Myopia has emerged as a major ocular health issue
recently because of its increasing prevalence worldwide1
and its progressive nature in children.
Myopia or near-sightedness is caused due to increase in
axial length or corneal curvature. The increase in axial length is governed by
different etiological factors2, among all near work3
and peripheral retinal image formation4 have been formulated to be
Animal studies5, 6
have shown that elimination of signals from the fovea did not interfere with
emmetropization, but inducing hyperopic
defocus on the peripheral retina promoted development of axial myopia in infant
monkeys. This experiment led to the proposal, peripheral retina defocus leads
to alternation of retinal shape causing axial elongation and myopia progression
Donder10 and Helmholtz11 considered myopia to be an
acquired anomaly associated with over-exertion in near work. It was observed that during near work myopic
children shows lag of accommodation 12
which results in a reduced power of the eye thus causing relative hyperopic
defocus at near, Since it is known from animal studies5, 6
that a hyperopic defocus leads to the development of myopia, the Lag of
accommodation might be a risk factor for the development and/ or progression of
As peripheral hyperopic
defocus triggers myopia progression, the treatment modality for Myopia should
be potentially focused on modifying peripheral refraction to counterbalance the
known stimulus that triggers eye elongation and subsequent progression of myopia.
The conventional myopic spectacle lens increases hyperopic defocus in periphery
so to change RPR profile studies have tried adding tints(radiant refracting
lens) or pantascopic tilt which resulted in myopic defocus at peripheral
retinal plane14, 15
although study has shown that these
changes are only for distance , hyperopic defocus still persists near work.16
Conventional soft and
rigid gas permeable (RGP) contact lenses reduces relative peripheral hyperopia,
and can even results in relative peripheral myopia, particularly in high myopia17, 18.
Commercially available multifocal
contact lenses (MFSCL) intended for presbyopic correction served as myopia
control lenses in some studies 19, 20
. The peripheral add power area has shown to induce significant changes in the
peripheral refractive error profile in myopic eyes as compared to distance
power in the periphery19. Walline JJ et al., 21
in their study found 50% reduction in myopia progression and 29% reduction in
axial elongation during the 2-year treatment period with MSCL.
Reverse geometry contact lenses for corneal reshaping tend
to have promising result in retarding eye elongation 22-24. Ortho k lenses alter ocular
growth pattern by inducing relative peripheral myopic refractive error (RPRE)
whereas the central refraction is fully corrected. Studies comparing
conventional RGP and ortho k lenses have found ortho k lenses have significantly
reduced myopia in the central 20° VF in myopic children25.
Majority of studies have measured RPR
only in horizontal meridian using different modalities of myopia correction,
Atichson et al.,26 found that in vertical meridian myopes
had peripheral myopic defocus. Study on
size and shape of myopic eye by Verkicherla et al.,9
reported difference in peripheral refraction along horizontal and vertical
meridian. On measurement for near peripheral refraction in myopia by Calver et
showed peripheral hyperopia in low myopes and peripheral myopia in high myopes.
However there is a lacunae in all the previous study as none of them have
measured horizontal and vertical meridian PRP for distant and near with all the
modalities such as single vision glasses, Anti-myopia lenses, spherical soft
contact lens, multifocal contact lens and ortho-K. So, the aim of our study is
to measure horizontal and vertical meridian PRP for distant and near with
different corrective modalities.
Subjects: All participants will be drawn from L V Prasad Eye
Institute, Hyderabad. Their informed consent will be obtained prior to the
experiment and experiment protocol will be approved by institute’s ethic
Age -18 to 25 years
Myopia of at least -1.00D , astigmatism of no
more than -1.00D
Best corrected logMAR visual acuity of 0.0logMAR
for distance and 0.4logMAR for near.
No ocular pathology
Contraindications/ intolerance to contact lens
One eye from each
subject will be investigated (eye with the more myopic refraction will be used).
Comprehensive eye examination will be performed, which includes subjective non
cyclopelgic refraction, slit lamp examination, axial length measurement with
lens star and undilated fundus examination.
will be measured in both horizontal and vertical meridians using —- open
field binocular auto refractometer at a distance of 3mtrs and 40cms. The
subject will be seated with the head stabilized in a chin-rest so that the eye
will be aligned with the central target.
Subjects will be asked only to and rotate their eyes to view a series of
fixation targets. Refractive error will be measured 3 times on-axis, and 3 times
at each eccentricity in 5° increments out to 35° both nasally and temporally
horizontally and out to 15° vertically. Readings will be averaged for each
subject in all positions. The axis of the auto refractor will be aligned with
the centre of the entrance pupil during all measurements. For near Maltase
cross will be given as a target placed 40cms away from corneal apex.
Each subject will have
to participate for 2 days, Day 1 will consist of measurements with glasses,
anti –myopia lenses, Single vision soft contact lens and multifocal contact
Subjects will be fitted
with Ortho K lenses and advised to sleep with lenses on at least for 8 hours,
the next day lenses will be removed and measurement will be performed. All the
tests will be performed in randomised order.
Material / Instrument required:
Open field autorefractometer
Anti- myopia lenses (Essilor)
Single vision SCL (B& L , J & J)
Multifocal SCL (central distance design – low
add à B
Ortho K lenses (Paragon CRT)
1. Holden, B.A., et al., Global Prevalence of Myopia and High Myopia
and Temporal Trends from 2000 through 2050. Ophthalmology, 2016. 123(5): p. 1036-42.
C.W., D. Ramamurthy, and S.M. Saw, Worldwide
prevalence and risk factors for myopia. Ophthalmic Physiol Opt, 2012. 32(1): p. 3-16.
B., et al., Associations between near
work, outdoor activity, and myopia among adolescent students in rural China:
the Xichang Pediatric Refractive Error Study report no. 2. Arch Ophthalmol,
2009. 127(6): p. 769-75.
J., F. Rempt, and W.P. Hoogenboom, Acquired
myopia in young pilots. Ophthalmologica, 1971. 163(4): p. 209-15.
E.L., 3rd, et al., Peripheral vision can
influence eye growth and refractive development in infant monkeys. Invest
Ophthalmol Vis Sci, 2005. 46(11): p.
J., L.F. Hung, and E.L. Smith, 3rd, Recovery
of peripheral refractive errors and ocular shape in rhesus monkeys (Macaca
mulatta) with experimentally induced myopia. Vision Res, 2012. 73: p. 30-9.
A., et al., Peripheral refractive errors
in myopic, emmetropic, and hyperopic young subjects. J Opt Soc Am A Opt
Image Sci Vis, 2002. 19(12): p.
R., Peripheral refraction for distance
vision in emmetropes and myopes.
Ophthal. Physiol. Opt., 2007.
P.K., et al., Eye shape and retinal
shape, and their relation to peripheral refraction. Ophthalmic Physiol Opt,
2012. 32(3): p. 184-99.
F.C. and W.D. Moore, On the anomalies of
accommodation and refraction of the eye: With a preliminary essay on
physiological dioptrics. Vol. 22. 1864: New Sydenham Society.
Helmholtz, H., Treatise on Physiological
Optics. Hamburg, Germany: Verlag von Leopold Voss; 1909. Translated by
Southhall JPC. 1962, New York: Dover Publications.
J.E., et al., Accommodation and related
risk factors associated with myopia progression and their interaction with
treatment in COMET children. Invest Ophthalmol Vis Sci, 2004. 45(7): p. 2143-51.
J., et al., A dynamic relationship
between myopia and blur-driven accommodation in school-aged children.
Vision Res, 1995. 35(9): p.
R.C., et al., Pantoscopic tilt in
spectacle-corrected myopia and its effect on peripheral refraction.
Ophthalmic Physiol Opt, 2008. 28(6):
J., et al., Effects of myopic spectacle
correction and radial refractive gradient spectacles on peripheral refraction.
Vision Res, 2009. 49(17): p.
D.A. and C.E. Kramer, Peripheral defocus
with spherical and multifocal soft contact lenses. Optom Vis Sci, 2013. 90(11): p. 1215-24.
J., et al., Peripheral refraction with
and without contact lens correction. Optom Vis Sci, 2010. 87(9): p. 642-55.
E., et al., Peripheral refraction in high
myopia with spherical soft contact lenses. Optom Vis Sci, 2012. 89(3): p. 263-70.
K., et al., Peripheral refraction with
different designs of progressive soft contact lenses in myopes. F1000Res,
2016. 5: p. 2742.
R., et al., Evaluating the peripheral
optical effect of multifocal contact lenses. Ophthalmic Physiol Opt, 2012. 32(6): p. 527-34.
J.J., et al., Multifocal contact lens
myopia control. Optom Vis Sci, 2013. 90(11):
J.J., L.A. Jones, and L.T. Sinnott, Corneal
reshaping and myopia progression. Br J Ophthalmol, 2009. 93(9): p. 1181-5.
L.E. and R. Lowe, Corneal reshaping
influences myopic prescription stability (CRIMPS): an analysis of the effect of
orthokeratology on childhood myopic refractive stability. Eye Contact Lens,
2013. 39(4): p. 303-10.
X., et al., Update on Orthokeratology in
Managing Progressive Myopia in Children: Efficacy, Mechanisms, and Concerns.
J Pediatr Ophthalmol Strabismus, 2017. 54(3):
P. and H. Swarbrick, Peripheral
refraction in myopic children wearing orthokeratology and gas-permeable lenses.
Optom Vis Sci, 2011. 88(4): p.
D.A., N. Pritchard, and K.L. Schmid, Peripheral
refraction along the horizontal and vertical visual fields in myopia.
Vision Res, 2006. 46(8-9): p.
R., et al., Peripheral refraction for
distance and near vision in emmetropes and myopes. Ophthalmic Physiol Opt,
2007. 27(6): p. 584-93.