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Evaluation of an Optical Defocus Treatment for Myopia Progression Among Schoolchildren During the COVID-19 Pandemic

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To identify the key insights or developments described in this article
1 Credit CME
Key Points

Question  Is an optical defocus treatment associated with slowed myopia progression among schoolchildren experiencing lockdown related to the COVID-19 pandemic?

Findings  In this exploratory analysis of 2 cohort studies including 171 schoolchildren during COVID-19 lockdown, treatment using a defocus incorporated multiple segments lens was associated with 46% less myopia progression and 34% less axial elongation compared with regular single vision lens treatment.

Meaning  These findings suggest that an optical defocus treatment may be associated with slower myopia progression, which has been exaggerated during the COVID-19 pandemic, among schoolchildren.


Importance  Myopia progression has been found to be worsening during the COVID-19 pandemic. It is important to control the rapid myopia progression in this period.

Objective  To analyze the association of COVID-19–related lockdown measures with myopia progression in schoolchildren and to compare the performance of defocus incorporated multiple segments (DIMS) lens with that of single vision lens (SVL) treatment in reducing myopia progression.

Design, Setting, and Participants  This cohort study involved an exploratory, prespecified, comparison of 2 independent longitudinal studies performed at the same institute beginning in 2019. Data from Hong Kong schoolchildren (aged 7-13 years) were gathered and analyzed. Data analysis was performed from June to July 2021.

Exposure  Schoolchildren in study 1 wore a DIMS lens for 18 months, and those in study 2 wore a SVL for 24 months.

Main Outcomes and Measures  Cycloplegic spherical equivalent refraction and axial length were measured. Studies 1 and 2 started before the start of lockdown measures and continued throughout the lockdown. In both studies, periods of fewer and more COVID-19–related lockdown measures were identified. Because COVID-19 lockdown caused deviations from the visit schedule, myopia progression was normalized to 12-month change, which were compared between DIMS and SVL groups, also during the periods with less and more lockdown time.

Results  There were 115 participants (58 girls [50.4%]; mean [SD] age, 10.3 [1.5] years) in the DIMS group; their mean (SD) baseline refraction was −4.02 (1.46) D. There were 56 participants (29 girls [51.8%]; mean [SD] age, 10.8 [1.5] years) in the SVL group; their mean (SD) baseline refraction was −2.99 (1.06) D. After controlling for the covariates, DIMS treatment was significantly associated with 34% less axial elongation (0.19 mm [95% CI, 0.16 to 0.22 mm] vs 0.30 mm [95% CI, 0.25 to 0.35 mm]; P < .001) and 46% less myopic progression after 12 months (−0.31 D [95% CI, −0.39 to −0.23 D] vs −0.57 D [95% CI, −0.69 to −0.45 D]; P = .001) compared with SVL treatment. In both the DIMS and SVL groups, more lockdown time was associated with significantly more spherical equivalent refraction (−0.54 D [95% CI, −0.64 to 0.44 D] vs −0.34 D [95% CI, −0.44 to −0.25 D]; P = .01) and axial length (0.29 mm [95% CI, 0.25 to 0.32 mm] vs 0.20 mm [95% CI, 0.16 to 0.24 mm]; P = .001) compared with less lockdown time. No significant interaction between treatment type and lockdown time was observed.

Conclusions and Relevance  In this exploratory analysis, myopia progressed more rapidly in schoolchildren during the period when there were more COVID-19–related lockdown measures. However, optical treatment with DIMS was significantly associated with slower myopia progression compared with SVL treatment during the lockdown period.

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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

Article Information

Accepted for Publication: November 22, 2021.

Published: January 14, 2022. doi:10.1001/jamanetworkopen.2021.43781

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2022 Choi KY et al. JAMA Network Open.

Corresponding Author: Henry Ho-lung Chan, PhD, Centre for Myopia Research, School of Optometry, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong 00000 (henryhl.chan@polyu.edu.hk).

Author Contributions: Drs Chun and Chan had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Drs Choi and Chun are co–first authors.

Concept and design: Choi, Chun, To, Lam, Chan.

Acquisition, analysis, or interpretation of data: Chun, Tang, Lam, Chan.

Drafting of the manuscript: Choi, Chun, Tang.

Critical revision of the manuscript for important intellectual content: Choi, Chun, To, Lam, Chan.

Statistical analysis: Choi, Chun, Tang, Lam.

Obtained funding: Chun, To, Chan.

Administrative, technical, or material support: Chun, Tang, To, Lam, Chan.

Supervision: Chan.

Conflict of Interest Disclosures: Dr Lam reported receiving a patent for DIMS lens with royalties paid from Hoya Corporation. No other disclosures were reported.

Funding/Support: This study was supported by the PolyU-HKIF Children Eye Care Project, the General Research Fund from the Research Grants Council (PolyU grant 151001/17M), the Health and Medical Research Fund from the Food and Health Bureau (grant 05161146), the Innovation and Technology Fund, and the Government of the Hong Kong Special Administrative Region.

Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Additional Contributions: Natalie Y. Y. Chan, BSc, Yvonne Y. T. Li, BSc, and Vivian W. Y. Lo, BSc (all from the School of Optometry, The Hong Kong Polytechnic University), assisted with data collection. They were not compensated for this work beyond their normal salaries.

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