Upload
others
View
1
Download
0
Embed Size (px)
Citation preview
1
Myopia Control
Jeffrey J. Walline, OD PhDThe Ohio State University College of Optometry
Myopia Control Myopia Control Summary
-19% -7% 18% 40% 42% 76%46%
Bifocal / PALUndercorrection
Atropine
Pirenzepine
GP OK
Soft Bifocal
Specs
What is Clinically Meaningful?
• Assume
• ‐0.50 D per year progression
• From 8 to 16 years
• Begin as ‐1.00 D, end as ‐5.00 D
% Reduction Final Refractive Error
25 ‐4.00
50 ‐3.00
75 ‐2.00
100 ‐1.00
Clinically MeaningfulMethod Average Reduction (min; max)
Undercorrection ‐19 (‐22; ‐16)
GP Contact Lenses ‐7 (‐8; ‐5)
Bifocal/Multifocal Spectacles 18 (3.1; 32)
Pirenzepine 35 (30; 39)
Corneal Reshaping Contact Lenses 51 (26; 79)
Soft Bifocal Contact Lenses 52 (44; 58)
Atropine 81 (76; 96)
Myopia Control Summary
-19% -7% 18% 40% 42% 76%46%
Bifocal / PALUndercorrection
Atropine
Pirenzepine
GP OK
Soft Bifocal
Specs
Myopia Control‐Bifocal Specs
PALSV
•Gwiazda J, et al. IOVS 2003;44:1492-500.•COMET2 Study Group IOVS 2011;52:2749-57.
Spectacles
Sankaridurg P, et al. OVS 2010;87:631‐41
Is It Commercially Available?
2
Myopia Control‐Pirenzepine
Siatkowski RM, et al. J Aapos 2008;12:332-9.
Myopia Control Summary
-19% -7% 18% 40% 42% 76%46%
Bifocal / PALUndercorrection
Atropine
Pirenzepine
GP OK
Soft Bifocal
Specs
Side Effects
Accrual and Post‐Cessation
• Tong L, et al. Ophthalmol 2009;116:572‐9.
Accrual and Post‐Cessation
• Tong L, et al. Ophthalmol 2009;116:572‐9.
Accrual and Post‐Cessation
• Tong L, et al. Ophthalmol 2009;116:572‐9.
Myopia Control Summary
-19% -7% 18% 40% 42% 76%46%
Bifocal / PALUndercorrection
Atropine
Pirenzepine
GP OK
Soft Bifocal
Specs
Myopia Control Summary
42% 59%46%
AtropineOrthokeratology Soft Bifocal
Soft Bifocal Myopia Control
Anstice N, Phillips J. Ophthalmol 2011;118:1152‐61
3
Soft Bifocal Myopia Control
Sankaridurg P, et al. IOVS 2011;52:9362-7.
Soft Bifocal Myopia Control
Walline JJ, et al. OVS 2013;90:1207-14
Soft Bifocal Myopia Control
Lam CS, et al., BJO 2014;98:40-5
Orthokeratology Myopia Control
Cho P & Cheung SW. IOVS, 2012;53:7077‐85.
Orthokeratology Myopia Control
High Myopes
Charm J and Cho P. OVS 2013;90:530-9
Orthokeratology Myopia Control
Toric
Chen C, et al. IOVS 2013;54:6510-7
0.01% Atropine Myopia Control
Chia A, et al. Ophthalmol 2012;119:347-54
0.01% Atropine Myopia Control
0.01% 0.1% 0.5%
Accommo (D) ‐4.6 ‐10.1 ‐11.8
Pupil (meso, mm) 1.15 2.71 3.56
Pupil (photo, mm) 0.75 2.24 3.11
Dist VA (logMAR) ‐0 02 +0 01 ‐0 01Dist VA (logMAR) ‐0.02 +0.01 ‐0.01
Near VA (logMAR) ‐0.02 +0.06 +0.25
Reading specs (% yes) 6 61 70
Chia A, et al. Ophthalmol 2012;119:347-54
0.01% Atropine Myopia Control
Chia A, et al. AJO 2014;157:451-7
4
0.01% Atropine Myopia Control
• Not commercially available
• Compounding pharmacy
• 1 gt OU QHS
• $38 for 3 month supply$38 for 3 month supply
• 10 mL X 20 drops per mL
• 200 drops or 100 drops per eye
• 90 days = 3 months
Outdoor Time Myopia Control
Jones LA, et al. IOVS 2007;48:3524-32
Outdoor Time Myopia Control
Wu PC, et al. Ophthalmol 2013;120:1080-5
Outdoor Time Myopia Control
Not Myopic Myopic
Wu PC, et al. Ophthalmol 2013;120:1080-5
Outdoor Time Myopia Control
• What does this mean?
• Outdoor time preventsmyopia, but does not slow progression
Accrual of Treatment Effect
Atropine
Tong L, et al. Ophthalmol 2009;116:572‐9
Accrual of Treatment Effect
Multifocal Specs
Gwiazda J, et al. IOVS 2003;44:1492‐1500
Accrual of Treatment Effect
Cho P & Cheung SW. IOVS, 2012;53:7077‐85
Accrual of Treatment Effect
Hiraoka T, et al. IOVS 2012;53:3913‐9
5
Accrual of Treatment Effect
• What does this mean?
• Likely to be more effective because myopia control lasts for longer period of time
Pupil Size
OK SV
Chen Z, et al. OVS 2012;89:1636‐40
Pupil Size
Interaction, p < 0.001
Santodomingo J, et al. OVS 2013;90:1225-36
Pupil Size
• What does this mean?
• More retina with myopic blur = stronger myopia control
Peripheral Myopic Blur
Ortho-K
Specs
Cho 2005 Kakita 2011
Peripheral Myopic Blur
Interaction, p = 0.007
Santodomingo J, et al. OVS 2013;90:1225-36
Peripheral Myopic BlurNasal Temporal
Inferior
Zhong Y, et al. OVS 2014;91:404-11
all p < 0.001
Peripheral Myopic Blur
Sankaridurg P, et al. IOVS 2011;52:9362-7.
Peripheral Myopic Blur
• What does this mean?
• Greater myopic blur = greater myopia control
• Stronger add = better myopia control?
6
Can We Combine Treatments?
• Contact lens myopia control
• Optical effect
• Atropine
• Receptors at the retinal or scleral level
How Do CL Slow Myopia Progression? How Do CL Slow Myopia Progression?
• Smith EL, et al. IOVS 2005;46:3965‐72.
• Smith EL, et al. Vis Res 2009;49:2386‐92
How Do CL Slow Myopia Progression?
• Smith EL, et al. IOVS 2005;46:3965‐72.
• Smith EL, et al. IOVS 2007;48:3914‐22.
• Smith EL, et al. Vis Res 2009;49:2386‐92
How Do CL Slow Myopia Progression?
H →M 4 (45) 2 (22)
In front of retina
behind retina
Hyper→Myo 4 (45) 2 (22)
Emm→Myo 13 (77) 1 (6)
Hyper→Emm 11 (40) 6 (22)
No shift 8 (5) 103 (65)
Hoogerheide J, et al. Ophthalmologica. 1971;163:209-15
How Do CL Slow Myopia Progression?
Queiros A, et al. OVS 2010;87:323‐9
How Do CL Slow Myopia Progression?
Myope corrected with specs, CL
Myope corrected with corneal reshaping or soft bifocal
Do So Contact Lenses ↑Myopia?
Myopic Creep
Do So Contact Lenses ↑Myopia?
Liu Y, Wildsoet C. IOVS 2011;52:1078‐86
7
Do So Contact Lenses ↑Myopia?
Mutti DO, et al. IOVS 2011;52:199‐205
Do So Contact Lenses ↑Myopia?
-5.25
-4.75
-4.25
-3.75
3 25
Spectacle
Contact Lens
-3.25
-2.75
-2.25
-1.75
-1.25Baseline 1 Year 2 Years 3 Years
Do So Contact Lenses ↑Myopia?
25.0
25.5
26.0Spectacle
Contact Lens
23.5
24.0
24.5
Baseline 1 Year 2 Years 3 Years
Myopia Control Experience Treatment
Patients %
CRT 14 44
Daily disposable 8 25
Soft bifocal 7 22
Toric 2 6
Atropine 1 3
⅔ = myopia control
Race
Proportion by Race Asian (n = 14) White (n = 18)
CRT 64 28
Soft bifocal 14 28
Daily disposable 7 28
Toric 0 11
GP 0 6GP 0 6
Atropine 1 0
No FDA Approved Myopia Control
• Consent
Can Kids Safely Wear Orthokeratology? Orthokeratology Safety
• Watt and Swarbrick
• 123 cases reported in the literature
• 69% cases from China and Taiwan
• 55% 8 to 15 years old
65% d i 2001• 65% cases occurred in 2001
• 53% wore lenses for 1 year or less
• 61% 20/40 or better; 18% 20/200 or worse
• 40% Acanthamoeba
8
Orthokeratology Safety
Age at Fit Patient‐years
Children 12.2 ± 2.5 1435
Adults 38.0 ± 11.1 1164
Orthokeratology Safety
MK, >3 Months Wear Children Adults Overall
Cases 2 0 2
Incidence (per 10,000 pt‐yrs)13.9
1.7 to 50.40
0 to 31.77.7
0.9 to 27.8
Orthokeratology Safety
Stapleton, et al. Ophthalmol 2008;115:1655-62
Can Kids Safely Wear Soft Bifocal? Soft Contact Lens Safety
Discontinue CL CIECLAY Study
Wagner H, et al. OVS 2011;88: 973-80 Chalmers RL, et al. IOVS 2011;52:6690-96
Soft Contact Lens Safety
Wagner H, et al. OVS 2011;88:973‐80
Long‐Term Safety
Child Teen p‐value
Eyes appeared more red with CL 36 36 1.00
Allergies worse with CL 22 17 0.45
E lid “ ff ” ith CLEyelids more “puffy” with CL 12 12 1.00
Painful red eye that required doctor visit 21 19 0.85
Walline JJ, et al. ECL 2013;39:283-9
Long‐Term Safety
Child Teen p‐valueVascularization 0.4 ± 0.5 0.2 ± 0.4 0.28Epithelial microcysts 0.2 ± 0.5 0.1 ± 0.4 0.53Mucin balls (#) 1.0 ± 3.5 0.6 ± 2.6 0.62( )Central corneal thickness (μm) 562 ± 39 554 ± 37 0.42Cell density (cells/mm2) 3016 ± 366 3073 ± 327 0.53Coefficient of variation 30.0 ± 4.9 29.9 ± 5.6 0.96
Walline JJ, et al. ECL 2013;39:283-9
Summary
• Contact lenses and low concentration provide the best myopia control without side effects
• Don’t know if we can combine to get stronger effect
• Use strongest tolerable add for soft bifocal
• Outdoor time may prevent myopia but not slow progression
• Contact lenses are safe for children
• If properly care