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HomeMyopia News‘Myopia Super Session’ at American Academy of Optometry Meeting 2019

‘Myopia Super Session’ at American Academy of Optometry Meeting 2019

Dr. Sally Dillehay, Myopia Meeting Correspondent
Brien Holden Vision Institute

The American Academy of Optometry Annual Meeting and the 3rd World Congress of Optometry were held recently in Orlando, Florida (October 2019). On offer was 16 hours of continuing education on many aspects related to myopia and in addition, there were poster presentations on emerging issues related to myopia and its treatment.

There were also some varied and interesting topics such as “Barriers to the Business of Myopia Control” (Nagra) and “Myopia Control in the Astigmatic Patient” (Kinoshita et al). The large attendance at all the sessions indicated a widespread interest.

The speakers universally addressed the importance of tackling myopia citing the potential risks of high myopia such as cataract, glaucoma, retinal detachment, and myopic macular degeneration and said that the risks increase exponentially with higher levels of myopia.

During the “Myopia Super Session,” Dr. Mark Bullimore discussed the risks versus benefits of myopia control, with benefits clearly outweighing the potential risks. Bullimore emphasized that we have a duty to recognize the increased risk of potential diseases later in life from myopia, and that the risk of microbial keratitis with contact lenses is potentially very small in comparison.

Several speakers mentioned that Myopia Control is emerging as the new standard of care from a clinical standpoint. Manbir Nagra presented data for the future predicted prevalence in USA to be about 59%, higher than predicted previously, with 15% predicted to have high myopia.

In the future, there will be a considerable need for eye care practitioners (ECP)s in regions with increasing prevalence and fast progressors; however, the scope of practice for optometry varies considerably throughout the world and therefore for effective myopia management, multiple stakeholders will need to be involved and engaged.

During the “Myopia Super Session,” Dr. Mark Bullimore discussed the risks versus benefits of myopia control, with benefits clearly outweighing the potential risks. Bullimore emphasized that we have a duty to recognize the increased risk of potential diseases later in life from myopia, and that the risk of microbial keratitis with contact lenses is potentially very small in comparison.

Finally, they said that the role of peripheral refraction in myopia onset and progression remains unclear. Although animal studies clearly demonstrate a relationship, human studies fail to do so. However, it is clear that that the central and peripheral retina are involved in myopia development. There is also scant evidence for handheld devices causing myopia.

Dr. Mark Bullimore and Dr. Noel Brennan presented on Twelve Evidence Based Things That We Should Know About Myopia, with age being the most important factor that determines the rate of myopia progression. At ages 7-8, myopia progresses over 1.00D per year; at ages 10-11, it progresses about 0.50D per year.

For all age ranges, Asian eyes progress about 50% faster, and therefore average progression rates must be qualified against age and race. They did not find evidence that binocular vision or accommodative status influenced myopic progression. Parental myopia does not influence the rate of progression, it only increases the likelihood of developing myopia at an earlier age. More time outdoors delays the onset of myopia, but evidence that it slows the progression in already myopic eyes is limited.

Bullimore and Brennan suggested that the gold standard for describing efficacy of myopia progression control treatments should be the Cumulative Absolute Reduction in Axial Elongation (CARE), which is based on axial elongation as compared to an age and race match control. The highest level of CARE they have observed in the literature is 0.44mm or 1.2D over a period spanning several years. They also said that that rebound is a potential factor with all myopia treatments, and more needs to be understood. For atropine use, the concentration of most benefit remains unclear and is further compounded by varying compounding pharmacy approaches and the instability of the molecule with regards to pH.

Finally, they said that the role of peripheral refraction in myopia onset and progression remains unclear. Although animal studies clearly demonstrate a relationship, human studies fail to do so. However, it is clear that that the central and peripheral retina are involved in myopia development. There is also scant evidence for handheld devices causing myopia.

Dr. David Bernsten presented on optical control strategies, including potential spectacle options, as well as ortho k and multifocal contact lenses. No hint of the BLINK study data was presented, but he reported that the study finished this past summer and that they are working on a publication.

In the Joint Session held by the American Academy of Optometry and American Academy of Ophthalmology, Dr. Don Mutti presented on prevalence of myopia. Considering the different numbers within the Vitale et al paper, he thought that the US prevalence is more accurately represented by 31%, and it was 33% previously; therefore, it really has not increased. He reiterated that 30% is still high and that every myope should be treated.

Prevalence has greatly increased in Asia and it is worthy of calling an epidemic, or as Mutti stated, “Asia is where the real story is.” His presentation was followed by Dr. Judy Kim who presented a series of interesting cases. Extremely high myopia makes surgery difficult as the instruments are made for axial lengths of about 24mm, and she often has to operate on eyes that are 36 mm in length.

Dr. David Bernsten presented on optical control strategies, including potential spectacle options, as well as ortho k and multifocal contact lenses. No hint of the BLINK study data was presented, but he reported that the study finished this past summer and that they are working on a publication.

Dr. Michael Repka presented on atropine and went through the first ATOM study on 1% atropine through to the ATOM3 in premyopes as a preventative strategy. He discussed that the FDA declined to approve pirenzipine in 2003 due to adverse events, which occurred in 26% of subjects.

Dr. Michael Repka presented on atropine and went through the first ATOM study on 1% atropine through to the ATOM3 in premyopes as a preventative strategy. He discussed that the FDA declined to approve pirenzipine in 2003 due to adverse events, which occurred in 26% of subjects. He then went through the LAMP studies and compared ATOM vs LAMP results. He presented a partial list of atropine studies currently underway, most of which involved 0.01% but many also considering 0.05% or 0.1%.

Dr. Jeff Walline concluded with statements that myopia is a disease and needs to be treated as such. Some of the audience queries were: “How to manage a 2 year old with ROP.” Per Repka, ROP myopia appears to stabilize after about 2 years, and therefore no treatment is warranted.

The many presentations were excellent, and thought provoking in terms of what evidence is available and our understanding at this point in time. A key take-away message was to carefully review the methods and the data in published articles as the methods often influence the results and provide insight as to why studies often present conflicting results. Overall, it is an exciting time to be working in the eye care field, when there is so much interest and new developments to tackle myopia.

The consensus within the international eye care community represented at the meeting appears to be that treatment for myopia is warranted in order to decrease the potential long-term risks for diseases associated with the progression of myopia.