment group, only one child did not respond successfully to the treatment. The mean final VA showed no significant intergroup differences (p = 0.115). No amblyopia recurrence was observed at a mean follow-up of 118.33 weeks post resolution. Conclusions: Timely optical correction and patching effectively improve VA in children with high astigmatism, achieving outcomes comparable to those with low astigmatism. Full article

(This article belongs to the Special Issue Advanced Research in Myopia and Other Visual Disorders)

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14 pages, 3124 KiB

Open AccessArticle

Exploring the Risk: Peripheral Retinal Degenerations in Young Australian Adults

by Natalie Ann Watt, Nicholas Hockley and James Andrew Armitage

J. Clin. Med. 2025, 14(10), 3501; https://doi.org/10.3390/jcm14103501 - 16 May 2025

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Abstract

Background/Objectives: Peripheral retinal degenerations (PRDs) are structural anomalies in the outer regions of the retina, typically emerging in adolescence and early adulthood. Early detection is crucial, as some PRDs can lead to sight-threatening complications, such as retinal detachment, if left unmanaged. Due to [...] Read more.

Background/Objectives: Peripheral retinal degenerations (PRDs) are structural anomalies in the outer regions of the retina, typically emerging in adolescence and early adulthood. Early detection is crucial, as some PRDs can lead to sight-threatening complications, such as retinal detachment, if left unmanaged. Due to a paucity of research regarding PRDs and their association with axial length (AL) and refractive error (RE) in young Australian adults, this study aimed to investigate the prevalence of PRDs in this population and establish whether AL and RE could help predict the likelihood of PRD occurrence. Methods: A cross-sectional study was conducted on a mixed population (n = 221) of Australian adults aged 18 to 40. Demographic data, RE, AL, and a series of ultra-widefield (UWF) retinal images were obtained from participants’ undilated eyes using the Zeiss Clarus^TM 500. Results: The overall PRD prevalence was 8.15% (n = 442 eyes). Binary logistic regression revealed that a longer AL was a more significant factor in increasing the risk of PRD development across all myopia classifications compared to emmetropia than RE. The likelihood of a PRD was 50% at an AL of 26.9 mm and −6.50D of myopia, and 95% at 29.6 mm and −11.00D. Conclusions: PRD prevalence was lower than reported in other global studies, perhaps reflecting the diverse ethnic makeup of the cohort. While our study supports the conventional understanding that longer ALs, and high myopia are key risk factors for developing a PRD, it also provides new insights into the likelihood of detecting a PRD at a given AL or RE in a mixed population. This information is crucial for eye care practitioners, enabling early identification of at-risk individuals and screening for PRDs that may increase the risk of retinal detachment. Full article

(This article belongs to the Special Issue Advanced Research in Myopia and Other Visual Disorders)

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13 pages, 661 KiB

Open AccessArticle

Visual Acuity Among Portuguese School-Aged Population

by María Ibeth Peñaloza-Barbosa, Clara Martinez-Perez, Cristina Andreu-Vázquez, Miguel Ángel Sánchez-Tena and Cristina Alvarez-Peregrina

J. Clin. Med. 2025, 14(8), 2824; https://doi.org/10.3390/jcm14082824 - 19 Apr 2025

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Abstract

Background/Objectives: Visual acuity (VA) screening is highly valid in school-aged children for detecting visual impairments. This study aims to provide a comprehensive profile of VA among school-aged children (6–17 years old) from Lisbon, Portugal. Specifically, it focuses on estimating the prevalence of abnormal [...] Read more.

Background/Objectives: Visual acuity (VA) screening is highly valid in school-aged children for detecting visual impairments. This study aims to provide a comprehensive profile of VA among school-aged children (6–17 years old) from Lisbon, Portugal. Specifically, it focuses on estimating the prevalence of abnormal VA (VA < 0.8 in the worst eye) and establishing age-specific normative reference values (percentiles) for monocular and binocular VA within this urban sample. Methods: We performed an observational, descriptive, and cross-sectional study that included healthy children aged 6 to 17 years. Convenience sampling was used in three educational centers in Lisbon. Retinoscopy and monocular VA (right eye, left eye, and the eye with the lowest) and binocular VA were assessed using the Herman Snellen optotype. Descriptive statistics, prevalence of abnormal VA (worst-eye VA < 0.8), and monocular and binocular VA percentiles were calculated for the whole cohort and by age. Results: The sample consisted of 2215 children (49.6% of males; and 9.4 ± 2.6 years old). Binocular VA, right-eye VA, left-eye VA, and VA worst eye in the study cohort showed ranges of 0.92–1.00, 0.90–0.95, 0.89–0.97, and 0.85–0.94, respectively, for ages 6–17 years. In total, 86.8% of the study population had a normal VA (≥0.8). VA deficit was mild (0.8 < AV ≥ 0.3), moderate (0.3 < AV ≥ 0.125), and severe (VA < 0.125) in 10.5%, 1.1%, and 1.6% of children, respectively. Conclusions: Our study provides both age-specific normative reference values for visual acuity in Portuguese children and prevalence estimates for visual acuity deficits. These findings offer critical data to support early detection strategies and the development of age-adjusted vision-screening protocols in school-aged populations. Full article

(This article belongs to the Special Issue Advanced Research in Myopia and Other Visual Disorders)

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11 pages, 2222 KiB

Open AccessArticle

Impact of Pupil-Decentration on Visual and Refractive Outcomes in Myopic Patients Undergoing High Astigmatic PRK Surgery

by Adir Sommer, Margarita Safir, Waseem Nasser, Dror Ben Ephraim Noyman, Tzahi Sela, Gur Munzer, Igor Kaiserman, Eyal Cohen and Michael Mimouni

J. Clin. Med. 2025, 14(7), 2282; https://doi.org/10.3390/jcm14072282 - 27 Mar 2025

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Abstract

Background/Objectives: To compare the visual and refractive outcomes of myopic patients undergoing high astigmatic photorefractive keratectomy (PRK) surgery with and without pupillary decentration of treatment. Methods: In this retrospective study, we reviewed the medical records of myopic patients who underwent PRK [...] Read more.

Background/Objectives: To compare the visual and refractive outcomes of myopic patients undergoing high astigmatic photorefractive keratectomy (PRK) surgery with and without pupillary decentration of treatment. Methods: In this retrospective study, we reviewed the medical records of myopic patients who underwent PRK surgery for high astigmatism (>3 diopters [D]) between January 2013 and December 2023. The patients were divided into two groups based on whether the surgeon applied pupillary decentration during surgery. Preoperative, intraoperative, and postoperative parameters were compared between the groups. Adjustments were made to account for differences in baseline characteristics and intraoperative parameters. Results: Overall, the study included 575 eyes from 414 patients, of which 79 eyes were treated with pupil decentration. The pupil-decentered group exhibited significantly preoperative higher myopia (subjective spherical equivalent (SEQ) of −5.30 ± 3.12 D vs. −4.26 ± 2.45 D, p < 0.001) and subjective sphere (−3.40 ± 3.13 D vs. −2.31 ± 2.49 D, p < 0.001). Visual and refractive outcomes, including uncorrected visual acuity (UCVA) of logMAR 0.11 ± 0.77 vs. 0.09 ± 0.72 (p = 0.302), best-corrected visual acuity (BCVA) of 0.07 ± 0.92 vs. 0.07 ± 0.82 (p = 0.982), SEQ (−0.33 ± 0.93 vs. −0.19 ± 0.60D, p = 0.094), sphere (0.02 ± 0.98 vs. 0.15 ± 0.67 D, p = 0.142), cylinder (−0.71 ± 0.48 vs. −0.70 ± 0.55 D, p = 0.894), safety index (1.07 ± 0.27 vs. 1.12 ± 0.31, p = 0.236), and efficacy index (0.99 ± 0.31 vs. 1.07 ± 0.35, p = 0.065), showed no significant differences between the two groups. Postoperative outcomes remained comparable after adjusting for baseline and intraoperative parameters. Conclusions: Our findings suggest that, in myopic patients undergoing high-astigmatic PRK surgery, pupil decentration does not lead to superior postoperative visual and refractive outcomes. This highlights that, in this scenario, surgeons can preserve the efficacy and safety of the procedure even without applying pupil decentration. Full article

(This article belongs to the Special Issue Advanced Research in Myopia and Other Visual Disorders)

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10 pages, 1435 KiB

Open AccessArticle

Myopia Management in Hong Kong

by Han-Yu Zhang, Fang-Yu Xu, Kenneth Ka King Liu, Yan-Pui Chan, Amy Chow, Deborah Jones and Carly Siu Yin Lam

J. Clin. Med. 2025, 14(3), 698; https://doi.org/10.3390/jcm14030698 - 22 Jan 2025

Viewed by 897

Abstract

Objectives: We aimed to investigate how optometrists in Hong Kong are managing myopic and “pre-myopic” children. Methods: Clinical files for children aged 6 to 10 years old who had eye examinations from 2017 to 2021 were retrospectively reviewed. Children were grouped by the [...] Read more.

Objectives: We aimed to investigate how optometrists in Hong Kong are managing myopic and “pre-myopic” children. Methods: Clinical files for children aged 6 to 10 years old who had eye examinations from 2017 to 2021 were retrospectively reviewed. Children were grouped by the initial spherical equivalent refractive error (SER) as myopes or pre-myopes. The demographic data, refractive error, and myopia management recommended by the optometrists were analyzed. Results: A total of 1,318 children (859 myopes and 459 pre-myopes) from ten clinics in Hong Kong were included. Over 5 years, myopia management recommendations shifted significantly (p < 0.001). In 2017, only 18.4% of children were recommended to pursue myopia control (MC), increasing to 42.8% by 2021. The use of MC spectacle lenses increased from 7.3% in 2017 to 36.8% in 2021, becoming the most recommended option. Orthokeratology, MC contact lenses, and atropine remained stable at less than 5% over this period. Children recommended for MC approaches had significantly more myopia than those recommended single-vision lenses or monitoring (p < 0.05). Age of the first visit significantly correlated with SER change from the first visit to the next recommendation update for pre-myopes (r = 0.27, p = 0.013) but not for myopes. Conclusions: From 2017 to 2021, myopia management patterns in Hong Kong shifted significantly, with more children being recommended for myopia control. MC spectacle lenses emerged as the most commonly recommended method. Younger pre-myopes at their first visit were more likely to have earlier management updates. Full article

(This article belongs to the Special Issue Advanced Research in Myopia and Other Visual Disorders)

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17 pages, 4546 KiB

Open AccessArticle

Can AI Predict the Magnitude and Direction of Ortho-K Contact Lens Decentration to Limit Induced HOAs and Astigmatism?

by Wen-Pin Lin, Lo-Yu Wu, Wen-Kai Li, Wei-Ren Lin, Richard Wu, Lynn White, Rowan Abass, Rami Alanazi, Joseph Towler, Jay Davies and Ahmed Abass

J. Clin. Med. 2024, 13(18), 5420; https://doi.org/10.3390/jcm13185420 - 12 Sep 2024

Cited by 1 | Viewed by 1749

Abstract

Background: The aim is to investigate induced higher-order aberrations (HOA)s and astigmatism as a result of non-toric ortho-k lens decentration and utilise artificial intelligence (AI) to predict its magnitude and direction. Methods: Medmont E300 Video topographer was used to scan 249 corneas [...] Read more.

Background: The aim is to investigate induced higher-order aberrations (HOA)s and astigmatism as a result of non-toric ortho-k lens decentration and utilise artificial intelligence (AI) to predict its magnitude and direction. Methods: Medmont E300 Video topographer was used to scan 249 corneas before and after ortho-k wear. Custom-built MATLAB codes extracted topography data and determined lens decentration from the boundary and midpoint of the central flattened treatment zone (TZ). An evaluation was carried out by conducting Zernike polynomial fittings via a computer-coded digital signal processing procedure. Finally, an AI-based machine learning neural network algorithm was developed to predict the direction and magnitude of TZ decentration. Results: Analysis of the first 21 Zernike polynomial coefficients indicate that the four low-order and four higher-order aberration terms were changed significantly by ortho-k wear. While baseline astigmatism was not correlated with lens decentration (R = 0.09), post-ortho-k astigmatism was moderately correlated with decentration (R = 0.38) and the difference in astigmatism (R = 0.3). Decentration was classified into three groups: ≤0.50 mm, reduced astigmatism by −0.9 ± 1 D; 0.5~1 mm, increased astigmatism by 0.8 ± 0.1 D; >1 mm, increased astigmatism by 2.7 ± 1.6 D and over 50% of lenses were decentred >0.5 mm. For lenses decentred >1 mm, 29.8% of right and 42.7% of left lenses decentred temporal-inferiorly and 13.7% of right and 9.4% of left lenses decentred temporal-superiorly. AI-based prediction successfully identified the decentration direction with accuracies of 70.2% for right and 71.8% for left lenses and predicted the magnitude of decentration with root-mean-square (RMS) of 0.31 mm and 0.25 mm for right and left eyes, respectively. Conclusions: Ortho-k lens decentration is common when fitting non-toric ortho-k lenses, resulting in induced HOAs and astigmatism, with the magnitude being related to the amount of decentration. AI-based algorithms can effectively predict decentration, potentially allowing for better control over ortho-k fitting and, thus, preferred clinical outcomes. Full article

(This article belongs to the Special Issue Advanced Research in Myopia and Other Visual Disorders)

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15 pages, 9552 KiB

Open AccessArticle

Exploration of Choroidal Thinning Located Temporal to the Fovea: A Pilot Study

by Adèle Ehongo, Georgina Jawdat De Togme and Viviane De Maertelaer

J. Clin. Med. 2024, 13(17), 4978; https://doi.org/10.3390/jcm13174978 - 23 Aug 2024

Viewed by 838

Abstract

Background/Objectives: Posterior staphyloma (PS) is a hallmark of pathological myopia, corresponding to a circumscribed outpouching of the eyeball with choroidal thinning and inward scleral deformation at its edges. Its pathogenesis is still unclear, thus constituting a research priority as the prevalence of myopia [...] Read more.

Background/Objectives: Posterior staphyloma (PS) is a hallmark of pathological myopia, corresponding to a circumscribed outpouching of the eyeball with choroidal thinning and inward scleral deformation at its edges. Its pathogenesis is still unclear, thus constituting a research priority as the prevalence of myopia is increasing worldwide. Recently, it has been suggested that the optic nerve sheaths or oblique muscles are potential promoters of PS through the traction or compression effect that they apply to the eye wall. The inferior oblique muscle (IOM) inserts 1–2 mm from the macula. The projection of its insertion is accessible using Optical Coherence Tomography (OCT). Before launching prospective studies, we sought to detect any choroidal thinning (ChT) in the temporal vicinity of the macula and to measure the distance between it and the fovea (FT-distance). Methods: This retrospective cross-sectional pilot study included 120 eyes. Using Spectralis^®-OCT, the area centered by the Bruch’s membrane opening–fovea axis was analyzed for ChT and FT-distance. Results: Of the 112 defined eyes, 70% (78 eyes) had ChT. Pachymetry was significantly thinner (p = 0.018) in eyes with than without ChT. The mean FT-distance was 3601.9 ± 93.6 µm. Conclusions: The location of ChT coincided with the insertion distance of the IOM, suggesting a link between them. The association between the presence of ChT and a thinner pachymetry suggests a reduced scleral resistance, as a thinner pachymetry is related to a thinner sclera. Our results suggest a link between ocular deformation and the IOM, which may be relevant for the pathogenesis of PS, warranting further investigation. Full article

(This article belongs to the Special Issue Advanced Research in Myopia and Other Visual Disorders)

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11 pages, 235 KiB

Open AccessArticle

Refractive Errors, Amplitude of Accommodation, and Myopia Progression in Kazakhstani Medical Students: 5-Year Follow-Up

by Yuliya Semenova, Malika Urazhanova, Lisa Lim and Nazerke Kaiyrzhanova

J. Clin. Med. 2024, 13(13), 3985; https://doi.org/10.3390/jcm13133985 - 8 Jul 2024

Cited by 1 | Viewed by 1563

Abstract

Background/Objectives: this longitudinal study aimed to investigate the refractive errors, the amplitude of accommodation, and myopia progression in Kazakhstani medical students as they progressed from the first to the fifth course of their studies. Methods: A total of 696 students from Semey Medical [...] Read more.

Background/Objectives: this longitudinal study aimed to investigate the refractive errors, the amplitude of accommodation, and myopia progression in Kazakhstani medical students as they progressed from the first to the fifth course of their studies. Methods: A total of 696 students from Semey Medical University underwent non-cycloplegic and cycloplegic autorefraction in the first course, and 655 were available for examination in the fifth year of study. The amplitude of accommodation was measured before the instillation of cycloplegics using the push-up and push-down methods. A self-administered questionnaire was applied to evaluate the risk factors associated with myopia progression. Results: In the first course, the median spherical equivalent was −0.75 Diopters before cycloplegia and −0.25 Diopters after cycloplegia. In the fifth course, it constituted −1.125 Diopters before cycloplegia and −0.5 Diopters after cycloplegia. The proportion of students with myopia following cycloplegic refraction increased from 44.7% in the first course to 47.5% in the fifth course. The proportion of emmetropic students declined from 31.5% to 30.3%, and hyperopia decreased from 23.8% to 16.8%. The dioptric power of accommodative excess increased from 0.375 in the first year to 0.50 in the fifth year. The hours spent on near-work activities, such as reading books, writing, working at a computer, and using a mobile device, were significantly associated with a myopia progression of ≥0.5 Diopters. Conclusions: the findings of this study suggest implications for public health policy and educational practice. Full article

(This article belongs to the Special Issue Advanced Research in Myopia and Other Visual Disorders)

7 pages, 294 KiB

Open AccessArticle

Refractive Errors of School Children from Economically Disadvantaged Areas in Northwest México

by Emiliano Teran, Efrain Romo-García and Hector C. Santiago

J. Clin. Med. 2024, 13(11), 3094; https://doi.org/10.3390/jcm13113094 - 25 May 2024

Viewed by 1371

Abstract

Background: Refractive errors, including myopia, hyperopia, and astigmatism, are the leading causes of visual impairment in school-aged children and can significantly impact their academic performance and quality of life. This study aimed to assess the prevalence of refractive errors among school children [...] Read more.

Background: Refractive errors, including myopia, hyperopia, and astigmatism, are the leading causes of visual impairment in school-aged children and can significantly impact their academic performance and quality of life. This study aimed to assess the prevalence of refractive errors among school children from economically disadvantaged areas in Northwest México, using a consistent methodology to facilitate comparison with global data. Methods: We adopted the Refractive Error Study in Children (RESC) protocol by the World Health Organization to examine the prevalence of myopia, hyperopia, and astigmatism. The study comprised a systematic sampling of children aged 6 to 18 years from diverse schools in Northwest México. Trained optometrists conducted visual acuity testing and autorefraction, while ophthalmologists performed cycloplegic refraction to ensure accuracy. Results: The study found a myopia (SE ≤−1.50 D at least one eye) prevalence of 14.55% (95% CI: 13.27–15.91), with a higher incidence in females (6.92%) compared to males (6.00%) in at least one eye. Hyperopia (SE ≥ +1.00 D at least one eye) was less common, at 3.23% (95% CI: 2.61–3.95), with a slightly higher occurrence in males in at least one eye. Astigmatism (Cylinder ≥ 0.75 D at least one eye) was present in 18.63% (95% CI: 17.21–20.12) of the students in at least one eye, with no significant difference between genders. These findings are consistent with other studies in regions such as Puerto Rico and Iran, indicating widespread refractive error issues among schoolchildren. Conclusions: The high prevalence of refractive errors, particularly myopia and astigmatism, highlights the critical need for regular vision screenings in schools and the implementation of public health interventions to provide corrective eyewear. Our study confirms the importance of utilizing standardized methodologies like the RESC protocol to compare refractive error prevalence across different geographical and socio-economic contexts, thereby informing global public health strategies. Full article

(This article belongs to the Special Issue Advanced Research in Myopia and Other Visual Disorders)

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12 pages, 1239 KiB

Open AccessArticle

Prevalence and Estimation of the Evolution of Myopia in Spanish Children

by Miguel Ángel Sánchez-Tena, Clara Martinez-Perez, Cesar Villa-Collar, Mariano González-Pérez, Ana González-Abad, Grupo de Investigación Alain Afflelou and Cristina Alvarez-Peregrina

J. Clin. Med. 2024, 13(6), 1800; https://doi.org/10.3390/jcm13061800 - 21 Mar 2024

Cited by 4 | Viewed by 2742

Abstract

Background: In recent decades, myopia has turned into a public health issue across the world. Between 1993 and 2016, the percentage of myopes increased from 10.4% to 34.2%. This study aims to analyze the myopia prevalence in Spanish children from five to [...] Read more.

Background: In recent decades, myopia has turned into a public health issue across the world. Between 1993 and 2016, the percentage of myopes increased from 10.4% to 34.2%. This study aims to analyze the myopia prevalence in Spanish children from five to seven years old over the last five years and to predict the rate of myopia in Spain by 2030. Methods: The sample consisted of children aged between 5 and 7, who underwent an optometric examination consisting of the measurement of visual acuity (VA) and determination of objective and subjective refraction. The cut-off points to define refractive error are established by the spherical equivalent (SE) value: hyperopia for an SE over or equal to +0.50 D; myopia for an SE under or equal to −0.50 D; and emmetropia when the SE is between −0.50 D and +0.50 D. Results: The myopia rate in Spanish children aged between five and seven was 19%. Myopia prevalence progressively increased as children grew up (p ≤ 0.001). It is estimated that, in the year 2030, the rate of myopia will be 30.2% [CI: 25.3–35.0], of which 81.9% [CI: 78.3–85.3] will have low myopia, 10.0% [CI: 7.2–12.8] moderate myopia, and 7.3% [CI: 4.9–9.7] high myopia. Conclusions: Nineteen percent of Spanish children between five and seven are myopes. In 2030, is expected that 30.2% of Spanish children between 5 and 7 years of age will be myopes. These estimations will support eye care professionals in recommending that children spend more time outdoors to prevent the onset of myopia and the use of methods to control myopia to avoid reaching these figures of high myopia. Full article

(This article belongs to the Special Issue Advanced Research in Myopia and Other Visual Disorders)

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Review

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11 pages, 531 KiB

Open AccessReview

New Designs of Spectacle Lenses for the Control of Myopia Progression: A Scoping Review

by Marta Lupon, Carme Nolla and Genis Cardona

J. Clin. Med. 2024, 13(4), 1157; https://doi.org/10.3390/jcm13041157 - 19 Feb 2024

Cited by 5 | Viewed by 3841

Abstract

Myopia control with new designs of spectacle lenses is a flourishing area of research. The present work reviews the effectiveness of new designs (DIMSs, defocus-incorporated multiple segments; CARE, cylindrical annular refractive element; HALs/SALs, highly/slightly aspherical lenslets; DOT, diffusion optics technology) aiming at slowing [...] Read more.

Myopia control with new designs of spectacle lenses is a flourishing area of research. The present work reviews the effectiveness of new designs (DIMSs, defocus-incorporated multiple segments; CARE, cylindrical annular refractive element; HALs/SALs, highly/slightly aspherical lenslets; DOT, diffusion optics technology) aiming at slowing myopia progression. A search through the PubMed database was conducted for articles published between 1 January 2003 and 28 February 2023. Publications were included if they documented baseline central refraction (SER) and/or axial length (AL) data, and the change in these parameters, in myopic children wearing new designs of spectacle lenses (treatment group) compared to myopic children using single-vision lenses, SVLs (control group). The selection process revealed nine suitable articles. Comparing the mean and standard error values of the treatment and control groups, the highest differences in the change in the SER and AL were −0.80 (1.23) D [95% CI: −1.053 to −0.547; p < 0.001] and 0.35 (0.05) mm [95% CI: 0.252 to 0.448; p < 0.001], respectively; the effect of treatment provided by a HAL design, compared to SVLs, led to a deceleration of 54.8% in the SER and 50.7% in the AL. However, the heterogeneity of the results prevents reaching strong conclusions about the effectiveness of these new designs. Full article

(This article belongs to the Special Issue Advanced Research in Myopia and Other Visual Disorders)

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13 pages, 350 KiB

Open AccessReview

Risk Factors for Myopia: A Review

by Noelia Martínez-Albert, Inmaculada Bueno-Gimeno and Andrés Gené-Sampedro

J. Clin. Med. 2023, 12(18), 6062; https://doi.org/10.3390/jcm12186062 - 19 Sep 2023

Cited by 20 | Viewed by 9565

Abstract

Due to the myopia prevalence increase worldwide, this study aims to establish the most relevant risk factors associated with its development and progression. A review search was carried out using PubMed, Web of Science, and Scopus databases to identify the main myopia risk [...] Read more.

Due to the myopia prevalence increase worldwide, this study aims to establish the most relevant risk factors associated with its development and progression. A review search was carried out using PubMed, Web of Science, and Scopus databases to identify the main myopia risk factors. The inclusion criteria for the articles were those related to the topic, carried out in subjects from 5 to 30 years, published between January 2000 and May 2023, in English, and with the full text available. Myopia etiology has proven to be associated with both genetic and environmental factors as well as with gene–environment interaction. The risk of developing myopia increases in children with myopic parents (one parent ×2 times, two parents ×5 times). Regarding environmental factors, education is the main risk factor correlated with myopia prevalence increase. Further, several studies found that shorter distance (<30 cm) and longer time spent (>30 min) for near work increase the risk of myopia. Meanwhile, increased outdoor activity (>40 min/day) has been shown to be a key factor in reducing myopia incidence. In conclusion, the interventional strategy suggested so far to reduce myopia incidence is an increase in time outdoors and a reduction in the time spent performing near-work tasks. Full article

(This article belongs to the Special Issue Advanced Research in Myopia and Other Visual Disorders)

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Other

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14 pages, 2522 KiB

Open AccessSystematic Review

Efficacy of Myopia Prevention in At-Risk Children: A Systematic Review and Network Meta-Analysis

by Ssu-Hsien Lee, Bor-Yuan Tseng, Jen-Hung Wang and Cheng-Jen Chiu

J. Clin. Med. 2025, 14(5), 1665; https://doi.org/10.3390/jcm14051665 - 28 Feb 2025

Viewed by 1185

Abstract

Objectives: To evaluate the efficacy of myopia prevention methods in children without pre-existing myopia. Methods: A network meta-analysis was conducted following the PRISMA-NMA guidelines. Comprehensive searches were performed in PubMed, Embase, and Cochrane CENTRAL databases. The analysis focused on randomized controlled trials evaluating [...] Read more.

Objectives: To evaluate the efficacy of myopia prevention methods in children without pre-existing myopia. Methods: A network meta-analysis was conducted following the PRISMA-NMA guidelines. Comprehensive searches were performed in PubMed, Embase, and Cochrane CENTRAL databases. The analysis focused on randomized controlled trials evaluating myopia prevention strategies in children without prior myopia. Primary outcomes included annual changes in refraction and axial length, while secondary outcomes encompassed myopia incidence and adverse events. Effect sizes were reported as risk ratios (RR) or mean differences (MD) with 95% confidence intervals (CIs). Data synthesis utilized a random-effects model under a frequentist framework, with intervention efficacy ranked by P-scores. Study quality was assessed using the Cochrane risk-of-bias tool, and robustness was ensured via sensitivity and consistency analyses. Results: Low-level red light therapy and low-dose atropine were the most effective interventions for reducing refractive progression (MD: 0.48 D, 95% CI: 0.38–0.59 D; MD: 0.33 D, 95% CI: 0.23–0.43 D) and axial elongation (MD: −0.23 mm, 95% CI: −0.27 to −0.19 mm; MD: −0.12 mm, 95% CI: −0.16 to −0.08 mm). In addition, both significantly lowered myopia incidence (RR: 0.59, 95% CI: 0.45–0.79; RR: 0.55, 95% CI: 0.41–0.75). Outdoor activities and myopia awareness programs demonstrated moderate efficacy. Adverse events, including photophobia and dry eyes, were minor and self-limiting, with no serious complications reported. Conclusions: Low-level red light therapy and low-dose atropine are the most effective, generally safe strategies for preventing myopia in at-risk children without myopia, while a non-invasive approach, outdoor activities, provides moderate benefits. Full article

(This article belongs to the Special Issue Advanced Research in Myopia and Other Visual Disorders)

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14 pages, 1118 KiB

Open AccessSystematic Review

Peripheral Defocus in Orthokeratology Myopia Correction: Systematic Review and Meta-Analysis

by António Queirós, Inês Pinheiro and Paulo Fernandes

J. Clin. Med. 2025, 14(3), 662; https://doi.org/10.3390/jcm14030662 - 21 Jan 2025

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Abstract

Background: This study aimed to assess the effect of peripheral defocus with orthokeratology lenses (PDOK) on myopia control in children and adolescents through a systematic review and meta-analysis. Methods: A comprehensive search was conducted in the PubMed and Web of Science databases to [...] Read more.

Background: This study aimed to assess the effect of peripheral defocus with orthokeratology lenses (PDOK) on myopia control in children and adolescents through a systematic review and meta-analysis. Methods: A comprehensive search was conducted in the PubMed and Web of Science databases to identify randomized controlled trials (RCTs) and cohort studies on PDOK, using the keywords “peripheral refraction” and “orthokeratology”. Studies were included if they reported spherical equivalent (M) peripheral refraction at 25° and/or 30° with accompanying statistical data along the horizontal meridian before and after orthokeratology treatment. From the initial 133 studies, those excluded included nine non-English publications, 18 reviews, five meta-analyses, four systematic reviews, and 88 studies not meeting the inclusion criteria. Results: Nine studies (three RCTs and six cohort studies) were included, involving 259 participants aged six to 30 years with a baseline refractive error of M = −2.44 ± 0.27 D, and treatment duration ranging from 14 days to 12 months. All the studies showed an increase in myopic defocus at 30° nasal (−2.55 ± 1.10 D) and temporal (−2.79 ± 0.75 D) eccentricities, averaging −2.67 ± 0.95 D across both. The overall induced myopic defocus was M = −2.56 D (95% CI: −2.21 to −2.91, Z = 14.33, p < 0.001), according to forest plot analysis. Studies with treatment durations up to one year showed a higher myopic blur (M = −2.69 D, 95% CI: −2.48 to −2.89, Z = 25.93, p < 0.001) compared to shorter treatments of less than three months (M = −2.39 D, 95% CI: −1.76 to −3.02, Z = 7.41, p < 0.001). Conclusions: Orthokeratology lenses effectively induce myopic defocus at 30° eccentricity over both short- and long-term treatments in children and adolescents, suggesting potential benefits for myopia control in these age groups. Full article

(This article belongs to the Special Issue Advanced Research in Myopia and Other Visual Disorders)

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Open AccessSystematic Review

Systematic Review of Myopia Progression after Cessation of Optical Interventions for Myopia Control

by Yu-Chieh Chiu, Ping-Chiao Tsai, Ssu-Hsien Lee, Jen-Hung Wang and Cheng-Jen Chiu

J. Clin. Med. 2024, 13(1), 53; https://doi.org/10.3390/jcm13010053 - 21 Dec 2023

Cited by 5 | Viewed by 3730

Abstract

Despite high discontinuation rates for myopia optical interventions, limited attention has been given to the potential rebound effects post-discontinuation. This systematic review aims to assess the extent of the rebound effects following the cessation of common clinical optical myopia-control interventions in children. A [...] Read more.

Despite high discontinuation rates for myopia optical interventions, limited attention has been given to the potential rebound effects post-discontinuation. This systematic review aims to assess the extent of the rebound effects following the cessation of common clinical optical myopia-control interventions in children. A comprehensive search of PubMed, Embase, Cochrane CENTRAL, and ClinicalTrials.gov was conducted from inception to October 2023. The rebound effects, defined as changes in the axial length or spherical equivalent during and after treatment cessation, were categorized into four levels. These studies encompassed 703 participants and spanned from 2019 to 2023, with durations of treatment and cessation ranging from 6 months to 3.5 years and from 2 weeks to 5 years, respectively. This review, encompassing 14 studies, revealed a predominant strong rebound effect in orthokeratology (8 studies), a weak rebound effect in multifocal soft contact lenses (4 studies), and a variable rebound effect in peripheral-plus spectacle lenses (2 studies). Notably, with the increasing cessation duration, the rebound effects diminished, potentially linked to the reversal of choroidal thickening and the disappearance of peripheral myopic defocus. In conclusion, a temporal trend of rebound effects exists in all three myopia optical interventions, possibly contributing to their myopia control mechanisms. Full article

(This article belongs to the Special Issue Advanced Research in Myopia and Other Visual Disorders)

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