Orthokeratology and Myopia Control Park Slope Eye Brooklyn, NY
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Additive effects of orthokeratology and atropine 0.01% ophthalmic solution in slowing axial elongation in children with myopia: first year results

Additive effects of orthokeratology and atropine 0.01% ophthalmic solution in slowing axial elongation in children with myopia: first year results | Orthokeratology and Myopia Control Park Slope Eye Brooklyn, NY | Scoop.it
Purpose To investigate the additive effects of orthokeratology (OK) and atropine 0.01% ophthalmic solution, both of which are effective procedures to slow axial elongation in children with myopia.
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Myopia understanding evolves, becomes clearer

Myopia understanding evolves, becomes clearer | Orthokeratology and Myopia Control Park Slope Eye Brooklyn, NY | Scoop.it
Myopia understanding evolves, becomes clearer Insufficient sunlight exposure could play a part in the complicated interplay of environmental and genetic factors that trigger myopia, evidence suggests, lending further credence to calls encouraging children's outdoor time. “These results will help scientists focus efforts to prevent—or at least delay the onset of—myopia.” Published in the journal Nature Genetics, a new international study identifies 161 genetic factors for myopia-many of which are novel-that essentially quadruples the number of known genetic risk factors playing a role in all retinal cell types, most involved in processing light. Such research adds to a body of evidence that natural sunlight could be a significant environmental factor in developing a disorder that affects nearly 1 in every 3 Americans. Myopia, often called nearsightedness, occurs when the eyeball elongates and causes light to focus in front of the retina as opposed to directly on the light-sensitive tissue. Scientists remain unsure why the eyeball grows longer, though numerous studies show a strong association between measures of education and myopia prevalence. After all, onset typically occurs in young school-age children and progresses through age 20. That said, notable studies concluded it perhaps wasn't the close near-work associated with the classroom, but instead diminished outdoor time. In 2007, it was found that children participating in the greatest amount of sports or outdoor activity were least likely to develop the disorder. While further studies corroborated that conclusion, there remains investigation as to why. Researchers from the Gutenberg Health Study at Mainz University Medical Center believe their latest genetic research helps shed light on a possible answer using data from the international Consortium for Refractive Error and Myopia (CREAM) study. Evaluating more than 250,000 participants across North America, Europe and Asia, the study identified 161 genes related to myopia whereas it had only found nine the year before in a smaller meta-analysis. Furthermore, the study identified retinal cell physiology and light processing as prominent mechanisms, as well as functional contributions to refractive-error development in all cell types of the neurosensory retina, retinal pigment epithelium, vascular endothelium and extracellular matrix, researchers note. This supports the theory that internal layers of the eye communicate with external layers to trigger eye growth. "We have known for some time that education-related behavior is a major environmental factor in developing short-sightedness," notes study co-author Norbert Pfeiffer, head of the department of ophthalmology at Mainz University Medical Center, in a university news release. "Send your kids outside for two hours every day, and it's not just their eyes that will benefit," he adds. 'Outdoor time' the answer? That practical advice isn't far off the mark. In fact, only days ago former New York Congressman Ed Towns echoed researchers' sentiments in an opinion piece for The Hill that more should be done by governments globally to stem myopia progression-and that time spent outdoors could be an easy, commonsense fix. Unfortunately, Towns writes, there is little governmental effort to educate parents about the importance of outdoor play in reducing myopia's impact. "It is my sincere hope that we all stop turning a blind eye to this growing problem and start better protecting the eyesight of our children," he writes. Jeffrey Walline, O.D., Ph.D., AOA Council on Research member and associate dean for research at The Ohio State University College of Optometry who works extensively in myopia progression, says there's notable evidence that more outdoor time is associated with a decreased incidence of myopia onset. However, the mistake many people make is assuming that more outdoor time leads to slower progression of myopia after onset. "For some reason, outdoor time seems to delay the onset of myopia, but it does not have any effect after you become myopic," Dr. Walline says. Again, researchers need more evidence regarding what it is about outdoor time that makes it less likely for children to become myopic. This Mainz University research contributes to that puzzle. "The largest investigation of myopia genetics recently revealed mechanisms that may lead to myopia development, including a role for outdoor time that may be mediated through light-dependent signals from the retina," Dr. Walline says. "These results will help scientists focus efforts to prevent-or at least delay the onset of-myopia." Click here to read more about myopia control efforts and AOA's participation in a landmark U.S. Food and Drug Administration workshop devoted to influencing the premarket evaluation of myopia control devices. JULY 11, 2018Please enable JavaScript to view the comments powered by Disqus. comments powered by Disqus
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Scleral hypoxia is a target for myopia control

Scleral hypoxia is a target for myopia control | Orthokeratology and Myopia Control Park Slope Eye Brooklyn, NY | Scoop.it
Myopia is the leading cause of visual impairment. Myopic eyes are characterized by scleral extracellular matrix (ECM) remodeling, but the initiators and signaling pathways underlying scleral ECM remodeling in myopia are unknown.
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Update in myopia and treatment strategy of atropine use in myopia control

Update in myopia and treatment strategy of atropine use in myopia control | Orthokeratology and Myopia Control Park Slope Eye Brooklyn, NY | Scoop.it
Review Article...
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The wonders of Myopia control

Optometrist, Corrina McElduff gives us the low down on all things myopia control. To find out more, visit: http://www.lynnefernandes.co.uk/shop_services/myop...
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Can Distance Center and Near Center Multifocal Contact Lenses Control Myopia Progression in Children?

Can Distance Center and Near Center Multifocal Contact Lenses Control Myopia Progression in Children? | Orthokeratology and Myopia Control Park Slope Eye Brooklyn, NY | Scoop.it
Clinical Trials - clinicaltrials.gov Myopia has been increasing in prevalence and severity throughout the world over the last 30 years. Increasing levels of myo...
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What every parent needs to know about childhood myopia (short-sightedness)

Myopia (short-sightedness) is an eye condition that commonly develops during childhood and adolescence as the eye grows. While people often associate myopia ...
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Chester Quan's curator insight, May 31, 2:58 PM
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Chester Quan's curator insight, June 5, 1:57 AM
Kids are more nearsighted earlier and faster...
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Myopia Control with Atropine: Truth and Myths - Dr. Jeff Cooper

In this highly practical ODwire.org webinar, Jeffrey Cooper MS, OD, FAAO, FCOVD, Professor Emeritus, SUNY College of Optometry, will catch us up on the lates...
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Safety and efficacy following 10‐years of overnight orthokeratology for myopia control - Hiraoka - 2018 - Ophthalmic and Physiological Optics - Wiley Online Library

Purpose To compare rates of myopia progression and adverse events between orthokeratology (OK) and soft contact lens (SCL) wearers over a 10‐year period in schoolchildren. Methods Medical records of consecutive patients (≤16 years of age at baseline) who started OK for myopia correction and continued the treatment for 10 years were retrospectively reviewed. For the control group, patients who started using soft contact lenses (SCLs) for myopia correction and continued to use them for 10 years were also reviewed. Clinical data, including sex, age, manifest refraction, visual acuity, prescription lens power, and adverse events during the 10‐year period, were recorded. Estimated myopia progression was calculated as the sum of ‘changes in prescription lens power during 10 years’ and ‘residual refractive errors at the 10‐year visit,’ and was compared between groups. We also compared the incidence of adverse events between groups over the 10‐year study period. Results A total of 104 eyes of 53 patients who underwent OK treatment and 78 eyes of 39 patients who wore SCLs fulfilled the criteria. The estimated myopia progression over the 10‐year period found in the OK and SCL groups were −1.26 ± 0.98 and −1.79 ± 1.24 days, respectively; this difference was statistically significant (p = 0.001). Additionally, lower myopia progression was found in the OK in comparison to the SCL group at all baseline ages (p = 0.003 to p = 0.049) except at 16 years old (p = 0.41). No significant difference was found in the number of adverse events found between the OK (119) and SCL (103) groups (p = 0.72). Conclusions The results of this study supports the long‐term efficacy and safety of OK lens wear in reducing myopia progression in schoolchildren.
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Commercialization of research results PolyU turns novel myopia control contact lens to product | ASIA TODAY News & Events

The Hong Kong Polytechnic University (PolyU) entered into a licensing arrangement with Vision Science and Technology Co. Ltd. (VST), a local start-up supported by HKSTP-PolyU Tech Incubation Fund (TIF) and PolyU Tech Launchpad Fund (TLF), for commercializing PolyU's Defocus Incorporated Soft Contact (DISC) lens for myopia control in children. The arrangement exemplifies successful commercialization and transfer of PolyU technology facilitated by entrepreneurship efforts. Myopia (or short-sightedness) is a major cause of ocular morbidity for school children, especially among ethnic Chinese. The optometry research team led by Professor To Chi-ho, Head of the School of Optometry at PolyU, and Professor Carly Lam from the same School, developed the novel DISC lens for this purpose. The award-winning DISC lens brought new hope to the myopic population. The lens is a multi-zone soft contact lens which provides clear vision and at the same time projects blurred, out-of-focus (defocused) images onto the retina to slow down excessive eye growth in myopia. When a child has myopia, the light that enters the eye focuses in front of the retina rather than on it. The new method involves producing a clear image on the retina and another defocused or blurred image in front of the retina. In doing so, the DISC lens makes use of the natural homeostatic mechanism known as 'emmetropization', whereby the eye tends toward a size that allows it to receive focused images as it would do with normal vision, i.e. eye growth is regulated by optical inputs from the environment. The lens improves the wearer's vision and provides constant myopic defocus ("STOP" signal to myopia) at all viewing distances. Spanning two years with a sample of 128 subjects, the clinical control trial showed that DISC lens retarded the progression of myopia by approximately 60% in Hong Kong school children aged 8 to 13. More importantly, the children found the lens comfortable to wear. The new lens also provided clarity that was comparable to conventional single vision lens, which deliver the same optical focal point over their entire area. This technology was patented in Australia, the Chinese mainland, the US and various European countries. Professor To explained, "Since the DISC lens takes advantage of the natural homeostasis of the eye, the wearer can avoid suffering from the adverse effects of drug or surgery. Moreover, the functional element, optical defocus, can be incorporated into widely accepted forms of contact lens to provide clear and comfortable vision while myopia is being controlled." It opens up a new opportunity for treating other refractive errors, such as hyperopia, using suitable defocus. Besides Hong Kong, this technology is highly relevant to many Asian regions, including Singapore, Taiwan, and the Chinese mainland, where myopia prevalence is high. "I am glad that after years of hard work, the research on DISC lens eventually bears fruit through successful commercialization, benefiting children in need with real products," added Professor To. VST, the licensee of the DISC lens for myopia control, is a local company founded by Mr Jackson Leung Tse-man, a PolyU alumnus. Specializing in developing and distributing products for vision improvement, it is the first company in Hong Kong which adopts a tailor-made professional fitting approach to manufacture and provide soft myopic control lenses. The lenses are manufactured according to the prescription of the optometrists to ensure they match the needs of individual customer. VST manufactures DISC lenses using silicon hydrogel, a highly oxygen permeable material approved by the US Food and Drug Administration. It is also one of the most oxygen permeable materials for contact lenses. Under the commercialization arrangement, VST manufactures and provides DISC lenses via a network of optometric clinics, which are recruited as the company's authorized fitting centres. PolyU also prescribes DISC lens at its Optometry Clinic and will provide training for optometrists in fitting the DISC lens on the eyes. "As an optometrist graduate of PolyU, I see good potential in this advanced myopia control method and am impressed by its exceptional result in the clinical trial. The success of commercialization also has to do with PolyU's unreserved support for start-up companies. The licensing arrangement signifies PolyU's remarkable achievement in technology transfer and commercialization of the University's technology through entrepreneurship development," said Mr Leung, Founder and Director of VST. VST was awarded a total of HK$1.6 million, including a matching fund, under TIF and TLF schemes with funding support from the Technology Start-up Support Scheme for Universities under the Innovation and Technology Commission of the Hong Kong SAR Government, and aims to increase the number of authorized fitting centres so that the technology can benefit a wider community. PolyU has long been keen in nurturing the entrepreneurial culture and in providing support to aspiring entrepreneurs. One major way of support is the offer of various seed funds, which are monetary grants awarded to start-ups with no strings attached. The University also provides co-working space for entrepreneurs at PolyU InnoHub, mentorship support through the Startup Consultation Clinic manned by Entrepreneurs-in-Residence, practical training workshops, and opportunities to network with incubators and investors. - End - Press Contacts Professor To Chi-ho Head of the School of Optometry, PolyU Email (852) 2766 6102 Email chi-ho.to@polyu.edu.hk Mr Jackson Leung Tse-man Founder and Director, Vision Science and Technology Co. Ltd Email (852) 9098 8892 Email jacksonlamma@hotmail.com SOURCE / The Hong Kong Polytechnic University (PolyU)
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Shekhar Eye Orthokeratology & Myopia Control Research Center

Today on the World Optometry Day we inaugurated India’s first dedicated Orthokeratology & Myopia Control Research Center at the hands of Padmashree Dr Keiki R. Mehta & Dr Quresh Maskati Both past presidents of All India Ophthalmological Society.
Let’s fight against Myopia progression �
www.chandrashekharchawan.com
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Dr Jaume Paune on Myopia Control

Dr Jaume Paune from Barcelona expert in Orthokeratology & Myopia Control...
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Dr Nitesh Barot on Myopia Control

Dr Nitesh Barot from UK expert Optometrist on Orthokeratology & Myopia Control talks on tips to control Myopia.
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Orthokeratology Obstacles And How To Meet Them

Orthokeratology Obstacles And How To Meet Them | Orthokeratology and Myopia Control Park Slope Eye Brooklyn, NY | Scoop.it
We have a long way to go in our understanding of how ortho-k lenses fit, but there are strategies you can employ to help your patients understand them.
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How To Succeed In Orthokeratology (By Actually Trying)

How To Succeed In Orthokeratology (By Actually Trying) | Orthokeratology and Myopia Control Park Slope Eye Brooklyn, NY | Scoop.it
Part 3 of Steven Turpin's ortho-k series concludes with some orthokeratology tips for lens fitting, patient communication, and other paths to success!
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CooperVision’s MiSight® 1 day crowned ‘Contact Lens Product of the Year’ at the 2018 Optician Awards

CooperVision’s MiSight® 1 day crowned ‘Contact Lens Product of the Year’ at the 2018 Optician Awards | Orthokeratology and Myopia Control Park Slope Eye Brooklyn, NY | Scoop.it
World’s first contact lens proven to slow the rate of myopic progression in children recognised at leading UK industry awards.
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The Myopia Control Song

A parody written and performed by optometrist Sarah Morgan to highlight the risks associated with myopia (short-sightedness) and current approaches to limit ...
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Safety and efficacy following 10‐years of overnight orthokeratology for myopia control - Hiraoka - 2018 - Ophthalmic and Physiological Optics - Wiley Online Library

Purpose To compare rates of myopia progression and adverse events between orthokeratology (OK) and soft contact lens (SCL) wearers over a 10‐year period in schoolchildren. Methods Medical records of consecutive patients (≤16 years of age at baseline) who started OK for myopia correction and continued the treatment for 10 years were retrospectively reviewed. For the control group, patients who started using soft contact lenses (SCLs) for myopia correction and continued to use them for 10 years were also reviewed. Clinical data, including sex, age, manifest refraction, visual acuity, prescription lens power, and adverse events during the 10‐year period, were recorded. Estimated myopia progression was calculated as the sum of ‘changes in prescription lens power during 10 years’ and ‘residual refractive errors at the 10‐year visit,’ and was compared between groups. We also compared the incidence of adverse events between groups over the 10‐year study period. Results A total of 104 eyes of 53 patients who underwent OK treatment and 78 eyes of 39 patients who wore SCLs fulfilled the criteria. The estimated myopia progression over the 10‐year period found in the OK and SCL groups were −1.26 ± 0.98 and −1.79 ± 1.24 days, respectively; this difference was statistically significant (p = 0.001). Additionally, lower myopia progression was found in the OK in comparison to the SCL group at all baseline ages (p = 0.003 to p = 0.049) except at 16 years old (p = 0.41). No significant difference was found in the number of adverse events found between the OK (119) and SCL (103) groups (p = 0.72). Conclusions The results of this study supports the long‐term efficacy and safety of OK lens wear in reducing myopia progression in schoolchildren.
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Myopia progression control lens reverses induced myopia in chicks - Irving - 2017 - Ophthalmic and Physiological Optics - Wiley Online Library

Abstract Purpose To determine whether lens induced myopia in chicks can be reversed or reduced by wearing myopia progression control lenses of the same nominal (central) power but different peripheral designs. Methods Newly hatched chicks wore −10D Conventional lenses unilaterally for 7 days. The myopic chicks were then randomly divided into three groups: one fitted with Type 1 myopia progression control lenses, the second with Type 2 myopia progression control lenses and the third continued to wear Conventional lenses for seven more days. All lenses had −10D central power, but Type 1 and Type 2 lenses had differing peripheral designs; +2.75D and +1.32D power rise at pupil edge, respectively. Axial length and refractive error were measured on Days 0, 7 and 14. Analyses were performed on the mean differences between treated and untreated eyes. Results Refractive error and axial length differences between treated and untreated eyes were insignificant on Day 0. On Day 7 treated eyes were longer (T1; 0.44 ± 0.07 mm, T2; 0.27 ± 0.06 mm, C; 0.40 ± 0.06 mm) and more myopic (T1; −9.61 ± 0.52D, T2; −9.57 ± 0.61D, C; −9.50 ± 0.58D) than untreated eyes with no significant differences between treatment groups. On Day 14 myopia was reversed (+2.91 ± 1.08D), reduced (−3.83 ± 0.94D) or insignificantly increased (−11.89 ± 0.79D) in treated eyes of Type 1, Type 2 and Conventional treated chicks respectively. Relative changes in axial lengths (T1; −0.13 ± 0.09 mm, T2; 0.36 ± 0.09 mm, C; 0.56 ± 0.05 mm) were consistent with changes in refraction. Refractive error differences were significant for all group comparisons (p < 0.001). Type 1 length differences were significantly different from Conventional and Type 2 groups (p < 0.001). Conclusions Myopia progression control lens designs can reverse lens‐induced myopia in chicks. The effect is primarily due to axial length changes. Different lens designs produce different effects indicating that lens design is important in modifying refractive error. Introduction The prevalence of myopia has been shown in a number of studies to be increasing over time1-5 and has reached particularly high proportions in certain Asian populations.6-9 This has generated considerable interest in developing strategies to control myopia. To date these strategies have involved control of progression or prevention of onset (see Chassine et al., Cooper et al., Walline, or Sivak for reviews).10-13 Animal models can provide insight into the mechanisms controlling eye growth,14 and as such, they are valuable tools for developing new strategies for myopia control and possibly even reversal of existing myopia. In chicks, minus lenses induce myopia approximately equal to the inducing lens power.15-17 This myopia comes about mostly via an increase in axial length15, 17 although, a role for the optical components has also been shown.18-20 These studies clearly demonstrate the ability of the visual environment to influence ocular growth and refractive error. Similar findings in other species21-23 including monkeys24 led to the search for myopia control strategies in humans. Some success has been achieved in slowing myopic progression with lens designs that reduce relative peripheral hyperopia.25-35 It has not been shown definitively that it is the reduction in peripheral hyperopia that is specifically responsible for the success and there is evidence that peripheral refraction is unrelated to myopia progression in children.36-39 Most of the results attributed to relative peripheral hyperopia can be explained by alternative mechanisms.36 In general, the animal studies, in chicks, marmosets and guinea pigs, using dual focus Fresnel40, 41 or two zone lenses42-44 that claim to support the peripheral hyperopia hypothesis give results that are consistent with a response close to the average or weighted average power across the pupil. As such, none of these studies have findings that completely inhibit lens‐induced myopia. Two studies have reported results that do not correspond to the average power of the lens across the pupil. In one, monkeys subjected to dual focus lenses emmetropise to the relatively myopic focus.45 In the other, we (Woods et al.46) showed that lens induced myopia can be completely inhibited in chicks when the minus power is combined with Visioneering Technologies Inc. (http://www.vtivision.com) myopia progression control extended depth of focus lens designs (US patents 6,474,814/7,178,918). These lenses have a relatively positive powered peripheral lens design. There are at least two possible explanations for the Woods et al.46 results. The first is that a reduction in relative peripheral hyperopia does play an active role in reducing the development of myopia. Alternatively, a second explanation is that the increased depth of focus of the lenses reduces the emmetropization signal and the chicks simply fail to emmetropise to the inducing lens power. Should the second explanation hold, then if one were to induce myopia and subsequently apply the myopia progression control lenses, the expectation would be that the chicks would remain myopic (i.e., there is no need for the refractive error to change and no signal for change). If however, the chicks were to decrease in myopia, then there would be strong evidence that the eyes were in fact responding to the periphery of the lens. Therefore, the specific aim of this study was to determine whether myopia induced with conventional minus lenses worn for a period of 7 days could be reversed or reduced by wearing these myopia progression control lenses of the same nominal power but different peripheral designs (Type 1 and Type 2), over the next 7 days. Methods The study received ethical approval from the University of Waterloo's Animal Care Committee, complied with the Canadian Council on Animal Care use and treatment of research animals, and adhered to the ARVO guidelines for the use of animals in ophthalmic and vision research. The animals used in the study were Ross‐Ross strain chickens (Gallus gallus domesticus). They were raised on a 14 h light/10 h dark cycle in stainless steel brooders at 32°C and given food and water ad libitum. Chicks were monitored twice daily, once by the animal care technicians for health, and once by the researcher to assess the lenses. All lenses were supplied by Visioneering Technologies Inc. and had a measured power of −10.00D, verified using a lensometer (focimeter) with a 5 mm aperture. Conventional and Test lenses were identical in every respect, with the exception that the peripheral power profiles of the Test lenses had a continuous relative positive power gradient without any distinct optical zones or discontinuities. For specific details regarding the power profile the reader is referred to Figure 3 and the formula in Claim 1 of US patent #6474814. Type 1 decreased in minus from −10.00D at the centre to −7.25D (i.e., 2.75D less minus) at the pupil edge based on a 2.5 mm pupil diameter and were designed for and fitted at a vertex distance of 5 mm. Root mean square higher order aberrations provided by Visioneering Technologies, Inc. for a −10.00D lens power at a 2.5 mm aperture were 0.041 microns, as measured by the NIMO Model TR1504 (Lambda‐X, http://www.lambda-x.com) using a phase‐shifting Schlieren measurement technique. Type 2 lenses were similar but with a less steep power gradient which decreased from a central power of −10.00D to −8.68D (i.e., 1.32D less minus). Aberration data were not available for the Type 2 lenses but would be expected to be less than that of the Type 1 lenses. The overall diameter of the lenses was 20 mm including a flat flange to which Velcro™ was glued that was used to attach the lens to the bird. The optical portion of the lens was 15 mm in diameter and the lens was transparent throughout. The lens designs, which are highly aspheric and gradually change power creating a smooth, continuous power curve of increasing relative plus, were originally created based on human physiology and the predicted amount of lens power required to create the unique extended depth of focus. Those power profiles were then scaled to the anatomy (i.e., the pupil) of the chick to be equivalent to what the relative power profile would be in a human. Two different lens designs were chosen to be quite distinct from each other, so that the possibility of a dose‐response relationship could be examined between the two different lens designs. Fifty‐two newly hatched chicks were fitted unilaterally with Conventional design −10.00D lenses (spherical design), which they wore for 7 days to induce myopia. The lenses were attached to the right eye (RE) of all birds using Velcro™ rings held on by cyanoacrylic glue to the feathers around the eye. This allowed the lenses to be removed for cleaning. Two birds lost lenses prior to Day 7 and were eliminated from the study. On Day 7, the remaining 50 myopic chicks were randomly divided into three groups. Sixteen chicks were fitted with Type 1 lenses, 19 chicks were fitted with Type 2 lenses, and 15 remained with Conventional design lenses. Thus, all right eyes are considered treated; initially all had Conventional designs and then right eyes were subsequently treated with either Conventional, Type 1 or Type 2 designs. The left eyes were untreated and served as control eyes. Refractive error and axial length (anterior cornea to retina) were measured on alert birds using retinoscopy (precision of 0.50 dioptres)5, 47 and ultrasonography (Accutome A‐Scan Plus Ultrasound, http://www.accutome.com, precision of 0.02 mm)48 respectively on Days 0 (prior to lens application), 7 and 14 on all birds. The experimenter making the refractive error and axial length measurements was blind as to which of the three groups the chicks belonged. Lenses were only removed for measurement and cleaning when necessary. Birds that lost their lenses were removed from the study (N = 9; 2 prior to day 7, 1 Conventional, 2 Type 1, 4 Type 2). For birds with astigmatic refractive error, the mean ocular refractions (spherical equivalent) were used in the analysis. Results were analysed with respect to the mean differences (Mean [right eye (RE) – left eye (LE)] ± S.E.) between treated and untreated eyes in order to control for the small eye artefact.49 Comparisons were made between treatment assessment day (within group—Day 0, Day 7, Day 14) and lens design (between groups—Conventional, Type 1, Type 2) using a mixed design ANOVA and Bonferonni corrected post‐hoc tests (Statistica 8 software, http://www.statsoft.com). Results On Day 0 there were no statistically significant differences (p < 0.05) in refractive error or axial length between treated (RE) and untreated (LE) eyes for any of the groups and therefore no interocular differences between groups (see Table 1, Figure 1). On Day 7 treated eyes were longer and more myopic (~10D ≥95% compensation) than untreated eyes for all groups and there were no statistically significant differences (p < 0.05) between the groups (Table 1, Figure 1). Day Rx RE D (S.E.) Rx LE D (S.E.) Rx RE‐LE D (S.E.) Length RE mm (S.E.) Length LE mm (S.E.) Length RE‐LE mm (S.E.) Conventional lens (n = 14) 0 3.93 (0.63) 3.93 (0.64) 0.00 (0.14) 7.90 (0.06) 7.84 (0.06) 0.05 (0.05) 7 −6.07 (0.62) 3.43 (0.25) −9.50 (0.58) 9.04 (0.04) 8.64 (0.07) 0.40 (0.06) 14 −9.36 (0.71) 2.54 (0.19) −11.89 (0.79) 10.31 (0.06) 9.75 (0.08) 0.56 (0.05) Type 1 lens (n = 14) 0 3.86 (0.77) 3.86 (0.70) 0.00 (0.16) 7.80 (0.07) 7.81 (0.04) −0.01 (0.05) 7 −5.96 (0.55) 3.64 (0.25) −9.61 (0.52) 8.97 (0.10) 8.53 (0.07) 0.44 (0.07) 14 5.27 (1.12) 2.36 (0.18) 2.91 (1.08) 9.47 (0.11) 9.60 (0.08) −0.13 (0.09) Type 2 lens (n = 15) 0 4.37 (0.68) 4.37 (0.67) 0.00 (0.05) 7.72 (0.05) 7.77 (0.04) −0.05 (0.06) 7 −5.57 (0.58) 4.00 (0.24) −9.57 (0.61) 8.88 (0.05) 8.61 (0.06) 0.27 (0.06) 14 −1.47 (0.88) 2.37 (0.12) −3.83 (0.94) 10.02 (0.09) 9.66 (0.05) 0.36 (0.09) At Day 14, 14 Conventional treated birds, 14 Type 1 treated birds and 15 Type 2 treated birds still had lenses. As shown in Table 1 and Figure 1, treated eyes of chicks wearing Conventional design lenses were still longer (Mean RE‐LE = 0.56 mm ± 0.05) and more myopic (Mean RE‐LE = −11.89 D ± 0.79) than untreated eyes. Myopia progression control Type 1 treated eyes became more hyperopic (Mean RE‐LE = 2.91 D ± 1.08) and were shorter (Mean RE‐LE = −0.13 mm ± 0.09) than untreated eyes. Figure 1d,e indicates that treated eyes were longer than untreated eyes at Day 7. Treated eyes wearing myopia progression control Type 1 lenses that were longer than their untreated counter parts on Day 7 (8.97 treated vs 8.53 untreated) did become shorter than their untreated counterparts at Day 14 (9.47 treated vs 9.60 untreated), but did not shrink (9.47 Day 14 vs 8.97 Day 7). Rather, they continued to grow over the 7‐day period, albeit at a slower rate than previously (0.07 mm/day week 2 treatment vs 0.17 mm/day week 1 treatment). In Type 1 treated birds the treated eyes also grew slower during week 2 of treatment (0.07 mm/day) than the untreated eyes (0.15 mm/day). Refractive error, on the other hand, did reverse direction in absolute (Figure 1a) as well as relative (Figure 1c) terms with the Type 1 lenses. Myopia progression control Type 2 treated eyes were more myopic (Mean RE‐LE = −3.83 D ± 0.94) and longer (Mean RE‐LE = 0.36 mm ± 0.09) than untreated eyes but less myopic than Conventional treated eyes. Some but not all treated eyes developed astigmatism by day 14 (Table 2). No birds had astigmatism >1D on Day 0 or 7. The prevalence of astigmatism >1D on Day 14 for Conventional, Type 1 and Type 2 treated eyes was 14%, 43% and 53% respectively. Using Fisher's exact test, this prevalence was not significantly different between Conventional and Type 1 (p = 0.21) or Conventional and Type 2 (p = 0.0502) treated eyes. Percentage with astigmatism Mean (S.E.) D Conventional lens (n = 14) 14% −1.357 (0.923) Type 1 lens (n = 14) 43% −2.679 (0.913) Type 2 lens (n = 15) 53% −3.133 (0.844) A mixed design analysis of variance indicated a significant effect of lens design for both refractive error difference (F2,40 = 33.7; p < 0.001) and axial length difference (F2,40 = 7.1; p = 0.002). There was also a significant main effect of day for both refractive error difference (F2,80 = 193.6; p < 0.001) and axial length difference (F2,80 = 30.6; p < 0.001) as well as a significant interaction between lens type and day for refractive error difference (F2,80 = 50.8; p < 0.001) and axial length difference (F2,80 = 12.6; p < 0.001). Post hoc tests showed that the refractive error differences for all of the groups on Day 14 were significantly different from each other (p < 0.001). On Day 14 Type 1 length differences were significantly different from both the Conventional group and the Type 2 group (p < 0.001). Type 2 length differences were not significantly different from the Conventional group (p > 0.05). Figure 2 shows the individual variability of refractive error difference between the two eyes and axial length difference between the two eyes for the treatment days assessed and the three lens designs. Figure 3 shows the correlation between refractive error and axial length differences between the two eyes on Day 14 (Pearson's correlation coefficient, r = −0.64, p < 0.05). Discussion and conclusions Although unexpected, it is clear from these results that these myopia progression control lens designs can reverse lens‐induced myopia in 7–14 day old chickens and that the effect is largely the result of axial length changes (Figure 3). The results also suggest that peripheral lens design can affect refractive error. If in the Woods et al.46 study the large depth of focus produced by these lenses simply overwhelmed the normal emmetropization mechanism such that the eyes did not respond to the central minus power, then the expectation in this experiment would be that the birds would again not respond and remain myopic once myopia had been induced by the Conventional lenses. Since the birds did not maintain the same degree of myopia (and in the case of the Type 1 design, had a complete refractive reversal) that hypothesis is not supported. The two different myopia progression control lens designs behaved differently, indicating that the lens design itself is an important factor. There appear to be some outliers in the data. For example, three birds (one from each group) did not become as myopic on Day 7 with the Conventional lenses as one would expect (Figure 2). It is not clear why this occurred as there were no obvious differences between these birds and those that did respond as expected. There were also some birds (four on Day 7 and one on Day 14) whose refractive errors were not consistent with their axial lengths. Again, the reason for this is unclear. Axial length measurement error, inherent in measuring very small eyes, may account for some of the differences, however other physiological factors, such as cornea and crystalline lens powers, may contribute. While every effort was made to keep the lenses clean and centred on the pupil, the effects of any inadvertent decentration are unknown. Chickens, like most birds, have limited eye movement.50, 51 They also do not have a fovea, although they do have an area centralis. Any effects of eye movement and/or looking through the periphery of the lens with ‘central’ vision as a result of eye movement could not be controlled for and are unknown. That being said, no behavioural differences between birds with regard to head or eye posture were observed and birds with Test lenses could not be distinguished from those with conventional lenses on this basis. It is highly unlikely that any birds viewed only through the peripheral portion and not the central portion of the lens. It is well known that experimental myopia reverses quite rapidly in chicks (≤4 days) when either form deprivation52 or an inducing lens17, 53, 54 is removed. Induced myopia also reverses when negative lenses are replaced with positive lenses,15, 40 although in chicks this can induce significant astigmatism.15 The question addressed by the current experiment is whether or not myopia can be reversed while maintaining the same minus power in the central portion of the lens and altering the peripheral power. To our knowledge, the results from the Type 1 lens are the first in which myopia is completely reversed while maintaining the same central minus power and no positive power within the lens. Schaeffel and Howland55 did have a portion of their birds recover from myopia despite continuing to wear minus lenses. Unlike their findings, none of our birds that were treated continuously with the conventional lenses showed recovery. McFadden et al.40 have shown partial reversal of previously induced myopia in guinea pigs using −5D/+5D Fresnel lenses. Their lens design had both positive and negative power presented within the pupil. The refractive result for replacement of the initial myopia inducing minus lens with Fresnel lenses (−5D/+5D) was intermediate, between that of continued single vision minus lens wear and replacement of the initial myopia inducing lens with a single vision positive lens. Liu and Wildsoet43 induced myopia in 12 day old chicks by having them wear single vision −10D lenses for 5 days. They then replaced the −10D inducing lenses with 2 zone lenses (−5C/−10P or −10C/−5P). There was some regression of the previously induced myopia as would be expected from averaging of the power of the 2 zones but all chicks still remained somewhat myopic. Tse et al.41 did get complete recovery when −10D was replaced with a lens design incorporating both + and − 10D. This also is the response that would be expected if the eye were responding to the average of the two powers within the lens, which in the Tse et al. study would have averaged to plano. Although the Visioneering Technologies Inc. myopia progression control lenses have a gradient rise in relative plus power, the actual power throughout the lens is still negative. This negative lens power was verified by the use of a lensometer with a 5 mm lens stop aperture. Unlike the McFadden et al.40 experiment, our chicks cannot be responding directly to plus power as there is no actual plus power within the lens design. However, this does not prevent the peripheral image from lying in front of the retina. If the central power corrects the myopia induced by the Conventional lenses and the eye shape is flatter than the image surface created by the nominal central lens power, which in the chick it will be, any reduced minus power in the periphery will put the image in front of the retina presumably sending a stop signal to axial eye growth. This of course will change as the eye changes shape and the exact image position will depend where the peripheral focus was to start with, the shape of the eye and the manner in which the eye shape changes. Similar to our study, the Liu and Wildsoet43 experiment does have negative power throughout the lens (their −10C/−5P lens would be most similar to ours), but unlike our study, they did not observe complete reversal of previously induced myopia. This finding would suggest that the gradient nature of the design of the Visioneering Technologies Inc. myopia progression control lenses is of some significance, with a potential dose‐response type relationship being shown with these data between the Type 1 and Type 2 myopia progression control lens designs. A significant difference between our study and previous ones is that we used a lens design with continuous power change rather than one with discrete zones. It has been shown that the size of the central zone has an effect on whether or not central refractive status is affected.54, 56-58 It may be that the absolute power values are not as important as the relative difference between the centre and the periphery or possibly the change in power from centre to periphery. These data do suggest that perhaps the exact mechanism is more complicated than simply responding to absolute image position; there could be integration of information such that the eye is detecting the defocus gradient itself and using this to control eye growth. Another possibility is that the lenses are creating a ‘virtual aperture effect’ with the Type 1 lenses creating a smaller ‘aperture’ and therefore greater effect than the Type 2 lenses. Peripheral annular blur is visible through Type 1 but not Type 2 lenses. We have seen in other animal studies with real apertures that once the aperture size decreases below a critical level, usually about 4 mm the normal response to imposed defocus is altered.44, 54, 56-60 This has been interpreted as the periphery having more influence than the centre as the aperture decreases. Irving et al.54 found decreased compensation to both plus and minus lenses with apertures ≤5 mm. Interestingly in these experiments, despite the periphery being a translucent goggle, the default did not appear to be form deprivation myopia as would be expected if the periphery was simply having more influence. There may be some similarities to the ‘set point’ of McLean and Wallman59 or the ‘eye size effect’ of Siegwart and Norton.61 McLean and Wallman, creating large amounts of blur with high powered cylindrical lenses, observed that the eye returned to some ‘set point’. Siegwart and Norton found that pre‐treatment with plus lenses resulted in increased response to subsequent treatment and gave this as evidence for the operation of an ‘eye size’ mechanism. It is possible that the peripheral optics of these lenses are preventing the centre from controlling eye growth without providing any usable peripheral signal and the eye is reverting to some inherent refractive state or ‘set point’ via some ‘eye size’ mechanism. Further study is necessary to understand the underlying mechanisms of refractive control in general and the current lens design in particular. These results provide incentive to explore new possibilities. A limitation of the study is that peripheral refractions and ocular component data other than axial length were not obtained. Axial length measures were to the retina so, although we do not know what choroidal effects there may have been, any choroidal effects on axial length would have been accounted for in the length measures. Peripheral refractions and ocular component measures would be necessary for future research in optical modelling of image surfaces in relation to three dimensional continuous growth, but getting accurate, reliable peripheral refraction data will be a challenge because of the small eyes and inability to control fixation in chickens. Any induced astigmatism should also be considered. Apart from furthering our knowledge of how these myopia progression control lenses might work, the results of this study raise the issue of whether or not myopia, once it exists, can be reversed as the eye grows. Up until now efforts have been directed at reducing progression, or at best, preventing its occurrence. If in fact active myopia reversal turns out to be achievable, the practical application would be of considerable consequence to the human condition. Acknowledgements As well as providing financial support for the study, the lenses were designed and provided by Visioneering Technologies, Alpharetta GA, (US patents 6,474,814/7,178,918). Funding support to E. L. Irving from Natural Sciences and Engineering Research Council of Canada (NSERC) Discovery Grant 06554. These data have been partially presented at the American Academy of Optometry Annual meeting, November 12, 2014, Denver, Colorado, USA. The authors wish to acknowledge the editorial contributions of Sally Dillehay, OD and Linda Lillakas to this work. Disclosure The authors have no proprietary interest in any of the materials mentioned in this article. Visioneering Technologies, Inc. partially funded the study and paid consulting fees indirectly related to the study to E. Irving. References
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Eye Insight: Meet Dr. Xiaoying Zhu, Lead Clinician at University Eye Center's Myopia Control Clinic

In the 1970s, one in four children had myopia, the medical term for nearsightedness. Fast forward and that number has jumped to 40% of kids—nearly one in two...
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VM - Myopia Management Expert Launches Website

VM - Myopia Management Expert Launches Website | Orthokeratology and Myopia Control Park Slope Eye Brooklyn, NY | Scoop.it
Product: www.managemyopia.org Top Line: To help better manage one of the primary contributors to global vision loss—myopia—Thomas Aller, OD, FBCLA, a prominent authority on the disease, has launched an educational and informational website, ManageMyopia.org. The clinically reviewed resource will summarize the latest data on myopia so that management of the disease is easier for busy eyecare professionals to find, analyze and apply. Close Up: Vision care professionals have become concerned about the impact of myopia in children where it can become more severe over time, even resulting in blindness, if not treated. “Myopia is one of the principal causes of vision deterioration worldwide, and it is increasing here in the U.S. and globally,” said Aller. “The good news is that new research and promising modalities are being rapidly introduced. With ManageMyopia.org, ECPs will have immediate access to a centralized source of carefully vetted data developed to help them provide better vision for their patients.” Aller, who has been conducting myopia control research for more than 25 years, is the clinical content editor and curator for ManageMyopia.org. He holds several patents in the field of myopia and has enjoyed a long collaboration with leading myopia researchers. He is currently a visiting scholar at the University of California, Berkeley School of Optometry, as well as an adjunct professor, University of Houston College of Optometry. Additionally, Aller is on the clinical guidelines committee for the International Myopia Institute, a scientific, clinical advisor for Treehouse Eyes, an organization dedicated to finding myopia treatments for children. Aller is also on the advisory board for Visioneering Technologies, Inc., the makers of the NaturalVue multifocal 1 Day Contact Lenses. The new ManageMyopia website is supported by an unrestricted educational grant from Visioneering Technologies Inc. Supporting Aller on ManagingMyopia will be an advisory board comprised of several leading vision care experts. These include: • Jeffrey Cooper, MS, OD, FAAO, professor emeritus at the State University of New York (SUNY) College of Optometry. • S. Barry Eiden, OD, FAAO, president and medical director of North Suburban Vision Consultants, Ltd. and an assistant clinical professor at the University of Illinois, Chicago’s Department of Ophthalmology. • Alan N. Glazier, OD, FAAO, Dipl ABO, founder of the Shady Grove Eye and Vision Care, founder of ODs on Facebook and ODsonFB.com, as well as the MyopiaInstitute.com. • Somi Oh OD, FIAO, Orthokeratologist of Eye Boutique Optometry in Santa Clara, Calif., Consultant for Advance Vision Center of Optometry in San Jose, Calif., and of Dreamlens Research Co. in Seoul, Korea. • Christine Wildsoet, DipAppSc(Optom) BSc (PharmHons) PhD, FAAO, Professor at the School of Optometry/Vision Science Program, University of California, Berkeley. Wildsoet also heads the Berkeley Myopia Research Group, chairs a committee for the International Myopia Institute, and serves on the advisory board for MyFun, a European-based myopia research consortium. Vital Stats: The new website features the latest data highlights from research and peer-reviewed journals on leading-edge therapies for myopia, with a focus on evidence-based clinical data, practical treatment options, and hands-on management strategies. ManageMyopia.org also features streamlined navigation and a responsive, user-friendly interface to ensure easy access to information on mobile, tablet and desktop computers. www.managemyopia.org
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Jeffrey J. Walline, OD, PhD—Associate dean for research, The Ohio State University College of Optometry

Jeffrey J. Walline, OD, PhD—Associate dean for research, The Ohio State University College of Optometry | Orthokeratology and Myopia Control Park Slope Eye Brooklyn, NY | Scoop.it
Jeffrey J. Walline, OD, PhD, discusses working with kids, myopia, and In-N-Out Burger.
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Overnight Orthokeratology: Technology, Efficiency, Safety, and Myopia Control

Overnight Orthokeratology: Technology, Efficiency, Safety, and Myopia Control | Orthokeratology and Myopia Control Park Slope Eye Brooklyn, NY | Scoop.it
Journal of Ophthalmology is a peer-reviewed, Open Access journal that publishes original research articles, review articles, and clinical studies related to the anatomy, physiology and diseases of the eye.
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Dr Tom Arnold speaks on Myopia Control

Dr Tom Arnold OD from Texas USA experts in Scleral Lenses, Orthokeratology & Myopia Control talk in BIPOK Masterclass Knowledge Fest in Goa...
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Dr Cary Herzberg talks about Myopia Control

Cary Herzberg is Optometrist from USA expert in Myopia Control President of International Academy of Orthokeratology & Myopia Control...
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