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      Predictive factors associated with axial length growth and myopia progression in orthokeratology

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          Abstract

          Purpose

          To investigate the factors affecting axial length (AXL) growth and myopia progression in orthokeratology.

          Methods

          This prospective, observational study enrolled 28 new orthokeratology lens wearers from a contact lens clinic between March 2016 and March 2017. Among them, 32 eyes of 17 wearers who completed one year of follow-up were finally analyzed. All participants underwent central (C) and peripheral (nasal 30° [N30] and temporal 30° [T30]) AXL measurements as well as central and peripheral refraction, ocular aberrations, and corneal topography at baseline and every posttreatment visit. A generalized estimating equation (GEE) was used to assess the associations between AXL change and all independent variables in both eyes.

          Results

          The mean central AXL was 24.21 ± 0.60 mm and the mean baseline central spherical equivalent refractive error (SER) was −2.43 ± 0.97 diopters (D). Among all parameters that were significantly associated with AXL change in univariable GEE analyses, the baseline difference in AXL between C and N30 (β = −0.213, p < 0.001), baseline SER (β = −0.040, p < 0.033), posttreatment coma (β = −0.291, p < 0.031), third-order higher-order aberrations (HOAs) (β = −0.482, p < 0.001), and changes in second-order aberrations (β = 0.025, p = 0.027) at one year of follow-up were identified as significant factors in multivariable GEE analysis.

          Conclusions

          The inhibition of AXL elongation and myopia progression in orthokeratology lens wear is significantly associated with the peripheral myopization and asymmetric optical changes mostly induced by third-order HOAs.

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          Most cited references24

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          Retardation of myopia in Orthokeratology (ROMIO) study: a 2-year randomized clinical trial.

          This single-masked randomized clinical trial aimed to evaluate the effectiveness of orthokeratology (ortho-k) for myopic control. A total of 102 eligible subjects, ranging in age from 6 to 10 years, with myopia between 0.50 and 4.00 diopters (D) and astigmatism not more than 1.25D, were randomly assigned to wear ortho-k lenses or single-vision glasses for a period of 2 years. Axial length was measured by intraocular lens calculation by a masked examiner and was performed at the baseline and every 6 months. This study was registered at ClinicalTrials.gov, number NCT00962208. In all, 78 subjects (37 in ortho-k group and 41 in control group) completed the study. The average axial elongation, at the end of 2 years, were 0.36 ± 0.24 and 0.63 ± 0.26 mm in the ortho-k and control groups, respectively, and were significantly slower in the ortho-k group (P 0.54) but was correlated with the initial age of the subjects (P 1.00D per year) were 65% and 13% in younger (age range: 7-8 years) and older (age range: 9-10 years) children, respectively, in the control group and were 20% and 9%, respectively, in the ortho-k group. Five subjects discontinued ortho-k treatment due to adverse events. On average, subjects wearing ortho-k lenses had a slower increase in axial elongation by 43% compared with that of subjects wearing single-vision glasses. Younger children tended to have faster axial elongation and may benefit from early ortho-k treatment. (ClinicalTrials.gov number, NCT00962208.).
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            Updates of pathologic myopia.

            Complications from pathologic myopia are a major cause of visual impairment and blindness, especially in east Asia. The eyes with pathologic myopia may develop loss of the best-corrected vision due to various pathologies in the macula, peripheral retina and the optic nerve. Despite its importance, the definition of pathologic myopia has been inconsistent. The refractive error or axial length alone often does not adequately reflect the 'pathologic myopia'. Posterior staphyloma, which is a hallmark lesion of pathologic myopia, can occur also in non-highly myopic eyes. Recently a revised classification system for myopic maculopathy has been proposed to standardize the definition among epidemiological studies. In this META-PM (meta analyses of pathologic myopia) study classification, pathologic myopia was defined as the eyes having chorioretinal atrophy equal to or more severe than diffuse atrophy. In addition, the advent of new imaging technologies such as optical coherence tomography (OCT) and three dimensional magnetic resonance imaging (3D MRI) has enabled the detailed observation of various pathologies specific to pathologic myopia. New therapeutic approaches including intravitreal injections of anti-vascular endothelial growth factor agents and the advance of vitreoretinal surgeries have greatly improved the prognosis of patients with pathologic myopia. The purpose of this review article is to provide an update on topics related to the field of pathologic myopia, and to outline the remaining issues which need to be solved in the future.
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              Long-term effect of overnight orthokeratology on axial length elongation in childhood myopia: a 5-year follow-up study.

              Our prospective study was conducted to compare axial length elongation in myopic children receiving long-term overnight orthokeratology (OK) treatment to those wearing spectacles as controls. There were 59 subjects enrolled in this study. The OK group comprised 29 subjects who matched the inclusion criteria for OK. The control group comprised 30 subjects who also matched the inclusion criteria for OK, but preferred spectacles for myopia correction. Axial length was measured periodically for 5 years using an IOLMaster device, and the time course of changes was evaluated and compared between the groups. A total of 43 subjects (22 and 21 in the OK and control groups, respectively) completed the 5-year follow-up examinations. At baseline, the mean age ± SD was 10.04 ± 1.43 and 9.95 ± 1.59 years, the spherical equivalent refractive error was -1.89 ± 0.82 and -1.83 ± 1.06 diopters (D), and the axial length was 24.09 ± 0.77 and 24.22 ± 0.71 mm in the OK and control groups, respectively, with no significant differences between the groups. The increase in axial length during the 5-year study period was 0.99 ± 0.47 and 1.41 ± 0.68 mm for the OK and control groups, respectively, and the difference was statistically significant (P = 0.0236, unpaired t-test). The annual increases in axial length were significantly different between the groups for the first (P = 0.0002), second (P = 0.0476), and third years (P = 0.0385), but not for the fourth (P = 0.0938) and fifth (P = 0.8633) years. There were no severe complications throughout the study period. The current 5-year follow-up study indicated that OK can suppress axial length elongation in childhood myopia.
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                Author and article information

                Contributors
                Role: Data curationRole: Formal analysisRole: InvestigationRole: Writing – original draft
                Role: ConceptualizationRole: Funding acquisitionRole: MethodologyRole: SupervisionRole: ValidationRole: Writing – review & editing
                Role: Data curationRole: Formal analysisRole: InvestigationRole: Methodology
                Role: ConceptualizationRole: Project administrationRole: ResourcesRole: SupervisionRole: ValidationRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                12 June 2019
                2019
                : 14
                : 6
                : e0218140
                Affiliations
                [001]Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
                Keio University School of Medicine, JAPAN
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                http://orcid.org/0000-0003-1543-7961
                Article
                PONE-D-19-08347
                10.1371/journal.pone.0218140
                6561598
                31188890
                9e56a129-ace3-46a7-ab2e-28942e9b4a94
                © 2019 Kim et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 8 April 2019
                : 25 May 2019
                Page count
                Figures: 1, Tables: 5, Pages: 12
                Funding
                Funded by: Ministry of Health & Welfare
                Award ID: HI19C0577
                Award Recipient :
                This work was supported by a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (grant number: HI19C0577). The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Medicine and Health Sciences
                Ophthalmology
                Visual Impairments
                Myopia
                Biology and Life Sciences
                Anatomy
                Ocular System
                Ocular Anatomy
                Eye Lens
                Medicine and Health Sciences
                Anatomy
                Ocular System
                Ocular Anatomy
                Eye Lens
                Engineering and Technology
                Equipment
                Optical Equipment
                Optical Lenses
                Biology and Life Sciences
                Anatomy
                Head
                Eyes
                Medicine and Health Sciences
                Anatomy
                Head
                Eyes
                Biology and Life Sciences
                Anatomy
                Ocular System
                Eyes
                Medicine and Health Sciences
                Anatomy
                Ocular System
                Eyes
                Biology and Life Sciences
                Neuroscience
                Sensory Perception
                Vision
                Visual Acuity
                Biology and Life Sciences
                Psychology
                Sensory Perception
                Vision
                Visual Acuity
                Social Sciences
                Psychology
                Sensory Perception
                Vision
                Visual Acuity
                Biology and Life Sciences
                Anatomy
                Ocular System
                Ocular Anatomy
                Cornea
                Medicine and Health Sciences
                Anatomy
                Ocular System
                Ocular Anatomy
                Cornea
                Biology and Life Sciences
                Anatomy
                Ocular System
                Ocular Anatomy
                Pupil
                Medicine and Health Sciences
                Anatomy
                Ocular System
                Ocular Anatomy
                Pupil
                Engineering and Technology
                Equipment
                Optical Equipment
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