Spectacle lenses and emmetropization: the role of optical defocus in regulating ocular development

The purpose of our investigation was to determine whether early ocular growth and refractive development was regulated by visual feedback in infant monkeys. Specifically, we examined the ability of infant monkeys to compensate for optically induced changes in the eye's refractive state and to recover from experimentally induced refractive errors. For moderate-powered anisometropic lenses, infants exhibited differential interocular axial growth rates that reduced the lens-induced refractive imbalance between the two eyes. Infants treated with equal-powered lenses over both eyes also showed compensating growth. For lens powers between approximately -3 and +6 D, the resulting refractive-error changes, which were primarily due to alterations in vitreous chamber growth rates, were well correlated with the effective refractive state produced by the treatment lenses. When the stimulus for altered eye growth was removed and the infants were provided unrestricted vision, monkey eyes consistently grew toward emmetropia. The remarkable degree of adaptability exhibited by the eyes of infant monkeys demonstrates that emmetropization in this higher primate is an active process that is regulated on a continuous basis by optical defocus. Consequently, early in life spectacle lenses by changing the eye's effective focus can predictably alter ocular growth and the refractive status of one or both eyes.