One-year results for myopia control of orthokeratology with different back optic zone diameters: a randomized trial using a novel multispectral-based topographer

AIM:To present the 1-year results of a prospective cohort study investigating the efficacy,potential mechanism,and safety of orthokeratology(ortho-k)with different back optic zone diameters(BOZD)for myopia control in children.METHODS:This randomized clinical study was performed between Dec.2020 and Dec.2021.Participants were randomly assigned to three groups wearing ortho-k:5 mm BOZD(5-MM group),5.5 mm BOZD(5.5-MM group),and 6 mm BOZD(6-MM group).The 1-year data were recorded,including axial length,relative peripheral refraction(RPR,measured by multispectral refractive topography,MRT),and visual quality.The contrast sensitivity(CS)was evaluated by CSV-1000 instrument with spatial frequencies of 3,6,12,and 18 cycles/degree(c/d);the corneal higher-order aberrations(HOAs)were measured by iTrace aberration analyzer.The one-way ANOVA was performed to assess the differences between the three groups.The correlation between the change in AL and RPR was calculated by Pearson’s correlation coefficient.RESULTS:The 1-year results of 20,21,and 21 subjects in the 5-MM,5.5-MM,and 6-MM groups,respectively,were presented.There were no statistical differences in baseline age,sex,or ocular parameters between the three groups(all P>0.05).At the 1-year visit,the 5-MM group had lower axial elongation than the 6-MM group(0.07±0.09 vs 0.18±0.11 mm,P=0.001).The 5-MM group had more myopic total RPR(TRPR,P=0.014),with RPR in the 15°–30°(RPR 15–30,P=0.015),30°–45°(RPR 30–45,P=0.011),temporal(RPR-T,P=0.008),and nasal area(RPR-N,P<0.001)than the 6-MM group.RPR 15–30 in the 5.5-MM group was more myopic than that in the 6-MM group(P=0.002),and RPR-N in the 5-MM group was more myopic than that in the 5.5-MM group(P<0.001).There were positive correlations between the axial elongation and the change in TRPR(r=0.756,P<0.001),RPR 15–30(r=0.364,P=0.004),RPR 30–45(r=0.306,P=0.016),and RPR-N(r=0.253,P=0.047).The CS decreased at 3 c/d(P<0.001),and the corneal HOAs increased in the 5-MM group(P=0.030).CONCLUSION:Ortho-k with 5 mm BOZD can control myopia progression more effectively.The mechanism may be associated with greater myopic shifts in RPR.

Effects of different orthokeratology lens designs on slowing axial length elongation in children with myopia

AIM:To elucidate whether differences exist in the impact on retarding the elongation of axial length(AL)among children with myopia when utilizing orthokeratology(ortho-k)lenses employing the corneal refractive therapy(CRT)design versus those employing the vision shaping treatment(VST)design.METHODS:This retrospective clinical trial aimed to collect and analyze AL data from individuals who wore ortho-k lenses for three years.A total of 654 subjects were enrolled and prescribed one of the three specific brands of ortho-k lenses:CRT,Euclid,and Mouldway.The study’s primary focus was to compare the rates of AL elongation and myopic progression across these three brands of ortho-k lenses.RESULTS:In the 3-year follow-up,the AL elongation exhibited variations of 0.73±0.36 mm in the CRT lens group,0.59±0.37 mm in the Euclid lens group,and 0.63±0.38 mm in the Mouldway lens group.A noteworthy disparity emerged between the CRT and Mouldway groups(P<0.01),as well as between the CRT and Euclid groups(P<0.001).Additionally,it was observed that 32.1%of participants who wore CRT lenses experienced a decelerated progression of myopia,in contrast to 47.2%in the Euclid group and 44.4%in the Mouldway group.Statistical analyses revealed a statistically significant distinction between the CRT and Euclid groups(P<0.01),and similarly,the CRT group demonstrated a statistically significant difference when compared to the Mouldway group(P<0.05).CONCLUSION:Ortho-k lenses represent a pragmatic strategy for mitigating the advancement of myopia.In contradistinction to ortho-k lenses utilizing the CRT design,those employing the VST design exhibited a more favorable impact regarding retarding AL elongation.

Orthokeratology with increased compression factor in adolescent myopia control:a 2-year prospective randomized clinical trial

AIM:To explore the long-term efficacy,safety,and optical mechanism of orthokeratology with increased compression factor in adolescent myopia control.METHODS:A prospective,double-masked,and randomized clinical trial was performed from May 2016 to June 2020.Subjects aged between 8 and 16y,with myopia(-5.00 to-1.00 D),low astigmatism(≥-1.50 D)and anisometropia(≤1.00 D),were stratified into low(-2.75 to-1.00 D)and moderate(-5.00 to-3.00 D)myopia groups.Then they were randomly assigned to wear either increased compression factor(ICF;1.75 D)orthokeratology or conventional compression factor(CCF;0.75 D)orthokeratology.The data were recorded including axial length(AL),spherical equivalent(SE),best corrected visual acuity(BCVA),near visual acuity(NVA),corneal staining(using Efron grading scales),corneal hysteresis(CH),corneal resistance factor(CRF),higher-order aberrations(HOAs,expressed as root mean square,RMS_(h)),and subfoveal choroidal thickness(SFCh T)in the 2-year followup period.Pearson's correlation coefficient was conducted to analyze the association between the changes in AL and RMS_(h),SFCh T.RESULTS:At the 2-year visit,there were no statistical differences in all the parameters between the ICF group and the CCF group in low myopia subjects(P>0.05).For the moderate myopia subjects,the ICF group had shorter AL elongation(0.23±0.08 vs 0.30±0.11 mm,P=0.015),higher RMS_(h)(1.94±0.50 vs 1.65±0.51μm,P=0.041),and higher SFCh T(279.04±35.72 vs 254.08±29.60μm,P=0.008)than those in CCF group.The change in AL was negatively correlated with RMS_(h)(r=-0.687,P<0.001)and SFCh T(r=-0.464,P=0.013).CONCLUSION:ICF orthokeratology can control the progression of moderate myopia more effectively,which might be related to greater RMS_(h) and SFCh T.

Changes of retinal vessel density in low to moderate myopic eyes with orthokeratology evaluated by optical coherence tomography angiography

AIM:To explore the effect of orthokeratology(OK)fitting on retinal vessel density in low to moderate myopia adolescents by using optical coherence tomography angiography.METHODS:Children aged 10 to 14y with a cycloplegic spherical equivalent refraction of−0.50 diopter(D)to−5.00 D and astigmatism with more than−1.50 D were recruited.The enrolled adolescents were divided into OK group and spectacle group.During regular followup,adolescents were measured respectively at pre-wear,1,3,and 6mo after treatment.The follow-up included uncorrected distance visual acuity(UDVA),axial length(AL),superficial capillary plexus density(SCPD),deep capillary plexus density(DCPD),central retinal thickness(CRT),foveal avascular zone area(FAZ-A),foveal avascular zone perimeter(FAZ-P)and foveal vessel density in a 300-μmwide region around foveal avascular zone(FD-300).The collected data were analyzed using statistical methods.RESULTS:By one month,SCPD significantly increased in the fovea and superior retina,and DCPD significantly increased inferiorly in OK group compared to spectacle group(P<0.05).By three months,there were significant increases in SCPD in the fovea and inferior retina,and DCPD in the parafovea,superior,and inferior retina in OK group(P<0.05),while the increase in SCPD and DCPD in the fovea were observed by six months(P<0.05).The FD-300 significantly increased at every follow-up in OK group compared to spectacle group(P<0.05).No significant differences in the CRT,FAZ-A and FAZ-P and FD-300 were observed between two groups(P>0.05).OK group showed a significant improvement in UDVA after wearing OK,compared to spectacle group(P<0.01),while the AL did not show a significant difference between two groups(P>0.05).CONCLUSION:Short-term OK worn can increase local retinal vessel density in adolescents with low-to-moderate myopia.

Accommodation function comparison following use of contact lens for orthokeratology and spectacle use in myopic children: a prospective controlled trial

AIM： To study effects of orthokeratology（Ortho-k） on accommodation function in myopic children. METHODS： A prospective, non-randomized, case-control study was performed from September to October 2016. Eighty-three children with myopia were divided into two groups. One group was treated with the rigid contact lens for overnight Ortho-k, and the other was treated with single-vision spectacle lens（SVL）. Accommodation function were assessed by accommodative amplitude（AA）, accommodative sensitivity（AS）, accommodative lag（Lag）, negative relative accommodation（NRA）, and positive relative accommodation（PRA） before and 1, 3, 6 and 12 mo after treated. RESULTS： Totally 72 myopic children were finished the follow-up： 37 in Ortho-k group and 35 in SVL group. Wearing time had a significant effect on AA, AS, Lag, and NRA of myopic children in two groups（all P〈0.05）. Meanwhile, there was an interaction effect between wearing time and wearing types（FAA=5.3, FAS=45.5, FLag=7.0, FNRA=3.7, all P〈0.05）. However, the between-group difference of AA（F=0.1）, AS（F=3.2）, Lag（F=1.1）, NRA（F=0.3）, and PRA（F=0.1） showed no significance. AA, AS, NRA, Lag and PRA were improved significantly in Ortho-k group within 1 to 6 mo after wearing. CONCLUSION： Wearing Ortho-k can improve the accommodation function of myopic children, which might be one of the mechanisms for myopia control.

Short term effect of choroid thickness in the horizontal meridian detected by spectral domain optical coherence tomography in myopic children after orthokeratology

AIM： To investigate choroidal thickness changes in the horizontal meridian after orthokeratology. METHODS： This is a prospective cross-sectional observed study. Subjects （n=30; 11.3±1.7y） with low-to-moderate myopia （-1.0 to -6.0 diopters）, wore orthokeratology （Ortho-K） lenses for 3mo. Before and after Ortho-K, OCT scans were made through the fovea in the horizontal meridian. Choroid thickness around the fovea was acquired by custom software. The analyzed regions along the horizontal meridian were divided into 7 equal zones. Ocular parameters were measured by Lenstar LS 900 non-contact biometry. RESULTS： Only the right eye ocular parameters were analyzed in this study. Before Ortho-K, choroidal thickness along the horizontal meridian was 273.7±31.8 μm in the temporal zone, 253.1±38.6 μm in the macula zone, and 194.8±52.2 μm in the nasal zone. After Ortho-K, the choroid was thicker in each horizontal zone （P〈0.05）. The increased thickness was greatest in the temporal zone （13.5±22.5 μm） and least in the nasal zone （8.4±14.2 μm）. The axial length （AL） increased 0.02 mm （P〉0.05）. The choroid thickness change in each horizontal zone was negatively correlated with AL （r, -0.3 to -0.4; P〈0.05） except one of the nasal zones. CONCLUSION： In myopic children, the thickness of the choroid is greatest in the temporal zone and thinnest in the nasal zone. After nightly Ortho-K for 3mo, the thickness increase along the horizontal meridian. The choroid thickness changes are negatively correlated with the change of AL.

Novel application of multispectral refraction topography in the observation of myopic control effect by orthokeratology lens in adolescents

BACKGROUND Myopia,as one of the common ocular diseases,often occurs in adolescence.In addition to the harm from itself,it may also lead to serious complications.Thus,prevention and control of myopia are attracting more and more attention.Previous research revealed that single-focal glasses and orthokeratology lenses(OK lenses)played an important part in slowing down myopia and preventing high myopia.AIM To compare the clinical effects of OK lenses and frame glasses against the increase of diopter in adolescent myopia and further explore the mechanism of the OK lens.METHODS Changes in diopter and axial length were collected among 70 adolescent myopia patients(124 eyes)wearing OK lenses for 1 year(group A)and 59 adolescent myopia patients(113 eyes)wearing frame glasses(group B).Refractive states of their retina were inspected through multispectral refraction topography.The obtained hyperopic defocus was analyzed for the mechanism of OK lenses on slowing down the increase of myopic diopter by delaying the increase of ocular axis length and reducing the near hyperopia defocus.RESULTS Teenagers in groups A and B were divided into low myopia(0 D--3.00 D)and moderate myopia(-3.25 D--6.00 D),without statistical differences among gender and age.After 1-year treatment,the increase of diopter and axis length and changes of retinal hyperopic defocus amount of group A were significantly less than those of group B.According to the multiple linear analysis,the retinal defocus in the upper,lower,nasal,and temporal directions had almost the same effect on the total defocus.The amount of peripheral retinal defocus(15°-53°)in group A was significantly lower than that in group B.CONCLUSION Multispectral refraction topography is progressive and instructive in clinical prevention and control of myopia.

Relationship between contrast sensitivity and corneal shape following overnight orthokeratology

AIM: To evaluate the relationship between contrast sensitivity(CS) and corneal shape following overnight orthokeratology(OK). METHODS: We conducted a retrospective clinical study of 80 lens-wearing myopia patients, all of whom had undergone OK and had been evaluated by Orbscan II topography. We measured the surface irregularity index(SIRI) of corneal topography at 3 and 5 mm, the size of the flattened central corneal curvature of OK lens(zone A), the size of the cornea altered by OK lens(zone B), the size of the pupillary area at the corneal level(zone C), the area of crossover between zones A and C(zone AC), the area of crossover between zones B and C(BC), the ratio of BC to B(BC/B), and the ratio of AC to C(AC/C). CS was evaluated using the CSV-1000 with spatial frequencies of 3, 6, 12, and 18 cycles/degree(CPD). RESULTS: Multiple correlation analyses indicated significant negative correlations between CS, zone C, BC/B, and 3-mm SIRI(all P<0.01). There were no significant differences between CS, zone B, AC/A, or 5-mm SIRI(P=0.60, 0.94 and 0.11, respectively). Zone C was negatively correlated with 3, 6, 12, and 18 CPD. 5-mm SIRI were negatively correlated with 6, 12, and 18 CPD. BC/C was negatively correlated with 6 and 18 CPD. AC/C was positively correlated with 3 CPD. CONCLUSION: Zone C, 3-mm SIRI and BC/B affect the CS following overnight OK.

Efficacy of long-term orthokeratology treatment in children with anisometropic myopia

AIM:To explore the efficacy of the orthokeratology lens for anisometropic myopia progression.METHODS:A retrospective study was performed.Cycloplegic refraction and axial length(AL)were collected from 50 children(10.52±1.72 y)who visited Peking University Third Hospital from July 2015 to August 2020.These children’s one eyes(Group A)received monocular orthokeratology lenses at first,after different durations(12.20±6.94 mo),their contralateral eyes(Group B)developed myopia and receive orthokeratology as well.The data in 1-year of binocular period were recorded.AL growth rate(difference of follow-up and baseline per month)were compared between two groups by paired t test.Interocular differences of AL were compared by Wilcoxon test.RESULTS:During monocular period,the AL growth rate of the Group A(0.008±0.022 mm/mo)was significantly slower than that of the Group B(0.038±0.018 mm/mo;P<0.0001).However,during binocular period,the AL growth rate of the Group A(0.026±0.014 mm/mo)was significantly faster than that of the Group B(0.016±0.015 mm/mo;P<0.0001).The AL difference between both eyes was 0.6(0.46)mm,then significantly decreased to 0.22(0.39)mm when started binocular treatment(P<0.0001).However,it was significantly increased to 0.30(0.32)mm after a year(P<0.0001),but still significantly lower than baseline(P<0.0001).CONCLUSION:The orthokeratology lens is efficient for control the AL elongation of monocular myopia eyes and reduce anisometropia.For the condition that the contralateral eyes develop myopia and receive orthokeratology lens later,there is no efficiency observed on control interocular difference of AL during binocular treatment.

Photopic pupil size change in myopic orthokeratology and its influence on axial length elongation

AIM:To explore the photopic pupil size behavior in myopic children undergoing overnight orthokeratology(ortho-k)over 1-year period and its effects on the axial elongation.METHODS:A total of 202 Chinese myopic children were enrolled in this prospective clinical trial.Ninetyfive subjects in ortho-k group and eighty-eight subjects in spectacle group completed the 1-year study.Axial length(AL)was measured before enrollment and every 6mo after the start of ortho-k.The photopic pupil diameter(PPD)was determined using the Pentacam AXL and measured in an examination room with lighting of 300-310 Lx.Stepwise multiple linear regression analysis was used to identify variables contribution to axial elongation.RESULTS:Compared with spectacle group,the average 1-year axial elongation was significantly slower in the ortho-k group(0.25±0.27 vs 0.44±0.23 mm,P<0.0001).In ortho-k group,PPDs significantly decreased from 4.21±0.62 mm to 3.94±0.53 mm after 1mo of lens wear(P=0.001,Bonferroni correction)and the change lasts for 3-month visit.No significantly change during the other follow-up visits was found(P>0.05,Bonferroni correction).The 4.81 mm PPD may be a possible cutoff point in the ortho-k group.Subjects with PPD below or equal to 4.81 mm tended to have smaller axial elongation compared to subjects with PPD above 4.81 mm after 1-year period(t=-3.09,P=0.003).In ortho-k group,univariate analyses indicated that those with older age,greater degree of myopia,longer AL,smaller baseline PPD(PPDbaseline)experienced a smaller change in AL.In multivariate analyses,older age,greater AL and smaller PPDbaseline were associated with smaller increases in AL.In spectacle group,PPD tended to be stable(P>0.05,Bonferroni correction)and did not affect axial growth.CONCLUSION:PPDs experience significantly decreases at 1-month and 3-month ortho-k treatment.Children with smaller PPD tend to experience slower axial elongation and may benefit more from ortho-k.

Comparison of myopia control between toric and spherical periphery design orthokeratology in myopic children with moderate-to-high corneal astigmatism

AIM： To compare clinical results between toric and spherical periphery design orthokeratology（ortho-k） in myopic children with moderate-to-high corneal astigmatism. METHODS： This retrospective study enrolled 62 eyes of 62 subjects using toric ortho-k lenses. These subjects were assigned to the toric group. Based on the one-to-one match principle（same age, proximate spherical equivalence and corneal astigmatism）, 62 eyes of 62 subjects were enrolled and included in the spherical group. At one-year followup visit, visual acuity, corneal astigmatism, treatment zone decentration, axial elongation and adverse reaction were compared between these two groups. RESULTS： At the one-year visit, corneal astigmatism was significantly lower in the toric group（1.22±0.76 D） than in the spherical group（2.05±0.85 D）（P=0.012）. The mean magnitude of the treatment zone decentration was 0.62±0.42 mm in the toric group and 1.07±0.40 mm in the spherical group（P=0.004）. Axial elongation was significantly slower in the toric group（0.04±0.13 mm） than in the spherical group（0.09±0.13 mm）（P=0.001）. The oneyear axial elongation was significantly correlated with initial age（r=-0.487, P〈0.001） and periphery design of ortho-k lens（r=0.315, P〈0.001）. The incidence of corneal staining was lower in the toric group（8.1%） than in the spherical group（19.4%）（P〈0.001）. CONCLUSION： Toric periphery design ortho-k lenses may provide lower corneal astigmatism, better centration, slower axial elongation and lower incidence of corneal staining in myopic children with moderate-to-high corneal astigmatism.

Short and long term corneal biomechanical analysis after overnight orthokeratology

AIM: To investigate the short and long term corneal biomechanical changes after overnight orthokeratology(OK) and compare them with those occurring in subjects not wearing contact lenses.METHODS: Retrospective case control study enrolling 54 subjects that were divided into three groups 18 subjects each: control group(CG), short term(15 nights) OK(STOK) group, and long term(more than 1 y of OK wear) OK(LTOK) group. Corneal biomechanics were characterized using the Cor Vis? ST system(Oculus), recording parameters such as time [first/second applanation time(AT1, AT2)], speed [velocity of corneal apex at the first/second applanation time(AV1, AV2)], and amplitude of deformation(AD1, AD2) in the first and second corneal flattening, corneal stiffness(SPA1), biomechanically corrected intraocular pressure(b IOP) and corneal(CBI) and tomographic biomechanical indices(TBI).RESULTS: Significantly lower AD1 and standard deviate on of Ambrosio’s relational average thickness related to the horizontal profile(ARTh) values were found in the OK groups compared to CG(P<0.05). Likewise, significantly higher values of CBI were found in STOK and LTOK groups compared to CG(P<0.01). No significant differences between groups were found in integrated radius index(P=0.24), strain stress index(P=0.22), tomographic biomechanical index(P=0.91) and corneal stif fness parameter(SPA1, P=0.97). Significant inverse correlations were found between corneal thickness and CBI in STOK(r=-0.90, P<0.01) and LTOK groups(r=-0.71, P<0.01).CONCLUSION: OK does not seem to alter significantly the corneal biomechanical properties, but special care should be taken when analyzing biomechanical parameters influenced by corneal thickness such as amplitude of deformation, ARTh or CBI, because they change significantly after treatment but mainly due to the reduction and pachymetric progression induced by the corneal molding secondary to OK treatment.

Orthokeratology for myopia control: an optometrist’s view

Orthokeratology(OK)is a clinical technique that uses reverse geometry design rigid contact lenses to reshape the corneal profile and modify its refractive power during overnight lens wear in order to correct refractive error temporarily.OK achieves its reshaping effect through thinning of the central corneal epithelium.This raises concerns about the safety of this modality particularly in terms of microbial keratitis(MK).Since the mid 2000’s,with our increasing understanding of modifiable risk factors for MK in OK the prevalence of MK appears to have reduced significantly.It is now clear that the relative risk of MK in overnight OK is equivalent to other modalities of contact lens wear,provided that safe practice is followed in terms of lens fitting,wear and care.Although OK was originally used predominantly for correction of low to moderate myopic refractive error,its use for myopia control have become more common in recent years.This follows on from published clinical trials demonstrating an average of approximately 45%reduction in axial eye elongation when overnight OK is used in progressive myopic children.But there is significant individual variability in efficacy,and one of the current challenges for OK in myopia control is to identify those children who will benefit most from this particular intervention.Modifying OK lens parameters to customise corneal reshaping for enhanced myopia control efficacy also remains a significant challenge for the future of this modality.

Orthokeratology lens related infections

Orthokeratology is a reversible technique that temporarily changes the curvature of the cornea with the aim of addressing refractive errors. The United States Food and Drug Administration(FDA) granted approval for using reverse geometry contact lenses to correct myopia without any age restriction. Information from the pre-market applications to the FDA was rated as level Ⅱ evidence. Another unapproved use of overnight orthokeratology is for the prevention of myopic progression. Although orthokeratology is advocated to reduce myopic progression, there are limited long-term studies with substantial evidence of its benefits. Much of this evidence comes from non-robust experimental studies using historical or self-selected controls with relative high dropout rates. Although some positive results have been published in temporarily reducing the myopic refractive error and its progression, the use of these lenses can be associated with serious complications such as microbial keratitis. Microbial keratitis is a potentially vision-threatening adverse response associated with contact lens wear. In fact, contact lens wearhas been shown to be the predominant risk factor of microbial keratitis in some developed countries. Most of the published cases on overnight orthokeratology related microbial keratitis occurred in children or adolescents. Parents considering orthokeratology must make an informed decision about its temporary benefit and its potential for permanent loss of vision. The ophthalmic community should be reminded of the potential complications of orthokeratology.

Clinical study of controlling myopia progression of students wearing orthokeratology

Objective: To observe the clinical effects of wearing orthokeratology lenses to control the myopia progression of students. Methods: 105 cases (10-16 years) from January 2011 to October 2014 with low, moderate myopia were selected, the spherical equivalent was (-3.63 ± 0.95) D. 56 cases (112 eyes) were wearing orthokeratology lenses, 49 cases (98 eyes) were wearing glasses. Both groups were followed up for 2 years to observe the variations of spherical equivalent, axial length, intraocular pressure and corneal thickness. Results: The spherical equivalent changes after two years wearing: the spherical equivalent of the orthokeratology lenses group increased by (-0.47 ± 0.98) D, and that of the glasses group increased by (-1.59 ± 0.91) D;the difference was statistically significant (p < .05). The axial length changes after two years wearing: the axial length of the orthokeratology lenses group increased by (0.17 ± 1.09) mm, and that of the glasses group increased by (0.72 ± 1.08) mm, the difference between two groups was statistically significant (p < .05). The variations of intraocular pressure and corneal thickness were not statistically significant before and after wearing lenses in the orthokeratology lenses group (p > .05). Conclusions: Wearing orthokeratology lenses can effectively delay the progression of myopia and control axial growth. The lenses can be disseminated and used in clinical practice.

Relative peripheral refraction across 4 meridians after orthokeratology and LASIK surgery

Background:To characterize the axial and off-axis refraction across four meridians of the retina in myopic eyes before and after Orthokeratology(OK)and LASIK surgery.Methods:Sixty right eyes with a spherical equivalent(M)between−0.75 to−5.25 D(cylinder<−1.00 D)underwent LASIK(n=26)or OK(n=34)to treat myopia.Axial and off-axis refraction were measured with an open-field autorefractometer before and after stabilized treatments.Off-axis measurements were obtained for the horizontal(35°nasal and temporal retina)and vertical(15°superior and inferior retina)meridians,and for two oblique directions(45–225°and 135–315°)up to 20°of eccentricity.The refractive profile was addressed as relative peripheral refractive error(RPRE).Results:OK and LASIK post-treatment results showed an increase of myopic relative refraction at several eccentric locations.At the four meridians evaluated,the M component of the pre-treatment RPRE values was not statistically different(p>0.05)from the post-treatment RPRE within 30°and 20°of the central visual field after LASIK and OK,respectively.These results demonstrated that the treatment zone warrants an optimal central field of vision.Conclusions:The present study gives an overview of RPRE after refractive corneal reshaping treatments(OK and LASIK)across vertical,horizontal and two oblique meridians together.This allows a 3D representation of RPRE at the retina and shows that the myopic shift induced by both treatments is more relevant in horizontal directions.

Influence of overnight orthokeratology lens fitting decentration on corneal topography reshaping

Background:This retrospective study was designed to investigate the sole influence of orthokeratology(OK)lens fitting decentration on the Zernike coefficients of the reshaped anterior corneal surface.Methods:This study comprised a review of 106 right eyes and measurements of corneal topography both before OK and at 1-month follow-up visit.A routine was designed to calculate local corneal surface astigmatism and assist the determination of OK lens fitting decentration from pupil center.The pupil-centered corneal Zernike coefficients of baseline(PCCB)and post-treatment(PCCP)were calculated.Meanwhile,the OK-lens-centered corneal Zernike coefficients of post-treatment(OCCP)were also calculated and considered as the presumptive ideal fitting group without decentration.Relationships between lens fitting decentration and the change of Zernike coefficients including(PCCP−PCCB)and(PCCP−OCCP)were analyzed.Results:Patients with a mean age of 11±2.36 years old had an average spherical equivalent refractive error of−3.52±1.06 D before OK.One month after treatment,OK lens fitting decentration from pupil center was 0.68±0.35 mm.RMS of 3rd-order(P<0.05),RMS of 4th-order(P<0.001)and RMS of total high order(P<0.001)corneal Zernike coefficients were increased in PCCP by comparing with OCCP,which was solely caused by lens fitting decentration.Nevertheless,no significant difference was observed in C^(0)_(2)(P>0.05).For the high order corneal Zernike coefficients in(PCCP–OCCP),radial distance of decentration was correlated with C^(−1)_(3)(r=−0.296,P<0.05),C^(1)_(3)(r=−0.396,P<0.001),and C^(0)_(4)(r=0.449,P<0.001),horizontal decentration was significantly correlated with C^(1)_(3)(r=0.901,P<0.001)and C^(1)_(5)(r=0.340,P<0.001),and vertical decentration was significantly correlated with C^(−1)_(3)(r=0.904,P<0.001).Conclusions:OK lens fitting decentration within 1.5 mm hardly influenced the change of corneal spherical power for myopia correction,but significantly induced additional corneal high order Zernike coefficients including C^(−1)_(3),C^(1)_(3),C^(0)_(4),and C^(1)_(5).

Effect of orthokeratology on precision and agreement assessment of a new sweptsource optical coherence tomography biometer

Background:To evaluate the effect of orthokeratology on precision of measurements in children using a new swept-source optical coherence tomography(SS-OCT)optical biometer(OA-2000),and agreement between its measurements and those provided by the commonly used IOLMaster based on partial coherence interferometry(PCI).Methods:This study recruited fifty-one eyes of 51 normal children(8–16 years).An operator took measurements with the two biometers.Then,a second operator took measurements with the SS-OCT biometer.After orthokeratology was performed for one month,the same operators repeated the same procedures.Axial length(AL),mean keratometry(Km)at 2.5 mm and 3.0 mm diameters(Km2.5 and Km3.0),central corneal thickness(CCT),anterior chamber depth(ACD),lens thickness(LT)and corneal diameter(CD)were analyzed.Results:With the SS-OCT optical biometer,the test-retest repeatability of AL measurements was<0.06 mm.For all parameters,the coefficients of variation were<1.23%and the intraclass correlation coefficients were>0.95.The 95%limits of agreement of difference between the two devices for CD parameter were up to 1.53 mm.After orthokeratology,the fluctuation ranges of difference for Km3.0 measurement was 1.11 times higher than before orthokeratology,while the absolute values of difference for AL,Km2.5,ACD and CD measurements were comparable.Conclusions:Before and after orthokeratology,the SS-OCT biometer showed high repeatability and reproducibility for all measurements.Wearing orthokeratology contact lenses affected the agreement between SS-OCT and PCI biometers for Km3.0 measurements.The CD measurement showed poor agreement between the two devices.

Choroidal thickness,myopia,and myopia control interventions in children:a Meta-analysis and systemic review

AIM:To investigate changes of choroidal thickness(ChT) in children with myopia and the effect of current myopia control interventions on ChT.METHODS:Major literature databases were searched for studies relevant to myopia in children.All studies used swept-source optical coherence tomography(SS-OCT) or enhanced depth imaging optical coherence tomography(EDI-OCT) to measure the ChT value.The weighted mean difference(WMD) and 95% confidence interval(CI) were pooled to evaluate ChT in myopia children.RESULTS:A total of 11 eligible articles,including 1693 myopic and 1132 non-myopic eyes,were included in the first Meta-analysis.The sub-foveal choroidal thickness(SFCT;WMD=-40.06,95%CI,-59.36 to-20.75,P<0.001) and ChT at other sectors were significantly thinner in myopic eyes compared with the non-myopic eyes.The Meta-analysis revealed that the ChT decreased horizontally from the temporal sector toward the nasal sector in the pediatric myopia population.Another 11 studies reporting the effect of myopia control interventions were included in the second Meta-analysis for the relationship between myopia control treatments and ChT.SFCT significantly increased after orthokeratology(OK) treatment and OK combined with 0.01% atropine(OKA) treatment(WMD=19.47,95%CI,15.96 to 22.98,P<0.001;WMD=21.81,95%CI,12.92 to 29.70,P<0.001,respectively).The forest plots showed that SFCT changed little in myopic children receiving 0.01% atropine(P=0.30).Furthermore,the Meta-analysis showed that OK treatment had a stronger effect on the value of SFCT in myopic children as compared with 0.01% atropine(WMD=9.86;95%CI,-0.21 to 19.93,P=0.05).There is no difference between the treatment with OK and OKA treatment in ChT in myopic children(P=0.37).CONCLUSION:The ChT in myopic eyes is thinner than that in non-myopic eyes in pediatric population.Myopia control interventions including OK and OKA lead to ChT thickening,but other treatments such as 0.01% atropine did not show an increase in ChT.

Corneal Wavefront Aberrations in Patients Wearing Multifocal Soft Contact Lenses for Myopia Control

Purpose: The purpose of this study was to evaluate the change in corneal wavefront aberrations in young adults who have been fit with multifocal soft contact lenses for myopia progression control. Findings have been analyzed for statistical significance and clinical relevance and compared to reportedly successful Orthokeratology outcomes. Methods: The dominant eye of 40 participants (27 women, 13 men;mean age 27.3 ± 3.2 years;range 23 to 39 years) was fit with Proclear Multifocal center distance lenses (Coopervision, Pleasanton, USA) having a variety of distance powers and reading additions. Refractive errors were limited to a range of –6.00 D up to +1.00 D of sphere, and no greater than –1.00 D of cylinder. Corneal wavefront measurements were performed over 6 mm diameters with a Zeiss Atlas 9000 corneal topographer (Zeiss Meditec, Dublin, USA) prior to, and following lens fitting. Data were converted into rectangular Fourier optics terms M, J0, J45 and RMS values for each reading addition were statistically analyzed. Following evaluation of statistical significance and clinical relevance, results were compared to published data from successful Orthokeratology treatments. Results: Statistically significant changes in higher order aberrations were detected for lenses of all reading additions. Lens groups with higher Add-powers demonstrated stronger changes with increased significance. Final RMS values relating to 2nd, 3rd and 4th Zernike Orders reached clinical significance with a wavefront error of 0.10 μm, the equivalent of 0.25D. Moreover, as Add-powers increased, 3rd and 4th order aberrations likewise showed an increase. Pre-fitting astigmatism values accounted for the highest recorded aberrations and remained predominantly unchanged. Conclusion: Proclear Multifocal center-distance contact lenses were found to increase higher order wavefront aberrations in a manner dependent on their Add-power. In comparison to successful Orthokeratology outcomes, the amounts of resulting aberrations are notably different.