Safety Aspects of DIMS Technology Glasses, Fixation as a Marker for Amblyopia, Bielschowsky Head Tilt Test in Superior Oblique Paresis and Successful Late Topical Treatment of Orbital Infantile Hemangioma

Progressive childhood myopia has become a significant issue in East and Southeast Asia over the last 60 years and is associated with the risk of visual acuity degradation down to severe impairment or blindness [1], [2]. Over the last decade, various attempts to prevent excessive eye growth have been undertaken. These include the local application of atropine, which has long been known for its potential of lowering the eye growth rate. However, higher dosages (0.5% or higher) have significant side effects such as photophobia and decreased accommodation as well as a significant rebound of myopia on discontinuation. Low-dose atropine (0.01%) has been shown to be effective in a dose-dependent manner with little side effects and less profound rebound and thus has become the most common pharmacological treatment of childhood myopia [3], [4], [5]. Another approach targets the dependency of eyeball growth on defocus. Initial studies deploying spectacle lens designs intended to reduce peripheral hyperopic defocus could not show significant differences in the rate of myopia progression after 1 year when compared to a standard control lens. There was significantly less progression only for participants with a family history of myopia [6]. Recently, two new lens designs have been developed: Defocus Incorporated Multiple Segments (DIMS) and Highly Aspherical Lenslet Target (H. A. L. T.) technology spectacle lenses. Both designs aim to slow down or stop eye growth by means of a peripheral retinal myopic defocus [7]. While DIMS technology creates a simultaneous defocus by incorporating a central zone for distance refractive correction and a zone of multiple defocus segments (lenslets) of + 3.5 D surrounding the central zone [8], the H. A. L. T. technology provides a volume of myopic defocus (VoMD) through 11 concentric rings of contiguous lenslets [9]. For both lens designs, a significant slowdown of myopia progression and axial elongation has been shown in recent studies [8], [9], [10], [11]. In cases in which one method alone does not stop or significantly slow progression, a combination of atropine and DIMS or H. A. L. T. spectacle lenses may be applied. Despite intermittent perception of peripheral defocus, good tolerance and acceptance has been shown for DIMS lenses [12]. However, both treatments may substantially alter visual performance required for driving or participation in road traffic. Kaymak et al. therefore studied the impact of the combination of DIMS spectacle lenses and low-dose atropine (0.01%) on pupil and visual functions, including visual acuity, photopic and mesopic contrast sensitivity, mesopic vision, and glare sensitivity [13]. Looking through the lenslets area and atropine reduced visual acuity by 0.24 and 0.27 logMAR, respectively. The combination reduced visual acuity by 0.33 logMAR. Additional glare induced no additional reduction. While contrast sensitivity reduction increases with spatial frequency when looking through the lenslets area, additional atropine treatment did not show any additional effect. Pupil function was significantly reduced even 8 hours after atropine application. Even though under no condition did visual acuity drop below 0.3 logMAR and no other clinical relevant restriction of visual functions were found in this study, it has to be kept in mind that children concerned may be at risk from additional amblyopia or subnormal visual function.

Publication History

Article published online:
18 October 2022

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