Myopia control

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Reference library

In describing the meaning of a poem, George Orwell once wrote:

"Men of science can study the life-processes of a flower, or they can split it up into its component elements, but any scientist will tell you that a flower does not become less wonderful, it becomes more wonderful, if you know all about it."

The art of clinical practice requires much more than Science can explain, but Science is nonetheless important. Science works with ideas, imagination and intuition, but essentially has to do with facts. Clinical practice has to derive meaning from the Science, to understand its relevance to patients and their problems and to evolve by integrating new knowledge. Changing clinical practice is difficult but achievable by encouraging the scientist within us to continuously question, observe and seek to understand.

For those curious minds, let our ever-changing collection of resources take you on a journey of scientific discovery. They’ve influenced our thinking, they might just benefit yours...

Scientific resources for clinicians

Practical Tips for Managing Myopia

Morton M, Lee L, Morjaria P. Practical tips for managing myopia. Community Eye Health. 2019;32(105):17–18.

IMI - Clinical Management Guidelines Report. 2019.

Kate L. Gifford, Kathryn Richdale, Pauline Kang, Thomas A. Aller, Carly S. Lam, Y. Maria Liu, Langis Michaud, Jeroen Mulder, Janis B. Orr, Kathryn A. Rose, Kathryn J. Saunders, Dirk Seidel, J. Willem L. Tideman, Padmaja Sankaridurg; IMI – Clinical Management Guidelines Report. Invest. Ophthalmol. Vis. Sci. 2019;60(3):M184-M203.

Practical Ways to Modify and Control Ametropia. 2014.

Sankaridurg PR, Holden BA. Practical applications to modify and control the development of ametropia. Eye (Lond). 2014;28(2):134–141. doi:10.1038/eye.2013.255

Identifying Children at Risk of High Myopia using Centile Analysis

Chen Y, Zhang J, Morgan IG, He M. Identifying Children at Risk of High Myopia Using Population Centile Curves of Refraction. PLoS One. 2016;11(12):e0167642. Published 2016 Dec 28. doi:10.1371/journal.pone.0167642

Axial Length Centiles and Risk of Myopia

Tideman, J.W.L., Polling, J.R., Vingerling, J.R., Jaddoe, V.W.V., Williams, C., Guggenheim, J.A. and Klaver, C.C.W. (2018). Axial length growth and the risk of developing myopia in European children. Acta Ophthalmol, 96: 301-309. doi:10.1111/aos.13603

Growth Curves to Monitor Refractive Development

Sanz Diez, P., Yang, L., Lu, M. et al. Growth curves of myopia-related parameters to clinically monitor the refractive development in Chinese schoolchildren. Graefes Arch Clin Exp Ophthalmol 257, 1045–1053 (2019).

Emmetropisation and Aetiology of Refractive Errors

Flitcroft DI (2014). Emmetropisation and the aetiology of refractive errors. Eye (Lond) 28(2):169–179.

Ocular Predictors of Myopia Onset

Zadnik K, Mutti DO, Friedman NE, Qualley PA, Jones LA, Qui P, Kim HS, Hsu JC, Moeschberger ML (1999). Ocular predictors of the onset of juvenile myopia. Invest Ophthalmol Vis Sci 40(9):1936–1943

Cochrane Review. Interventions to slow myopia progression.

Walline JJ, Lindsley KB, Vedula SS, Cotter SA, Mutti DO, Ng SM, Twelker JD. Interventions to slow progression of myopia in children. Cochrane Database of Systematic Reviews 2020, Issue 1. Art. No.: CD004916. DOI: 10.1002/14651858.CD004916.pub4.

Efficacy Comparison of 16 Myopia Control Interventions.

Huang J, Wen, D,Wang Q, McAlinden C, Flitcroft I, Chen H, Saw S, Chen H, Bao F, Zhao Y, Hu L, Li X, Gao R, Lu W, Du Y, Jinag Z, Yu A, Lian H, Jiang Q, Yu Y, Qu J. Efficacy comparison of 16 interventions for myopia control in children: A network meta-analysis. Ophthalmology 123, 697–708. doi:10.1016/j.ophtha.2015.11.010

Overview of Reviews and Meta-Analyses of Myopia Control Interventions

Prousali E, Haidich AB, Fontalis A, Ziakas N, Brazitikos P, Mataftsi A. Efficacy and safety of interventions to control myopia progression in children: an overview of systematic reviews and meta-analyses. BMC Ophthalmol. 2019;19(1):106. Published 2019 May 9. doi:10.1186/s12886-019-1112-3

Safety of Orthokeratology Review

Liu YM, Xie P. The Safety of Orthokeratology--A Systematic Review. Eye Contact Lens. 2016;42(1):35–42. doi:10.1097/ICL.0000000000000219

Myopia Treatment Update Including Atropine

Wu, P., Chuang, M., Choi, J. et al. Update in myopia and treatment strategy of atropine use in myopia control. Eye 33, 3–13 (2019).

Myopia. An Underrated Global Challenge.

Holden B, Sankaridurg P, Smith E, Aller T, Jong M, He M. Myopia, an underrated global challenge to vision: where the current data takes us on myopia control. Eye (Lond). 2014;28(2):142–146. doi:10.1038/eye.2013.256

Increasing Prevalence of Myopia and Impact of Education

Williams KM, Bertelsen G, Cumberland P, et al. Increasing Prevalence of Myopia in Europe and the Impact of Education. Ophthalmology. 2015;122(7):1489–1497. doi:10.1016/j.ophtha.2015.03.018

Increasing Myopia in Northern Ireland

McCullough SJ, O'Donoghue L, Saunders KJ. Six Year Refractive Change among White Children and Young Adults: Evidence for Significant Increase in Myopia among White UK Children. PLoS One. 2016;11(1):e0146332. Published 2016 Jan 19. doi:10.1371/journal.pone.0146332

Atropine in European Eyes

Polling JR, Kok RG, Tideman JW, Meskat B, Klaver CC. Effectiveness study of atropine for progressive myopia in Europeans. Eye (Lond). 2016;30(7):998–1004. doi:10.1038/eye.2016.78

ATOM 2 Atropine Trial in Singapore - link-collapse Year Outcomes

Chia A, Lu QS, Tan D. link-collapse-Year Clinical Trial on Atropine for the Treatment of Myopia 2. Ophthalmology, Volume 123, Issue 2, 391 - 399

Diluted atropine in Korean Children

Moon JS, Shin SY. The diluted atropine for inhibition of myopia progression in Korean children. Int J Ophthalmol. 2018;11(10):1657–1662. Published 2018 Oct 18. doi:10.18240/ijo.2018.10.13

Atropine Efficacy Meta-Analysis

Gong Q, Janowski M, Luo M, et al. Efficacy and Adverse Effects of Atropine in Childhood Myopia: A Meta-analysis. JAMA Ophthalmol. 2017;135(6):624–630. doi:10.1001/jamaophthalmol.2017.1091

MiSight 3 Year Study Outcome

Chamberlain P, Peixoto-de-Matos SC, Logan NS, Ngo C, Jones D, Young G. A 3-year Randomized Clinical Trial of MiSight Lenses for Myopia Control. Optom Vis Sci. 2019 Aug;96(8):556-567. doi: 10.1097/OPX.0000000000001410.

Defocus Incorporated Soft Contacts Slow Myopia

Lam CS, Tang WC, Tse DY, Tang YY, To CH. Defocus Incorporated Soft Contact (DISC) lens slows myopia progression in Hong Kong Chinese schoolchildren: a 2-year randomised clinical trial. Br J Ophthalmol. 2014;98(1):40–45. doi:10.1136/bjophthalmol-2013-303914

Peripheral Defocus Spectacles (DIMS) for Myopia Control

Lam CSY, Tang WC, Tse DY, et al. Defocus Incorporated Multiple Segments (DIMS) spectacle lenses slow myopia progression: a 2-year randomised clinical trial. Br J Ophthalmol. 2020;104(3):363–368. doi:10.1136/bjophthalmol-2018-313739

Association between Axial Length and Visual Impairment in Myopia

Tideman JWL, Snabel MCC, Tedja MS, et al. Association of Axial Length With Risk of Uncorrectable Visual Impairment for Europeans With Myopia. JAMA Ophthalmol. 2016;134(12):1355–1363. doi:10.1001/jamaophthalmol.2016.4009

Visual Consequences of Refractive Error

Verhoeven, VJM, Wong KT et al. Visual Consequences of Refractive Errors in the General Population. Ophthalmology, 2015, Volume 122, Issue 1, 101 - 109

Myopia and Associated Pathological Complications

Saw, S.‐M., Gazzard, G., Shih‐Yen, E.C. and Chua, W.‐H. (2005), Myopia and associated pathological complications. Ophthalmic and Physiological Optics, 25: 381-391. doi:10.1111/j.1475-1313.2005.00298.x

High Myopia Prevalence and Pathological Complications

Verkicharla, PK, Ohno‐Matsui, K & Saw, SM. Current and predicted demographics of high myopia and an update of its associated pathological changes. Ophthalmic Physiol Opt 2015; 35: 465– 475. doi: 10.1111/opo.12238

Myopia – A 21st Century Public Health Issue

Serge Resnikoff; Jost B. Jonas; David Friedman; Mingguang He; Monica Jong; Jason J. Nichols; Kyoko Ohno-Matsui; Earl L. Smith III; Christine F. Wildsoet; Hugh R. Taylor; James S. Wolffsohn; Tien Y. Wong Investigative Ophthalmology & Visual Science February 2019, Vol.60, Mi-Mii.

IMI – Myopia Control Reports Overview and Introduction

James S. Wolffsohn; Daniel Ian Flitcroft; Kate L. Gifford; Monica Jong; Lyndon Jones; Caroline C. W. Klaver; Nicola S. Logan; Kovin Naidoo; Serge Resnikoff; Padmaja Sankaridurg; Earl L. Smith, III; David Troilo; Christine F. Wildsoet Investigative Ophthalmology & Visual Science February 2019, Vol.60, M1-M19.

IMI – Defining and Classifying Myopia: A Proposed Set of Standards for Clinical and Epidemiologic Studies

Daniel Ian Flitcroft; Mingguang He; Jost B. Jonas; Monica Jong; Kovin Naidoo; Kyoko Ohno-Matsui; Jugnoo Rahi; Serge Resnikoff; Susan Vitale; Lawrence Yannuzzi Investigative Ophthalmology & Visual Science February 2019, Vol.60, M20-M30.

IMI – Report on Experimental Models of Emmetropization and Myopia

David Troilo; Earl L. Smith, III; Debora L. Nickla; Regan Ashby; Andrei V. Tkatchenko; Lisa A. Ostrin; Timothy J. Gawne; Machelle T. Pardue; Jody A. Summers; Chea-su Kee; Falk Schroedl; Siegfried Wahl; Lyndon Jones Investigative Ophthalmology & Visual Science February 2019, Vol.60, M31-M88.

IMI – Myopia Genetics Report

Milly S. Tedja; Annechien E. G. Haarman; Magda A. Meester-Smoor; Jaakko Kaprio; David A. Mackey; Jeremy A. Guggenheim; Christopher J. Hammond; Virginie J. M. Verhoeven; Caroline C. W. Klaver; for the CREAM Consortium Investigative Ophthalmology & Visual Science February 2019, Vol.60, M89-M105.

IMI – Interventions for Controlling Myopia Onset and Progression Report

Christine F. Wildsoet; Audrey Chia; Pauline Cho; Jeremy A. Guggenheim; Jan Roelof Polling; Scott Read; Padmaja Sankaridurg; Seang-Mei Saw; Klaus Trier; Jeffrey J. Walline; Pei-Chang Wu; James S. Wolffsohn Investigative Ophthalmology & Visual Science February 2019, Vol.60, M106-M131.

IMI – Clinical Myopia Control Trials and Instrumentation Report

James S. Wolffsohn; Pete S. Kollbaum; David A. Berntsen; David A. Atchison; Alexandra Benavente; Arthur Bradley; Hetal Buckhurst; Michael Collins; Takashi Fujikado; Takahiro Hiraoka; Masakazu Hirota; Debbie Jones; Nicola S. Logan; Linda Lundström; Hidemasa Torii; Scott A. Read; Kovin Naidoo Investigative Ophthalmology & Visual Science February 2019, Vol.60, M132-M160.

IMI – Industry Guidelines and Ethical Considerations for Myopia Control Report

Lyndon Jones; Björn Drobe; José Manuel González-Méijome; Lyle Gray; Timo Kratzer; Steve Newman; Jason J. Nichols; Arne Ohlendorf; Stephanie Ramdass; Jacinto Santodomingo-Rubido; Katrina L. Schmid; Donald Tan; Kah-Ooi Tan; Fuensanta A. Vera-Diaz; Yee-Ling Wong; Kate L. Gifford; Serge Resnikoff Investigative Ophthalmology & Visual Science February 2019, Vol.60, M161-M183.

IMI – Clinical Management Guidelines Report

Kate L. Gifford; Kathryn Richdale; Pauline Kang; Thomas A. Aller; Carly S. Lam; Y. Maria Liu; Langis Michaud; Jeroen Mulder; Janis B. Orr; Kathryn A. Rose; Kathryn J. Saunders; Dirk Seidel; J. Willem L. Tideman; Padmaja Sankaridurg Investigative Ophthalmology & Visual Science February 2019, Vol.60, M184-M203.

Some of our work

MOSAIC Clinical Trial Methods

McCrann S, Flitcroft I, Strang NC, et al. Myopia Outcome Study of Atropine in Children (MOSAIC): an investigator-led, double-masked, placebo-controlled, randomised clinical trial protocol. HRB Open Res. 2019;2:15. Published 2019 Jul 23. doi:10.12688/hrbopenres.12914.1

Is the Optometry Profession Ready for Myopia Control?

McCrann S, Flitcroft I, Loughman J. Is optometry ready for myopia control? Education and other barriers to the treatment of myopia. HRB Open Research 2019,2:30

Association between Zinc and Myopia in US Children and Adolescents

Burke N, Butler JS, Flitcroft DI, McCartney D, Loughman J. Association of Total Zinc Intake with Myopia in US Children and Adolescents. Optometry and Vision Science. 2019;96:647-54. doi:10.1097/OPX.0000000000001418

Parental Attitudes to Myopia

McCrann S, Flitcroft DI, Lalor K, Bush A, Loughman J. Parental attitudes to myopia: A key agent of change for myopia control? Ophthalmic & Physiol Opt 2018; 38: 298–308. DOI: 10.1111/opo.12455

Analysis of Syndromic Forms of Myopia Reveals Novel Myopia Genes and Pathways

Flitcroft DI, Loughman J, Wildsoet CF, Williams C, Guggenheim JA, for the CREAM Consortium. Novel Myopia Genes and Pathways Identified From Syndromic Forms of Myopia. Investigative Ophthalmology & Visual Science. 2018;59(1):338-348. doi:10.1167/iovs.17-22173.

CHAMP – UK Atropine Trial Methods

Azuara-Blanco A, Logan N, Strang N, Saunders K, Allen PM, Weir R, Doherty P, Adams C, Gardner E, Hogg R, McFarland M, Preston J, Verghis R, Loughman J, Flitcroft DI, Mackey DA,Sze-Yee Lee S, Hammond C, Congdon N, Clarke M. Low-dose (0.01%) atropine eye-drops to reduce progression of myopia in children: a multicentre placebo-controlled randomised trial in the UK (CHAMP-UK)—study protocol. Br J Ophthalmol 2019;0:1–6. doi: 10.1136/bjophthalmol-2019-314819.

Retinal, Optical and Environmental Factors in Myopia

The complex interactions of retinal, optical and environmental factors in myopia aetiology Flitcroft DI. Progress in retinal and eye research (2012) 31 (6), 622-660.

Western Australia Atropine for the Treatment of Myopia (WA‐ATOM) study - Methods

Lee SSY, Mackey DA, Lingham G, Crew JM, Chen FK, Charng J, Fletcher N, Flitcroft DI, Loughman J et al. Western Australia Atropine for the Treatment of Myopia (WA‐ATOM) study: Rationale, methodology and participant baseline characteristics. Clin Experiment Ophthalmol. 2020; 1– 11.

Serum zinc levels and myopia

Burke, N., Butler, J.S., Flitcroft, I. and Loughman, J., The relationship between serum zinc levels and myopia. Clin Exp Optom. (2020) doi:10.1111/cxo.13069

Smartphone use and myopia

McCrann S, Loughman J, Butler JS, Paudel N, Flitcroft DI. Smartphone use as a possible risk factor for myopia. Clin Exp Optom. 2020. DOI:10.1111/cxo.13092

We can’t afford to turn a blind eye to myopia

Bourke CM, Loughman J, Fltcroft DI, Loskutova E, O’Brien C. We can’t afford to turn a blind eye to myopia, QJM: An International Journal of Medicine, 2019;hcz076,

Smartphone usage as a contributor to myopia

Loughman J, McCrann S, Paudel N, Butler JS, Flitcroft DI. (2019) Smartphone Usage as a Possible Contributor to the Increasing Prevalence of Myopia. Investigative Ophthalmology & Visual Science, 60 (9), 5855-5855.

Association between myopia and zinc in KNHANES

Burke N, Flitcroft DI, Butler JS, Loughman J. (2019) Association between Myopia and Lower Serum Zinc Status in Adolescents: The 2010 Korean National Health and Nutrition Examination Study. Investigative Ophthalmology & Visual Science, 60 (9), 5826-5826.

Attitudes and barriers to myopia control among optometrists

McCrann S, Flitcroft DI, Butler JS, Barrett C, Loughman J. (2019) Attitudes, Beliefs and Perceived Barriers toward Myopia Management in clinical practice. Investigative Ophthalmology & Visual Science, 60 (9), 5821-5821

Novel myopia genes identified from syndromic myopia

Flitcroft DI, Loughman J, Wildsoet CF, Williams C, Guggenheim JA. (2017). Novel Myopia Genes and Pathways identified from Syndromic Forms of Myopia. Investigative Ophthalmology & Visual Science 58 (8), 5480-5480

Big Data in epidemiological studies of refractive error

Moore M, Loughman J, Wahl S, Ohlendorf A, Flitcroft DI. (2017). The Potential value of Big-Data for Epidemiological Studies of Refractive Error. Investigative Ophthalmology & Visual Science 58 (8), 2397-2397.

Visual lifestyle of myopic children assessed with AI-powered wearable monitoring

Michael Mrochen, Pavel Zakharov, Burcu Nurözler Tabakcι, Cafer Tanrιverdi, Aylin Kιlιç, Daniel Ian Flitcroft; Visual lifestyle of myopic children assessed with AI-powered wearable monitoring. Invest. Ophthalmol. Vis. Sci. 2020;61(7):82.

Myopia Progression Centiles from Real World Data: An Ecologically Valid Tool for Myopia Treatment Efficacy Monitoring?

James Loughman, Michael Moore, Daniel Ian Flitcroft; Myopia Progression Centiles from Real World Data: An Ecologically Valid Tool for Myopia Treatment Efficacy Monitoring?. Invest. Ophthalmol. Vis. Sci. 2020;61(7):79.

Centile-based analysis of refractive development in the MiSight® 1 day Myopia Control trial.

Daniel Ian Flitcroft, James Loughman, Baskar Arumugam, Arthur Bradley, Paul Chamberlain; Centile-based analysis of refractive development in the MiSight® 1 day Myopia Control trial. Invest. Ophthalmol. Vis. Sci. 2020;61(7):1372.