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1
Myopia Control
Jeffrey J. Walline, OD PhDThe Ohio State University College of Optometry
Disclosures
• Bausch + Lomb: research materials
End of Lecture, You Will Be Able To…
• Talk to parents about myopia control options
• Understand how myopia progression slowed
• Understand how to maximize myopia control
Myopia Control Summary
Soft Bifocal-19 -7 21 40 43 76393036
AtropineOrthokeratologyMultifocal Specs
Myopia Control Summary
Soft Bifocal-19 -7 22 40 43 764630 36
AtropineOrthokeratologyMultifocal Specs
Soft Multifocal Myopia Control
2
Soft Multifocal Myopia Control
• Center‐distance design
• No evidence for center‐near design in literature
• Oasys for Presbyopia; J & J Vision Care
• Proclear Multifocal “D”; CooperVision
• Biofinity Multifocal “D”; CooperVision
• NaturalVue; Vision Technology Engineering
• MiSight; CooperVision
• Not available in the US
Soft Multifocal Myopia Control
Anstice N, Phillips J. Ophthalmol 2011;118:1152‐61
Soft Multifocal Myopia Control
Sankaridurg P, et al. IOVS 2011;52:9362-7.
Soft Multifocal Myopia Control
Walline JJ, et al. OVS 2013;90:1207-14
Soft Multifocal Myopia Control
Lam CS, et al., BJO 2014;98:40-5
Soft Multifocal Myopia Control
• MiSight
• Not available in the US
MiSight Brochure distributed by CooperVision at BCLA 2017
3
Soft Multifocal Myopia Control
• NaturalVue by VTI
Cooper J, et al. Eye Contact Lens. 2017
Soft Multifocal Myopia Control
• % slowing by soft bifocal contact lens type
Refractive Error Axial Elongation
Concentric Ring 36.3 44.4
Gradient 36.4 31.6
Soft Multifocal Myopia Control
Cheng X, et al. Optom Vis Sci. 2016;93(4):353-66
Soft Multifocal Myopia Control
Fujikado T, et al. Clin Ophthalmol. 2014;8:1947-56
Soft Multifocal Myopia Control
• Spherical equivalent, vertexed
• Strongest add (+2.50)
• Most require ‐0.50 to ‐0.75 D for best vision
Berntsen and Kramer. Optom Vis Sci 2013;90:1215-1224.
Soft Multifocal Myopia Control
• If vision still poor, decrease add power
• One step (0.50 D)
• Rare!
4
High Contrast Distance OU
p = 0.33
High Contrast Near OU
p = 0.27
Low Contrast Distance OU
p < 0.001
BLINK Questionnaire
• No differences
• Distance vision
• Near vision
• Ghost images
• Computer
• Strain or tiredness
• Contact lens comfort
• Sporting activities
Glare or Starbursts
p = 0.03
Changing Fixation Distance
p = 0.05
5
Overall
p = 0.05
Change in Vision‐Specific QoL
0
5
10
15
20
25
30
35
40
BLIMP
ACHIEVE
Change in Vision‐Specific QoL
Bonferroni, p < 0.005 indicates statistical significance
Orthokeratology Myopia Control
Orthokeratology Myopia Control
Cho P & Cheung SW. IOVS, 2012;53:7077‐85.
Orthokeratology Myopia Control
Charm J and Cho P. OVS 2013;90:530-9
High Myopes
6
Orthokeratology Myopia Control
Chen C, et al. IOVS 2013;54:6510-7
Toric
Which is Better: OK or SBCL?
10
20
30
40
50
60
70
80
% Slow RE % Slow AL
Soft Bifocal% slowing RE = 36.4% slowing AL = 37.9
Orthokeratology% slowing AL = 43.0
Which is Better: OK or SBCL?
Paune J, et al. Biomed Res Int 2015;2015:507572
Which is Better: OK or SBCL?
Paune J, et al. Biomed Res Int 2015;2015:507572
How Do OK and SBCL Slow Myopia? Peripheral Optical Profile
Myope corrected with specs, CL
Myope corrected with corneal reshaping or soft bifocal
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Atropine Myopia Control Atropine Myopia Control
Huang J, et al. Ophthalmol 2016;123:697‐708
Atropine Myopia Control
Huang J, et al. Ophthalmol 2016;123:697‐708
Atropine Myopia Control
0.01%
>0.01-<0.5%
0.5 and 1.0%
Favors Exp
Atropine Myopia Control
Treatment Author (year) Duration Completion (%)
1% atropine Chua (06) 2 years 87
0.1‐0.5% atropine Shih (99) 2 years 93
0.5% atropine Shih (01) 18 months 87
GP Walline (04) 3 years 100
GP Katz (04) 2 years 37
GP Khoo (99) 3 years 53
GP Perrigin (90) 3 years 56
GP Baldwin (69) 1 year 70
1% Atropine Myopia Control
Chua WH, et al. Ophthalmol 2006;113:2285‐91
8
1% Atropine Myopia Control
Chua WH, et al. Ophthalmol 2006;113:2285‐91
1% Atropine Myopia Control
Fan DS, et al. Japanese J Ophthalmol 2007;51:27-33
1% Atropine Myopia Control
Fan DS, et al. Japanese J Ophthalmol 2007;51:27-33
Atropine Myopia Control
Chia A, et al. Ophthalmol 2012;119:347-54
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 ‐0.01
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
Loughman J, Flitcroft DI. Br J Ophthalmol 2016;100:1525‐9
p = 0.08
9
0.01% Atropine Myopia Control
Loughman J, Flitcroft DI. Br J Ophthalmol 2016;100:1525‐9
p = 0.45
0.01% Atropine Myopia Control
Day 1 Day 3 Day 5 p‐value
Distance VA (logMAR, OD) ‐0.10 ± 0.10 ‐0.08 ± 0.07 ‐0.08 ± 0.05 0.55
Pupil size (mm, OD) 5.51 ± 1.74 6.55 ± 1.12 6.82 ± 0.61 0.04
Pupil Response 3.0 ± 0.0 2.8 ± 0.5 1.1 ± 0.9 <0.01
NPC (cm) 6.8 ± 2.4 7.0 ± 2.2 8.0 ± 3.2 0.25
Loughman J, Flitcroft DI. Br J Ophthalmol 2016;100:1525-9
Atropine Myopia Control
Chia A, et al. AJO 2014;157:451-7
Atropine Myopia Control
Chia A, et al. AJO 2014;157:451-7
0.01% Atropine Myopia Control
Chia A, et al. Ophthalmol. 2016;123:391‐9
0.01% Atropine Myopia Control
Clark TY, Clark RA. J Ocul Pharmacol Ther 2015;31:541‐5
10
0.05% Atropine Myopia Control
Lee JJ, et al. J Ocul Pharmacol Ther 2006;22:41-6
0.01% Atropine Myopia Control
• 0.01% not commercially available
• Compounded
• Central Ohio Compounding Pharmacy
• www.cocprx.com
• Leiter’s Compounding Pharmacy
• www.leiters.com
• O’Brien's Pharmacy
• www.obrienrx.com
• 1 gtt OU qhs
0.01% Atropine Myopia Control
• $84 10 mL bottle
• Lasts about 3 months
• Mailed directly to patient
0.01% Atropine Myopia Control
• Follow‐up
• Accommodation
• Pupil size
• Same conditions every time
• IOP
• Near blur?
• PAL
• Photophobia
• Transitions
Asians versus Whites
Li SM, et al. Optom Vis Sci 2014;91:342-50
Can We Combine Treatments?
• Contact lens myopia control
• Optical effect
• Atropine
• Receptors at the retinal or scleral level
11
Atropine Myopia Prevention Atropine Myopia Prevention
• 6‐12 years
• SE +1.00 to ‐1.00
• F/u at least one year
• 0.025% atropine 1 gtt OU qhs
Atropine Myopia Prevention
Fang PC, et al. J Ocul Pharmacol Ther 2010;26:341-5
Atropine Myopia Prevention
0.025% Atropine Control p‐value
Myopia onset 21% 54% 0.016
More than ‐0.50 D/year 8% 58% 0.0002
Outdoor Time Myopia Prevention
Wu PC, et al. Ophthalmol 2013;120:1080-5
Outdoor Time Myopia Prevention
Not Myopic Myopic
Wu PC, et al. Ophthalmol 2013;120:1080-5
12
Outdoor Time Myopia Prevention
Huang J, et al. Ophthalmol 2016;123:697-708
Outdoor Time Myopia Prevention
• Outdoor time prevents or delays the onset of myopia, but does not slow progression
Counselling Parents• Children can wear contact lenses
• Visually beneficial, also slow myopia progression
• May slow myopia progression with drops
• Best modality determined by you
• How often plan to wear CL?
• Swim?
• Nap frequently?
Summary• CLs, low [conc] atropine best myopia control
• Overnight OK, soft multifocal contact lenses = effective
• Use strongest tolerable add for soft bifocal
• Low concentration atropine needs more evidence
• Don’t know if we can combine to get stronger effect