In the Journals

No ‘one-size-fits-all’ approach to myopia control

Experts who reviewed research on methods for controlling myopia progression concluded that no one treatment is completely effective in all patients.

The work by the International Myopia Institute evaluated studies of interventions involving spectacles, contact lenses, pharmacology, outdoor influences and surgery.

Specifically, they considered research in: undercorrection with spectacle lenses, single vision peripheral defocus-correcting lenses, bifocal spectacle lenses, progressive-addition lenses, single vision soft contact lenses, gas permeables, soft multifocal contacts, orthokeratology, atropine, pirenzepine, 7-methylxanthine, timolol, time outdoors, vitamin D, indoor lighting, posterior scleral reinforcement, injection-based scleral strengthening, collagen cross-linking for scleral strengthening and combination therapies.

Lead author Christine Wildsoet OD, PhD, FAAO, FARVO, told Primary Care Optometry News that she and her team weighted evidence from randomized controlled trials most heavily in this review.

Among the many options available for slowing myopia progression, she said, “there appears to be no ‘one-size-fits-all’ among either optical or drug treatments, based on the variability in treatment effects reported in clinical trials. Perhaps this is not surprising, given the wide variety of behaviors exhibited by children, even within families, and differences in genetics, which likely influence myopia susceptibility.”

Topical atropine outperformed optical treatments despite unresolved questions, such as optimal dosing regimens, she said. “And the higher doses are not without significant ocular side effects, making optical treatments a more attractive starting option for many.”

Wildsoet noted that another pharmacological treatment, 7-methylxanthine, is available in a more “child friendly” oral formulation, but only in Denmark at this time.

“Studies examining the protective role of outdoor exposure have also yielded promising results in terms of myopia risk reduction, although the key factors underlying this protective effect remain elusive,” she told PCON. Surgical options “for stabilizing highly myopic eyes are lagging well behind treatments for slowing myopia progression and still largely limited to scleral buckling surgery.”

The need for urgent action “is helping to drive innovation in the area of intervention,” she said.

Wildsoet noted the interest in combination therapies, collagen cross-linking for highly myopic eyes and development of measurement instruments that will lead to the collection of better quality evidence.

“There is no better time for clinicians to fight myopia progression in their patients,” she concluded. – by Nancy Hemphill, ELS, FAAO

Disclosure: Wildsoet reported no relevant financial disclosures. Please see the full study for all other authors’ financial disclosures.

Experts who reviewed research on methods for controlling myopia progression concluded that no one treatment is completely effective in all patients.

The work by the International Myopia Institute evaluated studies of interventions involving spectacles, contact lenses, pharmacology, outdoor influences and surgery.

Specifically, they considered research in: undercorrection with spectacle lenses, single vision peripheral defocus-correcting lenses, bifocal spectacle lenses, progressive-addition lenses, single vision soft contact lenses, gas permeables, soft multifocal contacts, orthokeratology, atropine, pirenzepine, 7-methylxanthine, timolol, time outdoors, vitamin D, indoor lighting, posterior scleral reinforcement, injection-based scleral strengthening, collagen cross-linking for scleral strengthening and combination therapies.

Lead author Christine Wildsoet OD, PhD, FAAO, FARVO, told Primary Care Optometry News that she and her team weighted evidence from randomized controlled trials most heavily in this review.

Among the many options available for slowing myopia progression, she said, “there appears to be no ‘one-size-fits-all’ among either optical or drug treatments, based on the variability in treatment effects reported in clinical trials. Perhaps this is not surprising, given the wide variety of behaviors exhibited by children, even within families, and differences in genetics, which likely influence myopia susceptibility.”

Topical atropine outperformed optical treatments despite unresolved questions, such as optimal dosing regimens, she said. “And the higher doses are not without significant ocular side effects, making optical treatments a more attractive starting option for many.”

Wildsoet noted that another pharmacological treatment, 7-methylxanthine, is available in a more “child friendly” oral formulation, but only in Denmark at this time.

“Studies examining the protective role of outdoor exposure have also yielded promising results in terms of myopia risk reduction, although the key factors underlying this protective effect remain elusive,” she told PCON. Surgical options “for stabilizing highly myopic eyes are lagging well behind treatments for slowing myopia progression and still largely limited to scleral buckling surgery.”

The need for urgent action “is helping to drive innovation in the area of intervention,” she said.

Wildsoet noted the interest in combination therapies, collagen cross-linking for highly myopic eyes and development of measurement instruments that will lead to the collection of better quality evidence.

“There is no better time for clinicians to fight myopia progression in their patients,” she concluded. – by Nancy Hemphill, ELS, FAAO

Disclosure: Wildsoet reported no relevant financial disclosures. Please see the full study for all other authors’ financial disclosures.