201
|
Guggenheim JA, Williams C. Evidence For and Against Genetic Testing to Identify Children at Risk of High Myopia. Ophthalmology 2019; 126:1615-1616. [PMID: 31759498 DOI: 10.1016/j.ophtha.2019.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 08/12/2019] [Accepted: 08/13/2019] [Indexed: 10/25/2022] Open
|
202
|
Wolffsohn JS, Calossi A, Cho P, Gifford K, Jones L, Jones D, Guthrie S, Li M, Lipener C, Logan NS, Malet F, Peixoto-de-Matos SC, González-Méijome JM, Nichols JJ, Orr JB, Santodomingo-Rubido J, Schaefer T, Thite N, van der Worp E, Tarutta E, Iomdina E, Ali BM, Villa-Collar C, Abesamis-Dichoso C, Chen C, Pult H, Blaser P, Parra Sandra Johanna G, Iqbal F, Ramos R, Carrillo Orihuela G, Boychev N. Global trends in myopia management attitudes and strategies in clinical practice - 2019 Update. Cont Lens Anterior Eye 2019; 43:9-17. [PMID: 31761738 DOI: 10.1016/j.clae.2019.11.002] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 11/01/2019] [Indexed: 12/13/2022]
Abstract
PURPOSE A survey in 2015 identified a high level of eye care practitioner concern about myopia with a reported moderately high level of activity, but the vast majority still prescribed single vision interventions to young myopes. This research aimed to update these findings 4 years later. METHODS A self-administrated, internet-based questionnaire was distributed in eight languages, through professional bodies to eye care practitioners globally. The questions examined: awareness of increasing myopia prevalence, perceived efficacy of available strategies and adoption levels of such strategies, and reasons for not adopting specific strategies. RESULTS Of the 1336 respondents, concern was highest (9.0 ± 1.6; p < 0.001) in Asia and lowest (7.6 ± 2.2; p < 0.001) in Australasia. Practitioners from Asia also considered their clinical practice of myopia control to be the most active (7.7 ± 2.3; p < 0.001), the North American practitioners being the least active (6.3 ± 2.9; p < 0.001). Orthokeratology was perceived to be the most effective method of myopia control, followed by pharmaceutical approaches and approved myopia control soft contact lenses (p < 0.001). Although significant intra-regional differences existed, overall, most practitioners did not consider single-vision distance under-correction to be an effective strategy for attenuating myopia progression (79.6 %), but prescribed single vision spectacles or contact lenses as the primary mode of correction for myopic patients (63.6 ± 21.8 %). The main justifications for their reluctance to prescribe alternatives to single vision refractive corrections were increased cost (20.6 %) and inadequate information (17.6 %). CONCLUSIONS While practitioner concern about myopia and the reported level of activity have increased over the last 4 years, the vast majority of eye care clinicians still prescribe single vision interventions to young myopes. With recent global consensus evidence-based guidelines having been published, it is hoped that this will inform the practice of myopia management in future.
Collapse
Affiliation(s)
| | - Antonio Calossi
- Department of Physics (Optics and Optometry), University of Florence, Italy
| | - Pauline Cho
- School of Optometry, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region
| | - Kate Gifford
- School of Optometry and Vision Science, Queensland University of Technology, Brisbane, Australia
| | - Lyndon Jones
- Centre for Ocular Research & Education (CORE), University of Waterloo, Waterloo, Ontario, Canada
| | - Deborah Jones
- Centre for Ocular Research & Education (CORE), University of Waterloo, Waterloo, Ontario, Canada
| | - Sarah Guthrie
- Centre for Ocular Research & Education (CORE), University of Waterloo, Waterloo, Ontario, Canada
| | - Ming Li
- Eye Hospital of Wenzhou Medical University, China
| | - Cesar Lipener
- Contact Lens Section, Federal University of São Paulo/Paulista School of Medicine, São Paulo, Brazil
| | - Nicola S Logan
- School of Health & Life Sciences, Aston University, Birmingham, UK
| | - Florence Malet
- Point Vision Bordeaux, Ophthalmologic Center, Bordeaux, France
| | - Sofia C Peixoto-de-Matos
- Clinical and Experimental Optometry Research Lab (CEORLab) - Center of Physics, University of Minho, Portugal
| | - José M González-Méijome
- Clinical and Experimental Optometry Research Lab (CEORLab) - Center of Physics, University of Minho, Portugal
| | - Jason J Nichols
- University of Alabama at Birmingham School of Optometry, Birmingham, AL, USA
| | - Janis B Orr
- School of Health & Life Sciences, Aston University, Birmingham, UK
| | | | | | - Nilesh Thite
- International Association of Contact Lens Educators, Pune, India
| | - Eef van der Worp
- Eye-Contact-Lens Research & Education, Amsterdam, The Netherlands
| | - Elena Tarutta
- Department of Refraction Pathology, Binocular Vision and Ophthalmoergonomics, Helmholtz National Medical Research Centre of Eye Diseases, Moscow, Russia
| | - Elena Iomdina
- Department of Refraction Pathology, Binocular Vision and Ophthalmoergonomics, Helmholtz National Medical Research Centre of Eye Diseases, Moscow, Russia
| | - Bariah Mohd Ali
- Optometry and Vision Science Program, Faculty of Health Sciences, Universiti Kebangsaan, Malaysia
| | - César Villa-Collar
- Department of Pharmacy, Biotechnology, Optics and Optometry, European University of Madrid, Villaviciosa de Odón, Spain
| | | | - Connie Chen
- Department of Optometry, Chung Shan Medical University, Taichung, Taiwan
| | - Heiko Pult
- School of Health & Life Sciences, Aston University, Birmingham, UK; Optometry & Vision Research, Weinheim, Germany; School of Biomedical & Life Sciences, Cardiff University, Cardiff, UK
| | | | | | - Fatima Iqbal
- School of Optometry, The University of Faisalabad, Pakistan
| | - Raul Ramos
- Alcon Latin America, LACAR Vision Care, Barrio Loreto, Alcaldia Álvaro Obregón; Ciudad de México
| | | | - Nikolay Boychev
- School of Health & Life Sciences, Aston University, Birmingham, UK
| |
Collapse
|
203
|
Batres L, Peruzzo S, Serramito M, Carracedo G. Accommodation response and spherical aberration during orthokeratology. Graefes Arch Clin Exp Ophthalmol 2019; 258:117-127. [PMID: 31720836 DOI: 10.1007/s00417-019-04504-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 09/12/2019] [Accepted: 10/03/2019] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To evaluate the changes in the accommodative response and in the corneal and internal spherical aberration during 3 months of wear of orthokeratology lenses from the baseline. METHODS Fifty children aged 8 to 17 were recruited for a prospective study and were fitted with orthokeratology lenses. Refraction without cycloplegia, high and low uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), accommodation lag, horizontal near phoria without correction, corneal topography, corneal, and total wavefront aberration were performed at baseline, 1 day, 1 week, 1 month, and 3 months. Data were analyzed by Student's t test for related samples, repeated measures ANOVA test, and Pearson correlation test. RESULTS The spherical equivalent (SE) before and after 3 months was - 3.33 ± 1.60 D and - 0.30 ± 0.46 D, respectively. Accommodation lag was 0.53 ± 0.38 D and 0.20 ± 0.33 D at baseline and at 3 months, respectively. A moderate correlation between lag at the baseline and its change between baseline and the 3-month visit was found (P < 0.05; R = 0.748). The spherical aberration (SA) increased for anterior corneal and total measurement, being statistically significant for all visits (P < 0.05). The internal SA decreased: - 0.105 ± 0.006 at baseline and - 0.196 ± 0.203 at 1 week (P < 0.05). No difference between baseline and the follow-up visits in posterior corneal SA was found (P > 0.05) CONCLUSION: The negative SA of the lens increases during OK treatment compensated for the increase of the anterior corneal surface positive SA, in addition to increasing the accommodative response.
Collapse
Affiliation(s)
- L Batres
- Department of Optometry and Vision, Faculty of Optics and Optometry, Complutense University of Madrid, C/Arcos del Jalon 118, 28032, Madrid, Spain
- Ophthalmological Clinic Doctor Lens, Madrid, Spain
| | - S Peruzzo
- Department of Optometry and Vision, Faculty of Optics and Optometry, Complutense University of Madrid, C/Arcos del Jalon 118, 28032, Madrid, Spain
| | - M Serramito
- Department of Optometry and Vision, Faculty of Optics and Optometry, Complutense University of Madrid, C/Arcos del Jalon 118, 28032, Madrid, Spain
| | - G Carracedo
- Department of Optometry and Vision, Faculty of Optics and Optometry, Complutense University of Madrid, C/Arcos del Jalon 118, 28032, Madrid, Spain.
| |
Collapse
|
204
|
Tkatchenko TV, Tkatchenko AV. Pharmacogenomic Approach to Antimyopia Drug Development: Pathways Lead the Way. Trends Pharmacol Sci 2019; 40:833-852. [PMID: 31676152 DOI: 10.1016/j.tips.2019.09.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 09/04/2019] [Accepted: 09/16/2019] [Indexed: 12/29/2022]
Abstract
Myopia is the most common eye disorder in the world which is caused by a mismatch between the optical power of the eye and its excessively long axial length. Recent studies revealed that the regulation of the axial length of the eye occurs via a complex signaling cascade, which originates in the retina and propagates across all ocular tissues to the sclera. The complexity of this regulatory cascade has made it particularly difficult to develop effective antimyopia drugs. The current pharmacological treatment options for myopia are limited to atropine and 7-methylxanthine, which have either significant adverse effects or low efficacy. In this review, we focus on the recent advances in genome-wide studies of the signaling pathways underlying myopia development and discuss the potential of systems genetics and pharmacogenomic approaches for the development of antimyopia drugs.
Collapse
Affiliation(s)
| | - Andrei V Tkatchenko
- Department of Ophthalmology, Columbia University, New York, NY, USA; Department of Pathology and Cell Biology, Columbia University, New York, NY, USA.
| |
Collapse
|
205
|
Kaphle D, Atchison DA, Schmid KL. Multifocal spectacles in childhood myopia: Are treatment effects maintained? A systematic review and meta-analysis. Surv Ophthalmol 2019; 65:239-249. [PMID: 31622629 DOI: 10.1016/j.survophthal.2019.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 09/25/2019] [Accepted: 10/04/2019] [Indexed: 12/22/2022]
Abstract
We evaluate the impact of duration on the treatment effect of multifocal spectacle lenses used to inhibit myopia progression in children. A systematic literature search identified randomized controlled trials where multifocal lenses were prescribed as the intervention, with single-vision lenses as the control. Nine randomized control trials involving 1,701 children aged 8-13 years were included in the meta-analysis. Treatment effects, that is, differences in spherical equivalent refraction between intervention and nonintervention groups, were analyzed over both 6- and 12-month intervals. As treatment duration increased, effectiveness reduced. In 6-month intervals, treatment effects were 0.07 D (95 % CI 0.02, 0.13), 0.03 D (95% CI -0.02, 0.08), and 0.02 D (95% CI -0.05, 0.11) for baseline to 6, 6-12, and 12-18 months, respectively. For 12-month intervals, treatment effects were 0.21 D (95% CI 0.12, 0.29), 0.11 D (95% CI 0.03, 0.19), and 0.12 D (95% CI -0.01, 0.25) for baseline to 12, 12-24, and 24-36 months, respectively. Even during the second 6 months of wear, the ability of multifocal spectacle lenses to inhibit myopia progression was reduced. It is not appropriate to extrapolate the treatment effect observed in the first 6 months or 12 months to estimate the likely future benefit of treatment.
Collapse
Affiliation(s)
- Dinesh Kaphle
- School of Optometry and Vision Sciences and Institute of Health and Biomedical Innovation, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia.
| | - David A Atchison
- School of Optometry and Vision Sciences and Institute of Health and Biomedical Innovation, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - Katrina L Schmid
- School of Optometry and Vision Sciences and Institute of Health and Biomedical Innovation, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
| |
Collapse
|
206
|
Jaisankar D, Leube A, Gifford KL, Schmid KL, Atchison DA. Effects of eye rotation and contact lens decentration on horizontal peripheral refraction. Ophthalmic Physiol Opt 2019; 39:370-377. [PMID: 31482609 DOI: 10.1111/opo.12641] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 08/08/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE Peripheral refraction is important in design of myopia control therapies. The aim was to investigate the influence of contact lens decentration associated with eye rotation on peripheral refraction in the horizontal visual field. METHODS Participants were 10 emmetropes and 10 myopes in good general and ocular health. Right eyes underwent cycloplegic peripheral refraction, using a Grand-Seiko WAM-5500 Autorefractor, in 5° steps to ±35° eccentricities along the horizontal visual field. Targets were fixated using eye rotation only or head rotation only. Refractions were measured without correction and with three types of contact lenses: single vision, a multifocal centre-distance aspheric with +2.50 D add and NaturalVue aspheric. Photographs of eyes during lens wear were taken for each eye rotation. Effects of visual field angle, lens type and test method (head or eye rotation) on vector components of relative peripheral refraction were evaluated using repeated measures anovas. Test method for each visual field angle/lens combination were compared via paired t-tests. RESULTS Horizontal decentration ranges across the visual field were 1.2 ± 0.6 mm for single vision and 1.2 ± 0.4 mm for multifocal lenses but smaller at 0.7 ± 0.4 mm for NaturalVue lenses. There were only two significant effects of test method across the visual field angle/lens type combinations (single vision: for emmetropes horizontal/vertical astigmatism component at 35° nasal with mean difference -0.38 D and for myopes spherical equivalent refraction at 20° temporal with mean difference +0.24 D). CONCLUSION Upon eye rotation the contact lenses decentred on the eye, but not enough to affect peripheral refraction. For the types assessed and for the horizontal visual field out to ±35° when measurements were performed with the Grand-Seiko WAM-5500 autorefractor, it is valid to use eye rotations to investigate peripheral refraction.
Collapse
Affiliation(s)
- Durgasri Jaisankar
- Institute of Health & Biomedical Innovation and School of Optometry and Vision Science, Queensland University of Technology, Brisbane, Australia
| | - Alexander Leube
- Institute for Ophthalmic Research, Eberhard Karls University Tuebingen, Tuebingen, Germany.,Carl Zeiss Vision International GmbH, Aalen, Germany
| | - Kate L Gifford
- Institute of Health & Biomedical Innovation and School of Optometry and Vision Science, Queensland University of Technology, Brisbane, Australia
| | - Katrina L Schmid
- Institute of Health & Biomedical Innovation and School of Optometry and Vision Science, Queensland University of Technology, Brisbane, Australia
| | - David A Atchison
- Institute of Health & Biomedical Innovation and School of Optometry and Vision Science, Queensland University of Technology, Brisbane, Australia
| |
Collapse
|
207
|
Wolffsohn JS, Flitcroft DI, Gifford KL, Jong M, Jones L, Klaver CCW, Logan NS, Naidoo K, Resnikoff S, Sankaridurg P, Smith EL, Troilo D, Wildsoet CF. IMI - Myopia Control Reports Overview and Introduction. Invest Ophthalmol Vis Sci 2019; 60:M1-M19. [PMID: 30817825 PMCID: PMC6735780 DOI: 10.1167/iovs.18-25980] [Citation(s) in RCA: 86] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
With the growing prevalence of myopia, already at epidemic levels in some countries, there is an urgent need for new management approaches. However, with the increasing number of research publications on the topic of myopia control, there is also a clear necessity for agreement and guidance on key issues, including on how myopia should be defined and how interventions, validated by well-conducted clinical trials, should be appropriately and ethically applied. The International Myopia Institute (IMI) reports the critical review and synthesis of the research evidence to date, from animal models, genetics, clinical studies, and randomized controlled trials, by more than 85 multidisciplinary experts in the field, as the basis for the recommendations contained therein. As background to the need for myopia control, the risk factors for myopia onset and progression are reviewed. The seven generated reports are summarized: (1) Defining and Classifying Myopia, (2) Experimental Models of Emmetropization and Myopia, (3) Myopia Genetics, (4) Interventions for Myopia Onset and Progression, (5) Clinical Myopia Control Trials and Instrumentation, (6) Industry Guidelines and Ethical Considerations for Myopia Control, and (7) Clinical Myopia Management Guidelines.
Collapse
Affiliation(s)
- James S Wolffsohn
- Ophthalmic Research Group, Aston University, Birmingham, United Kingdom
| | - Daniel Ian Flitcroft
- Children's University Hospital, University College Dublin and Dublin Institute of Technology, Dublin, Ireland
| | - Kate L Gifford
- Private Practice and Queensland University of Technology, Queensland, Australia
| | - Monica Jong
- Brien Holden Vision Institute and School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
| | - Lyndon Jones
- Centre for Ocular Research & Education (CORE), School of Optometry & Vision Science, University of Waterloo, Waterloo, Canada
| | - Caroline C W Klaver
- Department of Ophthalmology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Nicola S Logan
- Ophthalmic Research Group, Aston University, Birmingham, United Kingdom
| | - Kovin Naidoo
- African Vision Research Institute, University of KwaZulu-Natal, Durban, South Africa
| | - Serge Resnikoff
- Brien Holden Vision Institute and School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
| | - Padmaja Sankaridurg
- Brien Holden Vision Institute and School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
| | - Earl L Smith
- College of Optometry, University of Houston, Houston, Texas, United States
| | - David Troilo
- SUNY College of Optometry, State University of New York, New York, New York, United States
| | - Christine F Wildsoet
- Berkeley Myopia Research Group, School of Optometry & Vision Science Program, University of California Berkeley, Berkeley, California, United States
| |
Collapse
|
208
|
Jones L, Drobe B, González-Méijome JM, Gray L, Kratzer T, Newman S, Nichols JJ, Ohlendorf A, Ramdass S, Santodomingo-Rubido J, Schmid KL, Tan D, Tan KO, Vera-Diaz FA, Wong YL, Gifford KL, Resnikoff S. IMI - Industry Guidelines and Ethical Considerations for Myopia Control Report. Invest Ophthalmol Vis Sci 2019; 60:M161-M183. [PMID: 30817831 DOI: 10.1167/iovs.18-25963] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To discuss guidelines and ethical considerations associated with the development and prescription of treatments intended for myopia control (MC). Methods Critical review of published papers and guidance documents was undertaken, with a view to carefully considering the ethical standards associated with the investigation, development, registration, marketing, prescription, and use of MC treatments. Results The roles and responsibilities of regulatory bodies, manufacturers, academics, eye care practitioners, and patients in the use of MC treatments are explored. Particular attention is given to the ethical considerations for deciding whether to implement a MC strategy and how to implement this within a clinical trial or practice setting. Finally, the responsibilities in marketing, support, and education required to transfer required knowledge and skills to eye care practitioners and academics are discussed. Conclusions Undertaking MC treatment in minors creates an ethical challenge for a wide variety of stakeholders. Regulatory bodies, manufacturers, academics, and clinicians all share an ethical responsibility to ensure that the products used for MC are safe and efficacious and that patients understand the benefits and potential risks of such products. This International Myopia Institute report highlights these ethical challenges and provides stakeholders with recommendations and guidelines in the development, financial support, prescribing, and advertising of such treatments.
Collapse
Affiliation(s)
- Lyndon Jones
- Centre for Ocular Research & Education, School of Optometry & Vision Science, University of Waterloo, Waterloo, Canada
| | - Björn Drobe
- Essilor Research and Development, Vision Sciences AMERA, Center of Innovation and Technology AMERA, Singapore, Singapore
| | - José Manuel González-Méijome
- Clinical & Experimental Optometry Research Lab, Center of Physics (Optometry), School of Science, University of Minho, Braga, Portugal
| | - Lyle Gray
- Department of Vision Sciences, Glasgow Caledonian University, Glasgow, United Kingdom
| | - Timo Kratzer
- Carl Zeiss Vision International GmbH, Aalen, Germany
| | | | - Jason J Nichols
- University of Alabama at Birmingham, School of Optometry, Birmingham, Alabama, United States
| | - Arne Ohlendorf
- Carl Zeiss Vision International GmbH, Aalen, Germany.,Institute for Ophthalmic Research, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Stephanie Ramdass
- Vision Research Institute, Michigan College of Optometry, Ferris State University, Big Rapids, Michigan, United States
| | | | - Katrina L Schmid
- School of Optometry and Vision Science, Institute of Health and Biomedical Innovation, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Donald Tan
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-National University of Singapore Medical School, Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Kah-Ooi Tan
- Brien Holden Vision Institute, and School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | | | - Yee-Ling Wong
- Essilor Research and Development, Vision Sciences AMERA, Center of Innovation and Technology AMERA, Singapore, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Kate L Gifford
- Private Practice and School of Optometry and Vision Science, Institute of Health and Biomedical Innovation, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Serge Resnikoff
- Brien Holden Vision Institute, and School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| |
Collapse
|
209
|
Flitcroft DI, He M, Jonas JB, Jong M, Naidoo K, Ohno-Matsui K, Rahi J, Resnikoff S, Vitale S, Yannuzzi L. IMI - Defining and Classifying Myopia: A Proposed Set of Standards for Clinical and Epidemiologic Studies. Invest Ophthalmol Vis Sci 2019; 60:M20-M30. [PMID: 30817826 PMCID: PMC6735818 DOI: 10.1167/iovs.18-25957] [Citation(s) in RCA: 443] [Impact Index Per Article: 88.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Purpose We provide a standardized set of terminology, definitions, and thresholds of myopia and its main ocular complications. Methods Critical review of current terminology and choice of myopia thresholds was done to ensure that the proposed standards are appropriate for clinical research purposes, relevant to the underlying biology of myopia, acceptable to researchers in the field, and useful for developing health policy. Results We recommend that the many descriptive terms of myopia be consolidated into the following descriptive categories: myopia, secondary myopia, axial myopia, and refractive myopia. To provide a framework for research into myopia prevention, the condition of “pre-myopia” is defined. As a quantitative trait, we recommend that myopia be divided into myopia (i.e., all myopia), low myopia, and high myopia. The current consensus threshold value for myopia is a spherical equivalent refractive error ≤ −0.50 diopters (D), but this carries significant risks of classification bias. The current consensus threshold value for high myopia is a spherical equivalent refractive error ≤ −6.00 D. “Pathologic myopia” is proposed as the categorical term for the adverse, structural complications of myopia. A clinical classification is proposed to encompass the scope of such structural complications. Conclusions Standardized definitions and consistent choice of thresholds are essential elements of evidence-based medicine. It is hoped that these proposals, or derivations from them, will facilitate rigorous, evidence-based approaches to the study and management of myopia.
Collapse
Affiliation(s)
- Daniel Ian Flitcroft
- Children's University Hospital, Technological University Dublin, Dublin, Ireland
| | - Mingguang He
- Centre for Eye Research Australia; Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, Australia
| | - Jost B Jonas
- Department of Ophthalmology, Medical Faculty Mannheim of the Ruprecht-Karis-University Heidelberg, Mannheim, Germany
| | - Monica Jong
- Brien Holden Vision Institute and School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
| | - Kovin Naidoo
- Brien Holden Vision Institute and School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
| | | | - Jugnoo Rahi
- Institute of Child Health, University College London and Great Ormond Street Hospital for Children, London, United Kingdom
| | - Serge Resnikoff
- Brien Holden Vision Institute and School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
| | - Susan Vitale
- National Eye Institute, National Institutes of Health, Bethesda, Maryland, United States
| | - Lawrence Yannuzzi
- The Vitreous, Retina, Macula Consultants of New York and the LuEsther T. Mertz Retina Research Center, Manhattan Eye, Ear, and Throat Hospital, New York, New York, United States
| |
Collapse
|
210
|
Wolffsohn JS, Kollbaum PS, Berntsen DA, Atchison DA, Benavente A, Bradley A, Buckhurst H, Collins M, Fujikado T, Hiraoka T, Hirota M, Jones D, Logan NS, Lundström L, Torii H, Read SA, Naidoo K. IMI - Clinical Myopia Control Trials and Instrumentation Report. Invest Ophthalmol Vis Sci 2019; 60:M132-M160. [PMID: 30817830 DOI: 10.1167/iovs.18-25955] [Citation(s) in RCA: 87] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The evidence-basis based on existing myopia control trials along with the supporting academic literature were reviewed; this informed recommendations on the outcomes suggested from clinical trials aimed at slowing myopia progression to show the effectiveness of treatments and the impact on patients. These outcomes were classified as primary (refractive error and/or axial length), secondary (patient reported outcomes and treatment compliance), and exploratory (peripheral refraction, accommodative changes, ocular alignment, pupil size, outdoor activity/lighting levels, anterior and posterior segment imaging, and tissue biomechanics). The currently available instrumentation, which the literature has shown to best achieve the primary and secondary outcomes, was reviewed and critiqued. Issues relating to study design and patient selection were also identified. These findings and consensus from the International Myopia Institute members led to final recommendations to inform future instrumentation development and to guide clinical trial protocols.
Collapse
Affiliation(s)
- James S Wolffsohn
- Ophthalmic Research Group, Aston University, Birmingham, United Kingdom
| | - Pete S Kollbaum
- Indiana University, School of Optometry, Bloomington, Indiana, United States
| | - David A Berntsen
- The Ocular Surface Institute, College of Optometry, University of Houston, Houston, Texas, United States
| | - David A Atchison
- School of Optometry and Vision Science, Institute of Health and Biomedical Innovation, Queensland University of Technology, Australia
| | | | - Arthur Bradley
- Indiana University, School of Optometry, Bloomington, Indiana, United States
| | - Hetal Buckhurst
- School of Health Professions, Peninsula Allied Health Centre, Plymouth University, Plymouth, United Kingdom
| | - Michael Collins
- School of Optometry and Vision Science, Institute of Health and Biomedical Innovation, Queensland University of Technology, Australia
| | - Takashi Fujikado
- Department of Applied Visual Science, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Takahiro Hiraoka
- Department of Ophthalmology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Masakazu Hirota
- Department of Applied Visual Science, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Debbie Jones
- School of Optometry and Vision Science, University of Waterloo, Waterloo, Ontario, Canada
| | - Nicola S Logan
- Ophthalmic Research Group, Aston University, Birmingham, United Kingdom
| | | | - Hidemasa Torii
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Scott A Read
- School of Optometry and Vision Science, Institute of Health and Biomedical Innovation, Queensland University of Technology, Australia
| | - Kovin Naidoo
- African Vision Research Institute, University of KwaZulu-Natal, Durban, South Africa
| |
Collapse
|
211
|
Short Interruptions of Imposed Hyperopic Defocus Earlier in Treatment are More Effective at Preventing Myopia Development. Sci Rep 2019; 9:11459. [PMID: 31391523 PMCID: PMC6685965 DOI: 10.1038/s41598-019-48009-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 07/29/2019] [Indexed: 12/21/2022] Open
Abstract
The purpose of this study was to evaluate the effect of interrupting negative lens wear for short periods early or late during the development of lens-induced myopia in marmosets. Sixteen marmosets were reared with a −5D contact lens on their right eye (plano on contralateral eye) for 8 weeks. Eight marmosets had lenses removed for 30 mins twice/day during the first four weeks (early interruption) and eight during the last four weeks (late interruption). Data were compared to treated controls that wore lenses continuously (N = 12) and untreated controls (N = 10). Interocular differences (IOD) in vitreous chamber (VC) depth and central and peripheral mean spherical refractive error (MSE) were measured at baseline and after four (T4) and eight (T8) weeks of treatment. Visual experience during the interruptions was monitored by measuring refraction while marmosets were seated at the center of a 1 m radius viewing cylinder. At T4 the eyes that were interrupted early were not different from untreated controls (p = 0.10) and at T8 had grown less and were less myopic than those interrupted later (IOD change from baseline, VC: +0.07 ± 0.04 mm vs +0.20 ± 0.03 mm, p < 0.05; MSE: −1.59 ± 0.26D vs −2.63 ± 0.60D, p = 0.13). Eyes interrupted later were not different from treated controls (MSE, p = 0.99; VC, p = 0.60) and grew at the same rate as during the first four weeks of uninterrupted lens wear (T4 − T0: 3.67 ± 1.1 µm/day, T8 − T4: 3.56 ± 1.3 µm/day p = 0.96). Peripheral refraction was a predictive factor for the amount of myopia developed only when the interruption was not effective. In summary, interrupting hyperopic defocus with short periods of myopic defocus before compensation occurs prevents axial myopia from developing. After myopia develops, interruption is less effective.
Collapse
|
212
|
Harrington SC, O'Dwyer V. Ocular biometry, refraction and time spent outdoors during daylight in Irish schoolchildren. Clin Exp Optom 2019; 103:167-176. [PMID: 31187504 DOI: 10.1111/cxo.12929] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Revised: 04/10/2019] [Accepted: 04/23/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Previous studies have investigated the relationship between ocular biometry and spherical equivalent refraction in children. This is the first such study in Ireland. The effect of time spent outdoors was also investigated. METHODS Examination included cycloplegic autorefraction and non-contact ocular biometric measures of axial length, corneal radius and anterior chamber depth from 1,626 children in two age groups: six to seven years and 12 to 13 years, from 37 schools. Parents/guardians completed a participant questionnaire detailing time spent outdoors during daylight in summer and winter. RESULTS Ocular biometric data were correlated with spherical equivalent refraction (axial length: r = -0.64, corneal radius: r = 0.07, anterior chamber depth: r = -0.33, axial length/corneal radius ratio: r = -0.79, all p < 0.0001). Participants aged 12-13 years had a longer axial length (6-7 years 22.53 mm, 12-13 years 23.50 mm), deeper anterior chamber (6-7 years 3.40 mm, 12-13 years 3.61 mm), longer corneal radius (6-7 years 7.81 mm, 12-13 years 7.87 mm) and a higher axial length/corneal radius ratio (6-7 years 2.89, 12-13 years 2.99), all p < 0.0001. Controlling for age: axial length was longer in boys (boys 23.32 mm, girls 22.77 mm), and non-White participants (non-White 23.21 mm, White 23.04 mm); corneal radius was longer in boys (boys 7.92 mm, girls 7.75 mm); anterior chamber was deeper in boys (boys 3.62 mm, girls 3.55 mm, p < 0.0001), and axial length/corneal radius ratios were higher in non-White participants (non-White 2.98, White 2.94, p < 0.0001). Controlling for age and ethnicity, more time outdoors in summer was associated with a less myopic refraction, shorter axial length, and lower axial length/corneal radius ratio. Non-White participants reported spending significantly less time outdoors than White participants (p < 0.0001). CONCLUSION Refractive error variance in schoolchildren in Ireland was best explained by variation in the axial length/corneal radius ratio with higher values associated with a more myopic refraction. Time spent outdoors during daylight in summer was associated with shorter axial lengths and a less myopic spherical equivalent refraction in White participants. Strategies to promote daylight exposure in wintertime is a study recommendation.
Collapse
Affiliation(s)
- Síofra C Harrington
- School of Physics and Clinical and Optometric Sciences, Technological University Dublin, Dublin, Ireland
| | - Veronica O'Dwyer
- School of Physics and Clinical and Optometric Sciences, Technological University Dublin, Dublin, Ireland
| |
Collapse
|
213
|
Troilo D, Smith EL, Nickla DL, Ashby R, Tkatchenko AV, Ostrin LA, Gawne TJ, Pardue MT, Summers JA, Kee CS, Schroedl F, Wahl S, Jones L. IMI - Report on Experimental Models of Emmetropization and Myopia. Invest Ophthalmol Vis Sci 2019; 60:M31-M88. [PMID: 30817827 PMCID: PMC6738517 DOI: 10.1167/iovs.18-25967] [Citation(s) in RCA: 221] [Impact Index Per Article: 44.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Accepted: 10/20/2018] [Indexed: 11/24/2022] Open
Abstract
The results of many studies in a variety of species have significantly advanced our understanding of the role of visual experience and the mechanisms of postnatal eye growth, and the development of myopia. This paper surveys and reviews the major contributions that experimental studies using animal models have made to our thinking about emmetropization and development of myopia. These studies established important concepts informing our knowledge of the visual regulation of eye growth and refractive development and have transformed treatment strategies for myopia. Several major findings have come from studies of experimental animal models. These include the eye's ability to detect the sign of retinal defocus and undergo compensatory growth, the local retinal control of eye growth, regulatory changes in choroidal thickness, and the identification of components in the biochemistry of eye growth leading to the characterization of signal cascades regulating eye growth and refractive state. Several of these findings provided the proofs of concepts that form the scientific basis of new and effective clinical treatments for controlling myopia progression in humans. Experimental animal models continue to provide new insights into the cellular and molecular mechanisms of eye growth control, including the identification of potential new targets for drug development and future treatments needed to stem the increasing prevalence of myopia and the vision-threatening conditions associated with this disease.
Collapse
Affiliation(s)
- David Troilo
- SUNY College of Optometry, State University of New York, New York, New York, United States
| | - Earl L. Smith
- College of Optometry, University of Houston, Houston, Texas, United States
| | - Debora L. Nickla
- Biomedical Sciences and Disease, New England College of Optometry, Boston, Massachusetts, United States
| | - Regan Ashby
- Health Research Institute, University of Canberra, Canberra, Australia
| | - Andrei V. Tkatchenko
- Department of Ophthalmology, Department of Pathology and Cell Biology, Columbia University, New York, New York, United States
| | - Lisa A. Ostrin
- College of Optometry, University of Houston, Houston, Texas, United States
| | - Timothy J. Gawne
- School of Optometry, University of Alabama Birmingham, Birmingham, Alabama, United States
| | - Machelle T. Pardue
- Biomedical Engineering, Georgia Tech College of Engineering, Atlanta, Georgia, United States31
| | - Jody A. Summers
- College of Medicine, University of Oklahoma, Oklahoma City, Oklahoma, United States
| | - Chea-su Kee
- School of Optometry, The Hong Kong Polytechnic University, Hong Kong, SAR, China
| | - Falk Schroedl
- Departments of Ophthalmology and Anatomy, Paracelsus Medical University, Salzburg, Austria
| | - Siegfried Wahl
- Institute for Ophthalmic Research, University of Tuebingen, Zeiss Vision Science Laboratory, Tuebingen, Germany
| | - Lyndon Jones
- CORE, School of Optometry and Vision Science, University of Waterloo, Ontario, Canada
| |
Collapse
|