AAOpt 2024: Looking at myopia in an omnibus model

At the 2024 American Academy of Optometry, myopia expert Mark Bullimore, MCOptom, PhD, presented a poster titled, "Efficacy in myopia control: An omnibus model." In the poster, Bullimore investigates the definition of "normal progression" in myopic eyes and the change of efficacy over time.

Video transcript

Mark Bullimore, MCOptom, PhD:

I am Mark Bullimore. I reside in Boulder, Colorado. I'm affiliated with the University of Houston College of Optometry. We're in the early days of myopia control. If you think about glaucoma, we know what normal pressure is, we know what target pressure should be, we know how to interpret the efficacy of our surgical and pharmaceutical treatments. With myopia, we're still learning. The two aspects of the poster cover what is normal progression and how does efficacy change over time.

To talk about the first aspect, we know from our systematic reviews that Asian, myopic children progress about 40% faster than their white or European-descent peers. We also have shown that axial elongation, which drives myopia progression, that slows by about 15% per year. So a 12 year old is elongating or progressing at about half the rate of an eight-year old myopic child. That has a number of ramifications. First, we should treat younger children more aggressively, and we should institute treatment as soon as possible, because that younger myopic child is not only progressing faster, but they have further to go before their myopia stabilizes.

The other aspect that we're talking about is a better understanding of the efficacy of myopia control. One thing that's important to remember is that the treatment efficacy is greatest in the first year of treatment. What that means is that efficacy is going to be poorer in the second year. From a clinical perspective, you may see faster progression in Year 2 of your management of the child compared to Year 1. So that's something that you want to be aware of. The other thing that we've shown is that you can accurately predict the three-year efficacy, the three year slowing of elongation and progression from the one-year efficacy, and that has ramifications for how we might do clinical trials in the future.

Our analysis of myopia control efficacy includes all the possible modalities, be they contact lens, spectacle, or pharmaceutical. We really don't have long-term data on red light therapy, but we've looked at all of those modalities, and the conclusion really applies across all of them. The treatment effect in Year 2 is about half the treatment effect in Year 1. I think one of the important things to come out of the study is to demonstrate to the practitioner what is average progression as a function of age and race, and that allows you to set expectations of what you would see without or potentially with treatment.

The other thing that we're focusing on is what is a reasonable expectation in terms of the slowing or the progression that you're going to observe under treatment, and what should you be able to promise long term to the attentive parent that's also in the room with the child. I think one of the take homes from the data and the analysis is that the younger children are progressing more quickly, and you should be choosing your best evidence-based therapies for those children, and really consider a combination therapy of a pharmaceutical and an optical treatment, right off the bat, particularly if that child has other factors, like they're East Asian that mean that they're going to progress more than a white child.

It's important you stay up to date with the published literature, particularly the peer-reviewed, evidence-based literature, and whether you choose to read it yourself or digest it through newsletters or talking heads like myself. You need to be up to date, because it is a rapidly evolving field.

The other thing that we should avoid in practice is overpromising to parents. Myopia control rarely stops progression. There will be some progression, and there will be progression over time, so you've got to stay with it, but at the same time set reasonable expectations.