Over the past few decades, the prevalence of myopia has increased exponentially.1,2 In many populations—especially Asian cohorts—the morbidity associated with myopic progression can be devastating. Significant elongation of the eye often results in poor uncorrected acuity. Nearly as important, myopia is associated with increased risks for glaucoma, cataracts, peripheral retinal pathology (i.e., holes, tears and detachments) and myopic macular disease.
Ongoing research is evaluating several modalities to slow the rate of myopia. These include pharmaceutical intervention with anti-muscarinics (low-dose atropine and pirenzepine gel), orthokeratology (ortho-K) and multifocal spectacles and contact lenses. Clinical trials of ortho-K have demonstrated that progression is slowed by about 40%.1-3 Soft multifocal contact lens designs have demonstrated similar results: by reducing near eso fixation disparity, bifocal contact lenses may improve near vision comfort and reduce accommodation lag.1 A certain degree of protection seems to be afforded by peripheral myopic defocus lens designs.
Professor Brien Holden: In Memoriam
Initially, I was planning to highlight Brien Holden’s fabulous work on myopia this month; I never expected to provide a memoriam honoring his memory. At this year’s British Contact Lens Association (BCLA) meeting, Professor Holden presented a marvelous review of (1) what should concern us with myopic progression, (2) what we have learned to date and (3) how we might slow its progression.
|The Giant Among Giants|
The eye world lost an amazing individual in July. His resume reads like a novel: 275 refereed scientific articles, more than 450 abstracts and more than 125 keynote addresses. Over a career that spanned more than four decades, Professor Holden received 30 international awards from diverse organizations around the world for his endless contributions to research, clinical science, public health and philanthropy. He served as a mentor to so many of us and we’ll certainly have a story or two to tell about how he enjoyed life.
What many of our readers may not know is that Brien Holden’s PhD thesis was on the development and control of myopia, a passion he pursued tenaciously right up until his death. Professor Holden holds 10 patents with an additional nine pending, many of them related to slowing myopic progression.
Key points raised in his BCLA presentation include: (1) outdoor activities are essential to delay the onset and perhaps even reduce the rate of progression, (2) most soft lens designs actually promote myopia because of their negative spherical aberration in peripheral optics, (3) the recognition that ortho-K actually works and (4) the fact that peripheral plus (multifocal) lenses also work. Professor Holden envisioned a day when a stepped anti-myopia and extended depth-of-focus lens would be custom designed for each patient with more than 0.50D of myopia.
So, is the time to act now, as Professor Holden believed? If your comfort level is adequate using lenses for a non-FDA approved indication, perhaps it is good to discuss contact lens options with parents whose children are showing myopic progression. Also, low-dose atropine (0.02%) may be a viable alternative for any patient unable or unwilling to wear either ortho-K or multifocal lenses. However, research has shown slower myopia progression, but not slowing of eye growth, so the mechanism of myopia control remains a mystery.
Ortho-K and multifocal contact lenses appear to have significant benefits when fitted early in myopic patients. Thus, we call upon manufacturers to seek approval for novel designs, as in a stepped anti-myopia and extended depth of focus lens approach. In the meantime, I urge you to consider the exciting treatment modalities available to us today after careful and adequate education of parents and individuals who may benefit most when using these lenses. Professor Holden’s positive and lasting impact will most definitely live on.1. Anderson RL, Aller T, Walline JJ. COntrolling myopia, changing lives. Review of Cornea and Contact Lenses. 2014(9):24-29.
2. Kading D, Mayberry A. Slowing myopia progression in children. Review of Optometry. 2012(11):28-34.
3. Cho P, Cheung SW. Retardation of Myopia in Orthokeratology (ROMIO) study: a two-year randomized clinical trial. Invest Ophthalmol Vis. Sci. 2012. 53(11):7077-85.