Abstract
CONTEXT: Authors have refined myopia control strategies (MCS) from their experience treating more than 800 children who were followed at the Montreal School of Optometry Clinic (CUV). They developed a treatment algorithm known as the Montreal Experience (ME). Contrary to many other MCS, treatment modalities are selected after careful evaluation of a patient’s parameters (rate of progression, age of myopia onset, corneal parameters, pupil area), the risk factors for ocular pathology (growth charts), and taking into account the patient’s lifestyle and potential compliance. This represents a customized approach for each patient. PURPOSE: To evaluate the efficacy of MCS used following ME algorithm; the primary outcome relates to axial length progression over 24 months. METHODS: This is a retrospective study, conducted after approval of University IRB. Data were extracted from the file of each patient who: (1) consulted CUV between January 2017 and December 2018 and (2) were kept under the same MCS (same design/concentration). Clinical population is composed of 298 patients (35% Caucasian; 45% Asian; 20% others), with a median age of 11 (range 5–18). The treatment options were orthokeratology (OK-4 designs; N = 140), multifocal soft contact lenses (SMCL; 5 designs; N = 128), and low-dose atropine (LDA 0.01% to 0.25%; N = 42). RESULTS: Results are analyzed through sophisticated statistical models, designed for this purpose. At the end of a stepwise selection process that sequentially removed model terms that were not statistically significant, nine model terms remained: month, modality, the interaction of month and modality, refraction (SEQ), the interaction of SEQ and modality, gender, age, the interaction of age and month, and the interaction of age and modality. A total of 298 files were kept for analysis. Participant age varied from 9.7 to 12.5 years old. Baseline AL varied from 24.9 to 25.3 mm and SE refraction was −3.7 + 1.7 D on average. This study population was divided between Caucasian (34%), Asian (44%), and other ethnic origins (22%). Overall results indicate that results vary according to modality and months only. There is no statistical difference based on age, gender, and SEQ. All methods used were effective to slow the natural AL growth. Evolution was the lowest when using smaller treatment zones OK lenses (0.249 mm) and the highest (0.376 mm) for those treated with LDA. This OK advantage was statistically significant versus other modalities at 1 and 2 years. CONCLUSION: The Montreal Experience reveals that personalized MCS may be effective to manage myopia efficiently. It shows AL evolution comparable to the documented natural evolution of emmetropes, especially when using customized or smaller treatment zone OK lens design. Future work on other populations will confirm this tendency.
Highlights
It is known that myopia is becoming epidemic
High myopia is associated with a higher risk of developing significant ocular pathologies, which may lead to visual impairment at an older age
0.02%) was the treatment selected for 42 participants
Summary
High myopia is associated with a higher risk of developing significant ocular pathologies, which may lead to visual impairment at an older age. This is why the World Health Organization has identified myopia and high myopia as a public health issue [1] and has challenged governments, public agencies, eyecare professionals, and other stakeholders to develop strategies to reduce the burden of this avoidable blindness. Measurement means that ECP must evaluate the status of a patient during regular comprehensive vision and eye health exams, such as measuring refractive error and axial length whenever possible.
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
