Elsevier

Experimental Eye Research

Volume 114, September 2013, Pages 77-88
Experimental Eye Research

Optical treatment strategies to slow myopia progression: Effects of the visual extent of the optical treatment zone

https://doi.org/10.1016/j.exer.2012.11.019Get rights and content

Abstract

In order to develop effective optical treatment strategies for myopia, it is important to understand how visual experience influences refractive development. Beginning with the discovery of the phenomenon of form deprivation myopia, research involving many animal species has demonstrated that refractive development is regulated by visual feedback. In particular, animal studies have shown that optically imposed myopic defocus slows axial elongation, that the effects of vision are dominated by local retinal mechanisms, and that peripheral vision can dominate central refractive development. In this review, the results obtained from clinical trials of traditional optical treatment strategies employed in efforts to slow myopia progression in children are interpreted in light of the results from animal studies and are compared to the emerging results from preliminary clinical studies of optical treatment strategies that manipulate the effective focus of the peripheral retina. Overall, the results suggest that imposed myopic defocus can slow myopia progression in children and that the effectiveness of an optical treatment strategy in reducing myopia progression is influenced by the extent of the visual field that is manipulated.

Highlights

► Optical treatment strategies can slow the progression of myopia of children. ► Optically imposed myopic defocus effectively slows myopia progression. ► Peripheral treatment strategies are more effective than central only strategies.

Section snippets

Undercorrection versus full-correction spectacles

The finding that optically imposed myopic defocus slows axial growth in animals suggests that myopia in children should be self-limiting. If the refractive error is left uncorrected, progression should not occur. Similarly, at first glance, the results from animal studies imply that undercorrecting myopic eyes, i.e., prescribing spectacles for distance vision that do not fully correct the manifest myopic refraction, should slow myopia progression. Interestingly, the two recent studies that have

Multifocal spectacles versus single-vision spectacles

As documented in previous reviews, multifocal spectacles have for a variety of reasons been prescribed to children in efforts to reduce myopia progression (Cheng et al., 2010b; Grosvenor, 1998). However, most recent studies have been motivated by the observation that optically induced hyperopic defocus consistently produces axial myopia in animals, both young (Smith and Hung, 1999) and old (Zhong et al., 2004). Specifically, it has been hypothesized that children who consistently

Spectacles and contact lenses

The majority of optical treatment strategies for reducing myopia progression have been designed to influence the retinal image at the fovea. However, recent attempts to develop more effective optical treatment regimens have included optical designs/procedures that selectively influence the effective focus of the peripheral retina or impose optical effects over a very large part of the retina. These recent attempts have been motivated by observations in humans that suggest that the pattern of

Speculations and the need for future studies

The results summarized above and in previous reviews (Cheng et al., 2010b; Walline et al., 2011b) prove that various optical correction strategies can alter eye growth in children and, specifically, that it is possible to slow the progression of myopia relative to traditional correcting lenses. In particular, the available data from multifocal spectacle lens studies are robust and include the results from large, well-executed studies, the COMET study probably being the most noteworthy (Gwiazda

Conclusions

The novel lens designs and optical treatment strategies that have been studied and that are currently under investigation promise to produce not only statistically significant reductions in myopia progression, but also clinically significant reductions in the progression of myopia. Given that the investigations to date have largely ignored potentially important differences between subjects and have made little or no attempts to optimize optical treatment strategies for a given individual, it

Conflict of interest

The Author is a co-author on patents for lens designs to reduce myopia progression that involve manipulating peripheral refractive errors.

Acknowledgments

This work was supported by NIH grants EY-03611 and EY-07551 and funds from the Vision Cooperative Research Centre, Sydney, Australia.

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