La compensation réversible de la myopie

Quelles techniques pour diminuer l’évolution myopique ? 

Les avis sont variés sur l’effet de l’orthokératologie sur la myopie. 
Vous trouverez ci-dessous, différents abstracts à ce sujet :

Orthokeratology for Myopia Control: A Meta-analysis.

Optom Vis Sci. 2015 Jan 16.
Si JK1, Tang K, Bi HS, Guo DD, Guo JG, Wang XR.
To conduct a meta-analysis on the effects of orthokeratology in slowing myopia progression.


A literature search was performed in PubMed, Embase, and the Cochrane Library. Methodological quality of the literature was evaluated according to the Jadad score. The statistical analysis was carried out using RevMan 5.2.6 software.


The present meta-analysis included seven studies (two randomized controlled trials and five nonrandomized controlled trials) with 435 subjects (orthokeratology group, 218; control group, 217) aged 6 to 16 years. The follow-up time was 2 years for the seven studies. The weighted mean difference was -0.26 mm (95% confidence interval, -0.31 to -0.21; p < 0.001) for axial length elongation based on data from seven studies and -0.18 mm (95% confidence interval, -0.33 to -0.03; p = 0.02) for vitreous chamber depth elongation based on data from two studies.


Our results suggest that orthokeratology may slow myopia progression in children. Further large-scale studies are needed to substantiate the current result and to investigate the long-term effects of orthokeratology in myopia control.
PMID : 25599338 [PubMed - as supplied by publisher]
L’étude de Tang (orthokeratology for Myopia Control : A meta-analysis – Optom Vis Sci 2015 jan 16) conclut que des études à grands effectifs sont nécessaires pour justifier le fait que l’orthokératologie permet de ralentir la progression de la myopie chez les enfants. L’étude indique également qu’il est important d’étudier à long terme l’effet de l’orthokératologie sur la myopie.

Effect of dual-focus soft contact lens wear on axial myopia progression in children.

Ophthalmology. 2011 Jun; 118(6):1152-61. doi: 10.1016/j.ophtha.2010.10.035. Epub 2011 Jan 26.
Anstice NS1, Phillips JR.


To test the efficacy of an experimental Dual-Focus (DF) soft contact lens in reducing myopia progression.


Prospective, randomized, paired-eye control, investigator-masked trial with cross-over.


Forty children, 11-14 years old, with mean spherical equivalent refraction (SER) of -2.71 ± 1.10 diopters (D).


Dual-Focus lenses had a central zone that corrected refractive error and concentric treatment zones that created 2.00 D of simultaneous myopic retinal defocus during distance and near viewing. Control was a single vision distance (SVD) lens with the same parameters but without treatment zones. Children wore a DF lens in 1 randomly assigned eye and an SVD lens in the fellow eye for 10 months (period 1). Lens assignment was then swapped between eyes, and lenses were worn for a further 10 months (period 2).


Primary outcome was change in SER measured by cycloplegic autorefraction over 10 months. Secondary outcome was a change in axial eye length (AXL) measured by partial coherence interferometry over 10 months. Accommodation wearing DF lenses was assessed using an open-field autorefractor.


In period 1, the mean change in SER with DF lenses (-0.44 ± 0.33 D) was less than with SVD lenses (-0.69 ± 0.38 D; P < 0.001); mean increase in AXL was also less with DF lenses (0.11 ± 0.09 mm) than with SVD lenses (0.22 ± 0.10 mm; P < 0.001). In 70% of the children, myopia progression was reduced by 30% or more in the eye wearing the DF lens relative to that wearing the SVD lens. Similar reductions in myopia progression and axial eye elongation were also observed with DF lens wear during period 2. Visual acuity and contrast sensitivity with DF lenses were not significantly different than with SVD lenses. Accommodation to a target at 40 cm was driven through the central distance-correction zone of the DF lens.


Dual-Focus lenses provided normal acuity and contrast sensitivity and allowed accommodation to near targets. Myopia progression and eye elongation were reduced significantly in eyes wearing DF lenses. The data suggest that sustained myopic defocus, even when presented to the retina simultaneously with a clear image, can act to slow myopia progression without compromising visual function.


Proprietary or commercial disclosure may be found after the references.
Copyright © 2011 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved. PMID : 21276616
 Les lentilles à double foyer sont des lentilles concentriques qui alternent les zones de défocalisations rétiniennes et les zones de correction myopiques. Les résultats de l’étude d’Anstice montrent que l’évolution de la myopie sur les yeux équipés avec une lentille double foyer a été moindre qu’avec une lentille unifocale classique. Dans 70% des cas, l’évolution myopique est 30% inférieure avec ce type de lentilles de contact.

Optical treatment strategies to slow myopia progression: effects of the visual extent of the optical treatment zone.

2013 Sep;114:77-88. doi: 10.1016/j.exer.2012.11.019. Epub 2013 Jan 3.
Smith EL 3rd1.
1College of Optometry, University of Houston, 505 J Davis Armistead Building, Houston, TX 77204-2020, USA.


In order to develop effective optical treatment strategies for myopia, it is important to understand how visual experience influences refractive development. Beginning with the discovery of the phenomenon of form deprivation myopia, research involving many animal species has demonstrated that refractive development is regulated by visual feedback. In particular, animal studies have shown that optically imposed myopic defocus slows axial elongation, that the effects of vision are dominated by local retinal mechanisms, and that peripheral vision can dominate central refractive development. In this review, the results obtained from clinical trials of traditional optical treatment strategies employed in efforts to slow myopia progression in children are interpreted in light of the results from animal studies and are compared to the emerging results from preliminary clinical studies of optical treatment strategies that manipulate the effective focus of the peripheral retina. Overall, the results suggest that imposed myopic defocus can slow myopia progression in children and that the effectiveness of an optical treatment strategy in reducing myopia progression is influenced by the extent of the visual field that is manipulated.
Copyright © 2012 Elsevier Ltd. All rights reserved.


bifocals; contact lenses; hyperopia; myopia; orthokeratology; peripheral refractive error; progressive addition lens
PMID: 23290590, [PubMed - indexed for MEDLINE
Il est important de développer des techniques de traitements efficaces contre la myopie. Différentes études menées sur les animaux ont montrées que la défocalisation myopique imposée peut ralentir la progression de la myopie chez les enfants. La sous correction ne produit qu’une faible défocalisation myopique et uniquement sur une petite partie de la rétine. La sous correction fonctionne pour diminuer l’évolution myopique mais ne permet pas d’arrêter cette évolution.

A randomized clinical trial of progressive addition lenses versus single vision lenses on the progression of myopia in children.

Invest Ophthalmol Vis Sci. 2003 Apr;44(4):1492-500.
Gwiazda J1, Hyman L, Hussein M, Everett D, Norton TT, Kurtz D, Leske MC, Manny R, Marsh-Tootle W, Scheiman M. / 1New England College of Optometry, Boston, Massachusetts 02115, USA.


The purpose of the Correction of Myopia Evaluation Trial (COMET) was to evaluate the effect of progressive addition lenses (PALs) compared with single vision lenses (SVLs) on the progression of juvenile-onset myopia.


COMET enrolled 469 children (ages 6-11 years) with myopia between -1.25 and -4.50 D spherical equivalent. The children were recruited at four colleges of optometry in the United States and were ethnically diverse. They were randomly assigned to receive either PALs with a +2.00 addition (n = 235) or SVLs (n = 234), the conventional spectacle treatment for myopia, and were followed for 3 years. The primary outcome measure was progression of myopia, as determined by autorefraction after cycloplegia with 2 drops of 1% tropicamide at each annual visit. The secondary outcome measure was change in axial length of the eyes, as assessed by A-scan ultrasonography. Child-based analyses (i.e., the mean of the two eyes) were used. Results were adjusted for important covariates, by using multiple linear regression.


Of the 469 children (mean age at baseline, 9.3 +/- 1.3 years), 462 (98.5%) completed the 3-year visit. Mean (+/-SE) 3-year increases in myopia (spherical equivalent) were -1.28 +/- 0.06 D in the PAL group and -1.48 +/- 0.06 D in the SVL group. The 3-year difference in progression of 0.20 +/- 0.08 D between the two groups was statistically significant (P = 0.004). The treatment effect was observed primarily in the first year. The number of prescription changes differed significantly by treatment group only in the first year. At 6 months, 17% of the PAL group versus 30% of the SVL group needed a prescription change (P = 0.0007), and, at 1 year, 43% of the PAL group versus 59% of the SVL group required a prescription change (P = 0.002). Interaction analyses identified a significantly larger treatment effect of PALs in children with lower versus higher baseline accommodative response at near (P = 0.03) and with lower versus higher baseline myopia (P = 0.04). Mean (+/- SE) increases in the axial length of eyes of children in the PAL and SVL groups, respectively, were: 0.64 +/- 0.02 mm and 0.75 +/- 0.02 mm, with a statistically significant 3-year mean difference of 0.11 +/- 0.03 mm (P = 0.0002). Mean changes in axial length correlated with those in refractive error (r = 0.86 for PAL and 0.89 for SVL).


Use of PALs compared with SVLs slowed the progression of myopia in COMET children by a small, statistically significant amount only during the first year. The size of the treatment effect remained similar and significant for the next 2 years. The results provide some support for the COMET rationale-that is, a role for defocus in progression of myopia. The small magnitude of the effect does not warrant a change in clinical practice.
PMID: 12657584 [PubMed - indexed for MEDLINE]
Le but de l’étude de Comet est d’évaluer le benefice du port de lunettes avec des verres progressifs par rapport au port de lunettes avec des verres unifocaux. L’utilisation de verres progressifs chez l’enfant myope permet de ralentir la progression de la myopie sur une courte période (environ un an). Les résultats n’entrainant pas une différence importante sur l’évolution myopique, il est peu probable que les praticiens prennent l’habitude d’équiper leurs jeunes patients avec des verres progressifs.
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