Myopia Control. Disclosures. Myopia Control Summary. End of Lecture, You Will Be Able To. Soft Multifocal Myopia Control

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1 Disclosures Bausch + Lomb: research materials Myopia Control Jeffrey J. Walline, OD PhD The Ohio State University College of Optometry 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 Multifocal Specs Orthokeratology Soft Bifocal Atropine Myopia Control Summary Multifocal Specs Orthokeratology Soft Bifocal Atropine 1

2 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 Anstice N, Phillips J. Ophthalmol 2011;118: Sankaridurg P, et al. IOVS 2011;52: Walline JJ, et al. OVS 2013;90: MiSight Not available in the US Lam CS, et al., BJO 2014;98:40-5 MiSight Brochure distributed by CooperVision at BCLA

3 NaturalVue by VTI % slowing by soft bifocal contact lens type Refractive Error Axial Elongation Concentric Ring Gradient Cooper J, et al. Eye Contact Lens Cheng X, et al. Optom Vis Sci. 2016;93(4): Fujikado T, et al. Clin Ophthalmol. 2014;8: Spherical equivalent, vertexed Strongest add (+2.50) Most require 0.50 to 0.75 D for best vision If vision still poor, decrease add power One step (0.50 D) Rare! Berntsen and Kramer. Optom Vis Sci 2013;90:

4 High Contrast Distance OU High Contrast Near OU p = 0.33 p = 0.27 Low Contrast Distance OU BLINK Questionnaire No differences Distance vision Near vision Ghost images Computer Strain or tiredness Contact lens comfort Sporting activities p < Glare or Starbursts Changing Fixation Distance p = 0.03 p =

5 Overall Change in Vision Specific QoL BLIMP ACHIEVE p = 0.05 Change in Vision Specific QoL Orthokeratology Myopia Control Bonferroni, p < indicates statistical significance Orthokeratology Myopia Control Orthokeratology Myopia Control High Myopes Cho P & Cheung SW. IOVS, 2012;53: Charm J and Cho P. OVS 2013;90:

6 Orthokeratology Myopia Control Toric Which is Better: OK or SBCL? Soft Bifocal % slowing RE = 36.4 % slowing AL = 37.9 Orthokeratology % slowing AL = 43.0 % Slow RE % Slow AL Chen C, et al. IOVS 2013;54: Which is Better: OK or SBCL? Which is Better: OK or SBCL? Paune J, et al. Biomed Res Int 2015;2015: Paune J, et al. Biomed Res Int 2015;2015: How Do OK and SBCL Slow Myopia? Peripheral Optical Profile Myope corrected with specs, CL Myope corrected with corneal reshaping or soft bifocal 6

7 Huang J, et al. Ophthalmol 2016;123: % Favors Exp >0.01-<0.5% 0.5 and 1.0% Huang J, et al. Ophthalmol 2016;123: % 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 Chua WH, et al. Ophthalmol 2006;113:

8 1% 1% Chua WH, et al. Ophthalmol 2006;113: Fan DS, et al. Japanese J Ophthalmol 2007;51: % Fan DS, et al. Japanese J Ophthalmol 2007;51:27-33 Chia A, et al. Ophthalmol 2012;119: % 0.01% 0.1% 0.5% Accommo (D) Pupil (meso, mm) Pupil (photo, mm) Dist VA (logmar) Near VA (logmar) Reading specs (% yes) p = 0.08 Chia A, et al. Ophthalmol 2012;119: Loughman J, Flitcroft DI. Br J Ophthalmol 2016;100:

9 0.01% 0.01% Day 1 Day 3 Day 5 p value Distance VA (logmar, OD) 0.10 ± ± ± Pupil size (mm, OD) 5.51 ± ± ± Pupil Response 3.0 ± ± ± 0.9 <0.01 NPC (cm) 6.8 ± ± ± p = 0.45 Loughman J, Flitcroft DI. Br J Ophthalmol 2016;100: Loughman J, Flitcroft DI. Br J Ophthalmol 2016;100: Chia A, et al. AJO 2014;157:451-7 Chia A, et al. AJO 2014;157: % 0.01% Chia A, et al. Ophthalmol. 2016;123:391 9 Clark TY, Clark RA. J Ocul Pharmacol Ther 2015;31:

10 0.05% 0.01% 0.01% not commercially available Compounded Central Ohio Compounding Pharmacy Leiter s Compounding Pharmacy O Brien's Pharmacy 1 gtt OU qhs Lee JJ, et al. J Ocul Pharmacol Ther 2006;22: % $84 10 ml bottle Lasts about 3 months Mailed directly to patient 0.01% Follow up Accommodation Pupil size Same conditions every time IOP Near blur? PAL Photophobia Transitions Asians versus Whites Can We Combine Treatments? Contact lens myopia control Optical effect Atropine Receptors at the retinal or scleral level Li SM, et al. Optom Vis Sci 2014;91:

11 Atropine Myopia Prevention Atropine Myopia Prevention 6 12 years SE to 1.00 F/u at least one year 0.025% atropine 1 gtt OU qhs Atropine Myopia Prevention Atropine Myopia Prevention 0.025% Atropine Control p value Myopia onset 21% 54% More than 0.50 D/year 8% 58% Fang PC, et al. J Ocul Pharmacol Ther 2010;26:341-5 Outdoor Time Myopia Prevention Outdoor Time Myopia Prevention Not Myopic Myopic Wu PC, et al. Ophthalmol 2013;120: Wu PC, et al. Ophthalmol 2013;120:

12 Outdoor Time Myopia Prevention Outdoor Time Myopia Prevention Outdoor time prevents or delays the onset of myopia, but does not slow progression Huang J, et al. Ophthalmol 2016;123: 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 12