Optical myopia control interventions: Evaluation of methods and success in a real-world population

To explore methods of evaluating success of optical myopia control interventions, and to apply these methods retrospectively to a clinical population.

A retrospective cohort study was conducted on pediatric patients attending a United Kingdom myopia clinic and used defocus incorporated multiple segments (DIMS) spectacle lenses, dual-focus (DF), multifocal (MF) or orthokeratology (OrthoK) contact lenses. An intervention was deemed as successful if the progression rate met a threshold value using a variety of methods: (1) spherical equivalent refraction (SER) change; (2) axial length (AL) change (individual-based, population-based, and percentile-based); and (3) AL rate during intervention. Linear regression analyses were conducted to determine which factor(s) had a significant effect on the reduction in AL rate.

One hundred twenty-eight eyes of 64 children were analyzed (DIMs: 56, DF: 32, MF: 22, OrthoK: 18). Across the methods to assess success, 33% of eyes had a successful outcome and 32% obtained the mean AL reduction rate from equivalent clinical trials, with a mean (SD) individual-based age-adjusted reduction in AL progression of 0.11 (0.21) mm/year, 95% CI: -0.31 to 0.53 mm/year. Regression models were significant for the individual-based AL change method only, and for this regression, a faster AL rate preintervention was the only significant predictor of a larger AL reduction.

Monitoring the rate of AL progression prior to intervention has advantages such as predicting and measuring success in this UK clinical population. The large variability in treatment response and the 33% overall success rate should help inform balanced discussions about the risks/benefits of optical myopia management interventions.