This study aimed to investigate the 6-month effects of wearing orthokeratology (OK) lenses on the retina vessel density (VD), vessel diameter index (VDI), and foveal avascular zone (FAZ) of myopia children using optical coherence tomography angiography, and to further investigate the underlying mechanisms of Orthokeratology in myopia control.
Methods
Sixty-two eyes form 62 subjects were included in the study. Baseline and 6-month measurements of axial length (AL), anterior chamber depth (ACD), FAZ area, FAZ perimeter, FAZ circularity, vessel density (VD) and VDI from both the superficial capillary plexus (SCP) and deep capillary plexus (DCP) were obtained.
Results
The mean age of the participants was 11.02 years (range: 8 years to 15 years), with 41.9% males and 58.1% females. Six months after orthokeratology, ACD decreased significantly, and AL remain unchanged. SCP-VD and DCP-VD significantly increased after treatment without obvious change of VDI, and FAZ parameters remained unchanged. During follow-up period, SCP-VD increased in all subgroups especially in mild myopia group, and DCP-VD increased significantly in all subgroups except for the group 8–10 years.
Conclusion
After the 6-month treatment of orthokeratology in myopia children, the macular microvasculature changed significantly. We observed a significant increase of vessel densities in both SCP and DCP without obvious effect on vascular morphology. The changes of DCP-VD tended to be more sensitive in the elder subgroup, and the efficacy of orthokeratology might be greater in mild myopia group. OCT-A may provide additional information on myopia progression and the mechanisms of controlling myopia with OK lens treatment.
FrickeTRJongMNaidooKS, et al.Global prevalence of visual impairment associated with myopic macular degeneration and temporal trends from 2000 through 2050: systematic review, meta-analysis and modelling. Br J Ophthalmol2018; 102: 855–862. DOI:https://doi.org/10.1136/bjophthalmol-2017-311266
2.
NaidooKSFrickeTRFrickKD, et al.Potential lost productivity resulting from the global burden of myopia: systematic review, meta-analysis, and modeling. Ophthalmology2019; 126: 338–346. DOI:https://doi.org/10.1016/j.ophtha.2018.10.029
WangSKGuoYLiaoC, et al.Incidence of and factors associated with myopia and high myopia in Chinese children, based on refraction without cycloplegia. JAMA Ophthalmol2018; 136: 1017–1024. DOI:https://doi.org/10.1001/jamaophthalmol.2018.2658
5.
CheungCYLiJYuanN, et al.Quantitative retinal microvasculature in children using swept-source optical coherence tomography: the Hong Kong Children Eye Study. Br J Ophthalmol2019; 103: 672–679. DOI:https://doi.org/10.1136/bjophthalmol-2018-312413
BorrelliESarrafDFreundKB, et al.OCT Angiography and evaluation of the choroid and choroidal vascular disorders. Prog Retinal Eye Res2018; 67: 30–55. DOI:https://doi.org/10.1016/j.preteyeres.2018.07.002
8.
KashaniAHChenCLGahmJK, et al.Optical coherence tomography angiography: a comprehensive review of current methods and clinical applications. Prog Retinal Eye Res2017; 60: 66–100. DOI:https://doi.org/10.1016/j.preteyeres.2017.07.002
SpaideRFKlancnikJMJr.CooneyMJ. Retinal vascular layers imaged by fluorescein angiography and optical coherence tomography angiography. JAMA Ophthalmol2015; 133: 45–50. DOI:https://doi.org/10.1001/jamaophthalmol.2014.3616
11.
TeussinkMMBreukinkMBvan GrinsvenMJ, et al.OCT angiography compared to fluorescein and indocyanine green angiography in chronic central serous chorioretinopathy. Invest Ophthalmol Visual Sci2015; 56: 5229–5237. DOI:https://doi.org/10.1167/iovs.15-17140
12.
CennamoGRomanoMRNicolettiG, et al.Optical coherence tomography angiography versus fluorescein angiography in the diagnosis of ischaemic diabetic maculopathy. Acta Ophthalmol (Copenh)2017; 95: e36–e42. DOI:https://doi.org/10.1111/aos.13159
13.
YangYWangJJiangH, et al.Retinal microvasculature alteration in high myopia. Invest Ophthalmol Visual Sci2016; 57: 6020–6030. DOI:https://doi.org/10.1167/iovs.16-19542
14.
ZhangYZhangBFanM, et al.The vascular densities of the macula and optic disc in normal eyes from children by optical coherence tomography angiography. Graefes Arch Clin Exp Ophthalmol2020; 258: 437–444. DOI:https://doi.org/10.1007/s00417-019-04466-0
15.
UcakTIcelEYilmazH, et al.Alterations in optical coherence tomography angiography findings in patients with high myopia. Eye2020; 34: 1129–1135. DOI:https://doi.org/10.1038/s41433-020-0824-1
16.
MilaniPMontesanoGRossettiL, et al.Vessel density, retinal thickness, and choriocapillaris vascular flow in myopic eyes on OCT angiography. Graefe's Arch Clin Exp Ophthalmol2018; 256: 1419–1427. DOI:https://doi.org/10.1007/s00417-018-4012-y
17.
Al-SheikhMPhasukkijwatanaNDolz-MarcoR, et al.Quantitative OCT angiography of the retinal microvasculature and the choriocapillaris in myopic eyes. Invest Ophthalmol Visual Sci2017; 58: 2063–2069. DOI:https://doi.org/10.1167/iovs.16-21289
18.
HeJChenQYinY, et al.Association between retinal microvasculature and optic disc alterations in high myopia. Eye2019; 33: 1494–1503. DOI:https://doi.org/10.1038/s41433-019-0438-7
19.
YaprakACYaprakL. Retinal microvasculature and optic disc alterations in non-pathological high myopia with optical coherence tomography angiography. Graefe's Arch Clin Exp Ophthalmol2021; 259: 3221–3227. DOI:https://doi.org/10.1007/s00417-021-05216-x
20.
ChoPCheungSW. Protective role of orthokeratology in reducing risk of rapid axial elongation: a reanalysis of data from the ROMIO and TO-SEE studies. Invest Ophthalmol Visual Sci2017; 58: 1411–1416. DOI:https://doi.org/10.1167/iovs.16-20594
21.
KakitaTHiraokaTOshikaT. Influence of overnight orthokeratology on axial elongation in childhood myopia. Invest Ophthalmol Visual Sci2011; 52: 2170–2174. DOI:https://doi.org/10.1167/iovs.10-5485
22.
ChenYZhengCZhuR, et al.Assessing the efficacy of myopia control in monocular orthokeratology treated unilateral myopic children. BMC Ophthalmol2022; 22: 499. DOI:https://doi.org/10.1186/s12886-022-02693-4
23.
Santodomingo-RubidoJVilla-CollarCGilmartinB, et al.Long-term efficacy of orthokeratology contact lens wear in controlling the progression of childhood myopia. Curr Eye Res2017; 42: 713–720. DOI:https://doi.org/10.1080/02713683.2016.1221979
24.
HiraokaTKakitaTOkamotoF, et al.Long-term effect of overnight orthokeratology on axial length elongation in childhood myopia: a 5-year follow-up study. Invest Ophthalmol Visual Sci2012; 53: 3913–3919. DOI:https://doi.org/10.1167/iovs.11-8453
25.
WangAYangCShenL, et al.Axial length shortening after orthokeratology and its relationship with myopic control. BMC Ophthalmol2022; 22: 243. DOI:https://doi.org/10.1186/s12886-022-02461-4
26.
KangPSwarbrickH. Peripheral refraction in myopic children wearing orthokeratology and gas-permeable lenses. Optom Vis Sci2011; 88: 476–482. DOI:https://doi.org/10.1097/OPX.0b013e31820f16fb
LiZHuYCuiD, et al.Change in subfoveal choroidal thickness secondary to orthokeratology and its cessation: a predictor for the change in axial length. Acta Ophthalmol (Copenh)2019; 97: e454–e459. DOI:https://doi.org/10.1111/aos.13866
29.
Gonzalez-MesaAVilla-CollarCLorente-VelazquezA, et al.Anterior segment changes produced in response to long-term overnight orthokeratology. Curr Eye Res2013; 38: 862–870. DOI:https://doi.org/10.3109/02713683.2013.790977
30.
TangTLiXChenS, et al.Long-term follow-up of changes in ocular biometric parameters in orthokeratology lens wearers with relatively large-scale axial length reduction. Eye Vision2023; 10: 6. DOI:https://doi.org/10.1186/s40662-022-00324-z
31.
LiMYangYJiangH, et al.Retinal microvascular network and microcirculation assessments in high myopia. Am J Ophthalmol2017; 174: 56–67. DOI:https://doi.org/10.1016/j.ajo.2016.10.018
32.
GolebiewskaJBiala-GosekKCzeszykA, et al.Optical coherence tomography angiography of superficial retinal vessel density and foveal avascular zone in myopic children. PloS One2019; 14: e0219785. DOI:https://doi.org/10.1371/journal.pone.0219785
33.
ChengDChenQWuY, et al.Deep perifoveal vessel density as an indicator of capillary loss in high myopia. Eye2019; 33: 1961–1968. DOI:https://doi.org/10.1038/s41433-019-0573-1
34.
WongCWMatsumuraSHtoonHM, et al.Assessment of the macular microvasculature in high myopes with swept source optical coherence tomographic angiography. Front Med (Lausanne)2021; 8: 619767. DOI:https://doi.org/10.3389/fmed.2021.619767
35.
WylegalaAWangLZhangS, et al.Comparison of foveal avascular zone and retinal vascular density in healthy Chinese and Caucasian adults. Acta Ophthalmol (Copenh)2020; 98: e464–e469. DOI:https://doi.org/10.1111/aos.14316
36.
MammoZBalaratnasingamCYuP, et al.Quantitative noninvasive angiography of the fovea Centralis using speckle variance optical coherence tomography. Invest Ophthalmol Visual Sci2015; 56: 5074–5086. DOI:https://doi.org/10.1167/iovs.15-16773
37.
KuehleweinLTepelusTCAnL, et al.Noninvasive visualization and analysis of the human parafoveal capillary network using swept source OCT optical microangiography. Invest Ophthalmol Visual Sci2015; 56: 3984–3988. DOI:https://doi.org/10.1167/iovs.15-16510
38.
SamaraWASayEAKhooCT, et al.Correlation of foveal avascular zone size with foveal morphology in normal eyes using optical coherence tomography angiography. Retina2015; 35: 2188–2195. DOI:https://doi.org/10.1097/IAE.0000000000000847
39.
YuJJiangCWangX, et al.Macular perfusion in healthy Chinese: an optical coherence tomography angiogram study. Invest Ophthalmol Visual Sci2015; 56: 3212–3217. DOI:https://doi.org/10.1167/iovs.14-16270
40.
MoonJYGargICuiY, et al.Wide-field swept-source optical coherence tomography angiography in the assessment of retinal microvasculature and choroidal thickness in patients with myopia. Br J Ophthalmol2023; 107: 102–108. DOI:https://doi.org/10.1136/bjophthalmol-2021-319540
41.
ShimadaNOhno-MatsuiKHarinoS, et al.Reduction of retinal blood flow in high myopia. Graefe's Arch Clin Exp Ophthalmol2004; 242: 284–288. DOI:https://doi.org/10.1007/s00417-003-0836-0
WakabayashiTSatoTHara-UenoC, et al.Retinal microvasculature and visual acuity in eyes with branch retinal vein occlusion: imaging analysis by optical coherence tomography angiography. Invest Ophthalmol Visual Sci2017; 58: 2087–2094. DOI:https://doi.org/10.1167/iovs.16-21208
46.
WangXXiaL. Effect of macular vascular density on visual quality in young myopic adults. Front Med (Lausanne)2022; 9: 950731. DOI:https://doi.org/10.3389/fmed.2022.950731
47.
KurJNewmanEAChan-LingT. Cellular and physiological mechanisms underlying blood flow regulation in the retina and choroid in health and disease. Prog Retinal Eye Res2012; 31: 377–406. DOI:https://doi.org/10.1016/j.preteyeres.2012.04.004
LengYTamEKFalavarjaniKG, et al.Effect of age and myopia on retinal microvasculature. Ophthalmic Surg Lasers Imaging Retina2018; 49: 925–931. DOI:https://doi.org/10.3928/23258160-20181203-03
50.
WuQChenQLinB, et al.Relationships among retinal/choroidal thickness, retinal microvascular network and visual field in high myopia. Acta Ophthalmol (Copenh)2020; 98: e709–e714. DOI:https://doi.org/10.1111/aos.14372
51.
YangSZhouMLuB, et al.Quantification of macular vascular density using optical coherence tomography angiography and its relationship with retinal thickness in myopic eyes of young adults. J Ophthalmol2017; 2017: 1397179. DOI:https://doi.org/10.1155/2017/1397179
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
