A comprehensive series of reports on myopia published in a special issue of the scientific journal Investigative Ophthalmology and Visual Science (February, 2019), have provided a major update on the latest evidence to inform clinical practice and future research in the area. The landmark collaborative effort led by the International Myopia Institute (IMI), involved over 85 multidisciplinary experts from around the world and has delivered eight papers in areas critical to progressing the capacity of the eye care profession and researchers to meet the myopia challenge.
The reports cover the areas of interventions for myopia onset and progression, clinical management guidelines, industry guidelines, instrumentation, genetics, definitions and experimental models. Hundreds of peerreviewed studies and reports have been reviewed and interpreted by the authors to provide clear guidance for clinicians, researchers, industry and policy-makers on the most crucial areas.
Professor Serge Resnikoff, Chair of IMI, says the reports are the result of several years of work by committee members who have volunteered their time, knowledge and expertise for the common good.
“The IMI has brought a diverse group of people working in the area together, to identify and reach agreement on what aspects needed the most urgent attention and to establish a sound understanding of what the evidence tells us about those, and help inform and drive the necessary action among industry, practitioners, research and health agencies and governments,” said Prof Resnikoff.
Prof Resnikoff, a co-author of the Defining and Classifying Myopia report, says myopia had previously been defined in a variety of ways, creating confusion, especially among researchers, and limiting the comparability of studies.
“The committee reviewed the terminology and myopia thresholds to provide a standardised set of terminology, definitions and thresholds of myopia and its main ocular complications,” he said. “It is critical that we have now reached a global consensus, which will help facilitate a more robust knowledge base and promote better health policy.”
GUIDANCE FOR PRACTITIONERS
Of particular interest for practitioners are the reports on interventions for myopia onset and progression, clinical management guidelines, and industry guidelines and ethical considerations for myopia control.
Professor Padmaja Sankaridurg, Head of Myopia at Brien Holden Vision Institute and co-author of the Interventions for Myopia Onset and Progression report, says that over 170 peer-reviewed articles on myopia control have been published since 2002. “For a busy practitioner it is extremely difficult to keep abreast, and make sense of this evidence as it evolves,” she says.
“The interventions report has reviewed and interpreted a vast range of studies on the effectiveness of the different optical, pharmacological, environmental and surgical approaches for controlling the progression of myopia. This includes evidence for the use of single vision spectacles and contact lenses, bifocal and progressive addition spectacles, multifocal contact lenses, orthokeratology, atropine and increased outdoor time.”
The key steps for practitioners to inform their management of myopic patients are identified in the Clinical Myopia Management Guidelines report. This includes identifying risk factors for onset and progression, discussions with patients and parents about the associated risks of progression, recommendations for baseline examination procedures, and what patients need to be informed of, and consulted about, in reaching agreement on treatment strategies.
A further report on guidelines and ethical considerations in treatment, acknowledges that it may be decades before conclusive evidence that limiting myopia progression will reduce the risk of sight-threatening disease later in life is obtained. Nevertheless, the report identifies factors that clinicians must consider when determining the risks of intervention or non-intervention. It also notes that in most countries, the majority of myopia control treatments are prescribed ‘off-label’, encouraging practitioners to ensure a formal informed consent process is followed in such situations.
IMPLICATIONS FOR RESEARCHERS
Of further interest to researchers is the Clinical Myopia Control Trials and Instrumentation report, which presents best practice guidelines in designing trials, including the recommendation that they are conducted over a three year period and a minimum period of one year to assess rebound after treatment.
The Experimental Models report of Emmetropization and Myopia report, which involved the survey of over 800 published reports, provides guidance for researchers on how the different experimental models investigating myopia should be interpreted. The genetics report summarises gene identification in refractive error and myopia, which at this stage is providing insights into the ‘molecular machinery underlying eye growth’.
All IMI Reports and an overview are available at www.myopiainstitute.org.