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- A whistlestop tour of myopia management
A whistlestop tour of myopia management
Professor Ed Mallen outlined the case for slowing myopia progression and the effectiveness of management options at 100% Optical
31 May 2022
Professor Ed Mallen shared the latest insight on myopia during his presentation Myopia – pathways to therapy at 100% Optical (London ExCel, 23-25 April).
The University of Bradford academic told attendees that the evidence base behind different myopia management options is growing.
“The more data we get the more certain we can be about the efficacy of these interventions,” he said.
Mallen noted that high myopia is a risk factor for the development of ocular pathology, while the Brien Holden Vision Institute has estimated that half the world’s population will be myopic by 2050.
“That’s a scary prediction,” he emphasised.
“Even an average myope is still more vulnerable than an emmetrope,” Mallen added.
Turning to how the field of myopia management may develop in the future, Mallen emphasised the importance of repeatability in the methods used to measure the effectiveness of interventions.
Mallen noted that refraction falls short in this respect.
“As we move on to refinement of myopia management, I think we need a better measure,” he said.
Other considerations moving forward will be to explore when to stop myopia management and if there is a rebound effect.
“A really important question is if everyone can benefit from myopia management. We don’t know the answer yet,” Mallen highlighted.
Mallen outlined the research on different myopia management options, including atropine, orthokeratology, modified spectacle lenses and multifocal contact lenses.
He referred to the ATOM1 and ATOM2 trials where children received atropine eye drops of varying concentrations.
The best control effect was achieved with the lowest concentration of atropine, Mallen highlighted.
Mallen also referred to research by Dr Desmond Cheng, where bifocal spectacles were shown to have a clinically useful treatment effect that was sustained over a three-year period.
Turning to orthokeratology, Mallen noted that research led by Pauline Cho, comparing ortho-k contact lenses to single vision spectacles over a two-year period, found that axial elongation was halved in the intervention group.
Multifocal contact lenses have also been shown to reduce axial growth of the eye, with a multicentre study illustrating a sustained treatment effect in children wearing MiSight contact lenses over a six-year period.
Mallen mentioned research on defocus incorporated multiple segments (DIMS) spectacle lenses that illustrated a myopia management effect over a two-year period.
Jinhua Bao has published data on Stellest spectacle lenses with an aspherical lenslet design, suggesting that a higher level of asphericity is associated with more effective myopia control.
Concluding his presentation, Mallen shared his hope that myopia management products would become more affordable as research in the field advances.
“Is myopia going to become a disease of the poor – the people who can’t afford myopia management?” he questioned.
Comments (2)
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Anonymous01 June 2022
I believe there are two elements that any clinician who wants to undertake myopia management need to be aware of; (i) the limits of myopia management under the current model, ie a lot of patients I see for review have been fitted with an option after/as myopia is plateauing out [ie are likely gaining minimal benefit from the product], the BHVI calculator is good for looking at likely treatment effect. (ii) the limit of evidence range - ie most studies are conducted in children aged 6-15, outside this age range our evidence is limited, and - most importantly (iii) Most of the studies we cite (indeed are cited in IMI papers) are not rigorously assessed for bias. Walline et al (2020) should be read in its entirety so clinicians should recognise that the efficacy found by many studies are not borne out when bias is eliminated - what does this mean? well the figures we suggest (ie 49% MiSight, 51% MyoSmart, 50% OrthoK, etc) are likely vast overestimates.
The issue for clinicians is that we have a significant tendency towards survivor bias - if it works, its our success - if not we change intervention until it works (or has the patient naturally plateaued? who can say? ).
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Anonymous01 June 2022
If the increased use of digital devices (computers, phones) by children plays a role in the development / progression of myopia and its associated medical ophthalmic complications in later life - should the Government not require the manufacturers of these products to place a 'government health warning' on their use. This might be even more important because this issue is particularly applicable to children - not adults who are free to decide for themselves.
There's a long history of companies producing products that cause medical harm - is this going to be one of them?
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