Myopia Control. Disclosures. Prevalence. Cost. Prevalence. Bausch + Lomb: research materials

Transcription

1 Disclosures Bausch + Lomb: research materials Myopia Control Jeffrey J. Walline, OD PhD The Ohio State University College of Optometry Myopia Control Prevalence From: nature.com Prevalence Cost From: visionimpactinstitute.org/research/direct-costs-of-myopia-in-singapore 1

2 More Myopia = More Vision Loss End of Lecture, You Will Be Able To Myopia (D) 1.00 to to to to Talk to parents about myopia control options Understand how myopia progression slowed Understand how to maximize myopia control Odd Ratio Flitcroft DI. Prog Retin Eye Res 2012;31: 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 Myopia Control Summary Multifocal Specs Orthokeratology Soft Bifocal Atropine % Reduction Final Refractive Error Anstice N, Phillips J. Ophthalmol 2011;118: Sankaridurg P, et al. IOVS 2011;52:

3 Walline JJ, et al. OVS 2013;90: Lam CS, et al., BJO 2014;98:40-5 Myopia control or daily disposable? MiSight Not available in the US MiSight Brochure distributed by CooperVision at BCLA 2017 NaturalVue by VTI % slowing by soft bifocal contact lens type N=28 Children - Right Eye Refraction Refractive Error Axial Elongation Concentric Ring Gradient months 6 m 12 m 18 m 24 m Change in Refraction Change in Refraction with NaturalVue with Habitual Correction Multifocal 3

4 Orthokeratology Myopia Control Use highest add power in normal range (+2.50) Conduct a spherical over refraction Incorporate SOR in distance Rx Typically 0.50 to 0.75 D more minus Should work for over 99% If not, lower add power one step Cho P & Cheung SW. IOVS, 2012;53: Orthokeratology Myopia Control High Myopes Orthokeratology Myopia Control Toric Charm J and Cho P. OVS 2013;90:530-9 Chen C, et al. IOVS 2013;54: Orthokeratology Myopia Control How Do OK and SBCL Slow Myopia? Typically not more than 5.00 D treatment 4

5 Peripheral Optical Profile Atropine Myopia Control Myope corrected with specs, CL Myope corrected with corneal reshaping or soft bifocal 1% Atropine Myopia Control 0.01% Atropine Myopia Control Treatment Author (year) Duration Completion (%) 1% atropine Chua (06) 2 years % atropine Shih (99) 2 years % 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 Chia A, et al. Ophthalmol 2012;119: % Atropine Myopia Control 0.01% Atropine 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. AJO 2014;157:

6 0.01% Atropine Myopia Control 0.01% Atropine Myopia Control QHS Bedtime routine Side effects less upon awakening Doesn t sting Must be compounded Leiter s Chia A, et al. AJO 2014;157:451-7 Outdoor Time Outdoor Time Myopia Control Jones LA, et al. IOVS 2007;48: Outdoor Time Myopia Control Outdoor Time Myopia Control Not Myopic Myopic Wu PC, et al. Ophthalmol 2013;120: Wu PC, et al. Ophthalmol 2013;120:

7 Outdoor Time Myopia Control What does this mean? Outdoor time prevents myopia, but does not slow progression Bifocal Lenses In Nearsighted Kids (BLINK) Purpose: to determine the strongest add power that could be tolerated by kids Eligibility 8 11 years old Spherical equivalent, non cycloplegic subjective refraction 1.00 D to 5.00 D 1.00 DC 20/25 or better BCVA OD, OS No gas permeable contact lenses Condition affects vision, CL wear Diabetes, Sjogrens, etc. Randomization Proclear or Proclear Multifocal D OU Sphere D add D add D add Random order Protocol BLINK questionnaire Habitual visual acuity High contrast at distance OU Low contrast at distance OU High contrast at near OU BLINK Questionnaire 1. How clear was your vision when looking far away during the past week? Good Perfect 7

8 Subjects High Contrast Distance OU Completed (n = 9) Age (years) 10.2 ± 1.1 Gender (% Female) 77.8 Race (%) Caucasian 66.7 Native American, Pacific Islander 22.2 More than one race 11.1 HCVA Distance(logMAR) 0.02 ±0.09 HCVA Near (logmar) 0.10 ± 0.07 LCVA Distance (logmar) ± 0.10 M (D) 2.04 ± 0.32 J 0 (D) ± 0.18 J 45 (D) 0.01 ± 0.08 p = 0.33 High Contrast Near OU Low Contrast Distance OU p = 0.27 p < BLINK Questionnaire Glare or Starbursts No differences Distance vision Near vision Ghost images Computer Strain or tiredness Contact lens comfort Sporting activities p =

9 Changing Fixation Distance Overall p = 0.05 p = 0.05 BLINK Study Summary Objective vision and worse low contrast Subjective vision and worse Glare and starbursts (+4.00) Change fixation distance (+3.00 and +4.00) Overall (+3.00) Primarily due to add power Can We Combine Treatments? Contact lens myopia control Optical effect Atropine Receptors at the retinal or scleral level Can We Combine Treatments? Myopia Control Experience Jenny Huang, OD PhD 9

10 Treatment Race Patients % CRT Daily disposable 8 25 Soft bifocal 7 22 Toric 2 6 Atropine 1 3 Proportion by Race Asian (n = 14) White (n = 18) CRT Soft bifocal Daily disposable 7 28 Toric 0 11 GP 0 6 Atropine 1 0 ⅔ = myopia control No FDA Approved Myopia Control Consent Summary Multifocal contact lenses Strongest add, over refract Orthokeratology contact lenses Correction free clear vision 0.01% atropine Requires replication, doesn t affect axial elongation Outdoor time Prevents myopia, not slow progression 10