Emmetropization &

Myopia Epidemics

Rafael Iribarren

Argentina - 2023
DISCLOSURES
Inuit 1950 - 3% myopia in children growing in open air

Inuit 1970 - 45% myopia in children of residential schools

Chinese children Singapore - 30% myopia – 3 hs x week outdoors

Chinese Children Australia --- 3% myopia – 14 hs x week outdoors

Chinese children in Beijing year 1960 – 10-20% myopia prevalence

Chinese children in Beijing year 2000 – 65% myopia prevalence

Rose, Morgan et. al. – Archives of Ophthalmologoy 2008

Young et al. - Canadian Journal of Ophth 1970
Rozema et al. - Ophthalmic and Physiological Optics 2021
 Prevalence of myopia in Argentina.

Age High
1st Author Location n= (years) Published Myopia Myopia

Sanchez Villa María 646 40+ 2016 13,50% 2,00%

Cortinez Buenos Aires 1518 25-65 2008 29,20% 1,60%

Kotlik Mendoza 2299 24 2021 29,84% 1,22%

Magnetto Marcos Juárez 283 12 2019 3,53% -

Pablo Franco et al.
2021.
Revista Medicina
Buenos Aires,
and AIVO 2020
1998 my first ARVO, I meet FRANK SCHAEFFEL and BILL STELL

2000 helped by BILL my first published paper. I get to know about ATOM study

2004 BILL introduces IAN MORGAN and I know about oudoors in 2005

2009 a series of papers about the lens (FOTOHUI, HASHEMI & IAN MORGAN)

2010 really interested in “crystalline lens power” I find Bennett’s equation……

I meet JOS ROZEMA -- 2011

OPO - 1988
MY FIEND FERNANDO
GUIÑAZU LEMOS

BLUE GREEN
RED
McKeefry,
Murray,
Kulikowski
2001
There are 310 microns between Red and Blue
And more tan 1.00 diopter of focal difference
And only 54 microns between Red and Green
With only 0.15 diopters focal difference
 He has discovered how the
retina detects defocus – 2022
Early discovery times - 1988
In chicks,
alternating plus and minus lenses
in different time schedules during a day
showed that positive lenses were much
more powerful than negative lenses
in sending a signal for ocular growth control.

Winawer & Wallman Vision Res. 2002;42:2651-68.

 First detection of changes in
axial length due to choroidal
changes in humans with
defocus lenses, in short
periods, measured with Lenstar
2010 IOVS
SCHAEFFEL
 WHITE LETTERS BLACK LETTERS
ON DARK BACKGROUND OVER WHITE BACKGROUND

“S” CONES “L” CONES

RECEPTIVE FIELDS RECEPTIVE FIELDS
(BLUE) (RED)
Today 2023, after Frank Schaeffel, we can say
that the retina detects the sign of blur
with neuronal computing
the different contrast sensitivity
at which blue and red are projected,
sending a message to the sclera
to match focus and axial length.

2022
 DO YOU REMMEMBER THAT I TOLD YOU
THAT PLUS LENSES ARE MORE POWEFUL
TO GIVE A “STOP” SIGNAL FOR GROWTH,
THAN NEGATIVE ONES
TO GIVE A “GROW” SIGNAL?

THEIR BIOCHEMICAL SIGNAL

IS MORE SUSTAINED

Wallman & Winawer - 2002

Hammond, Wallman, Wildsoet . - 2013
 This study in 2022
showed that
Red – Green - Blue
perifoveal retina
between 6° & 12 °
Green - Red is the most
sensitive to blur.
DOMS SPECTACLES
& DOMS
THE IMPORTANCE OF ILLUMINATION
100 CANDELS AT 50 cm ARE 400 LUX
5 CANDELS AT 50 cm ARE 20 LUX
 AÑO 2011

THREE GROUPS OF CHICKS

GROWING UNRESTRICTED VISION
DURING 3 WHOLE MONTHS
YUVAL COHEN WITH THREE LEVELS OF ILLUMINATION

10.000 LUX SPHER EQU +1.10 D

3 MONTH OLD CHICKS 500 LUX SPHER EQU 0.00 D

ARE LIKE 3-4 YO
CHILDREN 50 LUX SPHER EQU -2.40 D
ASIA PACIFIC JOURNAL OF OPHTHALMOLOGY - 2022
 In myopic subjects tested
by Frank Schaeffel
with different blur stimuli
from some environmental cause
their retina has lost the capability
of detecting signals
to “stop” ocular growth.
 Should we ask
our patients at risk
whether they go
to bed at night
to read in the dark?

McKeefry,
Murray,
Kulikowski
2001
 AND WHAT ABOUT

THE EMMETROPIZATION PROCESS?

 “calculated” lens power
corneal power

cyclo spherical equivalent

anterior chamber depth

lens thickness

axial length
 -THERE IS VARIATION IN THE
COMPONENTS OF EMMETROPIC EYES

-CORNEA MAY HAVE BETWEEN

39.0 AND 47.0 DIOPTERS

-THE CRYSTALLINE IN CHILDREN

MAY BE BETWEEN 20.0 AND 28.0 D

- AND AXIAL LENGHT GOES

BETWEEN 22.00 AND 25.00 mm
 Courtesy - SHI MING LI del ANYANG MYOPIA STUDY, CHINA

corneal radius of curvature of right eye = 2,25 + 0,24 * alength lens powe r of right eye = 58,38 + -1,44 * alength
R-Square = 0,48 R-Square = 0,46

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7,00       
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20,00 22,00 24,00 26,00 20,00 22,00 24,00 26,00

axial length of right eye axial length of right eye

•MYOPIC CHILDREN WHO WERE ONCE
EMMETROPIC, NOW WHEN AGED 8-10

•MAY HAVE A 23.00mm EYE

IF THEIR CORNEAS ARE 43 D,
• AND 24.00mm WHEN THEIR
CORNEAS ARE NEAR 40 D,
•WHILE THOSE EYES WITH CORNEAS
OF 46 D MAY BE 22.00mm LONG.
 MUTTI et al.
2018 OVS
Baltimore Study
Ignacio Magneto et al. Revista OCE
Marcos Juárez Prospective Study 2020
 ROZEMA
DANKERT
IRIBARREN
LANCA
SAW

SCORM STUDY
SINGAPORE
IOVS 2019
Iribarren, Galán, Rozema
ROHIT SAXENA ET AL.
HINDU ATOM STUDY
OPO – JUNIO 2023
Change in Variables Atropine group Control group P value#
(Mean ± S.D.) [n = 70] [n = 50]

Spherical Equivalent (D) -0.18 ± 0.20 -0.59 ± 0.21 < 0.001

Axial length (mm) 0.21 ± 0.12 0.29 ± 0.11 0.056
Anterior chamber depth (mm) 0.05 ± 0.07 0.06 ± 0.05 0.300

Lens thickness (mm) -0.03 ± 0.07 0.005 ± 0.09 0.020

Keratometry (D) 0.12 ± 0.17 0.08 ± 0.20 0.330
Lens Power (D) -0.68 ± 0.35 -0.28 ± 0.43 < 0.001

ACCEPTED 12 – 6 – 2023 IN OPHTHALMIC AND PHYSIOLOGICAL OPTICS

How can we calculate the crystalline lens power
with the in vivo lens power Bennett equation
if the lens changes power at any time
with accommodation?

The only posible answer

is to measure the lens under cycloplegia
 “Working in myopia control in the clinic”

Refractive anomalies, like myopia, need the

pharmacy for diluted atropine drops, the optical
store for “defocus” o “contrast” myopia control
spectacles and special defocus contact lenses,
so it needs the necessary prescription of the
ophthalmologist that must perform cycloplegia.
BONUS TRACK
THANK YOU VERY MUCH!!!!!