Atropine for the treatment of childhood myopia. An intervention trial on efficacy of atropine and multi-focal glasses in controlling myopic progression. A randomized trial of the effects of rigid contact lenses on myopia progression. Can bifocals slow myopia progression? Effect of progressive addition lenses on myopia progression in Japanese children: a prospective, randomized, double-masked, crossover trial. A randomized clinical trial of bifocal glasses for myopic children with esophoria: results after 54 months. A randomized clinical trial of progressive addition lenses versus single vision lenses on the progression of myopia in children. Effects of different concentrations of atropine on controlling myopia in myopic children. The effectiveness of progressive addition lenses on the progression of myopia in Chinese children.
To evaluate the efficacy and safety of topical atropine, a nonselective muscarinic antagonist, in slowing the progression of myopia and ocular axial elongation in Asian children.
                Parallel-group, placebo-controlled, randomized, double-masked study.
                Four hundred children aged 6 to 12 years with refractive error of spherical equivalent -1.00 to -6.00 diopters (D) and astigmatism of -1.50 D or less.
                Participants were assigned with equal probability to receive either 1% atropine or vehicle eye drops once nightly for 2 years. Only 1 eye of each subject was chosen through randomization for treatment.
                The main efficacy outcome measures were change in spherical equivalent refraction as measured by cycloplegic autorefraction and change in ocular axial length as measured by ultrasonography. The primary safety outcome measure was the occurrence of adverse events.
                Three hundred forty-six (86.5%) children completed the 2-year study. After 2 years, the mean progression of myopia and of axial elongation in the placebo-treated control eyes was -1.20+/-0.69 D and 0.38+/-0.38 mm, respectively. In the atropine-treated eyes, myopia progression was only -0.28+/-0.92 D, whereas the axial length remained essentially unchanged compared with baseline (-0.02+/-0.35 mm). The differences in myopia progression and axial elongation between the 2 groups were -0.92 D (95% confidence interval, -1.10 to -0.77 D; P<0.001) and 0.40 mm (95% confidence interval, 0.35-0.45 mm; P<0.001), respectively. No serious adverse events related to atropine were reported.
                Topical atropine was well tolerated and effective in slowing the progression of low and moderate myopia and ocular axial elongation in Asian children. This randomized clinical trial assessed the treatment effects of atropine and/or multi-focal lenses in decreasing the progression rate of myopia in children.
                Two hundred and twenty-seven schoolchildren with myopia, aged from 6 to 13 years, who were stratified based on gender, age and the initial amount of myopia were randomly assigned to three treatment groups: 0.5% atropine with multi-focal glasses, multi-focal glasses, and single vision spectacles. Each subject was followed for at least eighteen months. These results report on the 188 patients available for the follow-up.
                The mean progression of myopia in atropine with multi-focal glasses group (0.41 D) was significantly less than the multi-focal (1.19 D) and single vision group (1.40 D) (p < 0.0001). But no significant difference was noted between the last two groups (p = 0.44). The progression of myopia was significantly correlated with the increases of axial length (r = 0.65, p = 0.0001), but not with the changes of corneal power (r=-0.09), anterior chamber depth (r = -0.023), lens thickness (r = -0.08), or intra-ocular pressure (r = -0.008).
                The 0.5% atropine with multi-focal lenses can slow down the progression rate of myopia. However, multi-focal lenses alone showed no difference in effect compared to control. To compare the effects of rigid gas-permeable contact lenses (RGPs) and soft contact lenses (SCLs) on myopia progression in children.
                We randomly assigned 116 subjects to wear RGPs or SCLs. Subjects underwent cycloplegic autorefraction, keratometry, and A-scan ultrasonographic axial length measurements at each annual visit. All analyses were conducted according to the original randomization assignment. The primary outcome measure was the 3-year change in spherical equivalent cycloplegic autorefraction.
                The mean +/- SD spherical equivalent cycloplegic refractive error progressed -1.56 +/- 0.95 diopters (D) for RGP wearers and -2.19 +/- 0.89 D for the SCL wearers during the 3 years of the study (analysis of covariance [ANCOVA], P<.001). The axial growth of the eyes was not significantly different between treatment groups (ANCOVA, P = .57). The steep corneal meridian of the RGP wearers steepened 0.62 +/- 0.60 D, and that of the SCL wearers steepened 0.88 +/- 0.57 D during the 3 years (ANCOVA, P = .01).
                The RGP wearers' myopia progressed less than that of the SCL wearers. The corneal curvature of the SCL wearers steepened more than that of the RGP wearers, but the axial growth was not significantly different between the groups. Most refractive error treatment effect was limited to the first year of the trial. The results of the study provide information for eye care practitioners to share with their patients, but they do not indicate that RGPs should be prescribed primarily for myopia control. Retrospective studies have suggested that in children with near point esophoria, bifocals can slow myopia progression by about 50 percent. A prospective study was conducted to test this hypothesis.
                Thirty-two children, all with near point esophoria, were randomly divided into either correction with single-vision or with bifocal lenses containing a +1.25 D and. Axial length and refraction were measured under cycloplegia every 6 months for 18 months. Twenty-eight children completed the study.
                Myopia progressed at an equal rate in both groups for the first 12 months. Progression was much faster during the first 6 months, which was during the school year, than during the second 6 months, which included all of the summer vacation (0.64 D/yr vs 0.29 D/yr). During the last 6 months, myopia progressed rapidly for children in single-vision lenses (0.80 D/yr) but slowly for those in bifocals (0.37 D/yr). A repeated-measure analysis of variance showed that season of the year had a significant effect on myopia progression (p > 0.002) and that the effect differed for the two treatment groups (p > 0.043). Over the whole 18-month study, myopia progressed at rate of 0.57 D/yr for those in single-vision lenses and 0.39 D/yr in those in bifocals (p = 0.26).
                Bifocals seemed to slow myopia progression in these children with near-point esophoria, although a longer-term study with more subjects is needed to confirm this finding. Myopia progressed more rapidly during the school year than during summer vacation. This prospective, randomized, double-masked, crossover trial was conducted to evaluate the clinical effectiveness of progressive addition lenses (PALs) compared with single-vision lenses (SVLs) on myopia progression in Japanese children.
                Ninety-two children fulfilling the inclusion criteria (age: 6-12 years, spherical equivalent refractive errors: -1.25 to -6.00 D) were randomly allocated to either 18 months of wearing PALs (near addition: +1.50 D) followed by 18 months of SVLs (group 1), or 18 months of wearing SVLs followed by 18 months of wearing PALs (group 2), and were followed up for 3 years (two-stage crossover design). The primary outcome measure was myopia progression, as determined by cycloplegic autorefraction.
                Eighty-six (93%) children completed both treatment periods. A mixed-model, two-way analysis of variance (ANOVA) performed using 3-year data identified a significant treatment effect of PALs compared with SVLs (P = 0.0007), with a mean 18-month difference of 0.17 D (95% CI: 0.07-0.26 D). This analysis also indicated a significant period effect (P = 0.0040) and a significant treatment-by-period interaction (P = 0.0223): Group 1 showed a slower myopia progression than did group 2.
                The use of PALs slowed myopia progression, although the treatment effect was small, as previously reported in ethnically diverse children in the United States. The significant treatment-by-period interaction suggests that early application of PALs would probably be more beneficial for these age and refraction ranges (isrctn.org number, 28611140). We previously reported results of a randomized clinical trial of bifocals as a type of myopia correction for children with near-point esophoria. After 30 months, the rate of myopia progression in 36 children wearing bifocals averaged 0.40 D/yr compared to 0.50 D/yr in 39 children wearing single-vision glasses (p= 0.046, age-adjusted). Here we report on the 46 children in that study who completed 54 months of followup.
                For each treatment group, we examined the pattern of change in myopia over the first and second halves of the 54-month period to see if the beneficial effect of wearing bifocals was present initially for those 46 children, as it was in the entire group, and to see if the myopia-slowing effect continued to accumulate during the second part of the study. During the last 12 months of the 54-month period, subjects were free to select any mode of myopic treatment, but this intent-to-treat analysis classified all children according to their original treatment assignment.
                During the first 24 months, the pattern of change in myopia differed between the two groups (p = 0.041), with those in bifocals showing slower progression. A similar trend was observed for vitreous chamber growth (p= 0.059). During the last 30 months, myopia progressed at a similar rate for both groups, including during the last year, when many subjects changed their mode of myopia correction.
                Wearing bifocals instead of single-vision glasses caused a slowing of myopia progression evident during the first two years. During the subsequent two-and-a-half years of followup, the difference in the degree of myopia was maintained, but did not increase. The purpose of the Correction of Myopia Evaluation Trial (COMET) was to evaluate the effect of progressive addition lenses (PALs) compared with single vision lenses (SVLs) on the progression of juvenile-onset myopia.
                COMET enrolled 469 children (ages 6-11 years) with myopia between -1.25 and -4.50 D spherical equivalent. The children were recruited at four colleges of optometry in the United States and were ethnically diverse. They were randomly assigned to receive either PALs with a +2.00 addition (n = 235) or SVLs (n = 234), the conventional spectacle treatment for myopia, and were followed for 3 years. The primary outcome measure was progression of myopia, as determined by autorefraction after cycloplegia with 2 drops of 1% tropicamide at each annual visit. The secondary outcome measure was change in axial length of the eyes, as assessed by A-scan ultrasonography. Child-based analyses (i.e., the mean of the two eyes) were used. Results were adjusted for important covariates, by using multiple linear regression.
                Of the 469 children (mean age at baseline, 9.3 +/- 1.3 years), 462 (98.5%) completed the 3-year visit. Mean (+/-SE) 3-year increases in myopia (spherical equivalent) were -1.28 +/- 0.06 D in the PAL group and -1.48 +/- 0.06 D in the SVL group. The 3-year difference in progression of 0.20 +/- 0.08 D between the two groups was statistically significant (P = 0.004). The treatment effect was observed primarily in the first year. The number of prescription changes differed significantly by treatment group only in the first year. At 6 months, 17% of the PAL group versus 30% of the SVL group needed a prescription change (P = 0.0007), and, at 1 year, 43% of the PAL group versus 59% of the SVL group required a prescription change (P = 0.002). Interaction analyses identified a significantly larger treatment effect of PALs in children with lower versus higher baseline accommodative response at near (P = 0.03) and with lower versus higher baseline myopia (P = 0.04). Mean (+/- SE) increases in the axial length of eyes of children in the PAL and SVL groups, respectively, were: 0.64 +/- 0.02 mm and 0.75 +/- 0.02 mm, with a statistically significant 3-year mean difference of 0.11 +/- 0.03 mm (P = 0.0002). Mean changes in axial length correlated with those in refractive error (r = 0.86 for PAL and 0.89 for SVL).
                Use of PALs compared with SVLs slowed the progression of myopia in COMET children by a small, statistically significant amount only during the first year. The size of the treatment effect remained similar and significant for the next 2 years. The results provide some support for the COMET rationale-that is, a role for defocus in progression of myopia. The small magnitude of the effect does not warrant a change in clinical practice. Although 1% atropine effectively slows myopia progression, it is associated with adverse effects, including photophobia, blurred near vision, and poor compliance. We investigated whether lower doses of atropine would control myopia progression. One hundred and eighty-six children, from 6 to 13 years of age, were treated each night with different concentrations of atropine eye drops or a control treatment for up to 2 years. The mean myopic progression in each of the groups was 0.04 +/-0.63 diopter per year (D/Y) in the 0.5% atropine group, 0.45+/-0.55 D/Y in the 0.25% atropine group, and 0.47+/-0.91 D/Y in the 0.1% atropine group. All atropine groups showed significantly less myopic progression than the control group (1.06+/-0.61 D/Y) (p<0.01). Our study also showed that 61% of students in the 0.5% atropine group, 49% in the 0.25% atropine group and 42% in the 0.1% atropine group had no myopic progression. However, 4% of children in the 0.5% atropine group, 17% in the 0.25% atropine group, and 33% in the 0.1% atropine group still had fast myopic progression (>-1.0 D/Y). In contrast, only 8% of the control group showed no myopic progression and 44% had fast myopic progression. These results suggest that all three concentrations of atropine had significant effects on controlling myopia; however, treatment with 0.5% atropine was the most effective. To evaluate the effectiveness of progressive addition lenses (PALs), with a near addition of +1.50 D, on the progression of myopia in Chinese children.
                We enrolled 178 Chinese juvenile-onset acquired myopes (aged 7-13 years, -0.50 to -3.00 D spherical refractive error), who did not have moderately or highly myopic parents, for a 2-year prospective study. They were randomly assigned to the PAL group or single vision (SV) group. Primary measurements, which included myopia progression and ocular biometry, were performed every 6 months. Treatment effect was adjusted for important covariates, by using a multiple linear regression model.
                One hundred and forty-nine subjects (75 in SV and 74 in PAL) completed the 2-year study. The myopia progression (mean +/- S.D.) in the SV and PAL groups was -1.50 +/- 0.67 and -1.24 +/- 0.56 D, respectively. This difference of 0.26 D over 2 years was statistically significant (p = 0.01). The lens type (p = 0.02) and baseline spherical equivalent refraction (p = 0.05) were significant contributing factors to myopia progression. Mean increase in the depth of vitreous chamber was 0.70 +/- 0.40 and 0.59 +/- 0.24 mm, respectively. This difference of 0.11 mm was statistically significant (p = 0.04). Age (p < 0.01) was the only contributing factor to the elongation of vitreous chamber. Different near phoria (p < 0.01) and gender (p = 0.02) caused different treatment effects when wearing SV lenses. However, there were no factors found to influence the treatment effect of wearing PALs.
                Compared with SV lenses, myopia progression was found to be retarded by PALs to some extent in Chinese children without moderately or highly myopic parents, especially for subjects with near esophoria or females.
The most likely effective treatment to slow myopia progression thus far is anti-muscarinic topical medication. However, side effects of these medications include light sensitivity and near blur. Also, they are not yet commercially available, so their use is limited and not practical. Further information is required for other methods of myopia control, such as the use of corneal reshaping contact lenses or bifocal soft contact lenses (BSCLs) with a distance center are promising, but currently no published randomized clinical trials exist.