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Prevention of myopia by partial correction of hyperopia: a twins study



To confirm the prediction of emmetropization feedback theory that myopia can be prevented by correcting the hyperopia of a child at risk of becoming myopic.


We conducted such myopia prevention treatment with twins at risk. Their hyperopia was partially corrected by one half at age 7 and in subsequent years until age 16.


Hyperopia progressively decreased in all eyes as expected. None of the twins developed myopia. The spherical equivalent refractions of the followed eyes were +1 and +1.25 D at age 16. Feedback theory accurately predicted these values.


The treatment of the twins with partial correction of their hyperopia was successful. Prevention of myopia with this technique is relatively simple and powerful. The use of this myopia prevention treatment has no adverse effects. This prevention treatment is indicated in children with a hyperopic reserve at risk of developing myopia.

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  1. 1.

    Sorsby A, Benjamin B, Davey JB et al (1961) Emmetropia and its aberrations. MRC special report series no. 293. Her Majesty’s Stationery Office, London

  2. 2.

    Zadnik K (1997) Myopia development in childhood. Optom Vis Sci 74:603–608

    CAS  Article  PubMed  Google Scholar 

  3. 3.

    Slataper FJ (1950) Age norms of refraction and vision. Arch Ophthalmol 43:466–481

    Article  Google Scholar 

  4. 4.

    Medina A (1987) A model for emmetropization: predicting the progression of ametropia. Ophthalmologica 194:133–139

    CAS  Article  PubMed  Google Scholar 

  5. 5.

    Medina A, Fariza E (1993) Emmetropization as a first-order feedback system. Vis Res 33(1):21–26

    CAS  Article  PubMed  Google Scholar 

  6. 6.

    Medina A (2015) The progression of corrected myopia. Graefes Arch Clin Exp Ophthalmol 253:1273–1277. doi:10.1007/s00417-015-2991-5

    Article  PubMed  Google Scholar 

  7. 7.

    Gwiazda J, Thorn F, Bauer J, Held R (1993) Emmetropization and the progression of manifest refraction in children followed from infancy to puberty. Clin Vis Sci 8:337–344

    Google Scholar 

  8. 8.

    Kempf GA, Collins SD, Jarman BL (1928) Refractive errors in the eyes of children as determined by retinoscopic examination with a cycloplegic. United States, 182. Government Printing Office, Washington

  9. 9.

    Ingram RM, Arnold PE (1991) Emmetropisation, squint and reduced visual acuity after treatment. Br J Ophthalmol 75:414–416

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  10. 10.

    Medina A (1987) A model for emmetropization: the effect of corrective lenses. Acta Ophthalmol 65:565–571

    CAS  Article  Google Scholar 

  11. 11.

    Mutti DO (2007) Emmetropize or not to emmetropize? The question for hyperopic development. Optom Vis Sci 84(2):97–102

    Article  PubMed  Google Scholar 

  12. 12.

    Zadnik K et al (2015) Prediction of juvenile-onset myopia. JAMA Ophthalmol 133(6):683–689. doi:10.1001/jamaophthalmol.2015.0471

    Article  PubMed  PubMed Central  Google Scholar 

  13. 13.

    Greene PR, Medina A (2016) Refraction data survey: 2nd generation correlation of myopia. Int Ophthalmol 36(9):609–614. doi:10.1007/s10792-016-0172-0

    Article  PubMed  Google Scholar 

  14. 14.

    Vitale S, Sperduto RD, Ferris FL (2009) Increased prevalence of myopia in the United States between 1971–1972 and 1999–2004. Arch Ophthalmol 127:1632–1639

    Article  PubMed  Google Scholar 

  15. 15.

    Wong L, Coggon D, Cruddas M, Hwang CH (1993) Education, reading, and familial tendency as risk factors for myopia. J Epidemiol Community Health 47:50–53

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  16. 16.

    Fernández-Montero A, Olmo-Jimenez JM, Olmo N, Bes-Rastrollo M, Moreno-Galarraga L, Moreno-Montañés J, Martínez-González MA (2015) The impact of computer use in myopia progression: a cohort study in Spain. Prev Med 71:67–71

    Article  PubMed  Google Scholar 

  17. 17.

    Rose KA, Morgan IG, Ip J, Kifley A, Huynh S, Smith W, Mitchell P (2008) Outdoor activity reduces the prevalence of myopia in children. Ophthalmology 115:1279–1285. doi:10.1016/j.ophtha.2007.12.019

    Article  PubMed  Google Scholar 

  18. 18.

    Bullimore MA, Jones LA, Moeschberger ML, Zadnik K, Payor RE (2002) A retrospective study of myopia progression in adult contact lens wearers. Invest Ophthalmol Vis Sci 43(7):2110–2113

    PubMed  Google Scholar 

  19. 19.

    Kałuzny BJ, Koszewska-Kołodziejczak A (2005) Changes of eye refraction, corneal power and lens power during growth in emmetropia, myopia and hyperopia. Klin Oczna 107:464–467

    PubMed  Google Scholar 

  20. 20.

    Greene PR, Brown OS, Medina AP, Graupner HB (1996) Emmetropia approach dynamics with diurnal dual-phase cycling. Vis Res 36(15):2249–2251

    CAS  Article  PubMed  Google Scholar 

  21. 21.

    Chia A et al (2012) Atropine for the treatment of childhood myopia: safety and efficacy of 0.5%, 0.1%, and 0.01% doses (atropine for the treatment of myopia 2). Ophthalmology 119(2):347–354

    Article  PubMed  Google Scholar 

  22. 22.

    Shih YF et al (2001) An intervention trial on efficacy of atropine and multi-focal glasses in controlling myopic progression. Acta Ophthalmol Scand 79(3):233–236

    CAS  Article  PubMed  Google Scholar 

  23. 23.

    Oakley KH, Young FA (1975) Bifocal control of myopia. Am J Optom Physiol Opt 52:738–764

    Article  Google Scholar 

  24. 24.

    Phillips J (2005) Monovision slows juvenile myopia progression unilaterally. Br J Ophthalmol 89:1196–1200. doi:10.1136/bjo.2004064212

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  25. 25.

    Medina A (2016) Detecting the effect of under-correcting myopia. Graefes Arch Clin Exp Ophthalmol 254:409–410. doi:10.1007/s00417-015-3111-2

    Article  PubMed  Google Scholar 

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Special thanks to the dedicated mathematical assistance of Francisco Gaya. Funding was provided by Multivision Research.

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Corresponding author

Correspondence to Antonio Medina.

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The authors have no proprietary or financial conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study. Additional informed consent was obtained from all individual participants for whom identifying information is included in this article.



The feedback system output to an input lens of R diopters in the t-domain is the inverse Laplace transform of the output in the s-domain, which in turn is the transfer function times the step input in the s-domain:

$$\begin{aligned} o(t) & = L^{ - 1} \{ O(s)\} = L^{ - 1} \{ I(s)F(s)\} = \, L^{ - 1} \{ L[i(t)]F(s)\} \\ & = L^{ - 1} \{ R/[s(1 + ks)]\} = R[1{-}\exp ({-}t/k)] \\ \end{aligned}$$

where t is time, k is the time constant, I(s) is the step input in the s-domain, i(t) is the step input R in the time domain, O(s) is the output in the s-domain, o(t) is the output in the t-domain, L is the Laplace transform, and L −1 is the inverse Laplace transform.

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Medina, A. Prevention of myopia by partial correction of hyperopia: a twins study. Int Ophthalmol 38, 577–583 (2018).

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  • Emmetropia
  • Emmetropization
  • Myopia
  • Hyperopia
  • Myopia prevention
  • Feedback