Purpose: Soft contact lens wear is most frequently associated with morphologic changes in corneal endothelial cells, but the data are scarce in Asians. This study aimed to evaluate changes in corneal endothelial cell morphology after 6 months of wearing soft hydrogel contact lenses (SH) in young myopic adults living in Kuala Lumpur. Patients and methods: Forty-eight subjects were included in the study, 24 were fitted with SH contact lenses (A) and the rest were prescribed with glasses (B). Refraction was conducted subjectively and standard contact lens fitting protocol was followed. Corneal endothelial cell morphology (endothelial cell density, ECD; coefficient of variation, COV; cells’ hexagonality, HEX; and central corneal thickness, CCT) was evaluated using specular microscope. Data were collected at baseline and after 6 months of lens wear. Results: Mean age of all subjects was 21.23±1.30 years. All results are shown at baseline and 6 months, respectively. Mean refraction for A was –2.16±0.97 diopter sphere (DS) and –2.05±1.03 DS (P=0.49); for B was –2.72±1.51 DS and –2.73±1.51 DS (P=0.58). Mean ECD (cell/mm²) for A: 3104.19±237.30 and 3107.23±237.51 (P=0.07); for B: 3011.56±227.95 and 2983.83±244.55 (P=0.33). COV (%) for A: 46.52±8.63 and 48.53±10.65 (P=0.06); for B: 46.93±9.31 and 46.14±10.65 (P=0.88). HEX (%) for A: 46.21±10.12 and 45.15±10.01 (P=0.08); for B: 46.21±10.12 and 45.15±10.01 (P=0.12). CCT (µm) for A: 520.33±0.04 and 525.70±0.05 (P=0.41); for B: 532.00±0.04 µm and 530.00±0.05 µm (P=0.40). Conclusion: This study found no significant change in corneal endothelial cell morphology after 6 months of wearing SH contact lenses. This is probably due to better oxygen permeability of the contact lens material, good compliance, and short wearing period.

Purpose: To investigate changes in peripheral eye length (PEL) in myopic children undergoing orthokeratology (Ortho-K) treatment for 12 months using MRI. The results were compared to single vision spectacle wearers (SVS). Patients and Methods: A total of 70 children with myopia (aged 8– 9 years old) were recruited. A total of 45 children were fitted with Ortho-K, and 25 were fitted with SVS. The PEL and axial length (AL) were measured by using MRI 3-Tesla, whereas central and peripheral refraction (PR) measurements were conducted at ± 30 degrees horizontally with nasal (N) and temporal (T) intervals of 10°, 20°, and 30° and with an open field autorefractometer (WAM-5500 Grand Seiko). All the measurements were conducted at the baseline and 12 months. Results: The MRI analysis indicates that at 12 months, the SVS group showed more elongation of the PEL and AL at all eccentricities than the Ortho-K group did (p < 0.05). The Ortho-K group only showed significant PEL elongation beyond 20 degrees at N20, N30, T20, and T30 (p < 0.05); however, a significant reduction in the AL was detected in the center AL, N10, and T10 (p < 0.05). All eccentricities in the relative PR of the Ortho-K group were significantly more myopic than at the baseline (p < 0.05), whereas in the SVS group, all eccentricities in the relative PR were shown to be significantly more hyperopic than at the baseline (p < 0.05). The PEL and PR showed negative correlations at 12 months in the Ortho-K group. Conclusion: MRI analysis can be utilized to describe changes in PEL in myopic children. It appears that as myopia progressed in Ortho-K lens wearers, the PEL increased by a greater amount than the AL did; thus, the retina was reshaped to become increasingly oblate and to display peripheral myopic defocus.

Background: This is a cross-sectional study to further understand the effects of axial length elongation on the corneal endothelial cell’s morphology in myopic children. Abnormal changes in the morphology of corneal endothelium are indicators of corneal stress or instability which could be linked to myopia. Methods: 111 school children comprising of 37 emmetropes, 37 mild myopes and 37 moderate myopes aged 8-9 years old were recruited. Visual acuity was measured using the LogMar chart, cycloplegic refraction was determined using an open-field autorefractor (Grand Seiko WAM-5100, Hiroshima, Japan) and refined using subjective refraction. Morphology of corneal endothelial cells [endothelial cell density, coefficient of variation, hexagonality and central corneal thickness] was evaluated using a non-contact specular microscope (Topcon SP-2000P). Axial length was measured with A-scan ultrasound biometry (PacScan Plus, Sonomed Escalon, NY). The correlation between morphology of corneal endothelial cells and axial length were assessed using Pearson Correlation and Linear regression analysis. Results: There was no significant difference in corneal endothelial cells and axial length between gender (p>0.05). Significant reduction in endothelial cells density and hexagonality and increased coefficient of variation was found in eyes of higher myopic power which had longer axial when compared to emmetropes (p<0.001). Except for central corneal thickness, all corneal endothelial cells parameters correlated significantly with axial length (p<0.05). For every 1mm increase in axial length, endothelial cells density decreased by 73.27cells/mm2, hexagonality decreased by 2.32% and coefficient of variation increased by 1.75%. Conclusions: There were significant changes in morphology of cornea endothelial cells in young moderate myopic children of Chinese ethnicity at 8-9 years of age. This result provides normative data for Malaysian children of Chinese ethnicity that can be used for comparison and reference for clinical procedures, thereby facilitating decision-making with respect to interventions for myopia control, especially in prescribing contact lens for children.

There are limited reports available on the impact of wearing Orthokeratology (ortho-K) lenses on the quality of life of Asian children. This study evaluated and compared vision-related quality of life (VRQoL) between myopic children wearing ortho-K lenses and single-vision spectacles (SVSs), living in Kuala Lumpur, using Paediatric Refractive Error Profile (PREP) questionnaires. This is a cross sectional study. Myopic children who had been wearing ortho-K and SVSs for 12 months were recruited, and the questionnaires were distributed online. The PREP scores were obtained using a summary scoring method. The Shapiro-Wilk test was used to determine data normality. Unpaired t-test was performed for normally distributed data, and the Mann-Whitney test for non-normally distributed data. P < 0.05 was considered significant. A total of 70 subjects participated in this study (45 ortho-K and 25 SVSs), with a mean age of 10.86 ± 0.73 years. The mean scores for all the items were higher in ortho-K than SVS wearers (p < 0.05). With regard to symptoms during ortho-K lens wear at night, <10 % of the subjects reported difficulty falling asleep, itch/burning/dry eyes and foreign body sensation after lens insertion. Ortho-K improves the vision-related quality of life of myopic school children in Kuala Lumpur. Thus, it should be considered by more local optometrists when managing myopic children.