Empowering myopia control through technology, research and evidence: Asia-Pacific Myopia Management Symposium Recap #2

In recent years, advancements in technology and a growing body of research have significantly expanded our understanding of myopia development and treatment options. It is essential for eyecare practitioners seeking to effectively manage and mitigate the progression of myopia in their patients to stay informed about global trends, leverage advanced monitoring techniques, and adopt evidence-based practices. The Asia-Pacific Myopia Management Symposium (APMMS) 2023 hosted by CooperVision explored the theme of empowering myopia control through technology, research and evidence. 

This article is the second of a three-part series exploring the key themes of the symposium. 

Myopia management is increasingly regarded as a professional imperative for eyecare practitioners due to its significant impact on public health and vision-related quality of life.¹ The symposium offered insights and actionable strategies on how eyecare practitioners can engage and enhance their myopia management skills:

• Staying Informed with Global Trends: Regularly reviewing research findings and participating in global trend surveys, like those conducted by organizations such as the International Myopia Institute (IMI),² allows clinicians to stay updated on current practices and emerging interventions in myopia management. Understanding regional differences in myopia prevalence, such as the higher prevalence in certain parts of Asia,³ can inform clinical decision-making and help tailor treatment approaches to specific populations. By staying informed about global trends, clinicians can adapt their practices to incorporate new interventions as they emerge.
• Utilizing Advanced Monitoring Techniques: Incorporating advanced monitoring techniques, such as axial length percentiles, into clinical practice can improve the assessment of myopia progression and treatment efficacy. During her lecture, Tzu Hsun Tsai from Taiwan National University mentioned that observations have shown that baseline spherical equivalent refraction and percentile change rate are effective in estimating myopia progression in certain patient groups, such as orthokeratology users. Understanding gender differences in myopia progression, such as those observed in Taiwan, can also inform treatment decisions and help tailor interventions to individual patients.
• Adopting Evidence-Based Practices: Prioritizing evidence-based practices ensures that clinicians evaluate treatment options for myopia management based on robust evidence.⁴ For example, randomized controlled trials (RCTs) and meta-analyses provide valuable insights into the efficacy and safety of different interventions.⁵ Clinicians should also consider factors such as study duration, masking, cycloplegic autorefraction, and axial length data when evaluating research studies to ensure the reliability of the evidence.
• Leveraging Long-Term Clinical Trials: Long-term studies, such as the MiSight 1-day clinical trial, provide valuable insights into the long-term efficacy and safety of myopia-controlling interventions.⁶ For example, data from long-term trials can show the sustained effects of interventions over time and help identify factors that may influence treatment outcomes, such as patient compliance and follow-up. Clinicians can use data from these trials to make informed decisions about treatment options for their patients.
• Using Risk Assessment Tools: Employing tools for assessing myopia development and risk of progression, such as MyKidsVision.org and Ocumetra, helps clinicians identify patients who may benefit from early intervention. These tools provide valuable information about individual patient risk factors and help tailor treatment plans accordingly. Clinicians should consider factors such as family history, age of onset, and rate of progression when assessing patient risk and determining the appropriate course of action.
• Embracing Preventative Approaches: Adopting preventative approaches, such as lifestyle changes and pharmacological interventions, can delay the onset of myopia and reduce the risk of progression. For example, studies have shown that time spent outdoors⁷ and atropine therapy⁸ can help prevent myopia onset in pre-myopic individuals. Clinicians play a crucial role in educating patients and parents about these preventative measures and promoting optimal eye health from an early age. By embracing preventative approaches, clinicians can help reduce the burden of myopia-related complications and improve long-term eye health outcomes for their patients. 

The symposium emphasized the professional responsibility of eyecare practitioners to actively participate in myopia control efforts. By incorporating these strategies into their practice, eyecare practitioners can augment their capacity to successfully manage myopia, alleviate its public health implications, and enhance the quality of vision-related outcomes for their patients.

As the understanding of myopia continues to evolve, so too does research methodology and consequently how it is interpreted. Historically, many studies incorporated a control arm, where participants did not receive an intervention.^9,10 However, as it becomes clear that certain treatments can effectively manage or mitigate the progression of myopia, the ethics of withholding such treatments from control groups has been called into question.¹¹ Stopping a treatment to explore potential rebound effects raises similar concerns. Furthermore, high dropout rates in control groups—particularly when blinding is inadequate—and recruitment challenges driven by parental reluctance to have their child receive a placebo, complicate research. Some recent studies have used historical controls, requiring careful adjustment for key variables like age, sex, seasonal changes, refractive error, and familial myopia history.¹² Alternatives include comparisons to established treatments or employing survival analysis, where the time it takes for myopia to worsen allows early exit for placebo participants,¹¹ though this can limit long-term efficacy assessments. Multisite studies enhance generalizability by involving diverse geographical areas and larger participant pools, yet they remain infrequent. The ongoing evolution of research methodologies in response to ethical considerations continues to be a learning area, influencing how myopia treatments are studied and ultimately how conclusive and applicable the findings are.

These developments mean that clinical practice is becoming more dynamic, precise, and responsive to individual patient needs, enhancing both the effectiveness of treatments and the overall patient experience. Empowering myopia control through the integration of technology, research, and evidence is vital. The strategies provided by the Asia-Pacific Myopia Management Symposium are easily actionable by all eyecare practitioners to alleviate the global burden of myopia.