Myopia Control 2020: Where are we and where are we heading?

Abstract

Purpose: This review arms practitioners with the evidence-based information they need to fully manage myopia. Recent findings: The recent peer-reviewed literature is critically evaluated to provide a comprehensive analysis of the safety and efficacy of behavioural, optical and pharmaceutical myopia management. Importantly, the paper addresses not only who to treat, but how to treat them, and when to stop or modify treatments. Finally, the paper discusses expectations for treatment and why slowing myopia by even 1 dioptre improves long term health outcomes. Summary: The management of an individual child should be underpinned by the evidence-based literature and clinicians must stay alert to ongoing myopia research that will undoubtedly result in an evolution of the standard of care for the myopic and pre-myopic child.

Update and guidance on management of myopia. European Society of Ophthalmology in cooperation with International Myopia Institute

“…282 Nevertheless, in recent studies examining the rate of axial elongation, 0.01% atropine had minimal benefit. 283,284 These conflicting study results above are examples of conflicting evidence which seems to depend upon whether axial length or refractive change are used as outcome measures.…”

Axial length targets for myopia control

“…It is not surprising, therefore, that axial elongation has become an important outcome measure in clinical trials of interventions to slow the progression of myopia 18,26 . Most, 27,28 though not all, 29,30 widely adopted interventions show concurrent slowing of myopia progression and axial elongation. Three‐year clinical trials of myopia control are rare, 31‐33 but the MiSight® 1 day dual‐focus soft contact lens demonstrates a slowing of axial elongation across all 3 years of treatment 34 and 6‐year findings have been presented recently 35…”

Adverse event rates in the retrospective cohort study of safety of paediatric soft contact lens wear: the ReCSS study

“…Clinical trials of the efficacy of myopia control soft contact lenses have been designed to test the effect of lens wear on refractive error, and are typically in the range of 200 subjects followed longitudinally for at least 2 years 21,22 . This retrospective cohort study design allowed us to follow this large diverse cohort of young wearers fitted by many practitioners in practice.…”

“…These results give assurance of an acceptable range of safety during SCL wear in children which will be reinforced with teaching protocols that emphasise best practices for safe SCL wear. Much of the safety discussion amongst myopia control researchers promotes the potential long‐term safety implications of reduced retinal disease and other sight‐threatening ocular abnormalities if higher levels of myopia can be avoided; 20,22 although it may be difficult for families and eye care practitioners to imagine that far into the future. The results of the current study help to answer parents’ and practitioners' concerns about the risk/benefit of real‐world SCL use in children and young teens and assure the relative safety of SCL use in this age group.…”