A whistlestop tour of myopia management

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.