Natalia Vlasak’s research while affiliated with Netherlands Institute for Sound and Vision and other places

Aims/Purpose: The mechanism for the benefit from time outdoors at reducing the risk of myopia is not fully understood. The intensity and breadth of spectrum of outdoor light is likely to be relevant. Interventions based on light of different chromaticities to slow myopia progression are of increasing interest. A narrative review is presented that aims to assess the efficacy, effectiveness, and safety of myopia control interventions using violet light (VL); blue light (BL); and repeated low‐level red light (RLRL). Methods: A comprehensive literature search was undertaken for publications in English, evaluating the efficacy and safety of VL, BL and RLRL in human myopia control. Randomised controlled trials (RCTs) were prioritised but observational (non‐RCT) studies were included enabling evaluation of effectiveness and safety of interventions in real‐world clinics. Outcomes are changes in spherical equivalent refraction (SE) and/or axial length elongation (ALE). Results: 26 relevant publications were found. The literature is suggestive of a benefit from VL. Studies on RLRL reveal significant treatment effects. In most RLRL studies, control groups did not receive a sham control intervention, hence not controlling for placebo effects. Data concerning long‐term follow‐up are not available. Importantly, safety concerns have recently been raised, indicating that RLRL devices exceed maximum permissible exposure. Conclusions: Additional studies are needed to determine whether VL plays a key role in myopia progression and whether associated interventions are safe and effective. There is more evidence supporting the efficacy of RLRL in myopia control, but important safety concerns recently raised mean that these devices cannot be endorsed.

Aims: Most participants in myopia control studies have low and moderate myopia, relatively little is known about myopia control in high myopia. This review aims to evaluate the efficacy of myopia control strategies in high myopia and report on the structural and pathological complications of the eye. Methods: Comprehensive literature searches were undertaken using keywords in MEDLINE and EMBASE to identify publications in English, evaluating (1) the efficacy of myopia control strategies (environmental, pharmacological and optical) in high myopia (≤‐6.00D) and (2) the complications of high myopia. Outcomes include change in spherical error (SE) and/or axial length (AL) to evaluate progression in high myopia. Results: Twelve studies evaluating the efficacy of optical and pharmacological (none on environmental) interventions on axial elongation and myopic refractive error for high myopia control were identified. A statistically significant reduction in progression of refractive error in high myopes was reported with 1% and 0.5% atropine. Defocus Incorporated Multiple Segment spectacle lenses had lower efficacy in slowing high myopia progression compared to moderate and low myopia. Ortho‐K lenses were equally effective in reducing myopia progression in low, moderate and high myopia. All myopic patients have an increased risk of myopic macular degeneration, retinal detachment, cataract and glaucoma; with the risk increasing with level of myopia. Conclusions: High myopia has significant effects on quality of life and risk of pathological complications and vision impairment. Young children, excluding those with some syndromic associations, who are fast progressing moderate and high myopes require early intervention and close monitoring. Further research investigating the efficacy of myopia control strategies in highly myopic patients, both monotherapies and combination treatments, are necessary.

A review of light and colour therapies in myopia control

Trial design Double-masked crossover RCT (Research Registry: #8136) comparison of a new HOYA one-day disposable multifocal contact lens (HOMCL) with Alcon DAILIES TOTAL1® Multifocal (ADT1). Methods Sixty presbyopic participants from three countries attended for baseline measurements and fitting of both lens types and then for a fortnight completed daily diaries of symptoms with habitual optical correction, and VF-14 questionnaire. Participants collected either HOMCL or ADT1, when the vision was measured again, and they wore this product for a fortnight, completing daily diaries and VF-14. Participants then collected the other type and had vision and symptoms recorded in the same way. Results There were no serious adverse events. Primary outcomes were no significant differences between the lens types in willingness to purchase nor stated preference; no significant differences in the daily symptom ratings of comfort; statistically significant findings with the daily symptom ratings and VF-14 of better near vision with HOMCL and better distance vision with ADT1. Secondary outcomes were better high contrast distance visual acuity with ADT1 (<1 line), better low contrast distance visual acuity with ADT1; faster Wilkins rate of reading test with HOMCL; no significant differences in near visual acuity, wearing time, or number of lenses required during fitting process. Exploratory analyses were better handling scores with ADT1; and some, but not all of the dry eye data indicating better acceptance of HOMCL by patients with relatively dry eyes. For all measures, there were some participants who preferred/performed better with each lens type. Conclusions The differences between the performance of the two products were small. There was a trend in some clinical measurements and the daily diary data and VF-14 questionnaire, for HOMCL to outperform ADT1 for near vision and vice versa for distance vision.

• Increasing time outdoors reduces the risk of developing myopia. Likely mechanisms (Lingham et al., 2020) relate to outdoors having higher illuminance, a broader chromatic spectrum, a different effect on circadian rhythms, and different spatial frequency characteristics. Flicker may also be relevant. • Myopia control interventions have been proposed based on manipulating exposure to light of different chromaticities, involving repeated low-level red-light stimulation (RLRL), blue light (BL), and violet light (VL). • Purpose: To review evidence on the effectivity (RCTs), effectiveness (real-world observational studies), and safety of coloured light interventions for myopia control. The review considers a diversity of interventions (RLRL, BL, VL) and adopts a narrative format, considering diverse approaches in a holistic way, to highlight synergies or contradictions.

Background Myopia and especially high myopia are recognised as major public health concerns. Although the prevalence of high myopia in young children is low, 10–20% of high school children in Asia have high myopia, with many still progressing, and one in three patients with high myopia develop visual impairment with age. Most participants in myopia control studies have low and moderate myopia; relatively little is known about myopia control in high myopia. Method Literature searches were undertaken in MEDLINE and EMBASE to identify publications in English, investigating (Aim 1) the efficacy of myopia control strategies (environmental, pharmacological and optical) in high myopia (≤−6.00 D) and (Aim 2) the complications of high myopia using keywords. Outcomes included change in spherical equivalent refractive error (SE) and/or axial length (AL) to evaluate progression in high myopia. Results Aim 1: Twelve studies were identified that reported the efficacy of optical and pharmacological (none on environmental) interventions on AL and SE for high myopia control. A statistically significant reduction in progression of SE and AL in high myopes was reported with 1% and 0.5% atropine. Defocus Incorporated Multiple Segment spectacle lenses had lower efficacy in slowing high myopia progression compared to moderate and low myopia. Ortho‐K lenses were equally effective in reducing myopia progression in low, moderate and high myopia. Aim 2: Myopic patients have an increased risk of myopic macular degeneration, retinal detachment, cataract and glaucoma, with the risk increasing with the level of myopia. Conclusions High myopia has significant effects on quality of life, risk of pathological complications and vision impairment. Young children, excluding those with some syndromic associations, who are fast progressing moderate and high myopes require early intervention and close monitoring. Further research investigating the efficacy of myopia control strategies in highly myopic patients, both independently and through combination treatments, are necessary.

Purpose: To compare, in a non-inferiority double-masked crossover RCT (Research Registry: #8136), a new HOYA one-day disposable multifocal contact lens (HOMCL) with a market-leading product from Alcon (Dailies Total-One Multifocal; ADT1). Methods: Sixty presbyopic participants from three countries participated. Participants attended for baseline measurements and fitting of both lens types and then for a fortnight completed daily diaries of symptoms with habitual optical correction, and VF-14 questionnaire. Participants collected either HOMCL or ADT1, when the vision was measured again, and they wore this product for a fortnight, completing daily diaries and VF-14. Participants then collected the other type and had vision and symptoms recorded in the same way. Results: There were no serious adverse events. Primary outcomes were no significant differences between the lens types in willingness to purchase nor stated preference; no significant differences in the daily symptom ratings of comfort; statistically significant findings with the daily symptom ratings and VF-14 of better near vision with HOMCL and better distance vision with ADT1. Secondary outcomes were better high contrast distance visual acuity with ADT1 (<1 line) and better low contrast distance visual acuity with ADT1; no significant differences in measured near vision performance, Wilkins rate of reading test, wearing time, or number of lenses during fitting process. Exploratory analyses were daily diary ratings of near vision with ADT1 significantly worse than with habitual optical correction; and some, but not all of the dry eye data indicate better acceptance of HOMCL by patients with relatively dry eyes. For all measures, there were some participants who preferred or performed better with each lens type. Conclusions: The differences between the performance of the two products were small, supporting non-inferiority. There was a trend in some clinical measurements and the VF-14 questionnaire, for HOMCL to outperform ADT1 for near vision and vice versa for distance vision.

Background/aims Defocus incorporated multiple segments (DIMS) spectacle lenses are known to be able to inhibit axial length (AL) growth in myopic children compared with single vision (SV) spectacle lenses. However, it is not known whether AL growth is sufficiently inhibited to achieve the treatment goal of physiological AL growth. Methods Of the data already collected in 2014–2017 by Lam et al , the AL growth with DIMS and SV spectacle lenses was re-evaluated according to the age-matched myopia control system. The individual AL growth after the first year of treatment of each eye was plotted against the corresponding age of the same time point in a colour-coded scheme. The two treatment groups were further subdivided based on their age and their baseline AL. Results Overall, 65% (61% of male, 70% of female) of eyes with DIMS spectacle lenses and 16% (16% of male, 16% of female) of eyes with SV spectacle lenses are within range of physiological AL growth rate. Median AL growth rate of eyes with DIMS spectacle lenses is also within the range of physiological growth. In the subgroups, eyes with DIMS spectacle lenses were also superior to the ones with SV spectacle lenses regarding this treatment goal. Of the children with SV spectacle lenses, older children and children with eyes with high baseline AL were least likely to achieve physiological AL growth rate. Conclusions DIMS spectacle lenses can bring the AL growth rate of myopic children to the level of physiological AL growth rate, indicating 100% reduction of excessive myopic AL growth, independent of age and baseline AL. Older children and children with eyes with high AL have the risk to have increased AL growth without treatment.