One of the factors proposed to regulate the eye growth is the error signal derived from the defocus in the retina and actually, this might arise from defocus not only in the fovea but the whole visual field. Therefore, myopia could be better predicted by spatio-temporally mapping the ‘environmental defocus’ over the visual field. At present, no devices are available that could provide this information. A ‘Kinect sensor v1’ camera (Microsoft Corp.) and a portable eye tracker were used for developing a system for quantifying ‘indoor defocus error signals’ across the central 58° of the visual field. Dioptric differences relative to the fovea (assumed to be in focus) were recorded over the visual field and ‘defocus maps’ were generated for various scenes and tasks.

Studies have found reduced myopia progression with multifocal contact lenses, albeit with an unclear mechanism behind their protective effect. It is hypothesized that the induced myopic defocus of the addition zones of the multifocal contact lenses leads to choroidal thickening and therefore inhibits eye growth. In the current study, the effect of the optical design of multifocal contact lenses on choroidal thickness was investigated. Eighteen myopic participants wore four different contact lenses ((1) single-vision lenses corrected for distance, (2) single-vision lenses with +2.50 D full-field defocus, (3) Multifocal center-distance design, (4) Multifocal center-near design, both with addition power +2.50 D) for 30 min each on their right eye. Automated analysis of the macular choroidal thickness and vitreous chamber depth were performed before and after the wear of each of the contact lenses. Peripheral refraction profiles in primary gaze were obtained using eccentric photorefraction prior to contact lens wear. Choroidal thickness and vitreous chamber depth showed no significant differences to baseline with any of the contact lenses (all p > 0.05). Choroidal thickness increased by +2.1 ± 11.1 μm with the Multifocal center-distance design, by +2.0 ± 11.1 μm with the full-field defocus lens, followed by the Multifocal center-near design with +1.6 ± 11.3 μm and the single-vision contact lens correcting for distance with +0.9 ± 11.2 μm. Multifocal contact lenses have no significant influence on choroidal thickness after short-term wear. Therefore, changes in choroidal thickness might not be the main contributor to the protective effect of multifocal contact lenses in myopia control.

The popularity of myopia treatments based on the peripheral defocus theory has risen. So far, little evidence has emerged around the questions which of these treatments are effective and why. In order to establish a framework that enables clinicians and researchers to acknowledge the possible interactions of different defocus patterns across the retina, different peripheral refractive errors (PRX) of subjects and different designs of optical treatments were evaluated. Dioptric defocus patterns on the retinal level have been obtained by merging the matrices of dioptric defocus maps of the visual field of different scenarios with individual peripheral refractive errors and different optical designs of multifocal contact lenses. The newly obtained matrices were statistically compared using a non-parametric test with familywise error algorithms and multi-comparison tests. Results show that asymmetric peripheral refractive error profiles (temporal or nasal positively skewed) appear to be less prone to be changed by the defocus imposition of multifocal contact lenses than those presenting symmetric patterns (relative peripheral myopia or hyperopia).

This study addresses the importance of salience placement before or after scotoma development for an efficient target allocation in the visual field. Pre-allocation of attention is a mechanism known to induce a better gaze positioning towards the target. Three different conditions were tested: a simulated central scotoma, a salience augmentation surrounding the scotoma and a baseline condition without any simulation. All conditions were investigated within a virtual reality VR gaming environment. Participants were tested in two different orders, either the salient cue was applied together with the scotoma before being presented with the scotoma alone or the scotoma in the wild was presented before and, then, with the augmentation around it. Both groups showed a change in gaze behaviour when saliency was applied. However, in the second group, salient augmentation also induced changes in gaze behaviour for the scotoma condition without augmentation, gazing above and outside the scotoma following previous literature. These preliminary results indicate salience placement before developing an advanced stage of scotoma can induce effective and rapid training for efficient target maintenance during VR gaming. The study shows the potential of salience and VR gaming as therapy for early AMD patients.

Clinical studies and basic research have attempted to establish a relationship between myopia progression and single vision spectacle wear, albeit with unclear results. Single vision spectacle lenses are continuously used as the control group in myopia control trials. Hence, it is a matter of high relevance to investigate further whether they yield any shift on the refractive state, which could have been masked by being used as a control. In this review, eye development in relation to eyes fully corrected versus those under-corrected is discussed, and new guidelines are provided for the analysis of structural eye changes due to optical treatments. These guidelines are tested and optimised, while ethical implications are revisited. This newly described methodology can be translated to larger clinical trials, finally exerting the real effect of full correction via single vision spectacle lens wear on eye growth and myopia progression.