Research Update

Research Update Issue 28

April 2019  
Welcome to our monthly research update
Research Update is a resource available exclusively to IACLE and BCLA members to support your teaching and practice. Each month we send you a summary of some of the interesting findings appearing in peer-reviewed journals that month. Our aim is to help you keep up to date with the latest contact lens and anterior eye research, and to locate articles when you want to know more about a particular topic.
More information on Research Update and how to use it in your contact lens teaching here. Access archived issues via Member Login under Research.
Special Issue – April 2019
International Myopia Institute (IMI) White Papers

Myopia is projected to affect half of the world’s population by 2050 and it is feared that myopia could become the most common cause of irreversible blindness worldwide. The Editors of this special edition of Investigative Ophthalmology & Visual Science believe that myopia is a 21st century public health issue.

As a first major step, The International Myopia Institute has published a series of white papers in IOVS on defining and classifying myopia, potential interventions, clinical trials and instrumentation, industry guidelines and ethical considerations, clinical management guidelines, experimental models of emmetropization and myopia, and the genetics of myopia.

These articles, summarizing current knowledge in the field and showing trends for future developments, may form a basis for further research, bridging gaps, and connecting people who so far had not intensively exchanged information and ideas.

Here are some excerpts from the issue.

The IACLE Education Team
Journal reviewed in this issue  
  Investigative Ophthalmology & Visual Science 60:3 (and download PDFs)
Defining and classifying myopia
Flitcroft et al conducted a critical review of current terminology and choice of myopia thresholds to provide standardized terminology, definitions and thresholds of myopia, and its main ocular complications. The current consensus threshold for myopia is a spherical equivalent refractive error <0.50D and the corresponding threshold value for high myopia is <6.00D. ‘Pathologic myopia’ is proposed as the term for the adverse, structural complications of myopia, for which the authors also propose a clinical classification.

Invest Ophthalmol Vis Sci 2019;60:3 M20-M30. Click here for full text
Experimental models of emmetropization and myopia
Troilo et al cover the major findings that studies using animal models have contributed, including: the eye’s ability to detect retinal defocus and undergo compensatory growth, local retinal control of eye growth, regulatory changes in choroidal thickness, and identification of components in the biochemistry of eye growth leading to the characterization of signal cascades regulating eye growth and refractive state. These findings have shifted thinking about the control of eye growth and the development of refractive state.

Invest Ophthalmol Vis Sci. 2019;60:3 M31-M88. Click here for full text
Myopia genetics report
To address developments in genetic aspects of myopia, Tedja et al performed an extensive literature search and conducted informal discussions with key stakeholders. Almost 200 genetic loci have been identified for refractive error and myopia. Risk variants mostly carry low risk but are highly prevalent in the general population. Genetic findings offer a world of new molecules involved in myopiagenesis. The authors recommend large-scale, in-depth genetic studies using complementary big data analytics, consideration of gene-environment effects, and a focus on subgroups with extreme phenotypes and high familial occurrence.

Invest Ophthalmol Vis Sci. 2019;60:3 M89-M105. Click here for full text
Controlling myopia onset and progression
Interventions to prevent or delay the onset of myopia and slow its progression are growing in number, but evidence of treatment efficacy is variable. Wildsoet et al reviewed research behind such interventions under four categories: optical, pharmacological, environmental (behavioural) and surgical. In optical, pharmacological, and behavioural interventions, efficacy at an individual level appears variable, none being 100% effective. Understanding this variability and underlying mechanisms may guide combined and novel treatments.

Invest Ophthalmol Vis Sci. 2019;60:3 M106-M131. Click here for full text
Myopia control trials and instrumentation
Wolffsohn et al reviewed outcomes of myopia control trials which they classified as primary (refractive error and/or axial length), secondary (patient reported outcomes and treatment compliance), or exploratory (peripheral refraction, accommodative changes, ocular alignment, pupil size, outdoor activity/lighting levels, anterior and posterior segment imaging, and tissue biomechanics). Recommendations include: minimum 3-year clinical trial; stratified randomisation; mandatory examiner masking and masking of participants wherever possible; and axial length to be used as the primary outcome measure of efficacy of myopia control.

Invest Ophthalmol Vis Sci. 2019;60:3 M132-M160. Click here for full text
Industry guidelines and ethical considerations
Undertaking myopia control treatments on vulnerable populations creates an ethical challenge for a variety of stakeholders: regulatory bodies, manufacturers, academics, and eye care practitioners (ECPs). Jones et al reviewed published papers and guidance documents to discuss guidelines and ethical considerations for myopia control. ECPs should provide appropriate information to patients who are at risk of developing myopia or for whom myopia-related pathology could occur due to rapidly progressing myopia.

Invest Ophthalmol Vis Sci. 2019;60:3 M161-M183. Click here for full text
Clinical management guidelines
Gifford et al detail evidence-based best practice for managing the pre-, stable, and progressing myope, including risk factor identification, examination, selecting treatment strategies, and guidelines for ongoing management. ECP considerations such as informed consent, prescribing off-label treatment, and patient/parent communication are explained. ECPs providing myopia management services should have the appropriate training and necessary certification to care for children, and fit contact lenses and/or prescribe ocular medication.

Invest Ophthalmol Vis Sci. 2019;60:3 M184-M203. Click here for full text
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