The Science Behind
In developing the mEYEguide tool we are relying on research conducted over many decades by thousands of researchers worldwide. The concept of growth centiles has been in medical use for even longer.
Almost 30,000 research papers on myopia are listed on the Pubmed, the world's largest medical science database. We have tried to capture the important messages of this huge body of research by using the power of modern datascience tools. In total, data from over a million people included in published scientific papers have been distilled down into an easily digestible format and incorporated into mEYEguide.
Centile charts have been a standard part of monitoring children's height and weight for over a 100 years. Application of centile charts to refraction and eye growth is more recent, but the same principles apply:
Centiles help us to make sense of what a given prescription means. For example a glasses prescription of -2 in a 7 year-old girl suggests that she is likely to experience fast myopia progression and when she grows up she is likely to be much more myopic than most of her friends. The same prescription in a 17 year-old girl is likely to progress more slowly and is likely to end up in the low or middle part of the range in terms of glasses strength compared to adults of the same age.
This part of the tool simulates expected vision quality with glasses/contact lenses and without glasses/contact lenses (uncorrected vision). While a myopic child's vision with glasses/contact lenses should remain good, their uncorrected vision will worsen with increasing myopia. At low levels of myopia, preserving uncorrected vision quality is one of the goals of treatment to ensure a child is less dependent on their glasses/contact lenses for daily life.
Normal clear vision as experienced by a child with 20/20 vision when wearing glasses/contact lenses is illustrated for comparison purposes The blurred vision simulations are designed to illustrate uncorrected vision when not wearing glasses/contact lenses, this is the sort of vision people experience when they first get up in the morning and need to find their glasses or contact lenses. "How Your Child Sees Now" is calculated based on their current full prescription including any astigmatism. "How Your Child will see as an adult" is calculated based on her projected full adult prescription including any astigmatism.
All the available myopia management options have been tested in clinical trials, where children using a specific treatment are compared with children wearing conventional glasses. This allows us to show what sort of benefits might be expected from these new treatments. To express this in terms that make most sense to parents, we have described this in terms of the probability of a large change in glasses strength.
In terms of risk, we calculate this depending on how bad the myopia is. For lower levels we look at the risk of developing one of many eye diseases linked to myopia in later life, such as glaucoma, cataract, retinal detachment and myopic maculopathy. For higher levels of myopia we look at the risk of developing visual impairment in later life. The benefits are treatment are based on the average reported benefits from the current range of available treatments.
This field is changing very rapdily. As new information and treatments become available, we will be actively keeping mEYEguide updated. The link or QR-code will always show the most up to date version.
A vast amount of research has looked at how our behaviour affects our eyes. We have tried to distill this into the most important messages, but you can explore some of the references listed below or in our "Myopedia".
Links to the most important scientific publications are listed below, which represent either data sources or important papers in their particular area. As well as these sources, we have also analysed anonymised eye health records from over half a million European subjects from our Electronic Health Record partner, Ocuco Ltd.
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Kim DH, Lim HT. Myopia Growth Chart Based on a Population-Based Survey (KNHANES IV-V): A Novel Prediction Model of Myopic Progression in Childhood. J Pediatr Ophthalmol Strabismus 2019; 56: 73–77.
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Pan CW, Cheung CY, Aung T, et al. Differential Associations of Myopia with Major Age-Related Eye Diseases: The Singapore Indian Eye Study. Ophthalmology 2013;120:284-91.
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Pan CW, Cheung CY, Aung T, et al. Differential Associations of Myopia with Major Age-Related Eye Diseases: The Singapore Indian Eye Study. Ophthalmology 2013;120:284-91.
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Wong TY, Foster PJ, Johnson GJ, Seah SK. Refractive Errors, Axial Ocular Dimensions, and Age-Related Cataracts: The Tanjong Pagar Survey. Invest Ophthalmol Vis Sci 2003;44:1479-85.
Pan CW, Cheung CY, Aung T, et al. Differential Associations of Myopia with Major Age-Related Eye Diseases: The Singapore Indian Eye Study. Ophthalmology 2013;120:284-91.
Wong TY, Klein BE, Klein R, et al. Refractive Errors and Incident Cataracts: The Beaver Dam Eye Study. Invest Ophthalmol Vis Sci 2001;42:1449-54.
Chang MA, Congdon NG, Bykhovskaya I, et al. The Association between Myopia and Various Subtypes of Lens Opacity: See (Salisbury Eye Evaluation) Project. Ophthalmology 2005;112:1395-401.
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Burton TC. The Influence of Refractive Error and Lattice Degeneration on the Incidence of Retinal Detachment. Trans Am Ophthalmol Soc 1989;87:143-55; discussion 55-7.
Mitry D, Charteris DG, Yorston D, et al. The Epidemiology and Socioeconomic Associations of Retinal Detachment in Scotland: A Two-Year Prospective Population-Based Study. Invest Ophthalmol Vis Sci 2010;51:4963-8.
Liu HH, Xu L, Wang YX, et al. Prevalence and Progression of Myopic Retinopathy in Chinese Adults: The Beijing Eye Study. Ophthalmology 2010;117:1763-8.
Gao LQ, Liu W, Liang YB, et al. Prevalence and Characteristics of Myopic Retinopathy in a Rural Chinese Adult Population: The Handan Eye Study. Arch Ophthalmol 2011;129:1199-204.
Asakuma T, Yasuda M, Ninomiya T, et al. Prevalence and Risk Factors for Myopic Retinopathy in a Japanese Population: The Hisayama Study. Ophthalmology 2012;119:1760-5.
Wong YL, Sabanayagam C, Ding Y, et al. Prevalence, Risk Factors, and Impact of Myopic Macular Degeneration on Visual Impairment and Functioning among Adults in Singapore. Invest Ophthalmol Vis Sci 2018;59:4603-13.
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Choudhury F, Meuer SM, Klein R, et al. Prevalence and Characteristics of Myopic Degeneration in an Adult Chinese American Population: The Chinese American Eye Study. Am J Ophthalmol 2018;187:34-42.
Hopf S, Korb C, Nickels S, et al. Prevalence of Myopic Maculopathy in the German Population: Results from the Gutenberg Health Study. Br J Ophthalmol 2020;104:1254-9.
Leveziel N, Marillet S, Dufour Q, et al. Prevalence of Macular Complications Related to Myopia - Results of a Multicenter Evaluation of Myopic Patients in Eye Clinics in France. Acta Ophthalmol 2020;98:e245-e51.
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Loughman J, Moore M, Flitcroft DI. Myopia Progression Centiles from Real World Data: An Ecologically Valid Tool for Myopia Treatment Efficacy Monitoring?. Invest. Ophthalmol. Vis. Sci. 2020;61(7):79.
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Huang J, Wen D, Wang Q, et al. Efficacy comparison of 16 interventions for myopia control in children: A network meta-analysis. Ophthalmology 2016; 123: 697–708.
Chamberlain P, Peixoto-de-Matos SC, Logan NS, et al. A 3-year Randomized Clinical Trial of MiSight Lenses for Myopia Control. Optom Vis Sci 2019; 96: 556–567.
Flitcroft D.I, Loughman, Arumugam B, Bradley A, Chamberlain P. Centile-based analysis of refractive development in the MiSight® 1 day Myopia Control trial.. Invest. Ophthalmol. Vis. Sci. 2020;61(7):1372.
Bao J, Huang Y, Li X, et al. Spectacle Lenses With Aspherical Lenslets for Myopia Control vs Single-Vision Spectacle Lenses: A Randomized Clinical Trial. JAMA Ophthalmol. 2022;140(5):472–478. doi:10.1001/jamaophthalmol.2022.0401
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Gong Q, Janowski M, Luo M, Wei H, Chen B, Yang G, Liu L. Efficacy and Adverse Effects of Atropine in Childhood Myopia: A Meta-analysis. JAMA Ophthalmol. 2017 Jun 1;135(6):624-630. doi: 10.1001/jamaophthalmol.2017.1091.
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Lam CSY, Tang WC, Tse DY, et al. Defocus Incorporated Multiple Segments (DIMS) spectacle lenses slow myopia progression: a 2-year randomised clinical trial. British Journal of Ophthalmology 2020;104:363-368.
Bao J, Huang Y, Li X, et al. Spectacle Lenses With Aspherical Lenslets for Myopia Control vs Single-Vision Spectacle Lenses: A Randomized Clinical Trial. JAMA Ophthalmol. 2022;140(5):472–478.
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Rose KA, Morgan IG, Ip J, Kifley A, Huynh S, Smith W, Mitchell P. Outdoor activity reduces the prevalence of myopia in children. Ophthalmology. 2008 Aug;115(8):1279-85. doi: 10.1016/j.ophtha.2007.12.019. Epub 2008 Feb 21. PMID: 18294691.
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Xiong S, Sankaridurg P, Naduvilath T, Zang J, Zou H, Zhu J, Lv M, He X, Xu X. Time spent in outdoor activities in relation to myopia prevention and control: a meta-analysis and systematic review. Acta Ophthalmol. 2017 Sep;95(6):551-566. doi: 10.1111/aos.13403.
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Kate L. Gifford, Kathryn Richdale, Pauline Kang, Thomas A. Aller, Carly S. Lam, Y. Maria Liu, Langis Michaud, Jeroen Mulder, Janis B. Orr, Kathryn A. Rose, Kathryn J. Saunders, Dirk Seidel, J. Willem L. Tideman, Padmaja Sankaridurg; IMI – Clinical Management Guidelines Report. Invest. Ophthalmol. Vis. Sci. 2019;60(3):M184-M203.
Foreman, J., Salim, A. T., Praveen, A., Fonseka, D., Ting, D. S. W., He, M. G., ... & Dirani, M. (2021). Association between digital smart device use and myopia: a systematic review and meta-analysis. The Lancet Digital Health, 3(12), e806-e818.
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Physical activity and exercise guidelines
O’Donoghue L, Kapetanankis VV, McClelland JF, et al. (2015) Risk Factors for Childhood Myopia: Findings from the NICER Study. Invest Ophthalmol Vis Sci. 56:1524-30
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Rose KA, Morgan IG, Ip J, Kifley A, Huynh S, Smith W, Mitchell P. Outdoor activity reduces the prevalence of myopia in children. Ophthalmology. 2008 Aug;115(8):1279-85.
Cao K, Wan Y, Yusufu M, et al. Significance of outdoor time for myopia prevention: a systematic review and meta-analysis based on randomized controlled trials. Ophthalmic Res 2020; 63: 97–105.
Xiong S, Sankaridurg P, Naduvilath T, Zang J, Zou H, Zhu J, Lv M, He X, Xu X. Time spent in outdoor activities in relation to myopia prevention and control: a meta-analysis and systematic review. Acta Ophthalmol. 2017 Sep;95(6):551-566.
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Ramessur R, Williams KM and Hammond CJ. Risk factors for myopia in a discordant monozygotic twin study. Ophthalmic Physiol Opt 2015; 35: 643–651.
Gifford KL, Richdale K, Kang P, Aller TA, Lam CS, Liu YM, et al. IMI – Clinical Management Guidelines Report. Invest Ophthalmol Vis Sci. 2019;60(3):M184-M203.
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Screen time guidelines for children - resources for eye care practitioners - Myopia Profile Date accessed: 08/11/22
* we haven't listed every paper here, but feel free to contact us if you have any specific questions or feel we've missed an important paper!