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Myopia Control

Article in Eye & Contact Lens Science & Clinical Practice · January 2016
DOI: 10.1097/ICL.0000000000000172

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 Advances in Ophthalmology & Visual System

Axial Length in Orthokeratology Patients: Large Case

Series

Abstract Research Article

Purpose: To evaluate axial length measurements obtained over a three-year Volume 5 Issue 2 - 2016
period in children undergoing Orthokeratology (Ortho-K).
Michael J Lipson*, Jordan K Harris, Henry D
Methods: Patient records were identified from a specialty contact lens practice.
Data were obtained from myopic patients who were prescribed Ortho-K wear. Lather, Leslie M Niziol and David C Musch
Demographic data at baseline included age at commencement of Ortho-K and Department of Optometry, University of Michigan, USA
ethnicity. Clinical data recorded at baseline and at years 1, 2 and 3 included
subjective refraction, corneal topography, corneal curvature, axial length, pupil *Corresponding author: Michael Lipson, Department of
size, and lens design, changes in lens parameters, lens wear habits, wearing time Optometry, University of Michigan, 39901 Traditions Dr.
and unaided visual acuity. The primary outcome measure was change in axial #230 Northville, MI 48168, USA, Tel: 2483054525;
Email:
length during the study period.
Results: 194 eyes of 97 subjects were included in data analysis. Mean age at start Received: July 29, 2016 | Published: November 14, 2016
of Ortho-K was 10.4 years (SD=1.9). Mean axial length was 24.59 mm (SD=0.85)
at baseline and 24.87 mm (SD=0.87) at the three year evaluation, for a mean
change in axial length of 0.28 mm (SD=0.64). 65.5% of eyes (n=127) showed little
or no change (<0.5 mm) in axial length during the study period. 20.1% of eyes
(n=39) showed moderate increase in axial length of 0.5-1.0 mm and14.4% of eyes
(n=28) showed >1.0 mm increase in axial length during the 3-year study period.
Linear mixed regression analysis showed a significant association between older
age at initiation of Ortho-K and less increase in axial length (p=0.0077). Axial
length changes were not associated with duration of wear (both hours/night and
nights/week) or baseline corneal curvature.
Conclusion: Use of Ortho-K may help reduce axial length elongation in myopic
eyes. Age of the initial treatment is a key factor. The baseline of cornea curvature
and duration of the wear are not directly associated with treatment outcome.
Of note, during the three-year study, 65.5% of treated eyes (n=127) showed a
minimal or clinically insignificant increase of axial length (<0.5mm). Early
treatment should be considered.

Keywords: Axial length; Myopia progression; Orthokeratology; Overnight

corneal reshaping; Biometry

Introduction also affect myopia development [8-11]. One study reported that
increasing time spent outdoors can delay the onset of myopia
The prevalence of myopia in the United States and throughout [12]. The complex nature of the genetic and environmental
the world has increased dramatically over the last 30-40 years. interactions that contribute to myopia progression is a topic of
The National Health and Nutrition Examination Survey of the ongoing studies worldwide.
US population, conducted from 1999 to 2004, reported the
prevalence of myopia to be 42% of individuals in the 12 to 54-year- Identifying ways to prevent or reduce myopic progression are
old age group, compared to 25% for the same age group 30 years important to eye care providers as well as patients and parents
previous [1,2]. In Singapore and Taiwan, prevalence has been of myopic children. Substantial increases in axial length and
estimated at 80% of young adults [3]. Within the next five years, the resulting myopic progression requires repeated refractive
it is estimated that myopia will affect nearly 2.5 billion people corrections during childhood, and places those with higher myopia
worldwide [4]. When myopia is initially seen in children 4-9 years at risk of sight-threatening complications such as maculopathy,
old, it often progresses substantially during growth years that retinal detachment, cataracts and glaucoma [13-17]. Once myopia
follow [3]. The increasing rate of myopia prevalence has been develops, various methods of slowing its progression have been
linked to both genetic and environmental factors. A child’s risk of attempted in conjunction with clinical testing of these methods
developing myopia increases threefold if both parents are myopic [11,18-20]. These include pharmaceutical agents such as atropine,
[5,6]. Two independent research groups, using genome-wide multifocal spectacle lenses, specially-designed soft contact lenses,
association studies, have identified 20 genetic loci that have been rigid gas-permeable contact lenses, spectacle under-correction,
linked to myopia [7]. Environmental factors such as long periods and Orthokeratology (Ortho-K) [11]. Ortho-K is the application
of near work, type of optical correction, and limited outdoor time of specially-designed, reverse-geometry; rigid-gas-permeable

Submit Manuscript | http://medcraveonline.com Adv Ophthalmol Vis Syst 2016, 5(2): 00154
 Copyright:
Axial Length in Orthokeratology Patients: Large Case Series ©2016 Lipson et al. 2/7

contact lenses worn only while sleeping to temporarily reshape vi. Best-corrected visual acuity –monocularly and binocularly.
the cornea, such that refractive error is corrected without the
vii. Horizontal visible iris diameter (HVID) / Corneal diameter.
need to wear any correction during waking hours. To date,
numerous clinical studies have reported a beneficial effect of viii. Lens design.
Ortho-K on slowing or stopping myopic progression [20-25].
Ortho-K requires adherence to prescribed wear time, and children ix. Axial length.
in one retrospective study were shown to be very adherent to the Follow-up data+ collected at exams 1, 2 and 3 years after initial
prescribed Ortho-K wearing schedule [26]. fitting included:
Although some clinical studies evaluating myopia progression I. Axial length – as above
have used change in cycloplegic refraction (objective and/or
subjective) as the outcome measure to determine if refractive II. Uncorrected visual acuity – monocular and binocular
changes have occurred [11], others used change in axial length III. Average number of nights lenses worn per week
as the outcome measure of growth-related refractive changes
[27,28]. The advantage to using axial length is twofold: axial IV. Average number of hours lenses worn per night
length is an objective measure and has been associated with
V. Position of treatment zone (centered or direction of
complications of myopia [14-17]. In this observational study,
decentration)
we evaluated children who have worn Ortho-K lenses regularly
for three years to analyze changes in axial length and refractive VI. Manifest refraction (sphere and cylinder)
status after commencing use of Ortho-K. We performed this study
VII. Manual keratometry readings
to demonstrate results that could be expected with typical myopic
patients presenting to practitioners in clinical practice. This large VIII. SimK readings from topography
case series represents a sample of a common demographic seen
by practitioners prescribing Ortho-K in the United States. + All follow-up data were obtained between 1 and 9 hours
after lens removal.
Methods
Statistical Methods
This study was approved by the University of Michigan
Descriptive statistics of the sample were summarized with
Medical School Institutional Review Board (IRBMED). This was a
means and standard deviations (SD) for continuous measures,
retrospective study evaluating data from patients in the practice
and frequencies and percentages for categorical measures. Mixed
of the first author (MJL). Patients whose records were selected
linear regression [30] was used to estimate the effect of covariates
for analysis in the study included those who began regular
on axial length change from baseline over time (yearly up to 3
wear of Ortho-K lenses between April 2007 and October 2011,
years). This model accounted for the correlation between the two
were 7-14 years old, had myopia between -1.00D and -6.50D,
eyes of a subject and the correlation within a single eye over time.
had less than 2.00D of astigmatism, attended routine follow-
The following variables were investigated for a relationship with
up care at recommended intervals for at least 3 years after
axial length change: age at start of Ortho-K, baseline measures of
commencing Ortho-K wear, and did not wear spectacles at any
the eye (spherical component of myopia, cylinder, flat K reading
time. Subjects excluded from analysis included those who had
(manual and simK), steep K (manual and simK), shape factor
not worn Ortho-K lenses regularly (stopping for more than two
(eccentricity), pupil diameter, corneal diameter), time-varying
weeks), had annual exams greater than 15 months from baseline
measures of usage (hours/night and nights/week of contact
or previous annual exam, or who were diabetic. Refractive data
wear), and location of treatment zone (from topography). Note:
were based on subjective manifest refraction. Axial length was
Flat K reading is the least curvature measurement in a particular
measured with a hand-held MMD PalmScanA2000 (Calabasas,
meridian of the cornea taken from manual keratometry and from
CA) ultrasonic A-scan. This device has been validated as accurate
topography. SAS version 9.4 (Cary, NC) was used for all statistical
in a previous study [29] that followed an identical protocol by the
analysis.
same operator (MJL) for all axial length measurements. Corneal
curvature was monitored with manual keratometry and corneal Results
topography with Carl Zeiss Meditec (Dublin, CA) - Humphrey
Atlas 993 or Medmont (Nunawading, Victoria, Australia) - E300. 141 patient records were screened for study participation.
Of those, 44(31%) were not eligible. Reasons for exclusion
Baseline information obtained at the time of initial presentation included: lack of compliance with follow-up schedule (n=14),
for Ortho-K evaluation and fitting included the subject’s age and missing data (n=9), less than 3 years of follow-up (n=2), started
the following for both eyes of each subject: Ortho-K elsewhere (n=5), no baseline axial length data (n=12)
i. Subjective refraction (sphere/cylinder/spherical equivalent). and discontinued Ortho-K (n=2). 97study participants (194
eyes) were included in the data analyses. Ethnicity of the subject
ii. Manual keratometry readings. population was Asian (n= 88, 90.7%) and Caucasian (n=9, 9.3%).
iii. SimK (Simulated Manual Keratometry) measurements from Baseline descriptive data on eyes are detailed in (Table 1). Mean
topography. age at start of Ortho-K was 10.4 years (SD=1.9). Ortho-K lenses
worn by the subjects were of four different designs: CRT lenses
iv. Corneal eccentricity/shape factor (Paragon Vision Science - Mesa, AZ) were used in 128 eyes (66%),
CRT-Dual Axis Lenses (Paragon Vision Science - Mesa, AZ) were
v. Pupil size (mesopic).

Citation: Lipson MJ, Harris JK, Lather HD, Niziol LM, Musch DC (2016) Axial Length in Orthokeratology Patients: Large Case Series. Adv Ophthalmol Vis
Syst 5(2): 00154. DOI: 10.15406/aovs.2016.05.00154
 Copyright:
Axial Length in Orthokeratology Patients: Large Case Series ©2016 Lipson et al. 3/7

used in 20 eyes (10%), Emerald lenses (Euclid Systems-Herndon, The mean baseline axial length was 24.59mm (SD=0.85)
VA) were used in 20 eyes (10%), and custom-designed Ortho-K and at the three year evaluation was 24.87mm (SD=0.87), for a
lenses were used in 26 eyes (13%). The various lens designs were mean increase in axial length of 0.28mm (SD=0.64), which was
used to achieve optimally centered treatment (defined by post- statistically significant (p<0.0001) (Table 2). 65.5% of eyes
treatment topography) and best unaided visual acuity during (n=127) showed little or no change in axial length during the
waking hours. Study subjects wore the same lens design in each study period (defined as <0.50mm increase) for the 3-year study
eye except for one subject, who wore a CRT lens in one eye and a period.20.1% of eyes (n=39) showed moderate increase in axial
CRT-Dual Axis lens in the other eye. length (defined as 0.50 to1.00mm increase). 14.4% of eyes (n=28)
showed >1.00mm increase in axial length during the 3-year study
Table 1: Baseline descriptive data on the study participants.
period. Change in axial length stratified by starting age is shown
in (Figure 1). Results show that for children starting Ortho-K at
Baseline Data (n=194 Eyes of 97 Subjects) age 6-7 (n=26) at baseline, mean axial length change at 3 years
was 0.57mm. For children ages 8-9 (n=60), 10-11 (n=58) and
Attribute Mean (SD) Range 12-14 (n=50), mean axial length change at 3 years since starting
Ortho-K were 0.46mm,0.15mm and 0.06mm, respectively.
Sphere (D) -2.96(1.24) -6.25 to -.75
Linear mixed regression analysis was used to identify factors
Cylinder (D) -.32(.38) -2.50 to -0.25 that predicted axial length change over time (Table 3). Age at
Ortho-K initiation was associated with axial length change such
Spherical Equivalent (D) -3.12(1.25) -6.50 to -.75 that for every year older at Ortho-K initiation, axial length change
decreased by 0.06mm (p-value = 0.0077). Descriptively, mean
Manual Flat K (D) 42.42(1.14) 39.00 - 45.50 age at start of Ortho-K for eyes with little to no, moderate, and
substantial change in axial length after 3 years was 10.8 years
SimK Flat K (D) 42.81(1.23) 39.00 – 45.87
(SD=1.9), 9.6 years (SD=1.6), and 9.5 years (SD=1.8), respectively.
Shape Factor .32(.10) 0.01 - 0.65 On average, for every additional year of follow-up, change in axial
length from baseline increased by 0.14mm (p-value < 0.0001).
Pupil Size (mm) 6.0(.6) 4.0 – 8.0 Pre-Ortho-K measures including the spherical component of
myopia, cylinder, flat and steep K reading, shape factor, pupil
Corneal Diameter (mm) 11.56(.36) 11.00 – 12.10 diameter, corneal diameter, as well as Ortho-K usage, and location
of treatment zone were not significantly associated with change
Axial Length (mm) 24.59(.85) 21.89 -28.03
in axial length.
Table 2: Descriptive statistics on axial length (mm), for the sample of 194 eyes.

Axial Length Data

Time Mean (SD) Min, Max Median P-value*

Baseline 24.59 (0.85) 21.89, 28.03 24.57
Year 1 24.58 (0.89) 22.09, 26.75 24.59 0.9826
Year 2 24.74 (0.57) 21.18, 27.16 24.74 0.0056
Year 3 24.87 (0.87) 22.68, 26.83 24.90 <0.0001
Baseline to Year 1 Change -0.01 (0.53) -2.08, 1.35 0.02 0.9826
Year 1 to Year 2 Change 0.16 (0.48) -1.40, 1.18 0.18 0.0002
Year 2 to Year 3 Change 0.13 (0.37) -0.69, 1.40 0.08 <0.0001
Baseline to Year 3 Change 0.28 (0.64) -1.80, 2.44 0.23 <0.0001

*P-values from linear mixed regression for the comparison between baseline and follow-up measure, accounting for correlation between eyes of
a subject

Discussion Axial length changes with other modes of correction

This case series represents a large group of children treated Our results show that use of Ortho-K was associated with less
with Ortho-K and followed for three years to monitor changes in axial length increase than historical increases in similar aged
axial length. Axial length changes were evaluated in the context children wearing other forms of vision correction [27,31,32]. A
of other factors, such as age at start of Ortho-K, initial refraction, study conducted in China, reported a mean of .36 mm increase in
pupil size, corneal topographical changes, lens design, and axial length in the first year following the onset of myopia [31].
wearing time. These factors are listed in (Table 3). In the second and third year following the onset of myopia, they

Citation: Lipson MJ, Harris JK, Lather HD, Niziol LM, Musch DC (2016) Axial Length in Orthokeratology Patients: Large Case Series. Adv Ophthalmol Vis
Syst 5(2): 00154. DOI: 10.15406/aovs.2016.05.00154
 Copyright:
Axial Length in Orthokeratology Patients: Large Case Series ©2016 Lipson et al. 4/7

reported 0.30 mm and 0.21 mm annual increases in axial length Ethnicity and axial length increases
respectively. For the three years following the onset of myopia,
this study showed a mean total increase in axial length of 0.87 mm. It is notable that 91% of our study participants were Asian
While these data provide a reference point, they do not provide Americans. Asian children have been shown to develop myopia at
normative data on axial length increase during childhood. This younger age and progress at a higher rate than other ethnic/racial
is due to numerous variables that may contribute to refractive groups [31,33,34]. This may relate to differences in posterior
and axial length changes including age of myopia onset [27,31], scleral/retinal contour and the resulting difference in peripheral
ethnicity [31-36], hours of near work [37], hours of time spent refraction [41-43]. A recent 3-year study on myopic progression in
outdoors [38], mode of refractive correction [20,24,39] and Asian-Canadian children showed single vision spectacle wearers
parental history of myopia [40]. had a mean change in axial length of 0.82 (SD=0.05) mm over the
3-year study period (an increase of 0.39 mm after one year, an
Table 3: Linear mixed regression model results for the association of additional 0.23 mm after two years, and an additional 0.20 mm
variables with axial length change from baseline over time. Note: each increase after three years) [44]. The age and ethnicity of subjects
variable is entered into a separate model.
in the study was very similar to that of our study subjects.
Linear Mixed Regression Analysis of Baseline Attributes to Age and axial length changes
Predict Axial Length Changes
As children get older, the rate of axial length change decreases
Variable Estimate SE P-value
for those who wear glasses or Ortho-K. But, children who start
Time (years) 0.14 0.02 <0.0001 Ortho-K younger have the largest reduction in axial length change
Spherical Equivalent 0.03 0.03 0.3196 vs. children wearing glasses. In this study, children who started
Ortho-K at age 6-7 showed a mean increase of 0.57mm in axial
Astigmatism -0.04 0.11 0.6742
length over a 3 year period compared to spectacle-wearing
Age at start of OCR -0.06 0.02 0.0077 children in a study by Hyman et al. [33], who showed 1.10 mm of
Manual Flat K -0.04 0.04 0.2897 axial length increase in three years. In contrast, the 10-11 year-
old Ortho-K wearers in our study showed0.15 mm axial length
Manual Steep K -0.05 0.04 0.1872 increase versus 0.50 mm of axial length increase in the 11 year-
SimK Flat -0.07 0.03 0.0586 old spectacle wearers. As a reference, (Table 4) summarizes axial
length change for age groups for different modes of correction.
SimK Steep -0.06 0.03 0.0721
Shape Factor -0.23 0.43 0.5974 Axial length increases vs. refractive increases
Pupil Diameter (mm) -0.05 0.07 0.5104 As a point of reference in evaluating axial length changes
relative to refractive changes, Hyman et al. [33] reported that
Corneal Diameter (mm) 0.01 0.12 0.9505
a 1 mm increase in axial length was associated with 2.04 D of
Hours/Night 0.05 0.04 0.1650 myopia progression and alternatively, 1 D of myopia progression
Nights/Week -0.02 0.02 0.3167 was associated with 0.50 mm of axial elongation. Those numbers,
applied to our study, would suggest that our mean increase of
Topography (Center vs Other) 0.04 0.05 0.3770 0.28 mm over the three-year study period would result in a 0.57D
SE: Standard Error increase in myopic refraction.

Studies of myopia control with ortho-k

Three meta-analysis evaluations of the effect of Ortho-K on
reducing myopic progression and increasing axial length have
been recently published. They report 41-45% less increase in
axial length in wearers of Ortho-K compared to various control
groups corrected with single vision spectacles or soft contact
lenses [45-47]. Given the fact that we didn’t have a control group,
we summarized our findings in terms of the percentage of
subjects who experienced little or no progression which is similar
to what Cho et al. [20] did in their study. Their study categorized
myopic progression using “fast progressors” (refractive change of
>1.00D /year or axial length changes of >0.36 mm/yr) vs. “slow
progressors” (refractive change of ≤0.50D /year or axial length
changes of ≤0.18 mm/yr) in wearers of Ortho-K lenses vs. a control
group wearing single vision spectacles. That study found the
percentage of fast progressors was 34% in the control group vs.
Figure 1: Plot of axial length change at each year of the study for 15% in the Ortho-K group and the percentage of slow progressors
different age groups. Sample size for each group: age 6-7, n=26: age 8-9, was 14% in the control group vs. 46% in the Ortho-K group. Using
n=60: age 10-11, n=58: age 12-14, n=50. At three years, the axial length
changes for each group are: age 6-7, 0.57 mm; age 8-9, 0.46 mm; age
the criteria established in the Cho study, our results showed less
10-11, 0.15 mm and age 12, 13 and 14, 0.06 mm. myopic progression in Ortho-K wearers than reported in the Cho
study.

Citation: Lipson MJ, Harris JK, Lather HD, Niziol LM, Musch DC (2016) Axial Length in Orthokeratology Patients: Large Case Series. Adv Ophthalmol Vis
Syst 5(2): 00154. DOI: 10.15406/aovs.2016.05.00154
 Copyright:
Axial Length in Orthokeratology Patients: Large Case Series ©2016 Lipson et al. 5/7

Table 4: Axial length change (mm) for various studies by age, correction modality and total number of patients.

Summary of Studies on 3 yr Increase in Axial Length (mm)

Age at Start This Study Cho et al. [20] Cho et al. [20] Hyman et al. [33] Cheng et al. [43]
Correction Modality
Ortho-K Ortho-K Spectacles Spectacles Spectacles
6-7 0.57 1.10 Age 8-13
8-9 0.46 0.49 0.81 0.82
10-11 0.15 0.31 0.55 0.57
12 + 0.06 None

Mean 3 yr change 0.28 0.36 (2yr) 0.63 (2yr) 0.71 0.82

How ortho-k slows myopic progression one option to slow myopic progression. Advantages for children
choosing Ortho-K over spectacle correction include no vision
Investigations into myopia control over the previous decade correction required during daily activities and the slowing of
have generated theories to explain why Ortho-K slows axial length myopic progression. The disadvantages of Ortho-K are the ongoing
increases in myopic children [48-50]. Most have centered on the potential for eye irritation caused by debris under the lens while
effect of the optical changes to the peripheral refractive profile sleeping and potential for variable visual acuity dependent on a
created by Ortho-K. Similar to spectacles and contact lenses, specific number of hours of nightly wear of the lenses. Ongoing
Ortho-K creates sharp focus on the central area of the retina risks of complications with Ortho-K relate to corneal abrasion
(macula and peri-macular area). But, peripheral to the macular and microbial keratitis. That said, recent studies have shown
area, while spectacle and contact lens correction creates relative that Ortho-K poses less risk of microbial keratitis than that of
peripheral hyperopia, Ortho-K creates relative peripheral myopia overnight wear of soft lenses [58].
[51-56]. This relative peripheral myopic defocus inhibits the
signaling for the eye to elongate [50]. Summary
Axial length - other factors Use of Ortho-K was associated with less axial length increase
than historical increases in similar aged children wearing other
While a previous study of Ortho-K wearers [48] documented
forms of vision correction to correct their myopia. Age at start
corneal thickness changes, particularly of the epithelial layer,
of Ortho-K was the only clinically significant factor associated
the changes reported in these studies were between 10 and 15
with axial length changes during our three-year study. Because
microns, which are not clinically substantial enough to affect
of the lack of concurrent controls in our study, and comparison
our findings. Another study showed no significant changes in
of 3 year results with outcomes from populations that differ
the length of the anterior segment, which indicates that axial
from ours, conclusions should be viewed with due caution. Our
length measurement, should be a valid method to monitor myopic
retrospective study showed the mean change in axial length in
progression in children undergoing Ortho-K [49].
Ortho-K wearers over a three year period was an increase of 0.28
The future of myopia control with ortho-k mm. Additional study of peripheral refractive profiles of children
being treated with Ortho-K will add to our understanding of the
It is likely that there is more involved in myopia control ideal peripheral refractive profile that may stop or slow myopic
with Ortho-K than reshaping the cornea for best central visual progression even more effectively. For now, use of Ortho-K slows
acuity. Individually designing Ortho-K lenses for optimal myopia myopia progression for the majority of children.
control may involve creation of custom lens profiles generated
from baseline measurements of posterior retinal shape and References
peripheral refraction [52-56]. The ideal amount and location
1. Vitale S, Ellwein L, Cotch MF, Ferris FL, Sperduto R (2008) Prevalence
of the relative peripheral myopia required for optimal myopia of refractive error in the United States, 1999-2004. Arch Ophthalmol
control is not known at this time [57]. Peripheral refraction was 126(8): 1111-1119.
not performed on subjects in this study and the Ortho-K lenses
used for this study’s participants were not custom-designed 2. Vitale S, Sperduto RD, Ferris FL (2009) Increased prevalence of
myopia in the united states between 1971-1972 and 1999-2004. Arch
based on this parameter. Future study of Ortho-K recipients that
Ophthalmol 127(12): 1632-1639.
include collection of peripheral refractive data may reveal why
some subjects showed no progression compared to those who 3. Lin LL, Shih YF, Tsai CB, Chen CJ, Lee LA, et al. (1999) Epidemiologic
still progressed. study of ocular refraction among schoolchildren in Taiwan in 1995.
Optom Vis Sci 76(5): 275-281.
Ortho-K vs. other modes of correction
4. Kempen JH, Mitchell P, Lee KE, Tielsch JM, Broman AT, et al. (2004)
Currently, myopic children and their parents who are The prevalence of refractive errors among adults in the United States,
concerned about myopic progression can consider Ortho-K as Western Europe, and Australia. Arch Ophthalmol 122(4): 495-505.

Citation: Lipson MJ, Harris JK, Lather HD, Niziol LM, Musch DC (2016) Axial Length in Orthokeratology Patients: Large Case Series. Adv Ophthalmol Vis
Syst 5(2): 00154. DOI: 10.15406/aovs.2016.05.00154
 Copyright:
Axial Length in Orthokeratology Patients: Large Case Series ©2016 Lipson et al. 6/7

5. Farbrother JE, Kirov G, Owen MJ, Guggenheim JA (2004) Family 24. Cho P, Cheung SW, Edwards M (2005) The longitudinal orthokeratology
aggregation of high myopia: estimation of the sibling recurrence risk research in children (LORIC) in Hong Kong: A pilot study on refractive
ratio. Invest Ophthalmol Vis Sci 45(9): 2873-2878. changes and myopic control. Curr Eye Res 30(1): 71-80.
6. Mutti DO, Mitchell GL, Moeschberger ML, Jones LA, Zadnik K (2002) 25. Kakita T, Hiraoka T, Oshika T (2011) Influence of overnight
Parental myopia, near work, school achievement, and children’s orthokeratology on axial elongation in childhood myopia. Invest
refractive error. Invest Ophthalmol Vis Sci 43(12): 3633-3640. Ophthalmol Vis Sci 52(5): 2170-2174.
7. Hysi PG, Wojciechowski R, Rahi JS, Hammond CJ (2014) Genome-wide 26. Lipson MJ (2008) Long-term clinical outcomes for overnight corneal
association studies of refractive error and myopia, lessons learned, reshaping in children and adults. Eye Contact Lens 34(2): 94-99.
and implications for the future. Invest Ophthalmol Vis Sci 55(5): 3344-
3351. 27. Mutti DO, Hayes JR, Mitchell GL, Jones LA, Moeschberger ML, et al.
(2007) Refractive error, axial length, and relative peripheral refractive
8. Donovan L, Sankaridurg P, Ho A, Naduvilath T, Smith EL, et al. (2012) error before and after the onset of myopia. Invest Ophthalmol Vis Sci
Myopia progression rates in urban children wearing single-vision 48(6): 2510-2519.
spectacles. Optom Vis Sci 89(1): 27-32.
28. Walline JJ, Jones LA, Sinott LT (2009) Corneal reshaping and myopia
9. Young TL (2009) Molecular genetics of human myopia: an update. progression. Br J Ophthalmol 93(9): 1181-1185.
Optom Vis Sci 86(1): E8-E22.
29. Lipson MJ (2015) Axial length measurement: PalmScan vs IOLMaster.
10. Wu PC, Tsai CL, Wu HL, Yang YH, Kuo HK (2013) Outdoor activity Eye Contact Lens 41(3): 156-159.
during class recess reduces myopia onset and progression in school
children. Ophthalmology 120(5): 1080-1085. 30. Laird NM, Ware JH (1982) Random-effects models for longitudinal
data. Biometrics 38(4): 963-974.
11. Walline JJ, Lindsley K, Vedula SS (2011) Interventions to slow
progression of myopia in children (Review). The Cochrane Library, 31. Xiang F, He M, Morgan IG (2012) Annual changes in refractive errors
Issue 12. and ocular components before and after the onset of myopia in Chinese
children. Ophthalmology 119(7): 1478-1484.
12. Jones LA, Sinnott LT, Mutti DO, Mitchell GL, Moeschberger ML, et al.
(2007) Parental history of myopia, sports and outdoor activities, and 32. Fan DSP, Lam DSC, Chan CKM, Fan AH, Cheung EYY et al. (2007)
future myopia. Invest Ophthalmol Vis Sci 48()8: 3524-3532. Topical atropine in retarding myopic progression and axial length
growth in children with moderate to severe myopia: a pilot study. Jpn J
13. Praveen MR, Vasavadd AR, Jani UD, Trivedi RH, Choudhary PK (2008) Ophthalmol 51(1): 27-33.
Prevalence of cataract type in relation to axial length in subjects with
high myopia and emmetropia in an Indian population Am J Ophthalmol 33. Hyman L, Gwiazda J, Hussein M, Norton TT, Wang Y, et al. (2005)
145(1): 176-181. Relationship of age, sex, and ethnicity with myopia progression and
axial elongation in the correction of myopia evaluation trial. Arch
14. Saw SM, Gazzard G, Shih-Yen EC, Chua WH (2005) Myopia and Ophthalmol 123(7): 977-987.
associated pathological complications. Ophthalmic Physiol Opt 25(5):
381-391. 34. Thorn F, Gwiazda J, Held R (2005) Myopia progression is specified by
a double exponential growth function. Optom Vis Sci 82(4): 286-297.
15. Foster PJ, Jiang Y (2014) Epidemiology of myopia. Eye(Lond) 28(2):
202-208. 35. He M, Zheng Y, Xiang F (2009) Prevalence of myopia in urban and rural
children in mainland China. Optom Vis Sci 86(1): 40-44.
16. Pan CW, Cheung CY, Aung T, Cheung CM, Zheng YF, et al. (2013)
Differential associations of myopia with major age-related eye 36. Wen G, Tarczy-Hornock K, McKean-Cowdin R, Cotter SA, Borchert M, et
diseases. Ophthalmology 120(2): 284-291. al. (2013) Prevalence of myopia, hyperopia, and astigmatism in non-
hispanic white and asian children: multi-ethnic pediatric eye disease
17. Jones D, Luensmann D (2012) The prevalence and impact of high study. Ophthalmology 120(10): 2109-2116.
myopia. Eye & Contact Lens 38(3): 188-196.
37. Ip JM, Saw SM, Rose KA, Morgan IG, Kifley A, et al. (2008) Role of near
18. Johnson K (2014) Are we myopic about myopia control?. Contact Lens work in myopia: findings in a sample of Australian school children.
& Anterior Eye 37(4): 237-239. Invest Ophthalmol Vis Sci 49(7): 2903-2910.
19. Aller T and Wildsoet C (2013) Optical control of myopia has come of 38. Sherwin JC, Reacher MH, Keogh RH, Khawaja AP, Mackey DA, et al.
age: or has it?. Optom Vis Sci 90(5): e135-e137. (2012) The association between time spent outdoors and myopia in
children and adolescents. Ophthalmology 119(10): 2141- 2151.
20. Cho P, Cheung SW (2012) Retardation of myopia in orthokeratology
(ROMIO) study: A 2-Year randomized clinical trial. Invest Ophthalmol 39. Cheng D, Woo GC, Drobe B, Schmid KL (2014) Effect of bifocal and
Vis Sci 53(11): 7077-7085. prismatic bifocal spectacles on myopia progression in children:three-
year results of a randomized clinical trial. JAMA Ophthalmol 132(3):
21. Hiraoka T, Kakita T, Okamoto F, Takahashi H, Oshika T (2012) Long- 258-264.
term effect of overnight orthokeratology on axial length elongation in
childhood myopia: a 5-year follow-up study. Invest Ophthalmol Vis Sci 40. Kang P, Gifford P, McNamara P, Wu J, Yeo S, et al. (2010) Peripheral
53(7): 3913-3919. refraction in different ethnicities. Invest Ophthalmol Vis Sci 51(11):
6059-6065.
22. Santodomingo-Rubido J, Villa-Collar C, Gilmartin B, Gutiérrez-Ortega R
(2012) Myopia control with orthokeratology contact lenses in Spain: 41. Charman WN, Mountford J, Atchison DA, Markwell EL (2006)
refractive and biometric changes. Invest Ophthalmol Vis Sci 53(8): Peripheral refraction in orthokeratology patients. Optom Vis Sci 83(9):
5060-5065. 641-648.
23. Downie LE, Lowe R (2013) Corneal reshaping influences myopic 42. Queiros A, Gonzalez-Meijome JM, Jorge J, Villa-Collar C, Gutiérrez AR
prescription stability (crimps): an analysis of the effect of (2010) Peripheral refraction in myopic patients after orthokeratology.
orthokeratology on childhood myopic refractive stability. Eye & Optom Vis Sci 87(5): 323-329.
Contact Lens 39(4): 303-310.

Citation: Lipson MJ, Harris JK, Lather HD, Niziol LM, Musch DC (2016) Axial Length in Orthokeratology Patients: Large Case Series. Adv Ophthalmol Vis
Syst 5(2): 00154. DOI: 10.15406/aovs.2016.05.00154
 Copyright:
Axial Length in Orthokeratology Patients: Large Case Series ©2016 Lipson et al. 7/7

43. Cheng D, Schmid KL, Woo GC (2007) Myopia prevalence in Chinese- 51. Cheung SW, Cho P (2013) Validity of axial length measurements for
Canadian children in an optometric practice. Optom Vis Sci 84(1): 21- monitoring myopic progression in orthokeratology. Invest Ophthalmol
32. Vis Sci 54(3): 1613-1615.
44. Wen D, Huang J, Chen H, Bao F, Savini G, et al. (2015) Efficacy and 52. Smith EL (2011) A case for peripheral optical treatment strategies for
acceptability of orthokeratology for slowing myopic progression in myopia. Optom Vis Sci 88(9): 1029-1044.
children: a systematic review and meta-analysis. J of Ophthal Article
ID 360806. 53. Kang P, Fan Y, Oh K, Trac K, Zhang F, et al. (2012) Effect of single vision
soft contact lenses on peripheral refraction. Optom Vis Sci 89(7):
45. Si JK, Tang K, Bi HS, Guo DD, Guo JG, et al. (2015) Orthokeratology for 1014-1021.
myopia control: a meta-analysis. Optom Vis Sci 92: 252-257.
54. Kang P, Gifford P, Swarbrick H (2013) Can manipulation of
46. Sun Y, Xu F, Zhang T, Liu M, Wang D, et al. (2015) Orthokeratology orthokeratology lens parameters modify peripheral refraction? Optom
to Control Myopia Progression: A Meta-Analysis. PLoS One 10(4): Vis Sci 90(11): 1237-1248.
e0124535.
55. Atchison DA, Pritchard N, Schmid KL (2006) Peripheral refraction
47. Alharbi A, Swarbrick HA (2003) The effects of overnight along the horizontal and vertical visual fields in myopia. Vision
orthokeratology lens wear on corneal thickness. Invest Ophthalmol Research 46(8-9): 1450-1458.
Vis Sci 44(6): 2518-2523.
56. Lipson MJ, Sandall G (2016) Myopia Control: Science or Luck. Eye and
48. Lin Z, Martinez A, Chen X, Sankaridurg P, Holden BA, et al. (2010) Contact Lens 42(1): 80-81.
Peripheral defocus with single-vision spectacle lenses in myopic
children. Optom Vis Sci 87(1): 4-9. 57. Bullimore MA, Sinnott LT, Jones-Jordan LA (2013) The Risk of Microbial
Keratitis With Overnight Corneal Reshaping Lenses. Optom Vis Sci
49. Kang P, Swarbrick H (2011) Peripheral refraction in myopic children 90(9): 937-944.
wearing orthokeratology and gas-permeable lenses. Optom Vis Sci
88(4): 476-482. 58. Liu YM, Xie P (2016) The Safety of Orthokeratology--A Systematic
Review. Eye Contact Lens 42(1): 35-42.
50. Faria-Ribeiro M, Queiros A, Lopes-Ferreira D, Jorge J, González-
Méijome JM, et al. (2013) Peripheral refraction and retinal contour in
stable and progressive myopia. Optom Vis Sci 90(1): 9-15.

Citation: Lipson MJ, Harris JK, Lather HD, Niziol LM, Musch DC (2016) Axial Length in Orthokeratology Patients: Large Case Series. Adv Ophthalmol Vis
Syst 5(2): 00154. DOI: 10.15406/aovs.2016.05.00154

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