Long Term Observation Of Fundus Progression In Highly Myopic Children And Peripheral Defocus Modifying Lenses On Myopia Control

Objective1.To investigate the progression of myopic maculopathy(MM),parapapillary diffuse choroidal atrophy(PDCA)and associated factors in highly myopic Chinese children during 4 years follow up.2.To observe the 4-year myopia progression in children of wearing peripheral defocus modifying lenses,and assess the efficacy of myopia control.3.To compare the differences in disc foveal distance(DFD)and parapapillary atrophy(PPA)between children wearing PDMLs and SVLs and investigate the effect of peripheral refraction on the development of retinal morphological features.Methods:1.The inclusion criterion was a baseline age of less than 18 years and a refractive error of<-6.0 diopters.The included children accepted the fundus photographs and followed up for more than 4 years.Myopic maculopathy was defined as recommended by the Meta-analysis of Pathologic Myopia Study Group.Biometric measurements of fundus structures were carried out using the Image J software.PDCA,fundus tessellation were recorded.Multivariate analysis was used to explore the risk factors with PDCA and MM.2.Retrospective,non-randomized controlled trial at a tertiary referral center.Children aged 8～14 years who wore peripheral defocus modifying lenses(PDMLs)and single vision lenses(SVLs)consecutively for 4 years were collected from the electronic medical records.PDMLs was an asymmetric design and slowed the myopia development using peripheral vision control technology.Finally,88 children were included after propensity score matching.Only right eyes were analyzed and generalized Estimation Equation(GEE)model was used to determine whether myopia progression differed between the two groups.3.The myopic children from part 2 who continuously wore SVLs,PDMLs for more than 1 year and received fundus photography were included in the study.The width of PPA and DFD were measured in pixels using Image J software,and the differences between the two groups were compared using Mann-Whitney U test.Results:1.The study included 274 children(mean age:11.7±2.5 years;mean refractive error:-7.66±1.87 diopters)with a mean follow-up of 4.9±1.2 years.MM progression was detected in 52 eyes(18.9%;95%confidence interval[CI]:14.3%,23.7%).In multivariable analysis,MM progression was associated with a decrease in refractive error(odds ratio[OR]:0.72;95%CI:0.56,0.92;P<0.001)(i.e.higher myopization)and enlargement of parapapillary gamma zone(OR:7.68;95%CI:1.63,36.2;P=0.002).Incident peripapillary diffuse choroidal atrophy noted in 47 of 236 eyes(20.0%;95%CI,14.8%-25.2%),was correlated with a decrease in refractive error(OR:0.70;95%CI:0.54,0.92;P=0.009)(i.e.,higher myopization)and greater gamma zone enlargement(OR:8.28;95%CI:1.33,51.7;P=0.02).2.Annual myopia progression was(-0.85±0.43)D,(-0.60±0.35)D,(-0.64±0.26)D and(-0.53±0.28)D in PDMLs group,and(-0.82±0.42)D,(-0.79±0.44)D,(-0.61±0.40)D and(-0.58±0.33)D in SVLs group,respectively.59.1%(26/44)in PDMLs group progressed lower than 2.00 D,slightly higher than that of 50.0%(22/44)in SVLs group(χ~2=2.06,P=0.12).After stratified by age,the differences in myopia progression between PDMLs and SVLs were+0.35D、+0.23D and-1.03D.In GEE model,annual myopia progression was associated with age(β=0.06;standard error:0.01;95%CI:0.03,0.09;P<0.001),treatment(β=-0.09;standard error:0.05;95%CI:-0.19,-0.01;P=0.04).3.27 patients were collected in the SVLs group,the width of PPA was 41.4±6.8,and the DFD was 2.58±1.78 at baseline.19 patients were included in the PDMLs group,the width of PPA was 40.2±5.4,and the DFD was 2.32±1.77.During the follow-up period,the change of DFD was 1.71±5.63 in PDMLs group and 1.25±5.63in SVLs group.The change of PPA was 1.39±1.43 in the PDMLs group and1.35±1.30 in the SVLs group.There was no significant difference in changes between the two groups.After stratified by wearing time,the DFD development in PDMLs was shorter than SVLs group(0.95±5.28 vs.1.46±2.78,Z=2.24,P=0.03).While,the myopia progression was also slower in PDMLs group(-1.26±0.42 D vs.-1.69±0.37 D,Z=-2.28,P=0.04).Conclusions1.The MM prevalence at baseline was 35.4%,50.7%,and 13.9%for categories 0,1,and 2,respectively.Progression of MM during a mean follow-up of 4.9 years was detected in 18.9%of highly myopic schoolchildren.We observed an incident PDCA in 47 of the remaining 235 eyes(20.0%).Enlarging gamma zone may be a biomarker for progression of MM and may be measured in schoolchildren with progressing myopia.Considering the relatively high progression rate,the findings suggest that myopia in schoolchildren may have a risk of converting into pathologic myopia in later life.2.Compared to single vision lenses,peripheral defocus modifying lenses could relatively slow myopia progression moderately,especially in the second wearing year.The efficacy of myopia control was associated with age,and the marked difference was found in younger children.It was suggested that personalized design and fitting may be added in the process in future,so as to improve the effect of myopia prevention and control.This study provides more clinical evidence for the myopia prevention and control of PDMLs.Age should be considered in the fitting,and the lens should be accurately selected to adapt to the crowd.3.The increase of the DFD was shorter in PDMLs in the second wearing year compared with SVLs group.This study suggests that PDMLs can delay the DFD increase,which provides a new idea for the prevention and control of myopia,and high myopia.This study suggests that the lens design should be optimized,and further studies should be conducted on the peripheral defocus modifying contact lens to observe the influence on retina.