Long -term effects of optical defocus on eye growth and refractogenesis.

Introduction: The aim of this paper was to study the effect of binocular and alternating monocular myopic constant defocus prescribed in spectacle format on myopia onset and progression in children.

Material And Methods: 129 children aged 5–12 years were divided into 4 groups: 48 children aged 5–8 years (1st group) with emmetropia and risk factors of myopia development were prescribed the continuous wearing of plus lenses to induce myopia of 1.0 D. 46 children aged 7–11 years (2nd group) with low myopia from −0.75 to −2.25 D were prescribed 2 pairs of spectacles for alternating continuous wearing. One eye was corrected for distance to obtain residual myopia in spectacles of about 0.50 D, and the fellow eye was corrected to obtain residual or induced myopia of about 1.50 D. The children changed spectacles every day. Control data were obtained from 15 children aged 6–9 years (1st control group) with pseudomyopia with no correction administered, and 20 low myopic children aged 7–12 years (2nd control group) wearing conventional spectacle correction. Autorefractometry before and after cycloplegia and ultrasound biometry were performed.

Results: A hyperopic shift caused by thinning of the crystalline lens and deepening of the anterior chamber in all patients of the 1st group was observed after 1 month and persisted over the follow -up period. Horizontal diameter (HD) increased more than 3 times as much as the axial length (AL). No cases of myopia onset were observed during the 9 -year follow -up period. 36 (81.8%) children of the 2nd group had stable refraction over the 4 year follow up, an insignificant increase in the AL and a significant increase in the HD were revealed. A 3-year follow -up revealed an increase in cycloplegic refraction in both control groups; the AL increased significantly, while the HD showed an insignificant increase.

Conclusions: Permanent low myopic defocus of the image in binocular spectacle format inhibits eye growth and refraction shift to myopia in children with low hyperopia, emmetropia and low myopia. The method of alternating monolateral low myopic defocus arrests the myopia progression in 81.8% of children with low myopia for 4 years and 66% for 7 years.