Dr Noel A. Brennan is Research Fellow at Johnson & Johnson Vision, where he has been since 2011. Prior to that he co-directed a privately-owned research consulting company and, before that, was an academic faculty member at the University of Melbourne, reaching the level of Reader.
Download the poster (.pdf), which was originally shared at the American Academy of Optometry (AAO) annual meeting, 2018.
Evidence-Based Efficacy of Myopia Control Interventions
Noel A. Brennan1 MScOptom, PhD, FAAO Xu Cheng1 MD, PhD, FAAO Mark Bullimore2 MCOptom, PhD, FAAO, FARVO
1. Johnson & Johnson Vision
2. Independent Consultant
Purpose
Decision-making in modern clinical practice is increasingly dependent on evidence-based medicine. Previous analyses of the efficacy of myopia control interventions have delivered results as percentage or absolute reduction in myopia progression over a given time frame. Estimates of longer term efficacy have been constructed around these estimates but fail to account for two important recent observations: (i) myopia control efficacy tends to an absolute effect rather than a relative effect across the progression range, and (ii) efficacy may decrease over time on both absolute and relative bases. Here, we apply the principles of evidence-based medicine to efficacy of myopia control interventions.
Methods
We systematically reviewed the literature, including relevant peer-reviewed conference abstracts, to categorize quality of investigations of a set of myopia control interventions currently of interest (see Table) based on adherence to evidence-based principles. The only indisputable metric than can be used is data-driven estimates of cumulative absolute reduction in progression rather than absolute annual or relative rates. The primary variable should be reduction in axial elongation because of its assumed relevance to disease development but refractive error serves as an important secondary endpoint. We also identified maximum efficacy outcomes of each category of intervention.
Results
The table shows the classification of 32 identified studies according to quality of evidence. Study designs to the left in the table represent more rigorous levels of evidence. Despite the popularity of low-dose (0.01%) atropine, there is no direct evidence of a reduction in axial elongation with this intervention. Orthokeratology (in a cohort study) and spectacles (in a controlled, randomized study with selective inclusion criteria) have provided the largest recorded treatment effects. Soft, multizone lenses have the greatest weight of evidence but do not demonstrate superior performance possibly because of insufficient study periods. Increased time outdoors alone does not provide a large treatment effect but may be a useful adjunct therapy. It should be noted that rebound was not examined in any of studies except for one cohort study with low-dose atropine.
Conclusion
The maximum treatment effect that can currently be supported is 0.43mm for axial elongation and 1.05D for refractive error; however, such efficacy may be restricted to a subset of patients and rebound cannot be ruled out. Any suggestions of greater potential efficacy are speculative and not evidence-based. This analysis establishes a precedent for evidence-based reporting of myopia control interventions.
