Short-Term Axial Length Effects of Combining Paracentral Collimating Apertures with Near-Peripheral Myopic Defocus for Myopia Control.

Background/Objectives: Myopia is a growing global problem. Current preventative treatments are inadequate, and myopia control spectacles intentionally degrade peripheral optical quality over large retinal areas. Variable results have been related to near-peripheral retinal refractive variability and chromatic refractive spread. A narrow paracentral band of collimating apertures created by annuli with plus-add surrounding appropriately small distance-correcting areas is proposed to decrease defocus and dynamic accommodation cues at the most responsive retinal area for controlling axial elongation while optimizing peripheral vision. Methods: Axial lengths (AL), with the contralateral myopic eye serving as the control, were measured in a child with masking after distance and near viewing with a stick-on placed coaxially on a single-vision (SV) spectacle lens during the AL diurnal cycle's ascending phase only during the experimental sessions at myopia onset and two years later in a case study. The stick-on consisted of a 3.5 mm-wide annular +3D lens containing collimating apertures created by surrounding 1.5 mm-wide circular openings within the stick-on with plus power over the SV minus lens. Results: There was no elongation during near viewing in the child's eye with the stick-on, while the contralateral control eye without the stick-on elongated. The expected increase in elongation during distance viewing during the child's AL diurnal cycle's ascending phase was reduced at age 8 and again at age 10 in the eye with the stick-on compared to the eye without the stick-on. Adaptation was immediate. Central and peripheral visual acuities were no different with or without the stick-on. Conclusions: This proof-of-concept study in a single child at myopia onset and two years later during myopia progression suggests the potential of this novel strategy for reducing short-term axial elongation during distance and near viewing. Stick-ons, clip-ons, electronic and non-electronic spectacles and contact lenses combining near-peripheral collimation with near-peripheral myopic defocus treatment at the narrow near-peripheral retinal area should be further explored for controlling myopia without reduction of peripheral vision.