A Comparison of the Effects of Orthokeratology Lens,

Medcall Lens, and Ordinary Frame Glasses on the

Accommodative Response in Myopic Children

Xiaoxia Han, M.D., Dongjun Xu, M.D., Weizhong Ge, M.D., Zhi Wang, M.D., Xiaodong Li, M.D., and
Weihua Liu, M.D.
Department of Ophthalmology, Affiliated Yixing People Hospital of Jiangsu University, Jiangsu, China
• Myopia is the inability to see things clearly unless they're relatively
close to your eyes. Also called nearsightedness or shortsightedness,
myopia is the most common refractive error among children and
young adults.
• Myopia occurs when the eye grows too long from front to back,
causing light to come to a focus in front of the retina instead of
directly on it. Other contributing factors include a cornea that is too
curved for the length of the eyeball or a lens inside the eye that is too
thick.
• Recent studies have found that the most important factors in the
occurrence and development of myopia in children are paracentral
defocus and accommodative lag
• More recently, clinical studies have also found that both hard and soft
contact lenses can enhance accommodative function.
• Orthokeratology (OKL), a new, nonsurgical procedure using specially
designed, gas permeable contact lenses to gently reshape the
curvature of the eye to improve refractive errors, had no effect on
accommodative function.
• Medcall lenses (MLs) is China’s Ministry of health myopia key
laboratory of innovative research and development of children’s
medical glasses
• Medcall lenses can reduce paracentral defocus. These lenses are
composed of a group of 360° concentric circles, with their diopters
gradually decreasing from the center to the periphery.
• the present study compared changes in accommodative response in
myopic children after one year of wearing ordinary frame glasses
(OFG), Mouldway orthokeratology lenses (M-OK), or ML
SUBJECT & METHODS
• A total of 240 myopic children treated in the department of
ophthalmology of the authors’ hospital between May 2013 and May
2015 were included in this study.
• There were 41 boys and 49 girls patients in OFG (the average age was
9.861.5 years
• There were 47 boys and 43 girls patients in M-OK (the average age
was 10.261.3 years)
• There were 29 boys and 31 girls patients in ML (the average age was
10.462.1 years)
SUBJECT & METHODS
• The children were randomly divided into three groups:
• OFG (90 cases) (the degree of diopter is 21.6760.62),
• M-OK (90 cases) (the degree of diopter is 21.5560.43),
• and ML (60 cases) (the degree of diopter is 21.6260.61).
Accommodative Lag Examination (MEM
Dynamic Retinoscopy)
• The vision mark of the test card was placed 40 cm from the myopia
benchmark, and the myopic dial was then rotated to expose the
cross-grate vision mark on the myopic dial (simultaneously
maintaining low lighting) so that the 60.50 D cross cylinder lens could
be located within the binocular vision window of the child (the
negative axis of this cross cylinder lens was fixed at 90° and the
positive axis was fixed as 180°). If the child reported that the
horizontal line appeared relatively clearer than the vertical line, this
indicated that the child’s accommodative response was less than the
accommodative stimulus (i.e., accommodative lag).
• One examiner then placed the positive lens of the 62.00 D
accommodative flippers in front of the child’s eyes and asked him/her
to focus on the letters on the visual acuity chart. This caused the clear
vision mark to become blurred, and when the child reported the
vision mark becoming clear, the examiner immediately placed the
negative lens in front of the child’s eyes. This caused the clear vision
mark to become blurred again, and when the child reported the
vision mark becoming clear again, the lenses were switched.
• Outcome indexes included diopter, accommodative lag, and binocular
accommodative facility before and after one year of wearing glasses
Statistical Analysis
• SPSS version 17.0 (SPSS, Chicago, IL) was used for statistical analysis.
• Multiple-factor ANOVA was used to compare the changes in
accommodative lag and accommodative facility after wearing glasses;
P,0.05 was considered to be statistically significant
RESULTS
CHANGES OF ACCOMODATION LAG
CHANGES OF ACCOMODATIVE SENSITIVE
CHANGES OF DIOPTER
 DISCUSSION
• A prospective study found that children with emmetropia exhibited
an accommodative lag before becoming myopic. An increase in
accommodative lag can be evident 2 years before the development of
clinical myopia.
(Gwiazda J, Thorn F, Bauer J, et al. Myopia children show insufficient accommodative response to blur. Invest
Ophthalmol Vis Sci 1993;34: 690–694)
• Ordinary frame glasses are the most commonly used method to
correct myopia
• The central diopter of OFG is less than in the peripheral area (i.e., the
diopter gradually increases from the center to the periphery)
• OKL can reshape corneal surface morphology, flattening the central
cornea and thickening the meso and peripheral areas. Two weeks of
OKL use has been shown to keep the front corneal surface flat while
the peripheral retina is in a myopic defocus state, thus delaying the
progression of myopia
• In this study, the accommodative lags in M-OK and ML were
significantly decreased
• this was because of several factors. Wearing glasses increased the
spherical aberration so that the imaging qualities, especially those in
the peripheral retina, were improved
• McLeod and Brand reported no change in accommodative lag after
wearing OKL. But in these studies, the assessments were performed
after 3 months, whereas we reviewed the patients after 1 year.
• Felipe-Marquez et al.reported that accommodative lag was unchanged
after 3 years of using glasses.
This may have been observed because the patients in that study were
all adults.
In present study myopic children, whose eyes were still developing and,
therefore, had stronger accommodative abilities.
LIMITATION
• the sample size in this study was small
• the follow-up time was short
• the results are subject to inherent study limitations.
• In this journal, they did not explaine about exclusion factor.