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The Treatment of Myopia and Refractive Errors in Children
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The Treatment of Myopia and Refractive Errors in Children

A special issue of Children (ISSN 2227-9067). This special issue belongs to the section "Pediatric Ophthalmology".

Deadline for manuscript submissions: closed (30 December 2024) | Viewed by 8278

Special Issue Editors

Dr. Sara Jayne McCullough

E-Mail Website
Guest Editor
Optometry and Vision Science Research Group, Ulster University, Coleraine, UK
Interests: paediatric vision; the development and progression of refractive error in children with a particular interest in the development and management of myopia
Dr. Lesley Doyle

E-Mail Website
Guest Editor
1. Vision Science Research Group, Ulster University, Coleraine, UK
2. Northern Ireland Clinical Research Network, Belfast, UK
Interests: paediatric vision; visual development; myopia development and management

Special Issue Information

Dear Colleagues,

Refractive error is the inability of the eye to properly focus light onto the retina, resulting in blurred vision, and this can be classified into myopia (short-sightedness), hyperopia (long-sightedness), and astigmatism. Refractive errors are typically corrected by wearing glasses or contact lenses, or through refractive surgery to improve visual clarity. Uncorrected refractive error in children can cause reduced vision, difficulties with how the eyes work together, and poor near focusing, and, as a result, can lead to reduced academic performance and behavioural issues.  Therefore, parents, educators, and health professionals need to be aware of potential signs of uncorrected refractive error to ensure the correction of these through timely eye examinations in order to support children’s development and overall well-being. 

In recent years, the prevalence of myopic refractive error has increased, most likely caused by changes in children’s visual environments, with children spending much less time outdoors and more time in intense learning environments and viewing digital devices.  Myopia results from the eyeball growing longer and at a rate faster than normal eye growth. While the vision defect caused by myopia is easily correctable, the elongation and stretching of the eye are associated with an increased risk of future sight-threatening pathology. Therefore, the increasing prevalence of myopia is a significant public health concern.  Recent developments in spectacle and contact lenses that help to slow down myopia progression have received significant research interest and show promise in curtailing this looming epidemic.   

This Special Issue invites the contribution of original articles, systematic evaluations, and analyses on myopia and refractive error treatment in children. We welcome your valuable contributions.

Dr. Sara Jayne McCullough
Dr. Lesley Doyle
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Children is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2400 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • refractive error
  • paediatric vision
  • visual development
  • hyperopia
  • astigmatism
  • myopia
  • myopia control
  • pre-myopia

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Published Papers (6 papers)

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Research

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16 pages, 1043 KiB  
Article
Ocular Biometry Distribution and One-Year Growth in Eight-Year-Old Southern European Schoolchildren Under the CISViT Project
by Mariam El Gharbi, Laura Guisasola, Alba Galdón, Valldeflors Vinuela-Navarro, Joan Pérez-Corral, Núria Tomás and Núria Vila-Vidal
Children 2025, 12(2), 221; https://doi.org/10.3390/children12020221 - 12 Feb 2025
Viewed by 521
Abstract
Objective: To analyse variations in axial length (AL), corneal radius (CR) and the AL/CR ratio over one year in eight-year-old schoolchildren, considering sex, ethnicity and refractive error. Methods: Vision screenings were conducted in 16 schools in Terrassa (Barcelona, Spain) with eight-year-old [...] Read more.
Objective: To analyse variations in axial length (AL), corneal radius (CR) and the AL/CR ratio over one year in eight-year-old schoolchildren, considering sex, ethnicity and refractive error. Methods: Vision screenings were conducted in 16 schools in Terrassa (Barcelona, Spain) with eight-year-old children as part of the CISViT project. Measurements included ocular biometrics (AL and CR) and non-cycloplegic autorefraction for refractive error. Parental questionnaires provided demographic data (birth date, ethnicity). The same procedures were repeated after one year. Results: Ocular biometric parameters differed by sex and ethnicity. Boys and children of Maghreb descent had longer AL and flatter CR than girls and Caucasian children (p < 0.001 for both visits). The AL/CR ratio was higher in boys than girls (p = 0.002 in the initial visit and p = 0.011 in the follow-up visit) but consistent across ethnicities (p = 0.291 and p = 0.390). AL and AL/CR ratio differed significantly by refractive error status (p < 0.001 in both visits), increasing in more myopic children, while CR showed no significant difference. In myopic children, the AL/CR ratio exceeded 3.0, and typical sex-based biometric differences diminished. Growth rates for AL and AL/CR ratio were similar across sex and ethnicity, indicating minimal demographic influence. Conclusions: AL and CR differ significantly by sex and ethnicity, with demographic differences evident in baseline measurements but not in growth rates over one year. The consistency of the AL/CR ratio across ethnicities, despite sex-based differences, supports its utility as a reliable metric for assessing refractive development in diverse populations. Full article
(This article belongs to the Special Issue The Treatment of Myopia and Refractive Errors in Children)
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14 pages, 1264 KiB  
Article
Efficacy of Asymmetric Myopic Peripheral Defocus Lenses in Spanish Children: 24-Month Randomized Clinical Trial Results
by Clara Martinez-Perez, Miguel Ángel Sánchez-Tena, Jose Miguel Cleva, Cesar Villa-Collar, Marta Álvarez, Eva Chamorro and Cristina Alvarez-Peregrina
Children 2025, 12(2), 191; https://doi.org/10.3390/children12020191 - 6 Feb 2025
Viewed by 1000
Abstract
Background/Objectives: Asymmetric myopic peripheral defocus lenses (MPDLs) have proven to be effective in slowing the progression of myopia in Spanish children over a period of 12 months. The purpose of this study was to assess the MPDL spectacles’ efficacy in slowing myopia [...] Read more.
Background/Objectives: Asymmetric myopic peripheral defocus lenses (MPDLs) have proven to be effective in slowing the progression of myopia in Spanish children over a period of 12 months. The purpose of this study was to assess the MPDL spectacles’ efficacy in slowing myopia progression over a 24-month period in children. Methods: This study extends the follow-up period of the double-masked, prospective, and randomized clinical trial previously published to 24 months. Children from 6 to 12 years were assigned to two groups: a control group wearing spherotorical single vision lenses (SVLs) or a treatment group wearing MPDL lenses. Inclusion criteria included children with myopia less than −0.50 D, astigmatism below 1.50 D, and best-corrected visual acuity of at least 20/20. Participants underwent cycloplegic autorefractive examination and axial length (AL) measurements at the baseline and six and twelve months in the study already published, and twenty-four months later in the present study. Lifestyle factors, including outdoor activities and digital device use, were also assessed. Baseline characteristics, including age, refractive error, and AL, were comparable between groups. Dropout rates were 15.9%, with 14 participants lost to follow-up, distributed equally between the two groups. Results: After 24 months of follow-up, 69 children remained in this study, comprising 34 participants in the SVL cohort and 35 in the MPDL cohort. Over 24 months, the MPDL group showed significantly less AL elongation than the SVL group (0.27 ± 0.23 mm and 0.37 ± 0.24 mm; p = 0.0341). The mean relative AL increase was 1.10 ± 0.95% in the MPDL group, compared to 1.56 ± 1.02% in the SVL group (p = 0.0322). Younger children exhibited faster AL growth, while digital device use and outdoor activities did not affect AL changes. Conclusions: MPDL spectacle lenses substantially slowed myopia progression over a 24-month period, with 28.7% less progression in absolute AL growth and 29.8% in relative AL growth compared to SVL. These results indicate that MPDL lenses are an effective method for slowing myopia progression. Full article
(This article belongs to the Special Issue The Treatment of Myopia and Refractive Errors in Children)
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15 pages, 3405 KiB  
Article
Inter-Examiner and Inter-Instrument Agreement of the Myopia Master with the IOL Master 700 and NVisionK 5001 in Myopic Children
by Emma L. McConnell, Cameron Woods, Lesley Doyle, Jane M. Fulton, Kathryn J. Saunders and Sara J. McCullough
Children 2025, 12(2), 121; https://doi.org/10.3390/children12020121 - 23 Jan 2025
Viewed by 615
Abstract
Background/Objectives: The measurement of axial length (AL) is important to monitor the success of interventions to slow childhood myopia, but traditional biometers are expensive for clinicians to acquire. To address this, Oculus has developed the Myopia Master (MM), which measures auto-refraction (AR), [...] Read more.
Background/Objectives: The measurement of axial length (AL) is important to monitor the success of interventions to slow childhood myopia, but traditional biometers are expensive for clinicians to acquire. To address this, Oculus has developed the Myopia Master (MM), which measures auto-refraction (AR), corneal curvature (CC) and AL. This study compared inter-instrument and inter-examiner measures on the MM, IOL Master 700 (Carl Zeiss Meditec, Jena, Germany) and NVisionK-5001 (Shin-Nippon, Tokyo, Japan) in myopic children. Methods: Fifty-six myopic children participated (mean age 11.93 ± 1.93 years). A first examiner obtained the following under cycloplegia: (i) AR using the NVisionK, (ii) AL and CC using the IOL Master 700 and (iii) AR, AL and CC using the MM. The latter measures were repeated by a second examiner to assess inter-examiner agreement of the MM. Mean differences (MD) and 95% limits of agreement (LoA) were calculated. Spherical equivalent refraction (SER) was calculated using AR values. Acceptable LoA for AL, SER and CC were defined as ±0.05 mm, ±0.40 D and ±0.06 mm, respectively. Results: Inter-instrument LoA between the MM and IOL Master 700 for AL and CC were acceptable (MD 0.02 mm; 95%LoA −0.02 to 0.06 mm and MD 0.025 mm, 95% LoA −0.03 to 0.08 mm, respectively). SER measures between the NVisionK-5001 and MM were not acceptable (MD −0.44 D, 95% LoA −0.91 to 0.03 D). SER values were, on average, 0.44 D more negative when using the MM. Inter-examiner measures on the MM were all acceptable (AL MD 0.00 mm; 95% LoA −0.04 to 0.04 mm; SER MD −0.01 D; 95% LoA −0.33 to 0.32 D; CC MD 0.01 mm; 95% LoA −0.03 to 0.05 mm). Conclusions: The MM demonstrated excellent inter-examiner repeatability. Inter-instrument agreement between the MM and IOL Master 700 for the AL and CC measures showed excellent agreement. The MM over-estimated myopia SER compared with the NVisionK-5001. Full article
(This article belongs to the Special Issue The Treatment of Myopia and Refractive Errors in Children)
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13 pages, 906 KiB  
Article
Perceptions and Barriers to Accessing Myopia Management in the UK
by Stephanie Kearney, Sophie Coverdale, Cheralynn Saunders, Mhairi Day, Lindsay Rountree, Kathryn Webber, Edward A. H. Mallen and Neema Ghorbani-Mojarrad
Children 2024, 11(12), 1490; https://doi.org/10.3390/children11121490 - 6 Dec 2024
Cited by 1 | Viewed by 1073
Abstract
Background/Objectives: Perceptions and barriers to myopia management (MM) in childhood have not been fully explored within some countries, including the UK, where there is minimal public health education on myopia. Methods: The aim of this mixed-methods study was to explore perceptions of myopia [...] Read more.
Background/Objectives: Perceptions and barriers to myopia management (MM) in childhood have not been fully explored within some countries, including the UK, where there is minimal public health education on myopia. Methods: The aim of this mixed-methods study was to explore perceptions of myopia and MM interventions using focus groups and a survey to obtain qualitative and quantitative data. Topics included the understanding of myopia, perceptions of MM, considerations when initiating MM, lifestyle risk factors, and barriers to uptake of intervention. Results: Parent awareness and understanding of myopia and MM is limited. Many parents felt that they had not been provided with sufficient explicit advice about their child’s diagnosis or treatment. Despite this, parents were aware of some of the protective lifestyle behaviours which may slow myopia progression. The common belief was that myopia can affect a child’s quality of life. The most common reason that MM had been recommended to parents by practitioners was to reduce disease risk. Conclusions: The cost and lack of public awareness that MM interventions are available were the main barriers to the uptake of MM. There is a need to improve practitioner communication of myopia and its management and, subsequently, improve the standard of children’s eyecare. Full article
(This article belongs to the Special Issue The Treatment of Myopia and Refractive Errors in Children)
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Review

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21 pages, 1013 KiB  
Review
Pharmaceutical Prescribing Privileges for Optometrists to Combat Childhood Myopia in Singapore: Public Health Policy Review and Analysis
by Tiong Peng Yap and Masuma Pervin Mishu
Children 2024, 11(12), 1548; https://doi.org/10.3390/children11121548 - 20 Dec 2024
Viewed by 1513
Abstract
Singapore’s national myopia prevention efforts have largely focused on school vision screening and public education on outdoor activities in the past two decades. Given the emergence of evidence-based myopia interventions, this policy review and analysis investigates the potential benefits and drawbacks of optometrist [...] Read more.
Singapore’s national myopia prevention efforts have largely focused on school vision screening and public education on outdoor activities in the past two decades. Given the emergence of evidence-based myopia interventions, this policy review and analysis investigates the potential benefits and drawbacks of optometrist prescribing privileges as it has been proposed to reduce the barriers to access effective interventions, such as combined therapy (e.g., orthokeratology treatment and low-dose atropine therapy). In this policy analysis, two policy options were identified to be feasible based on evidence from a systematic literature search and they were analysed along with status quo using the Centers for Disease Control and Prevention (CDC) Policy Analysis Framework. This includes independent prescribing and supplementary prescribing, where the former entails autonomous clinical decision making, and the latter entails co-management with ophthalmological supervision. The policy review and analysis found independent prescribing the most favourable and concluded that this should be implemented in view of its benefits for the community. Public health impact is expected to be substantial due to increased patient access, reduced treatment costs, early interventions, improved treatment compliance, and reduced wait times and inconvenience. It is feasible because treatment processes can be streamlined, and it can be implemented based on existing collaborative prescribing frameworks. Economical and budgetary impact is also substantial given the direct savings generated, which can consequently help to reduce the disease burden. Full article
(This article belongs to the Special Issue The Treatment of Myopia and Refractive Errors in Children)
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20 pages, 366 KiB  
Review
Myopia in Children: Epidemiology, Genetics, and Emerging Therapies for Treatment and Prevention
by Pier Luigi Surico, Uday Pratap Singh Parmar, Rohan Bir Singh, Yeganeh Farsi, Mutali Musa, Antonino Maniaci, Salvatore Lavalle, Fabiana D’Esposito, Caterina Gagliano and Marco Zeppieri
Children 2024, 11(12), 1446; https://doi.org/10.3390/children11121446 - 27 Nov 2024
Cited by 1 | Viewed by 2823
Abstract
Refractive errors, particularly myopia, are among the most prevalent visual impairments globally, with rising incidence in children and adolescents. This review explores the epidemiology and risk factors associated with the development of refractive errors, focusing on the environmental and lifestyle factors contributing to [...] Read more.
Refractive errors, particularly myopia, are among the most prevalent visual impairments globally, with rising incidence in children and adolescents. This review explores the epidemiology and risk factors associated with the development of refractive errors, focusing on the environmental and lifestyle factors contributing to the current surge in myopia. We provide an overview of key genetic factors and molecular pathways driving the pathogenesis of myopia and other refractive errors, emphasizing the complex interplay between genetic predisposition and environmental triggers. Understanding the underlying mechanisms is crucial for identifying new strategies for intervention. We discuss current approaches to slow myopia progression in pediatric populations, including pharmacological treatment regimens (low-dose atropine), optical interventions, and lifestyle modifications. In addition to established therapies, we highlight emerging innovations, including new pharmacological agents and advanced optical devices, and insights into potential future treatments. Cutting-edge research into gene therapy, molecular inhibitors, and neuroprotective strategies may yield novel therapeutic targets that address the root causes of refractive errors. This comprehensive review underscores the importance of early intervention and highlights promising avenues for future research, aiming to provide pediatricians with guidance to ultimately improve clinical outcomes in managing and preventing myopia progression in children and young adults. Full article
(This article belongs to the Special Issue The Treatment of Myopia and Refractive Errors in Children)
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