Dr. Mark Bullimore, an optometrist and a professor begins by stating the astounding increase in prevalence of myopia across the world in the past few decades. He identifies the myopia myth: that increase in screen usage causes myopia and clearly illustrates how this cannot be true.
He talks about other risk factors that link to increase prevalence of myopia such as parental history and outdoor activities.
He focuses on myopia control and the recent available evidence in field. We learn about some key points that one should look for evaluating the efficacy of a myopia control study. Axial length is a crucial component of the myopia epidemic as it is closely linked to the ocular diseases associated with myopia. Then we review some of the common strategies used to slow myopia progression and the evidence in the literature about it.
- Spectacle lenses
- Undercorrection
- Progressive addition lenses for patients with esophoria and accommodative lag
- Executive bifocals
- Plus power in the periphery
- Ortho-K
- Multifocal Contact lenses
- Spectacle lens with add in all meridians
- Pharmaceutical Approaches
- Atropine
After, informing us about the current treatment options available, Dr. Bullimore focuses on what the patients should know and how the benefits of the myopia control treatment weigh in comparison to the risks. He succinctly summarizes the scientific evidence for the different risk associated with contact lens wear among children.
We conclude the talk with the benefits of myopia control and it is necessary for eye care practitioners across the world to take charge of the myopia management because if we can slow myopia by a diopter we can reduce the risk of visul impairment by twenty percent.
Lastly, he concludes with some very important take home message for eyecare practitioners who treat myopia. The session ends with a Q and A session for the live audience.
References
PapersPrevalence
Vitale S, Sperduto RD, Ferris FL 3rd. Increased prevalence of myopia in the United States between 1971-1972 and 1999-2004. Arch Ophthalmol. 2009 Dec;127(12):1632-9.
https://pubmed.ncbi.nlm.nih.gov/20008719/
Risk Factors
Jones LA, Sinnott LT, Mutti DO, Mitchell GL, Moeschberger ML, Zadnik K. Parental history of myopia, sports and outdoor activities, and future myopia. Invest Ophthalmol Vis Sci. 2007 Aug;48(8):3524-32.
https://pubmed.ncbi.nlm.nih.gov/17652719/
Hu Y, Ding X, Guo X, Chen Y, Zhang J, He M. Association of Age at Myopia Onset With Risk of High Myopia in Adulthood in a 12-Year Follow-up of a Chinese Cohort. JAMA Ophthalmol. 2020 Sep 17;138(11):1–6.
https://pubmed.ncbi.nlm.nih.gov/32940622/
Overview of treatments
Brennan NA, Toubouti YM, Cheng X, Bullimore MA. Efficacy in myopia control. Prog Retin Eye Res. 2020 Nov 27:100923.
https://pubmed.ncbi.nlm.nih.gov/33253901/
Wildsoet CF, Chia A, Cho P, Guggenheim JA, Polling JR, Read S, Sankaridurg P, Saw SM, Trier K, Walline JJ, Wu PC, Wolffsohn JS. IMI – Interventions Myopia Institute: Interventions for Controlling Myopia Onset and Progression Report. Invest Ophthalmol Vis Sci. 2019 Feb 28;60(3):M106-M131.
https://pubmed.ncbi.nlm.nih.gov/30817829/
Importance of axial lenth
Tideman JW, Snabel MC, Tedja MS, van Rijn GA, Wong KT, Kuijpers RW, Vingerling JR, Hofman A, Buitendijk GH, Keunen JE, Boon CJ, Geerards AJ, Luyten GP, Verhoeven VJ, Klaver CC. Association of Axial Length With Risk of Uncorrectable Visual Impairment for Europeans With Myopia. JAMA Ophthalmol. 2016 Dec 1;134(12):1355-1363.
https://pubmed.ncbi.nlm.nih.gov/27768171/
Spectacle Undercorrection
Chung K, Mohidin N, O’Leary DJ. Undercorrection of myopia enhances rather than inhibits myopia progression. Vision Res. 2002 Oct;42(22):2555-9.
https://pubmed.ncbi.nlm.nih.gov/12445849/
Adler D, Millodot M. The possible effect of undercorrection on myopic progression in children. Clin Exp Optom. 2006 Sep;89(5):315-21.
https://pubmed.ncbi.nlm.nih.gov/16907670/
Progressive addition lenses
Edwards MH, Li RW, Lam CS, Lew JK, Yu BS. The Hong Kong progressive lens myopia control study: study design and main findings. Invest Ophthalmol Vis Sci. 2002 Sep;43(9):2852-8. PMID: 12202502.
https://pubmed.ncbi.nlm.nih.gov/12202502/
Gwiazda J, Hyman L, Hussein M, Everett D, Norton TT, Kurtz D, Leske MC, Manny R, Marsh-Tootle W, Scheiman M. A randomized clinical trial of progressive addition lenses versus single vision lenses on the progression of myopia in children. Invest Ophthalmol Vis Sci. 2003 Apr;44(4):1492-500.
https://pubmed.ncbi.nlm.nih.gov/12657584/
Correction of Myopia Evaluation Trial 2 Study Group for the Pediatric Eye Disease Investigator Group. Progressive-addition lenses versus single-vision lenses for slowing progression of myopia in children with high accommodative lag and near esophoria. Invest Ophthalmol Vis Sci. 2011 Apr 25;52(5):2749-57.
https://pubmed.ncbi.nlm.nih.gov/21282579/
Executive bifocal lenses
Cheng D, Woo GC, Drobe B, Schmid KL. Effect of bifocal and prismatic bifocal spectacles on myopia progression in children: three-year results of a randomized clinical trial. JAMA Ophthalmol. 2014 Mar;132(3):258-64.
https://pubmed.ncbi.nlm.nih.gov/24435660/
Plus in the periphery
Smith EL 3rd. Prentice Award Lecture 2010: A case for peripheral optical treatment strategies for myopia. Optom Vis Sci. 2011 Sep;88(9):1029-44.
https://pubmed.ncbi.nlm.nih.gov/21747306/
Ortho-K
Cho P, Cheung SW, Edwards M. The longitudinal orthokeratology research in children (LORIC) in Hong Kong: a pilot study on refractive changes and myopic control. Curr Eye Res. 2005 Jan;30(1):71-80.
https://pubmed.ncbi.nlm.nih.gov/15875367/
Cho P, Cheung SW. Retardation of myopia in Orthokeratology (ROMIO) study: a 2-year randomized clinical trial. Invest Ophthalmol Vis Sci. 2012 Oct 11;53(11):7077-85.
https://pubmed.ncbi.nlm.nih.gov/22969068/
Multifocal Contact lenses
Sankaridurg P, Bakaraju RC, Naduvilath T, Chen X, Weng R, Tilia D, Xu P, Li W, Conrad F, Smith EL 3rd, Ehrmann K. Myopia control with novel central and peripheral plus contact lenses and extended depth of focus contact lenses: 2 year results from a randomised clinical trial. Ophthalmic Physiol Opt. 2019 Jul;39(4):294-307.
https://pubmed.ncbi.nlm.nih.gov/31180155/
Chamberlain P, Peixoto-de-Matos SC, Logan NS, Ngo C, Jones D, Young G. A 3-year Randomized Clinical Trial of MiSight Lenses for Myopia Control. Optom Vis Sci. 2019 Aug;96(8):556-567.
https://pubmed.ncbi.nlm.nih.gov/31343513/
Walline JJ, Walker MK, Mutti DO, Jones-Jordan LA, Sinnott LT, Giannoni AG, Bickle KM, Schulle KL, Nixon A, Pierce GE, Berntsen DA; BLINK Study Group. Effect of High Add Power, Medium Add Power, or Single-Vision Contact Lenses on Myopia Progression in Children: The BLINK Randomized Clinical Trial. JAMA. 2020 Aug 11;324(6):571-580.
https://pubmed.ncbi.nlm.nih.gov/32780139/
Spectacle lenses with plus power in all meridians
Sankaridurg P, Donovan L, Varnas S, Ho A, Chen X, Martinez A, Fisher S, Lin Z, Smith EL 3rd, Ge J, Holden B. Spectacle lenses designed to reduce progression of myopia: 12-month results. Optom Vis Sci. 2010 Sep;87(9):631-41.
https://pubmed.ncbi.nlm.nih.gov/20622703/
Kanda H, Oshika T, Hiraoka T, Hasebe S, Ohno-Matsui K, Ishiko S, Hieda O, Torii H, Varnas SR, Fujikado T. Effect of spectacle lenses designed to reduce relative peripheral hyperopia on myopia progression in Japanese children: a 2-year multicenter randomized controlled trial. Jpn J Ophthalmol. 2018 Sep;62(5):537-543.
https://pubmed.ncbi.nlm.nih.gov/30083910/
Lam CSY, Tang WC, Tse DY, Lee RPK, Chun RKM, Hasegawa K, Qi H, Hatanaka T, To CH. Defocus Incorporated Multiple Segments (DIMS) spectacle lenses slow myopia progression: a 2-year randomised clinical trial. Br J Ophthalmol. 2020 Mar;104(3):363-368.
https://pubmed.ncbi.nlm.nih.gov/31142465/
Atropine
Chua WH, Balakrishnan V, Chan YH, Tong L, Ling Y, Quah BL, Tan D. Atropine for the treatment of childhood myopia. Ophthalmology. 2006 Dec;113(12):2285-91.
https://pubmed.ncbi.nlm.nih.gov/16996612/
Chia A, Chua WH, Cheung YB, Wong WL, Lingham A, Fong A, Tan D. 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. 2012 Feb;119(2):347-54.
https://pubmed.ncbi.nlm.nih.gov/21963266/
Yam JC, Jiang Y, Tang SM, Law AKP, Chan JJ, Wong E, Ko ST, Young AL, Tham CC, Chen LJ, Pang CP. Low-Concentration Atropine for Myopia Progression (LAMP) Study: A Randomized, Double-Blinded, Placebo-Controlled Trial of 0.05%, 0.025%, and 0.01% Atropine Eye Drops in Myopia Control. Ophthalmology. 2019 Jan;126(1):113-124.
https://pubmed.ncbi.nlm.nih.gov/30514630/
Kinoshita N, Konno Y, Hamada N, Kanda Y, Shimmura-Tomita M, Kaburaki T, Kakehashi A. Efficacy of combined orthokeratology and 0.01% atropine solution for slowing axial elongation in children with myopia: a 2-year randomised trial. Sci Rep. 2020 Jul 29;10(1):12750.
https://pubmed.ncbi.nlm.nih.gov/32728111/
Risks of myopia control treatments
Stapleton F, Keay L, Edwards K, Naduvilath T, Dart JK, Brian G, Holden BA. The incidence of contact lens-related microbial keratitis in Australia. Ophthalmology. 2008 Oct;115(10):1655-62.
https://pubmed.ncbi.nlm.nih.gov/18538404/
Chalmers RL, Wagner H, Mitchell GL, Lam DY, Kinoshita BT, Jansen ME, Richdale K, Sorbara L, McMahon TT. Age and other risk factors for corneal infiltrative and inflammatory events in young soft contact lens wearers from the Contact Lens Assessment in Youth (CLAY) study. Invest Ophthalmol Vis Sci. 2011 Aug 24;52(9):6690-6.
https://pubmed.ncbi.nlm.nih.gov/21527379/
Bullimore MA. The Safety of Soft Contact Lenses in Children. Optom Vis Sci. 2017 Jun;94(6):638-646.
https://pubmed.ncbi.nlm.nih.gov/28514244/
Bullimore MA, Sinnott LT, Jones-Jordan LA. The risk of microbial keratitis with overnight corneal reshaping lenses. Optom Vis Sci. 2013 Sep;90(9):937-44.
https://pubmed.ncbi.nlm.nih.gov/23892491/
Benefits of myopia control
Bullimore MA, Brennan NA. Myopia Control: Why Each Diopter Matters. Optom Vis Sci. 2019 Jun;96(6):463-465.
https://pubmed.ncbi.nlm.nih.gov/31116165/
Tideman JW, Snabel MC, Tedja MS, van Rijn GA, Wong KT, Kuijpers RW, Vingerling JR, Hofman A, Buitendijk GH, Keunen JE, Boon CJ, Geerards AJ, Luyten GP, Verhoeven VJ, Klaver CC. Association of Axial Length With Risk of Uncorrectable Visual Impairment for Europeans With Myopia. JAMA Ophthalmol. 2016 Dec 1;134(12):1355-1363.
https://pubmed.ncbi.nlm.nih.gov/27768171/
Websites
BHVI Myopia Calculator