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Association between choriocapillaris perfusion and axial elongation in children using defocus incorporated multiple segments (DIMS) spectacle lenses

Eye volume 37, pages 3847–3853 (2023)Cite this article

Subjects

Abstract

Purpose

To investigate choroidal and ocular biological variables that influence axial length (AL) elongation in children wearing defocused incorporated multiple segments (DIMS) spectacle lenses.

Methods

This cohort study included 106 myopic children aged 7–14 years with a 1-year follow-up. Participants were divided into two groups according to the increase in AL in one year: rapid (>0.2 mm) and slow (≤0.2 mm) axial elongation groups. Cycloplegic autorefraction and AL were measured at baseline and after 6 and 12 months. The area of choriocapillaris flow voids (FVs) and choroidal thickness (ChT) at baseline were measured.

Results

Univariate linear regression analysis showed that AL elongation were significantly associated with the FVs area (standardised β = 0.198, P < 0.05) and age (standardised β = −0.201, P < 0.05). Multiple linear regression showed that the FVs area, age, and average K reading were associated with AL elongation. Multiple logistic regression analyses showed that greater degrees of myopia and larger FVs areas were risk factors for rapid axial elongation, while older age, large pupil diameter and steeper cornea were protective factors. In estimating axial elongation, the FVs area alone demonstrated an area under the curve (AUC) of 0.672 (95% CI, 0.569–0.775, P < 0.01), and that of FVs area and other ocular variables was 0.788 (95% CI, 0.697–0.878, P < 0.001).

Conclusion

Larger choriocapillaris FVs area at baseline may help to predict axial elongation in myopic eyes. The association between FVs area and axial elongation should be taken into consideration in further myopic cohort studies.

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Fig. 1: Calculation of the flow void area.
Fig. 2: Linear regression analysis betwee axial elongation, age and flow void.
Fig. 3: ROC Analysis to predict axial elongation.

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Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

References

  1. Morgan IG, French AN, Ashby RS, Guo X, Ding X, He M, et al. The epidemics of myopia: aetiology and prevention. Prog Retin Eye Res. 2018;62:134–49.

    PubMed  Google Scholar 

  2. Morgan I, Rose K. Myopia: is the nature-nurture debate finally over? Clin Exp Optom. 2019;102:3–17.

    PubMed  Google Scholar 

  3. Leo SW, Young TL. An evidence-based update on myopia and interventions to retard its progression. J AAPOS. 2011;15:181–9.

    PubMed  PubMed Central  Google Scholar 

  4. Chen J, Wu W, Wang Z, Zhai C, Deng B, Alzogool M, et al. Novel corneal protein biomarker candidates reveal iron metabolic disturbance in high myopia eyes. Front Cell Dev Biol. 2021;9:689917.

    PubMed  PubMed Central  Google Scholar 

  5. Wallman J, Winawer J. Homeostasis of eye growth and the question of myopia. Neuron. 2004;43:447–68.

    CAS  PubMed  Google Scholar 

  6. Zhu X, Park TW, Winawer J, Wallman J. In a matter of minutes, the eye can know which way to grow. Invest Ophthalmol Vis Sci. 2005;46:2238–41.

    PubMed  Google Scholar 

  7. Nickla DL, Wallman J. The multifunctional choroid. Prog Retin Eye Res. 2010;29:144–68.

    PubMed  Google Scholar 

  8. Summers J. The choroid as a sclera growth regulator. Exp Eye Res. 2013;114:120–7.

    CAS  PubMed  PubMed Central  Google Scholar 

  9. Wildsoet C, Wallman J. Choroidal and scleral mechanisms of compensation for spectacle lenses in chicks. Vis Res. 1995;35:1175–94.

    CAS  PubMed  Google Scholar 

  10. Zhang S, Zhang G, Zhou X, Xu R, Wang S, Guan Z, et al. Changes in choroidal thickness and choroidal blood perfusion in guinea pig Myopia. Investig Ophthalmol Vis Sci. 2019;60:3074–83.

    CAS  Google Scholar 

  11. Zhou X, Zhang S, Zhang G, Chen Y, Lei Y, Xiang J, et al. Increased choroidal blood perfusion can inhibit form deprivation myopia in guinea pigs. Investig Ophthalmol Vis Sci. 2020;61:25.

    CAS  Google Scholar 

  12. Zhou X, Zhang S, Yang F, Yang Y, Huang Q, Huang C, et al. Decreased choroidal blood perfusion induces myopia in guinea pigs. Invest Ophthalmol Vis Sci. 2021;62:30.

    CAS  PubMed  PubMed Central  Google Scholar 

  13. Augustin HG, Koh GY. Organotypic vasculature: from descriptive heterogeneity to functional pathophysiology. Science. 2017;357. https://doi.org/10.1126/science.aal2379.

  14. Xu A, Sun G, Duan C, Chen Z, Chen C. Quantitative assessment of three-dimensional choroidal vascularity and choriocapillaris flow signal voids in myopic patients using SS-OCTA. Diagnostics. 2021;11. https://doi.org/10.3390/diagnostics11111948.

  15. Liu X, Lin Z, Wang F, Peng X, He W, Chen D, et al. Choroidal thickness and choriocapillaris vascular density in myopic anisometropia. Eye Vis. 2021;8:48.

    Google Scholar 

  16. Sankaridurg P, Bakaraju RC, Naduvilath T, Chen X, Weng R, Tilia D, et al. Myopia control with novel central and peripheral plus contact lenses and extended depth of focus contact lenses: 2 year results from a randomised clinical trial. Ophthalmic Physiol Opt. 2019;39:294–307.

    PubMed  PubMed Central  Google Scholar 

  17. Walline JJ, Walker MK, Mutti DO, Jones-Jordan LA, Sinnott LT, Giannoni AG, et al. Effect of high add power, medium add power, or single-vision contact lenses on myopia progression in children: the BLINK randomized clinical trial. JAMA. 2020;324:571–80.

    PubMed  PubMed Central  Google Scholar 

  18. Anstice NS, Phillips JR. Effect of dual-focus soft contact lens wear on axial myopia progression in children. Ophthalmology. 2011;118:1152–61.

    PubMed  Google Scholar 

  19. Lam CSY, Tang WC, Tse DY, Lee RPK, Chun RKM, Hasegawa K, et al. Defocus Incorporated Multiple Segments (DIMS) spectacle lenses slow myopia progression: a 2-year randomised clinical trial. Br J Ophthalmol. 2020;104:363–8.

    PubMed  Google Scholar 

  20. Lam CSY, Tang WC, Qi H, Radhakrishnan H, Hasegawa K, To CH, et al. Effect of defocus incorporated multiple segments spectacle lens wear on visual function in myopic Chinese children. Transl Vis Sci Technol. 2020;9:11.

    PubMed  PubMed Central  Google Scholar 

  21. Brennan NA, Toubouti YM, Cheng X, Bullimore MA. Efficacy in myopia control. Prog Retin Eye Res. 2021;83:100923.

    PubMed  Google Scholar 

  22. Tideman JWL, Polling JR, Jaddoe VWV, Vingerling JR, Klaver CCW. Environmental risk factors can reduce axial length elongation and myopia incidence in 6- to 9-year-old children. Ophthalmology. 2019;126:127–36.

    PubMed  Google Scholar 

  23. Ma Y, Zou H, Lin S, Xu X, Zhao R, Lu L, et al. Cohort study with 4-year follow-up of myopia and refractive parameters in primary schoolchildren in Baoshan District, Shanghai. Clin Exp Ophthalmol. 2018;46:861–72.

    PubMed  PubMed Central  Google Scholar 

  24. Woodman EC, Read SA, Collins MJ, Hegarty KJ, Priddle SB, Smith JM, et al. Axial elongation following prolonged near work in myopes and emmetropes. Br J Ophthalmol. 2011;95:652–6.

    PubMed  Google Scholar 

  25. Tan CS, Ouyang Y, Ruiz H, Sadda SR. Diurnal variation of choroidal thickness in normal, healthy subjects measured by spectral domain optical coherence tomography. Investig Ophthalmol Vis Sci. 2012;53:261–6.

    Google Scholar 

  26. Woodman-Pieterse EC, Read SA, Collins MJ, Alonso-Caneiro D. Regional changes in choroidal thickness associated with accommodation. Investig Ophthalmol Vis Sci. 2015;56:6414–22.

    Google Scholar 

  27. Hoseini-Yazdi H, Vincent SJ, Read SA, Collins MJ. Astigmatic defocus leads to short-term changes in human choroidal thickness. Investig Ophthalmol Vis Sci. 2020;61:48.

    Google Scholar 

  28. Chiang ST, Phillips JR, Backhouse S. Effect of retinal image defocus on the thickness of the human choroid. Ophthalmic Physiol Opt. 2015;35:405–13.

    PubMed  Google Scholar 

  29. Spaide RF. Choriocapillaris flow features follow a power law distribution: implications for characterization and mechanisms of disease progression. Am J Ophthalmol. 2016;170:58–67.

    PubMed  Google Scholar 

  30. Sampson DM, Gong P, An D, Menghini M, Hansen A, Mackey DA, et al. Axial length variation impacts on superficial retinal vessel density and foveal avascular zone area measurements using optical coherence tomography angiography. Invest Ophthalmol Vis Sci. 2017;58:3065–72.

    PubMed  Google Scholar 

  31. Bennett AG, Rudnicka AR, Edgar DF. Improvements on Littmann’s method of determining the size of retinal features by fundus photography. Graefes Arch Clin Exp Ophthalmol. 1994;232:361–7.

    CAS  PubMed  Google Scholar 

  32. Yen J, Chang F, Chang S. A new criterion for automatic multilevel thresholding. IEEE Trans image Process. 1995;4:370–8.

    CAS  PubMed  Google Scholar 

  33. Phansalkar N, More S, Sabale A, Joshi M, editors. Adaptive local thresholding for detection of nuclei in diversity stained cytology images. International Conference on Communications and Signal Processing; Kerala, India, 2011, pp. 218–20, https://doi.org/10.1109/ICCSP.2011.5739305.

  34. Chu Z, Cheng Y, Zhang Q, Zhou H, Dai Y, Shi Y, et al. Quantification of choriocapillaris with Phansalkar local thresholding: pitfalls to avoid. Am J Ophthalmol. 2020;213:161–76.

    PubMed  PubMed Central  Google Scholar 

  35. Yam JC, Jiang Y, Tang SM, Law AKP, Chan JJ, Wong E, et al. Low-Concentration Atropine for Myopia Progression (LAMP) Study: a randomized, double-blinded, placebo-controlled trial of 0.05%, 0.025%, and 0.01% atropine eye drops in myopia control. Ophthalmology. 2019;126:113–24.

    PubMed  Google Scholar 

  36. Cho P, Cheung SW. Retardation of myopia in Orthokeratology (ROMIO) study: a 2-year randomized clinical trial. Invest Ophthalmol Vis Sci. 2012;53:7077–85.

    PubMed  Google Scholar 

  37. Lam CS, Tang WC, Lee PH, Zhang HY, Qi H, Hasegawa K, et al. Myopia control effect of defocus incorporated multiple segments (DIMS) spectacle lens in Chinese children: results of a 3-year follow-up study. Br J Ophthalmol. 2021. https://doi.org/10.1136/bjophthalmol-2020-317664.

  38. Wei S, Li SM, An W, Du J, Liang X, Sun Y, et al. Safety and efficacy of low-dose atropine eyedrops for the treatment of myopia progression in Chinese Children: a randomized clinical trial. JAMA Ophthalmol. 2020;138:1178–84.

    PubMed  PubMed Central  Google Scholar 

  39. Zhou WJ, Zhang YY, Li H, Wu YF, Xu J, Lv S, et al. Five-year progression of refractive errors and incidence of myopia in school-aged children in Western China. J Epidemiol. 2016;26:386–95.

    CAS  PubMed  PubMed Central  Google Scholar 

  40. Zhao J, Mao J, Luo R, Li F, Munoz SR, Ellwein LB. The progression of refractive error in school-age children: Shunyi district, China. Am J Ophthalmol. 2002;134:735–43.

    PubMed  Google Scholar 

  41. Howlett MH, McFadden SA. Spectacle lens compensation in the pigmented guinea pig. Vis Res. 2009;49:219–27.

    PubMed  Google Scholar 

  42. Chen Z, Niu L, Xue F, Qu X, Zhou Z, Zhou X, et al. Impact of pupil diameter on axial growth in orthokeratology. Optom Vis Sci. 2012;89:1636–40.

    PubMed  Google Scholar 

  43. Sng CC, Lin XY, Gazzard G, Chang B, Dirani M, Chia A, et al. Peripheral refraction and refractive error in singapore chinese children. Invest Ophthalmol Vis Sci. 2011;52:1181–90.

    PubMed  Google Scholar 

  44. Yu T, Xie X, Wei H, Shen H, Wu Q, Zhang X, et al. Choroidal changes in lens-induced myopia in guinea pigs. Microvasc Res. 2021;138:104213.

    CAS  PubMed  Google Scholar 

  45. Fitzgerald ME, Wildsoet CF, Reiner A. Temporal relationship of choroidal blood flow and thickness changes during recovery from form deprivation myopia in chicks. Exp Eye Res. 2002;74:561–70.

    CAS  PubMed  Google Scholar 

  46. Wallman J, Wildsoet C, Xu A, Gottlieb MD, Nickla DL, Marran L, et al. Moving the retina: choroidal modulation of refractive state. Vis Res. 1995;35:37–50.

    CAS  PubMed  Google Scholar 

  47. Prousali E, Dastiridou A, Ziakas N, Androudi S, Mataftsi A. Choroidal thickness and ocular growth in childhood. Surv Ophthalmol. 2021;66:261–75.

    PubMed  Google Scholar 

  48. Laviers H, Zambarakji H. Enhanced depth imaging-OCT of the choroid: a review of the current literature. Graefes Arch Clin Exp Ophthalmol. 2014;252:1871–83.

    CAS  PubMed  Google Scholar 

  49. Branchini LA, Adhi M, Regatieri CV, Nandakumar N, Liu JJ, Laver N, et al. Analysis of choroidal morphologic features and vasculature in healthy eyes using spectral-domain optical coherence tomography. Ophthalmology. 2013;120:1901–8.

    PubMed  Google Scholar 

  50. Agrawal R, Gupta P, Tan KA, Cheung CM, Wong TY, Cheng CY. Choroidal vascularity index as a measure of vascular status of the choroid: Measurements in healthy eyes from a population-based study. Sci Rep. 2016;6:21090.

    CAS  PubMed  PubMed Central  Google Scholar 

  51. Lin E, Ke M, Tan B, Yao X, Wong D, Ong L, et al. Are choriocapillaris flow void features robust to diurnal variations? A swept-source optical coherence tomography angiography (OCTA) study. Sci Rep. 2020;10:11249.

    PubMed  PubMed Central  Google Scholar 

  52. Ye J, Shen M, Huang S, Fan Y, Yao A, Pan C, et al. Visual acuity in pathological myopia is correlated with the photoreceptor myoid and ellipsoid zone thickness and affected by choroid thickness. Invest Ophthalmol Vis Sci. 2019;60:1714–23.

    PubMed  Google Scholar 

  53. Zhou X, Zhang S, Zhang GY, Chen YZ, Lei Y, Xiang J, et al. Increased Choroidal Blood Perfusion Can Inhibit Form Deprivation Myopia in Guinea Pigs. Investig Ophthalmol Vis Sci. 2020;61. https://doi.org/10.1167/iovs.61.13.25.

  54. Woodman EC, Read SA, Collins MJ. Axial length and choroidal thickness changes accompanying prolonged accommodation in myopes and emmetropes. Vis Res. 2012;72:34–41.

    PubMed  Google Scholar 

  55. Chang X, Li M, Lv L, Yan X, Liu Y, Zhu M, et al. Assessment of choroidal vascularity and choriocapillaris blood perfusion after accommodation in myopia, emmetropia, and hyperopia groups among children. Front Physiol. 2022;13:854240.

    PubMed  PubMed Central  Google Scholar 

  56. Hoseini-Yazdi H, Read SA, Alonso-Caneiro D, Collins MJ. Retinal OFF-pathway overstimulation leads to greater accommodation-induced choroidal thinning. Invest Ophthalmol Vis Sci. 2021;62:5.

    PubMed  PubMed Central  Google Scholar 

  57. Su L, Ji YS, Tong N, Sarraf D, He X, Sun X, et al. Quantitative assessment of the retinal microvasculature and choriocapillaris in myopic patients using swept-source optical coherence tomography angiography. Graefes Arch Clin Exp Ophthalmol. 2020;258:1173–80.

    PubMed  Google Scholar 

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Funding

This work was supported by the Capital’s Funds for Health Improvement and Research (No. 202-1G-4083), the National Natural Science Foundation of China (Grant Nos. 82171092, 81870684), the National Key R&D Program of China (Nos. 2021YFC2702100, 2020YFC2008200).

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Author notes

  1. These authors contributed equally: Xuewei Li, Jie Hu.

Authors and Affiliations

  1. Institute of Medical Technology, Peking University Health Science Center, Beijing, China

    Xuewei Li, Zisu Peng, Sitong Chen, Liyuan Sun, Kai Wang, Yan Li & Mingwei Zhao

  2. Department of Ophthalmology & Clinical Centre of Optometry, Peking University People’s Hospital, Beijing, China

    Xuewei Li, Jie Hu, Zisu Peng, Sitong Chen, Liyuan Sun, Kai Wang, Yan Li & Mingwei Zhao

  3. College of Optometry, Peking University Health Science Center, Beijing, China

    Xuewei Li, Jie Hu, Zisu Peng, Sitong Chen, Liyuan Sun, Kai Wang, Yan Li & Mingwei Zhao

  4. Eye Disease and Optometry Institute, Peking University People’s Hospital, Beijing, China

    Xuewei Li, Jie Hu, Zisu Peng, Sitong Chen, Liyuan Sun, Kai Wang, Yan Li & Mingwei Zhao

  5. Beijing Key Laboratory of the Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, China

    Xuewei Li, Jie Hu, Zisu Peng, Sitong Chen, Liyuan Sun, Kai Wang, Yan Li & Mingwei Zhao

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Contributions

XL and JH participated in the conception and design of this work, data acquisition and analysis, literature search and manuscript writing. ZP contributed to data collection and data analysis. SC and LS contributed to data collection, the acquisition of fundus photographs and picture processing of the datasets. YL and MZ contributed to the interpretation of the data and revision of the manuscript for this study. KW contributed to the design of the work, interpretation of the data, and revision of the manuscript for this study. All authors read and approved the final version of the manuscript.

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Correspondence to Kai Wang.

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Li, X., Hu, J., Peng, Z. et al. Association between choriocapillaris perfusion and axial elongation in children using defocus incorporated multiple segments (DIMS) spectacle lenses. Eye 37, 3847–3853 (2023). https://doi.org/10.1038/s41433-023-02629-2

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