IMI 2021 Yearly Digest


Research Abstract Summary

Paper title: IMI Yearly Digest

Authors: Monica Jong (1,2,3), Jost B Jonas (4), James S Wolffsohn (5), David A Bernsten (6), Pauline Cho (7), Danielle Clarkson-Townsend (8.9), Daniel I Flitcroft (10), Kate L Gifford (11,12), Annechien E G Haarman (13,14), Machelle T Pardue (8,15), Kathryn Richdale (16), Padmaja Sankaridurg (2,3), Milly S Tedja (13,14), Christine F Wildsoet (17), Joan E Bailey-Wilson (18), Jeremy A Guggenheim (19), Christopher J Hammond (20), Jaakko Kaprio (21), Stuart MacGregor (22), David A Mackey (23,24,25), Anthony M Musolf (18), Caroline C W Klaver (13,26,14,27), Virginie J M Verhoeven (13,14,28), Veronique Vitart (29), Earl L Smith 3rd (16)

  1. Discipline of Optometry and Vision Science, University of Canberra, Canberra, Australian Capital Territory, Australia
  2. Brien Holden Vision Institute, Sydney, New South Wales, Australis
  3. School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
  4. Department of Ophthalmology Medical Faculty Maanheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
  5. Optometry and Vision Science Research Group, Aston University, Birmingham, United Kingdom
  6. The Ocular Surface Institute, College of Optometry, University of Houston, Houston, Texas, United States
  7. Centre for Myopia Research, School of Optometry, The Hong Kong Polytechnic University, Hong Kong SAR, China
  8. Centre for Visual and Neurocognitive Rehabilitation, Atlanta VA Healthcare System, Decatur, Georgia, United States.
  9. Gangarosa Department of Environmental Health, Emory University, Atlanta, Georgia, United States.
  10. Department of Ophthalmology, Children's University Hospital, Dublin, Ireland.
  11. Myopia Profile Pty Ltd, Brisbane, Queensland, Australia.
  12. Queensland University of Technology (QUT) School of Optometry and Vision Science, Kelvin Grove, Queensland, Australia.
  13. Department of Epidemiology, Erasmus Medical Centre, Rotterdam, the Netherlands.
  14. Department of Ophthalmology, Erasmus Medical Centre, Rotterdam, the Netherlands.
  15. Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia, United States.
  16. College of Optometry, University of Houston, Houston, Texas, United States.
  17. School of Optometry, University of California, Berkeley, California, United States.
  18. Computational and Statistical Genomics Branch, National Human Genome Research Institute, National Institutes of Health, Baltimore, Maryland, United States.
  19. School of Optometry and Vision Sciences, Cardiff University, Cardiff, United Kingdom.
  20. Section of Academic Ophthalmology, School of Life Course Sciences, King's College London, London, United Kingdom.
  21. Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland.
  22. Statistical Genetics, QIMR Berghofer Medical Research Institute, Brisbane, Australia.
  23. Centre for Eye Research Australia, Ophthalmology, Department of Surgery, University of Melbourne, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia.
  24. Department of Ophthalmology, Menzies Institute of Medical Research, University of Tasmania, Hobart, Tasmania, Australia.
  25. Centre for Ophthalmology and Visual Science, Lions Eye Institute, University of Western Australia, Perth, Western Australia, Australia.
  26. Department of Ophthalmology, Radboud University Medical Centre, Nijmegen, the Netherlands.
  27. Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland.
  28. Department of Clinical Genetics, Erasmus Medical Centre, Rotterdam, the Netherlands.
  29. Medical Research Council Human Genetics Unit, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom

Date: April 2021

Reference: Jong M, Jonas JB, Wolffsohn JS, Berntsen DA, Cho P, Clarkson-Townsend D, Flitcroft DI, Gifford KL, Haarman AEG, Pardue MT, Richdale K, Sankaridurg P, Tedja MS, Wildsoet CF, Bailey-Wilson JE, Guggenheim JA, Hammond CJ, Kaprio J, MacGregor S, Mackey DA, Musolf AM, Klaver CCW, Verhoeven VJM, Vitart V, Smith EL 3rd. IMI 2021 Yearly Digest. Invest Ophthalmol Vis Sci. 2021 Apr 28;62(5):7. ([Link to open access paper)


The IMI Yearly Digest 2021 is a culmination of research providing updates on key clinical trials, clinical management opportunities and new interventions in myopia management, since Volume One of the IMI reports were published in early 2019. Each of the committees which published a report in Volume One provided an update in the latest publications since. A search of PubMed revealed 1,000 research articles on myopia published in 2019 and 2020. 

Since 2019, advances in research on optical interventions have shown substantial slowing of myopia progression from defocus-incorporated multisegment spectacle lenses (DIMS), MiSight dual focus soft lens and high Add power centre-distance soft multifocal lens (the BLINK study). 

New findings from Phase 2 of the LAMP study showed tolerable side-effects and similar treatment effects from 0.025% and 0.05% concentrations of atropine.  Ongoing trials into the effects of low-dose atropine on children from the US and Europe will provide a comparison for eyes with less melanin pigment.

The use of atropine as a combination therapy has also been assessed from studies which found that 0.01% atropine alongside orthokeratology was able to increase the overall treatment effect.

The IMI also makes recommendations on study designs, clinical trial lengths, utilizing cycloplegic refraction and suggests further understanding is needed on:

  • Universal definitions and classifications of myopia, high myopia and pathological myopia.  Using clear language allows for consistent comparisons across studies
  • The merits of reporting myopia treatment effects either as a percentage reduction or as axial length reduction
  • The role of ocular hypotensive pharmacological treatments in the mechanism of action for myopia control
  • The function of genome-wide sequencing in identifying the causal genes, how these influence biological processes and potential targeted interventions
  • The role of spherical aberration in the treatment effect of OrthoK
  • The ethical considerations for assigning a placebo control group to a study where the efficacy of the intervention is known and there is a likelihood of myopic progression.

A key feature of the digest has been the discovery that in many countries, 64% of eyecare practitioners were not actively prescribing optical interventions for slowing myopia despite knowing SV corrections are ineffective.  A lack of availability and knowledge of the options are cited as possible reasons for this.

The IMI Yearly Digest 2021 does not take in any publications since mid-2020: another Digest is planned for publication in early 2023, taking in the latest science in this fast moving field over 2021 and 2022.

What does this mean for my practice?

Several treatments now exist with evidence for slowing myopia progression, and eyecare practitioners who have so far been reluctant to prescribe myopia management options can be reassured that they have been shown to be effective from good quality study designs. Carefully designed and controlled clinical trials can continue to inform proactive, evidence-based practice for children with myopia.

What do we still need to learn?

 Further research further our understanding of:

  •         the role dopamine release plays in choroidal thickness
  •         the extent to which changing ambient lighting and behaviour can impact circadian rhythms
  •         existing risk factors such as environmental influences and the interaction with genetic susceptibility


Title: IMI 2021 Yearly Digest

Authors: Monica Jong, Jost B Jonas, James S Wolffsohn, David A Berntsen, Pauline Cho, Danielle Clarkson-Townsend, Daniel I Flitcroft, Kate L Gifford, Annechien E G Haarman, Machelle T Pardue, Kathryn Richdale, Padmaja Sankaridurg, Milly S Tedja, Christine F Wildsoet, Joan E Bailey-Wilson, Jeremy A Guggenheim, Christopher J Hammond, Jaakko Kaprio, Stuart MacGregor, David A Mackey, Anthony M Musolf, Caroline C W Klaver, Virginie J M Verhoeven, Veronique Vitart, Earl L Smith 3rd

Purpose: The International Myopia Institute (IMI) Yearly Digest highlights new research considered to be of importance since the publication of the first series of IMI white papers.

Methods: A literature search was conducted for articles on myopia between 2019 and mid-2020 to inform definitions and classifications, experimental models, genetics, interventions, clinical trials, and clinical management. Conference abstracts from key meetings in the same period were also considered.

Results: One thousand articles on myopia have been published between 2019 and mid-2020. Key advances include the use of the definition of premyopia in studies currently under way to test interventions in myopia, new definitions in the field of pathologic myopia, the role of new pharmacologic treatments in experimental models such as intraocular pressure-lowering latanoprost, a large meta-analysis of refractive error identifying 336 new genetic loci, new clinical interventions such as the defocus incorporated multisegment spectacles and combination therapy with low-dose atropine and orthokeratology (OK), normative standards in refractive error, the ethical dilemma of a placebo control group when myopia control treatments are established, reporting the physical metric of myopia reduction versus a percentage reduction, comparison of the risk of paediatric OK wear with risk of vision impairment in myopia, the justification of preventing myopic and axial length increase versus quality of life, and future vision loss.

Conclusions: Large amounts of research in myopia have been published since the IMI 2019 white papers were released. The yearly digest serves to highlight the latest research and advances in myopia.

(Link to open access paper)


About Ailsa

Ailsa Lane is a contact lens optician based in Kent, England. She is currently completing her Advanced Diploma In Contact Lens Practice with Honours, which has ignited her interest and skills in understanding scientific research and finding its translations to clinical practice.