About

Dr. Donald Mutti is the E.F. Wildermuth Foundation Professor in Optometry at The Ohio State University College of Optometry. He received his Doctor of Optometry degree in 1982 from the School of Optometry at the University of California Berkeley and later earned his PhD in 1992 after returning to Berkeley as a National Eye Institute Post-Doctoral Research Fellow. His professional experience includes conducting clinical research at CooperVision Ophthalmic Products, where he co-holds a patent in soft contact lens design. Dr. Mutti's research focuses on eye growth, refractive error development, and ocular biometry, with significant contributions to understanding myopia and emmetropization. He is a co-investigator on the NIH-funded Collaborative Longitudinal Evaluation of Ethnicity and Refractive Error (CLEERE) Study, which investigates normal eye growth and risk factors for myopic refractive error. He also served as the Principal Investigator of the Berkeley Infant Biometry Study, a comprehensive investigation into ocular component development in infancy. A Fellow of the American Academy of Optometry and a silver Fellow of the Association for Research in Vision and Ophthalmology, Dr. Mutti has received numerous awards for his research and teaching, including the Borish Award, the Glenn A. Fry Award, and the Herbert G. Mote Award for distinguished teaching.

Research topics

• Ophthalmology
• Medicine
• Optometry
• Internal medicine
• Optics
• Surgery
• Endocrinology
• Psychology
• Physics
• Psychiatry
• Demography
• Materials science
• Neuroscience
• Physical therapy
• Biology
• Composite material

Selected publications

• Frequency of retinal findings after 8 years in the Bifocal Lenses in Nearsighted Kids ( <scp>BLINK</scp> ) Study

  Ophthalmic and Physiological Optics · 2025-06-13

  articleOpen access

  PURPOSE: The purpose of the study is to report the frequency of retinal findings in myopic children and determine the association with the amount of myopia or axial length. DESIGN: The BLINK study was a myopia control, multi-centre randomised clinical trial following myopic children with multifocal soft contact lenses. PARTICIPANTS: Children aged 7-11 years with myopia (sphere) from -0.75 to -5.00 D and 1.00 D cylinder or less at baseline who completed the final BLINK2 study visit (n = 235). METHODS: Children had an annual dilated fundus examination. Retinal findings were classified into three main categories: vitreous, peripheral retina and other retinal findings, and further subdivided into 17 subcategories. MAIN OUTCOME MEASURES: Frequencies were calculated. Groups used median splits of spherical equivalent refractive error and axial length, and differences were assessed using chi-squared tests. Incidence was calculated. RESULTS: Overall, 186/235 (79.1%) participants had at least one retinal finding and 81/235 (34.5%) participants had at least one vitreous or peripheral retinal finding that could increase the risk of sight-threatening complications. One participant had a retinal detachment. The incidence of any retinal finding in those with no previous findings was 12.5/100 person-years (95% confidence interval = 10.2-15.0). Peripheral retinal finding incidence was 2.4/100 person-years (1.8-3.2), while the vitreous finding incidence was 1.7/100 person-years (1.2-2.4). At each dilated examination, at least 7.2% of participants had a newly documented finding. Sex, age, spherical equivalent refractive error and axial length were not associated with differences in findings (all p ≥ 0.08). CONCLUSION: Almost 80% of children with juvenile-onset myopia had a documented retinal finding, which was not associated with the amount of myopia or axial length. Almost 35% had a vitreous or peripheral retina finding that could increase the risk for potential sight-threatening complications, which warrants routine dilation and close follow-up to monitor for retinal changes.

  PublisherOA PDFDOI

• Axial length as a function of age, sex, and ethnicity: Results from the CLEERE study

  Optometry and Vision Science · 2025-10-23 · 3 citations

  articleOpen access1st authorCorresponding

  SIGNIFICANCE: Axial length is emerging as the primary outcome variable used for assessing myopia control efficacy, in both clinic and clinical trials. This report provides a model of axial length as a function of age, sex, and race/ethnicity, in addition to percentiles of axial length across age in childhood. PURPOSE: To model axial length in juvenile-onset myopia and children in general as a function of age, sex, race/ethnicity, parental history of myopia, diopter-hours of near work, and hours of outdoor/sports activities. METHODS: Axial length from the time of myopia onset was modeled using quadratic fits as a function of age, sex, race/ethnicity, and other covariates. Myopic participants were 590 children in the Collaborative Longitudinal Evaluation of Ethnicity and Refractive Error (CLEERE) study with at least three annual visits: one without myopia, an onset visit 1 year later (spherical equivalent at least -0.75 D), and another visit after myopia onset. Percentiles for axial length from the entire CLEERE sample were determined using 23,154 observations from 4877 children. RESULTS: Axial elongation in myopic children was greatest at younger ages, slowing with age in a quadratic trajectory between 6 and 14 years. The average rate of elongation at a given age, however, was independent of the age of myopia onset. In the general sample of children, axial length percentiles at age 6 years were similar across racial/ethnic groups, but Asian American children had the steepest increases in axial length with age, followed by Native American and Hispanic children. The shallowest increases occurred in Black and White children. Females had shorter axial lengths than males by 0.4 to 0.5 mm, but a higher probability of being myopic for a given age and axial length percentile. Parental history of myopia, time spent reading, and time spent in outdoor/sports activity were not significant factors for axial length in multivariate models. CONCLUSIONS: The models of axial length as a function of age, sex, and race/ethnicity, along with their percentiles, may prove useful in sample size planning for clinical trials, for judging efficacy of myopia control in individual children, and for comparison to more recent datasets.

  PublisherOA PDFDOI

• Axial Growth and Myopia Progression After Discontinuing Soft Multifocal Contact Lens Wear

  JAMA Ophthalmology · 2025-01-16 · 5 citations

  letterOpen access

  Importance: For myopia control to be beneficial, it would be important that the benefit of treatment (slowed eye growth) is not lost because of faster than normal growth (rebound) after discontinuing treatment. Objective: To determine whether there is a loss of treatment effect (rebound) after discontinuing soft multifocal contact lenses in children with myopia. Design, Setting, and Participants: The Bifocal Lenses in Nearsighted Kids 2 (BLINK2) cohort study involved children with myopia (aged 11-17 years at BLINK2 baseline) who completed the BLINK Study randomized clinical trial. Enrollment was from September 2019 through January 2021; follow-up was completed in January 2024. In the BLINK2 Study, all children wore high-add (+2.50 diopter [D]) multifocal soft contact lenses for 2 years and single-vision soft contact lenses during the third year to determine if rebound occurred. Exposure: High-add multifocal soft contact lenses and single-vision soft contact lenses. Main Outcomes and Measures: Eye length (optical biometry) and refractive error (cycloplegic autorefraction) were measured annually. Results: Of 248 participants enrolled in BLINK2, 235 completed the study. The median age at the baseline visit was 15 years (range, 11-17 years); 146 participants (59%) were female, and 102 (41%) were male. At baseline for BLINK2, mean (SD) axial length and spherical equivalent refractive error were 25.2 (0.9) mm and -3.40 (1.40) D, respectively. After participants switched from multifocal to single-vision contact lenses, axial elongation increased by 0.03 mm per year (95% CI, 0.01 to 0.05) regardless of their original BLINK treatment assignment (P = .81). There was also an increase in myopia progression after switching to single-vision lenses of -0.17 D per year (95% CI, -0.22 to -0.12) that did not depend on the original BLINK treatment assignment (P = .57). There continued to be a difference in axial length and refractive error throughout BLINK2 based on the BLINK Study treatment assignment with the original high-add group having shorter eyes and less myopia than the original medium-add (+1.50 D) and single-vision groups. Conclusions and Relevance: The BLINK2 Study found no evidence of a loss of treatment effect after discontinuing multifocal contact lenses in older teenagers. These data suggest eye growth and myopia progression returned to faster but age-expected rates and support continuing multifocal lenses until cessation of elongation and progression.

  PublisherOA PDFDOI

• Role of ocular accommodation in emmetropisation among highly farsighted infants

  British Journal of Ophthalmology · 2025-10-15

  articleSenior author

  PURPOSE: To assess the relationship between accommodative lag (defocus) and accommodative response to determine which drives emmetropisation in highly farsighted 3-month-old infants who successfully reached emmetropia in a 15-month period. MATERIALS AND METHODS: 35 highly hyperopic (≥+5.00 D most hyperopic meridian) 3-month-old infants (57% female) were enrolled in a clinical trial (NCT03669146) to determine the effect on emmetropisation (reaching <+3.0 D) of partial refractive correction (full correction reduced by 3.0 D) and visual exercises to stimulate accommodation. Refractive error was obtained by cycloplegic (1% cyclopentolate) retinoscopy and accommodation was assessed with the monocular estimation method (MEM) at near (33 cm) and with the PlusOptix PowerRefractor (Plusoptix, Nuremberg, Germany) at distance (6 m) and near (33 cm). The effect of accommodative response and lag on emmetropisation was analysed using a repeated measures regression model of change in spherical equivalent refractive error as a function of accommodative lag and accommodative response. RESULTS: Greater loss of hyperopia was associated with more robust accommodative response at both distance (measured with the PowerRefractor) and near (measured with MEM). These relationships increased in strength with increasing age, reaching B=-0.32 and B=-0.47 diopters of loss of hyperopia per diopter of accommodative response at 18 months (interaction between response and age p=0.004 and p<0.001 for distance and near, respectively). Linear regression analyses showed no significant associations between change in refractive error and defocus at distance or near. CONCLUSION: Contrary to defocus-based models of emmetropisation, greater accommodative response and not hyperopic defocus had the stronger influence on the rate of emmetropisation in hyperopic infants.

  PublisherDOI

• Emmetropization in highly hyperopic infants: A randomized clinical trial of partial refractive correction

  Optometry and Vision Science · 2025-04-22 · 3 citations

  articleSenior author

  SIGNIFICANCE: Highly hyperopic infants are at greater risk for not undergoing emmetropization and later developing conditions such as strabismus, amblyopia, and early literacy and reading problems. An early intervention consisting of partial hyperopic correction and encouragement of accommodation may influence the rate of emmetropization in these high-risk infants. PURPOSE: This study aimed to determine if moderate spectacle partial correction (3.00 D cut from cycloplegic) and visual exercises to promote accommodation enhance emmetropization (reaching ≤+3.00 D) in highly hyperopic (≥+5.00 D to ≤+7.00 D) 3-month-old infants compared with no treatment (observation). METHODS: Thirty-five highly hyperopic 3-month-old infants (57% female) were randomized to observation or treatment ( clinicaltrials.gov ; NCT03669146). Primary analysis compared the mean hyperopia at 18 months of age in treated versus untreated participants. Data were also modeled using proportional hazards survival analysis (time to reach ≤+3.00 D). RESULTS: There was no significant difference in refractive error at 18 months of age between infants in the treated (+1.6 ± 0.6 D) and observation groups (+1.2 ± 0.7 D; p = 0.23) but treatment affected the rate of emmetropization depending on baseline hyperopia (p = 0.01). At 12 months of age, treated infants had similar refractive errors regardless of baseline hyperopia but untreated infants at 12 months underwent faster emmetropization if their baseline hyperopia was <+5.50 D and slower emmetropization if it was >+5.50 D. CONCLUSIONS: Partial hyperopic refractive correction with accommodative exercises in highly hyperopic infants did not affect average refractive error at 18 months. However, treatment affected the rate of emmetropization and how long it took to reach ≤+3.00 D. Treatment slowed the rate of emmetropization at lower levels of initial hyperopia but may enhance emmetropization at higher levels.

  PublisherDOI

• Three-Year Change in Subfoveal Choroidal Thickness and Area With Multifocal Contact Lens Wear in the Bifocal Lenses in Nearsighted Kids (BLINK) Study

  Investigative Ophthalmology & Visual Science · 2025-05-02 · 5 citations

  articleOpen access

  Purpose: To evaluate changes in subfoveal choroidal thickness and area in children wearing soft multifocal contact lenses (MFCLs) for myopia control. Methods: Analyses included 281 myopic children aged 7 to 11 years in the Bifocal Lenses in Nearsighted Kids (BLINK) Study randomly assigned to wear single vision contact lenses (SVCLs), +1.50 D add, or +2.50 D add center-distance MFCL. Subfoveal choroidal thickness and choroidal area were measured using spectral-domain optical coherence tomography before and after 2 weeks of lens wear, and then annually for 3 years. Repeated measures linear regression was used to determine the effect of contact lens wear on the choroid and test the association between choroidal changes and axial elongation. Results: After initiating contact lens wear, mean ± SE subfoveal choroidal thickness and choroidal area increased in the +2.50 D MFCL group compared with the SVCL group by 8 ± 3 µm (P = 0.003) and 0.07 ± 0.02 mm2 (P = 0.002), a difference maintained throughout the 3-year study (P ≥ 0.55). Increased choroidal thickness and area after 2 weeks in the +2.50 D MFCL group vs. SVCL group were associated with less axial elongation over 3 years (β = -0.0058 mm/µm and -0.947 mm/mm2; P = 0.02 and P = 0.006; 20% and 29% of total treatment effect, respectively). Conclusions: The choroid increased in subfoveal thickness and area after 2 weeks of +2.50 D MFCL wear, which was maintained for 3 years and was associated with slower axial elongation. However, only a portion of the treatment effect can be accounted for by the choroidal parameters.

  PublisherOA PDFDOI

• The association between pupillary responses and axial length in children differs as a function of season

  Scientific Reports · 2024-01-05 · 3 citations

  articleOpen accessSenior author

  The association between pupillary responses to repeated stimuli and adult refractive error has been previously demonstrated. This study evaluated whether this association exists in children and if it varies by season. Fifty children aged 8-17 years (average: 11.55 ± 2.75 years, 31 females) with refractive error between + 1.51 and - 5.69 diopters (non-cycloplegic) participated (n = 27 in summer, and n = 23 in winter). The RAPDx pupilometer measured pupil sizes while stimuli oscillated between colored light and dark at 0.1 Hz in three sequences: (1) alternating red and blue, (2) red-only, and (3) blue-only. The primary outcome was the difference in pupillary responses between the blue-only and red-only sequences. Pupillary constriction was greater in response to blue light than to red for those with shorter eyes in summer (β = - 9.42, P = 0.034) but not in winter (β = 3.42, P = 0.54). Greater constriction comprised faster pupillary escape following red light onset and slower redilation following stimulus offset of both colors (P = 0.017, 0.036, 0.035 respectively). The association between axial length and children's pupillary responses in summer, but not winter may be explained by greater light-associated release of retinal dopamine in summer. Shorter eyes' more robust responses are consistent with greater light exposure inhibiting axial elongation and reducing myopia risk.

  PublisherOA PDFDOI

• Predicting the onset of myopia in children by age, sex, and ethnicity: Results from the CLEERE Study

  Optometry and Vision Science · 2024-04-01 · 15 citations

  articleOpen access1st authorCorresponding

  SIGNIFICANCE: Clinicians and researchers would benefit from being able to predict the onset of myopia for an individual child. This report provides a model for calculating the probability of myopia onset, year-by-year and cumulatively, based on results from the largest, most ethnically diverse study of myopia onset in the United States. PURPOSE: This study aimed to model the probability of the onset of myopia in previously nonmyopic school-aged children. METHODS: Children aged 6 years to less than 14 years of age at baseline participating in the Collaborative Longitudinal Evaluation of Ethnicity and Refractive Error (CLEERE) Study who were nonmyopic and less hyperopic than +3.00 D (spherical equivalent) were followed up for 1 to 7 years through eighth grade. Annual measurements included cycloplegic autorefraction, keratometry, ultrasound axial dimensions, and parental report of children's near work and time spent in outdoor and/or sports activities. The onset of myopia was defined as the first visit with at least -0.75 D of myopia in each principal meridian. The predictive model was built using discrete time survival analysis and evaluated with C statistics. RESULTS: The model of the probability of the onset of myopia included cycloplegic spherical equivalent refractive error, the horizontal/vertical component of astigmatism (J0), age, sex, and race/ethnicity. Onset of myopia was more likely with lower amounts of hyperopia and less positive/more negative values of J0. Younger Asian American females had the highest eventual probability of onset, whereas older White males had the lowest. Model performance increased with older baseline age, with C statistics ranging from 0.83 at 6 years of age to 0.92 at 13 years. CONCLUSIONS: The probability of the onset of myopia can be estimated for children in the major racial/ethnic groups within the United States on a year-by-year and cumulative basis up to age 14 years based on a simple set of refractive error and demographic variables.

  PublisherOA PDFDOI

• Peripheral Defocus, Pupil Size, and Axial Eye Growth in Children Wearing Soft Multifocal Contact Lenses in the BLINK Study

  Investigative Ophthalmology & Visual Science · 2023-11-01 · 16 citations

  articleOpen access

  Purpose: The purpose of this study was to evaluate the relationship between peripheral defocus and pupil size on axial growth in children randomly assigned to wear either single vision contact lenses, +1.50 diopter (D), or +2.50 D addition multifocal contact lenses (MFCLs). Methods: Children 7 to 11 years old with myopia (-0.75 to -5.00 D; spherical component) and ≤1.00 D astigmatism were enrolled. Autorefraction (horizontal meridian; right eye) was measured annually wearing contact lenses centrally and ±20 degrees, ±30 degrees, and ±40 degrees from the line of sight at near and distance. Photopic and mesopic pupil size were measured. The effects of peripheral defocus, treatment group, and pupil size on the 3-year change in axial length were modeled using multiple variables that evaluated defocus across the retina. Results: Although several peripheral defocus variables were associated with slower axial growth with MFCLs, they were either no longer significant or not meaningfully associated with eye growth after the treatment group was included in the model. The treatment group assignment better explained the slower eye growth with +2.50 MFCLs than peripheral defocus. Photopic and mesopic pupil size did not modify eye growth with the +2.50 MFCL (all P ≥ 0.37). Conclusions: The optical signal causing slower axial elongation with +2.50 MFCLs is better explained by the lens type worn than by peripheral defocus. The signal might be something other than peripheral defocus, or there is not a linear dose-response relationship within treatment groups. We found no evidence to support pupil size as a criterion when deciding which myopic children to treat with MFCLs.

  PublisherDOI

• Evaluation of a Pilot Protocol for Detecting Infant Hyperopia

  Optometry and Vision Science · 2023-03-23 · 5 citations

  articleSenior author

  SIGNIFICANCE Highly hyperopic children are at greater risk for developing conditions such as strabismus, amblyopia, and early literacy and reading problems. High hyperopia is a common finding in infants in a pediatric medical practice, and early detection can be done effectively in that setting with tropicamide autorefraction. PURPOSE This study aimed to evaluate the effectiveness of a pilot screening program to detect high hyperopia in 2‐month‐old infants in a pediatric medical practice in Columbus, Ohio. METHODS Cycloplegic refractive error (1% tropicamide) was measured by retinoscopy and autorefraction with the Welch Allyn SureSight (Welch Allyn/Hillrom, Skaneateles Falls, NY) in 473 infants (55.4% female) who were undergoing their 2‐month well‐baby visit at their pediatrician's medical practice. Cycloplegic retinoscopy (1% cyclopentolate) was repeated at a subsequent visit in 35 infants with ≥+5.00 D hyperopia in the most hyperopic meridian during the screening. RESULTS Twenty‐eight infants (5.9%) had high hyperopia (spherical equivalent, ≥+5.00 D), and 61 (12.9%) had high hyperopia (≥+5.00 D in at least one meridian of at least one eye) by retinoscopy with 1% tropicamide. The mean ± standard deviation spherical equivalent tropicamide cycloplegic refractive error measured with retinoscopy was +2.54 ± 1.54 D (range, −3.25 to +7.00 D) and with SureSight was +2.29 ± 1.64 D (range, −2.90 to +7.53 D). Retinoscopy done using 1% cyclopentolate was 0.44 ± 0.54 D more hyperopic in spherical equivalent than with 1% tropicamide ( P &lt;. 001). CONCLUSIONS High hyperopia was a common finding in 2‐month‐old infants in a pediatric medical setting that could be detected effectively by cycloplegic autorefraction using tropicamide. Greater cooperation between pediatric primary vision and medical care could lead to effective vision screenings designed to detect high hyperopia in infants.

  PublisherDOI

Recent grants

• Soft Bifocal Contact Lens Myopia Control - Clincal Center

  NIH · $2.9M · 2014–2019

• NIH Grant R01EY011801

  NIH · $2.2M · 2006

• Examination of Myopia Progression and Consequences and Mechanism of Soft Multifocal Contact Lens Myopia Control - Clinical Center

  NIH · $2.6M · 2014–2026

Frequent coauthors

• Karla Zadnik

  264 shared

• Jeffrey J. Walline

  National Eye Institute

  99 shared

• Lisa Jones

  89 shared

• G. Lynn Mitchell

  SUNY College of Optometry

  87 shared

• Lisa A. Jones‐Jordan

  SUNY College of Optometry

  81 shared

• Loraine T. Sinnott

  SUNY College of Optometry

  75 shared

• J. Daniel Twelker

  University of Arizona

  59 shared

• Melvin L. Moeschberger

  The Ohio State University

  47 shared

Labs

• Karla Zadnik LabPI

Education

• Ph.D., Optometry

  The Ohio State University

  1985

• M.S., Optometry

  The Ohio State University

  1982

• B.S., Optometry

  The Ohio State University

  1979

Awards & honors

• Borish Award from the American Academy of Optometry (1996)
• Glenn A. Fry Award from the American Optometric Foundation (…
• Graduate Teaching Award from the Graduate Organization in Vi…
• Herbert G. Mote Award for distinguished teaching (2009, 2011…
• Alumnus of the Year of the UC Berkeley School of Optometry (…