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Effect of Switching Myopia Control Strategies on Axial Elongation in Children with Poor Response to Highly Aspherical
Minfeng Chen1, Xianling Yang1, Haoquan Hu1
1Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China.
Insights
For children with myopia progression unresponsive to highly aspherical lenslet (HAL) wear, switching to diffusion optics technology (DOT) spectacles or orthokeratology (OK) lenses significantly reduced axial length elongation compared to continued HAL wear.
Area of Science:
- Ophthalmology
- Pediatric Optometry
- Myopia Control Research
Background:
- Myopia is a growing public health concern in children.
- Highly aspherical lenslet (HAL) spectacles are used for myopia control.
- Some children exhibit poor response to initial myopia control interventions.
Purpose of the Study:
- To compare axial length (AL) elongation in children with poor response to HAL wear.
- To evaluate different second-line myopia control interventions for these children.
Main Methods:
- Retrospective study of 4097 myopic children after 1 year of HAL wear.
- Identified poor responders (AL elongation ≥0.26 mm/year).
- Compared outcomes of continued HAL, HAL plus 0.01% atropine, switching to DOT spectacles, or switching to orthokeratology (OK) lenses over a second year.
Main Results:
- 168 children were analyzed (42 per group) after propensity score matching.
- Significant differences in spherical equivalent refraction (SER) progression and AL elongation were found (p < 0.001).
- Diffusion optics technology (DOT) spectacles showed the least AL elongation and SER progression; DOT and OK lenses significantly reduced odds of poor response compared to continued HAL.
Conclusions:
- Switching to DOT spectacles or OK lenses is more effective than continued HAL wear for children with poor initial response.
- DOT spectacles demonstrated the most favorable outcomes in reducing axial elongation.
- Early modification of myopia control strategies can improve outcomes for high-risk children.
Purpose:
To compare axial length (AL) elongation in children with poor response to highly aspherical lenslet (HAL) wear, following different second-line myopia control interventions.
Methods:
This retrospective study included 4097 myopic children who completed 1 year of HAL wear. Poor responders were defined as children with axial elongation ≥0.26 mm/year despite HAL therapy. These children were followed for an additional year and categorised into four groups based on the second-year interventions: continued HAL wear (HAL-HAL), HAL combined with 0.01% atropine (HAL-HALA), switching to diffusion optics technology spectacles (HAL-DOT) and switching to orthokeratology lenses (HAL-OK). Primary outcomes included changes in spherical equivalent refraction (SER) and AL. Logistic regression and multivariable linear regression analyses were performed.
Results:
After propensity score matching, 168 subjects (42 per group) were included. Significant differences in second-year SER progression and AL elongation were observed among groups (both p < 0.001). The HAL-DOT group exhibited the smallest AL elongation and less SER progression compared with the other groups. Logistic regression showed that, compared with the HAL-HAL group, the HAL-DOT (Odds Ratio (OR) = 0.11, p < 0.001) and HAL-OK groups (OR = 0.34, p = 0.04) had significantly lower odds of a poor response (axial elongation ≥0.26 mm/year). No significant association was found for the HAL-HALA group (p = 0.12). Multivariable regression showed all intervention groups reduced AL elongation, with the greatest effect in the HAL-DOT group (β = -0.227 mm, p < 0.001).
Conclusion:
Among children with a poor response to initial HAL treatment, switching to alternative interventions, especially DOT, was associated with more favourable axial elongation outcomes and less SER progression. Early treatment modification may help improve outcomes in high-risk children.
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