Clinically Meaningful

Transcription

1 Myopia Control Myopia Control -19% -7% 18% 40% 42% 46% 76% Jeffrey J. Walline, OD PhD The Ohio State University College of Optometry Undercorrection GP Bifocal / PAL Pirenzepine Specs OK 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 Clinically Meaningful Method 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) Contact Lenses 52 (44; 58) 81 (76; 96) -19% -7% 18% 40% 42% 46% 76% Undercorrection GP Bifocal / PAL Pirenzepine Specs OK Myopia Control Bifocal Specs Spectacles Is It Commercially Available? PAL SV Gwiazda J, et al. IOVS 2003;44: COMET2 Study Group IOVS 2011;52: Sankaridurg P, et al. OVS 2010;87:

2 Myopia Control Pirenzepine Side Effects -19% -7% 18% 40% 42% 46% 76% Siatkowski RM, et al. J Aapos 2008;12: Undercorrection GP Bifocal / PAL Pirenzepine Specs OK Accrual and Post Cessation Accrual and Post Cessation Accrual and Post Cessation Tong L, et al. Ophthalmol 2009;116: Tong L, et al. Ophthalmol 2009;116: Tong L, et al. Ophthalmol 2009;116: Myopia Control -19% -7% 18% 40% 42% 46% 76% 42% 46% 59% Orthokeratology Undercorrection Bifocal / PAL Pirenzepine GP Specs OK Anstice N, Phillips J. Ophthalmol 2011;118:

3 Myopia Control Myopia Control Myopia Control Sankaridurg P, et al. IOVS 2011;52: Walline JJ, et al. OVS 2013;90: Lam CS, et al., BJO 2014;98:40-5 Orthokeratology Myopia Control Orthokeratology Myopia Control High Myopes Orthokeratology Myopia Control Toric Cho P & Cheung SW. IOVS, 2012;53: Charm J and Cho P. OVS 2013;90:530-9 Chen C, et al. IOVS 2013;54: % Myopia Control 0.01% Myopia Control 0.01% Myopia Control 0.01% 0.1% 0.5% Accommo (D) Pupil (meso, mm) Pupil (photo, mm) Dist VA (logmar) Near VA (logmar) Reading specs (% yes) Chia A, et al. Ophthalmol 2012;119: Chia A, et al. Ophthalmol 2012;119: Chia A, et al. AJO 2014;157:

4 0.01% Myopia Control Not commercially available Compounding pharmacy 1 gt OU QHS $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 Outdoor Time Myopia Control Jones LA, et al. IOVS 2007;48: Wu PC, et al. Ophthalmol 2013;120: Outdoor Time Myopia Control Not Myopic Myopic Outdoor Time Myopia Control What does this mean? Outdoor time prevents myopia, but does not slow progression Accrual of Treatment Effect Wu PC, et al. Ophthalmol 2013;120: Tong L, et al. Ophthalmol 2009;116:572 9 Accrual of Treatment Effect Accrual of Treatment Effect Accrual of Treatment Effect Multifocal Specs Gwiazda J, et al. IOVS 2003;44: Cho P & Cheung SW. IOVS, 2012;53: Hiraoka T, et al. IOVS 2012;53:

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 Pupil Size Interaction, p < Chen Z, et al. OVS 2012;89: Santodomingo J, et al. OVS 2013;90: Pupil Size What does this mean? More retina with myopic blur = stronger myopia control Ortho-K Specs Cho 2005 Kakita 2011 Interaction, p = Santodomingo J, et al. OVS 2013;90: Nasal Temporal What does this mean? Greater myopic blur = greater myopia control Stronger add = better myopia control? Inferior all p < Sankaridurg P, et al. IOVS 2011;52: Zhong Y, et al. OVS 2014;91:

6 Can We Combine Treatments? Contact lens myopia control Optical effect Receptors at the retinal or scleral level Smith EL, et al. IOVS 2005;46: Smith EL, et al. Vis Res 2009;49: Smith EL, et al. IOVS 2005;46: Smith EL, et al. IOVS 2007;48: Smith EL, et al. Vis Res 2009;49: behind retina In front of 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: Queiros A, et al. OVS 2010;87:323 9 Do So Contact Lenses Myopia? Do So Contact Lenses Myopia? Myope corrected with specs, CL Myope corrected with corneal reshaping or soft bifocal Myopic Creep Liu Y, Wildsoet C. IOVS 2011;52:

7 Do So Contact Lenses Myopia? Do So Contact Lenses Myopia? Do So Contact Lenses Myopia? Spectacle Contact Lens Spectacle Contact Lens Baseline 1 Year 2 Years 3 Years 23.5 Baseline 1 Year 2 Years 3 Years Mutti DO, et al. IOVS 2011;52: Myopia Control Experience Treatment Race Patients % CRT Daily disposable 8 25 Soft bifocal 7 22 Toric Proportion by Race Asian (n = 14) White (n = 18) CRT Soft bifocal Daily disposable 7 28 Toric 0 11 GP ⅔ = myopia control 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 % cases occurred in % wore lenses for 1 year or less 61% 20/40 or better; 18% 20/200 or worse 40% Acanthamoeba 7

8 Orthokeratology Safety Orthokeratology Safety Orthokeratology Safety MK, >3 Months Wear Children Adults Overall Cases Incidence (per 10,000 pt yrs) to to to 27.8 Age at Fit Patient years Children 12.2 ± Adults 38.0 ± Stapleton, et al. Ophthalmol 2008;115: Can Kids Safely Wear? Soft Contact Lens Safety Discontinue CL CLAY Study CIE Soft Contact Lens Safety Wagner H, et al. OVS 2011;88: Chalmers RL, et al. IOVS 2011;52: Wagner H, et al. OVS 2011;88: Long Term Safety Child Teen p value Eyes appeared more red with CL Allergies worse with CL Eyelids more puffy with CL Painful red eye that required doctor visit Long Term Safety Child Teen p value Vascularization 0.4 ± ± Epithelial microcysts 0.2 ± ± Mucin balls (#) () 1.0 ± ± Central corneal thickness (μm) 562 ± ± Cell density (cells/mm 2 ) 3016 ± ± Coefficient of variation 30.0 ± ± 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 Walline JJ, et al. ECL 2013;39:283-9 Walline JJ, et al. ECL 2013;39: