Treehouse Eyes Start Date Month/Year

In April 2021, the World Council of Optometry passed a resolution that declares support for myopia management as standard of care¹

1. World Council of Optometry. Resolution: The standard of care for Myopia Management by Optometrists. https://worldcouncilofoptometry.info/resolution-the-standard-of-care-for-myopia-management-by-optometrists. Accessed 2nd March 2022.

Evidence-based standard of care combines three main components:

COVID Myopia looking at 123,535 children 1.4x to 3x WORSE

Progression of Myopia in School-Aged Children After COVID-19 Home Confinement

Jiaxing Wang, MD, PhD¹; Ying Li, MD, PhD¹; David C. Musch, PhD, MPH²; et al

Nan Wei, MD³; Xiaoli Qi, MD³; Gang Ding, MD³; Xue Li, MD³; Jing Li, MD³; Linlin Song, MD³; Ying Zhang, MD³; Yuxian Ning, MD³; Xiaoyu Zeng, MD³; Ning Hua, MD³; Shuo Li, MD, PhD⁴; Xuehan Qian, MD, PhD³

Author Affiliations Article Information

JAMA Ophthalmol. 2021;139(3):293-300. doi:10.1001/jamaophthalmol.2020.6239

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For every 1 Diopter of myopia progression reduced, we can reduce the risk of myopic maculopathy by 40%

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Bullimore MA, Brennan NA. Myopia Control: Why Each Diopter Matters. Optom Vis Sci. 2019 Jun;96(6):463-465. doi: 10.1097/OPX.0000000000001367. PMID: 31116165.

Eyes are Supposed to Grow

Emmetropes: 0.20 mm slowing to 0.10 mm per year

Refractive error projection of an emmetropic 5 year old (purple) vs real patient data treated with atropine

Example of a child who refused Tx for 2 years and progressed. Triangles represent AXL stability with treatment

Myopia Risk Factors

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Myopia Suspects (like GLC!)–Prediction of Juvenile Onset CLEERE study

• 4512 non-myopia kids
• Evaluated 13 risk factors and found refractive error very predictive

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What's causing all this myopia?

The classic Nature Argument

• Myopia in both parents = 35%
• Myopia in one parent = 25%
• No myopic parents = < 10%
• Females more myopic than males

FedOpto Medillian Columbia 2015

Dr. Monica Jong, Brien Holden Vision Institute

“70% of today’s myopia is environmentally driven. 30% is genetic.”

• Lack of outdoor time
• Near demand (?)

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Outdoor Activities

The more the better!

~2% reduction in risk/hr/wk

What about Diet?

• What:
• 851 children, 653 had myopia, average age 12.
• Followed for 3 years

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• What they found…. 
• Axial length was longest in highest quartile group of total cholesterol compared to lowest (0.34mm delta)
• Longest in highest quartile group of saturated fat intake vs lowest (0.29mm difference)

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https://doi.org/10.1016/j.ophtha.2009.10.003

Conclusion: Higher saturated fats and cholesterol intake are associated with longer axial length in otherwise healthy children

When parents ask about �screentime . . .

• The World Health Organization recommends <1 hour of sedentary screen time for children
• In the United States, a sample of 40,337 children 2-17 years of age was assessed
• Found that use of screens (4 hours/day) to be associated with lower psychological well-being, including less curiosity, lower self-control, more distractibility, more difficulties in making friends, less emotional stability, being more difficult to care for, and inability to finish tasks.

Questions

Spectacle Treatments

Defocus Incorporated Multiple Segments (DIMS) spectacle lenses

• Looked at 160 children in DIMS lenses vs SV control group.
• Found: myopia progressed 52% more slowly in Ref Error and 62% less axial elongation

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Diffusion Optics (CYPRESS)

Looked into how reducing contrast in glasses can reduce myopia progression

• What:
• 256 myopic children (mean age 6-10 years)
• Looked at 12 month difference between spectacle wearing group vs control

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• What happened?
• Mean difference vs. control 12 months later was -0.40 D representing 74% reduction.
• Control group grew 0.15mm in axial length vs 0.10 in control

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Undercorrection doesn’t work

• What:
• 94 myopic children between the ages of 9-14 years old
• Half the subjects were undercorrected (by roughly +0.75)
• -0.50 to -4.50D of myopia

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• What Happened?
• Mean progression after 2 years
• 1.00D – Undercorrected group
• 0.77D - Fully corrected group

The importance of adherence to recommended wear time:

Bao J, Huang Y, Li X, et al. Spectacle Lenses With Aspherical Lenslets for Myopia Control vs Single-Vision Spectacle Lenses: A Randomized Clinical Trial. JAMA Ophthalmol. 2022;140(5):472–478.

Stellest™ lens Control (Single vision)

Highly Aspheric Lenslets group

Graph comparing axial elongation between test and control groups during 2-year treatment period¹

FULL-TIME WEARING GROUP

(≥12 hours/day)

50% faster progression

for part-time wearers

PART-TIME WEARING GROUP

(<12 hours/day)

n=32

n=22

n=16

n=34

Questions

Soft Multifocal Treatments

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Eef van der Worp, Giancarlo Montani. Powerful Profiles. Contact Lens Spectrum, April 2023.

Cumulative MiSight Effect over 10 years provides an estimated 0.87mm of Slowing Eye Growth = more than 2.00D of Myopia Control

**Analysis of treatment age and years in treatment needs further investigation and likely that both can be utilized to demonstrate treatment efficacy.

Analysis of MiSight study result by subject age

Approximately 50% slowing at each age.

1% Atropine worked!

ATOM 1

ATOM 2

0.5% vs 0.1% vs 0.01%

Efficacy Results from the Atropine in the Treatment of Myopia (ATOM) StudyW. Chua; V. Balakrishnan; D. Tan; Y. Chan; ATOM Study Group Invest Ophthal Published:2006 ,

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5 Year Clinical Trial Atropine in the Treatment of Myopia (ATOM2) StudyW. Chua; V. Balakrishnan; D. Tan; Y. Chan; ATOM Study Group Invest Ophthal Published:2014 ,

LAMP

438 Children ages 4-12 with myopia at least 1.0 Diopter over a year

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4 groups:

0.05%, 0.025%, 0.01% and placebo given nightly to both eyes for 1 year

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Randomized, double masked

Results (p < 0.001) Refractive error

Results (p < 0.001) Axial Length

Results (p < 0.001) Accommodation

Results (p < 0.001) Pupil Size photopic

LAMP 3 Year Results

How much rebound effect?

• 0.05% Small (0.04 mm)
• 0.025% None
• 0.01% None

LAMP phase 2 -3

Switched the kids on placebo to 0.05% atropine

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Found: SE change of 0.18D change in year 2 vs 0.82 in year 1.

AL: 0.15mm year 2 vs 0.43mm in year 1.

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Phase 3: Tested washing out … and guess what. Those that washed out progressed faster than kids who stayed in treatment.

Low-Concentration Atropine for Myopia Progression (LAMP) Study

A Randomized, Double-Blinded, Placebo-Controlled Trial of 0.05%, 0.025%, and 0.01% Atropine Eye Drops in Myopia ControlJason C. Yam, FCOphthHK, FRCS(Edin) Yuning Jiang, MMED Shu Min Tang, PhD Clement C. Tham, FCOphthHK, FRCOphthLi Jia Chen, MRCSEd(Ophth), PhD Chi Pui Pang, DPhil Published:July 06, 2018DOI:https://doi.org/10.1016/j.ophtha.2018.05.029

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SMART Study

• What:
• 382 myopia children
• Followed for 3 years
• 172 treated with OK
• 110 treated with SV CLs

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• What happened?! 
• -0.13 +/- 0.62 diopters in the OK group
• -1.03 +/-0.58 diopters in the SV CL group

CAMP Study

• What:
• 342 myopia children
• Followed for 3 years

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• What happened?! 
• 70% of patients had less than 0.10mm per year of axial elongation on OrthoK

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• 78% OK patient stay
• 68% Soft MF
• 22% Atropine

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Questions

Light Treatment

Light therapy

• Low Level Red Light: 1031 myopic children age 6-16. Repeated low level red light significantly reduced axial length.

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• Violet light: Compared children wearing UV block CLs vs transmissible and transmissible CLs suppressed myopia the most. 1 year later 0.014mm vs 0.19mm in UV blocking vs transmissible

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• 78% OK patient stay
• 68% Soft MF
• 22% Atropine

Questions

Questions?

We think big for little eyes.

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