Global trends in myopia management attitudes and strategies in clinical practice

PURPOSE: Myopia is a global public health issue; however, no information exists as to how potential myopia retardation strategies are being adopted globally. METHODS: A self-administrated, internet-based questionnaire was distributed in six languages, through professional bodies to eye care practitioners globally. The questions examined: awareness of increasing myopia prevalence, perceived efficacy and adoption of available strategies, and reasons for not adopting specific strategies. RESULTS: Of the 971 respondents, concern was higher (median 9/10) in Asia than in any other continent (7/10, p<0.001) and they considered themselves more active in implementing myopia control strategies (8/10) than Australasia and Europe (7/10), with North (4/10) and South America (5/10) being least proactive (p<0.001). Orthokeratology was perceived to be the most effective method of myopia control, followed by increased time outdoors and pharmaceutical approaches, with under-correction and single vision spectacles felt to be the least effective (p<0.05). Although significant intra-regional differences existed, overall most practitioners 67.5 (±37.8)% prescribed single vision spectacles or contact lenses as the primary mode of correction for myopic patients. The main justifications for their reluctance to prescribe alternatives to single vision refractive corrections were increased cost (35.6%), inadequate information (33.3%) and the unpredictability of outcomes (28.2%). CONCLUSIONS: Regardless of practitioners' awareness of the efficacy of myopia control techniques, the vast majority still prescribe single vision interventions to young myopes. In view of the increasing prevalence of myopia and existing evidence for interventions to slow myopia progression, clear guidelines for myopia management need to be established

Global trends in myopia management attitudes and strategies in clinical practice – 2019 Update

Purpose: A survey in 2015 identified a high level of eye care practitioner concern about myopia with a reported moderately high level of activity, but the vast majority still prescribed single vision interventions to young myopes. This research aimed to update these findings 4 years later. Methods: A self-administrated, internet-based questionnaire was distributed in eight languages, through professional bodies to eye care practitioners globally. The questions examined: awareness of increasing myopia prevalence, perceived efficacy of available strategies and adoption levels of such strategies, and reasons for not adopting specific strategies. Results: Of the 1336 respondents, concern was highest (9.0 ± 1.6; p < 0.001) in Asia and lowest (7.6 ± 2.2; p < 0.001) in Australasia. Practitioners from Asia also considered their clinical practice of myopia control to be the most active (7.7 ± 2.3; p < 0.001), the North American practitioners being the least active (6.3 ± 2.9; p < 0.001). Orthokeratology was perceived to be the most effective method of myopia control, followed by pharmaceutical approaches and approved myopia control soft contact lenses (p < 0.001). Although significant intra-regional differences existed, overall, most practitioners did not consider single-vision distance under-correction to be an effective strategy for attenuating myopia progression (79.6 %), but prescribed single vision spectacles or contact lenses as the primary mode of correction for myopic patients (63.6 ± 21.8 %). The main justifications for their reluctance to prescribe alternatives to single vision refractive corrections were increased cost (20.6 %) and inadequate information (17.6 %). Conclusions: While practitioner concern about myopia and the reported level of activity have increased over the last 4 years, the vast majority of eye care clinicians still prescribe single vision interventions to young myopes. With recent global consensus evidence-based guidelines having been published, it is hoped that this will inform the practice of myopia management in future

A randomized clinical comparison of OPTI-FREE EXPRESS and ReNu MultiPLUS multipurpose lens care solutions

To evaluate subjective symptoms and clinical signs of tolerability and comfort in silicone and non-silicone hydrogel contact lens (CL) wearers using two different multipurpose solution (MPS) CL care regimens.This was a randomized, double-masked, contralateral, crossover, multicenter (n=9) study. One hundred and eleven subjects were enrolled in the study, and were randomly assigned either silicone hydrogel CLs or non-silicone hydrogel CLs. Before wear, the CLs were randomly conditioned for at least 10 hours in a multipurpose disinfection solution (MPDS) preserved with either: Regimen 1-polyquaternium-1 0.001% and myristamidopropyl dimethylamine 0.0005% (POLYQUADA (R) and ALDOXA (R), respectively; OPTIFREE EXPRESSA (R) MPDS, Alcon Laboratories, Inc., Fort Worth, TX, USA); or Regimen 2-multipurpose solution preserved with polyhexamethylene biguanide 0.0001% (PHMB, ReNu MultiPLUSA (R) MPS, Bausch & Lomb, Rochester, NY, USA). the study had two in-office visits, 1 week apart. Subjects wore assigned CLs for approximately 4 hours at each visit. At each visit, subjects' eyes were examined before CL insertion and at 2 hours and 4 hours after insertion. Corneal staining type and area, conjunctival staining, conjunctival injection, subjective symptoms (tolerability), and comfort were evaluated.One hundred and five subjects (210 eyes) completed the study. the total corneal staining score of area and type were statistically significantly less in Regimen 1 than in Regimen 2 (P < 0.000001). the area of conjunctival staining was statistically significantly less in Regimen 1 than in Regimen 2 (P=0.03). No clinically significant hyperemia was observed for either regimen. Both tolerability (P=0.02) and patient preference (P=0.05) were in favor of Regimen 1.Statistically significant clinical differences were evident between the two CL care regimens when used with silicone and non-silicone hydrogel CLs. OPTI-FREE EXPRESS MPDS users showed less corneal and conjunctival staining and reported greater comfort and tolerability to the CL/solution combination than ReNu MultiPLUS MPS users.Alcon Laboratories, Inc., BrazilUniversidade Federal de São Paulo, Contact Lens Dept, BR-04001083 Paraiso, SP, BrazilUniversidade Federal de São Paulo, Contact Lens Dept, BR-04001083 Paraiso, SP, BrazilWeb of Scienc

The use of ocular anatomical measurements using a rotating Scheimpflug camera to assist in the Esclera (R) scleral contact lens fitting process

Purpose: To test for associations between Pentacam (R) derived topography variables and to evaluate the predictive power of those variables in relation to scleral contact lens (SCL) fit. Setting: Department of Ophthalmology and Visual Sciences, Federal University of Sao Paulo, Sao Paulo-SP, Brazil. Design: Prospective observational non-randomised, non-comparative study. Methods: Forty-seven patients (63 eyes) were indicated for the use of Esclera (R) SCL. All patients underwent Scheimpflug imaging before the initial SCL evaluation. The following parameters were measured by Pentacam (R): corneal elevations, thickness, density, and anterior chamber depth (ACD). Correlations between the SCL parameters and the Pentacam measurements were analysed with Pearson's correlation coefficients. A simple linear regression model was created for each lens parameter using the most-correlated Pentacam variable. Results: In the total group, the results show correlations between the SCL parameters and the corneal astigmatism, ACD and pentacam-measured corneal height (Hm), with p < 0.001 each. In addition, an inverse correlation between the lens sagittal depth (LSD) and the anterior radii minimum was shown (p < 0.001). In the keratoconus group, the results show correlations between the SCL parameters and ACD and Hm (p < 0.001, each). An inverse correlation between the LSD and the total thickness corneal density average was also observed (p = 0.003). Conclusion: There was a positive correlation between the LSD and ACD, even as LD and ACD in the keratoconus group. Thus, these results suggest that certain Pentacam measurements can be good predictors of the most appropriate Esclera (R) lens to be fitted in keratoconus patients. (C) 2015 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.Univ Fed Sao Paulo, Dept Ophthalmol, Sao Paulo, SP, BrazilRenato Ambrosio Eye Inst, Rio De Janeiro, RJ, BrazilSadalla Amin Ghanem Eye Hosp, Joinville, SC, BrazilUniv Fed Sao Paulo, Dept Ophthalmol, Sao Paulo, SP, BrazilWeb of Scienc

NEW OPTION IN CONVENTIONAL SILICONE HYDROGEL CONTACT LENSES: THE BRAZILIAN EXPERIENCE

PURPOSE: To evaluate the clinical performance of a new conventional silicone hydrogel contact lens in spherical and toric designs. METHODS: We fitted the Perfect SH and Perfect Toric SH (World Vision Ophthalmic®, Brazil) in 19 patients (33 eyes). Contact lens material was Filcon II (hydration: 74%; Dk: 60 x 10-11@35C). We evaluated demographics (sex, age), also if the patient had tried to wear contact lenses before, best-corrected visual acuity with spectacles and with contact lenses, spherical equivalent of the refraction, design of the fitted lenses (between spherical and toric), keratometry, the base-curve of the fitted lenses, the occurrence of complications, and patient’s satisfaction with the new lenses. RESULTS: Fourteen patients were female (73,7%) and five were male (26,3%). The average spectacle-corrected visual acuity (LogMAR) was 0,31 ±0,35. The LogMar visual acuity with contact lenses was 0,25±0,29. Seventeen (89,4%) patients were satisfied with the new contact lens and 2 (10,6%) were not. CONCLUSION: This new conventional silicone hydrogel contact lens could be considered an useful option for contact lens fitting in Brazil

Prevalence and causes of visual impairment in low middle income school children in São Paulo, Brazil

PURPOSE. Assess prevalence and causes of vision impairment among low-middle income school children in São Paulo.METHODS. Cluster sampling was used to obtain a random sample of children ages 11 to 14 years from public schools (grades 5-8) in three districts from June to November 2005. the examination included visual acuity testing, ocular motility, and examination of the external eye, anterior segment, and media. Cycloplegic refraction and fundus examination were performed in children with uncorrected visual acuity 20/40 or worse in either eye. A principal cause of visual impairment was determined for eyes with uncorrected visual acuity of 20/40 or worse.RESULTS. A total of 2825 children were enumerated and 2441 (86.4%) were examined. the prevalence of uncorrected, presenting, and best-corrected visual acuity 20/40 or worse in the better eye was 4.82%, 2.67%, and 0.41%, respectively. Spectacles were used by 144 (5.9%) children. Refractive error was a cause in 76.8% of children with visual impairment in one or both eyes; amblyopia, 11.4%; retinal disorders, 5.9%; other causes, 2.7%; and unexplained causes, 7.7%. Myopic visual impairment (spherical equivalent -0.50 D in one or both eyes) was not associated with age or grade level, but female sex was marginally significant (P = 0.070). Hyperopic visual impairment (+2.00 D or more) was not associated with age, grade level, or sex.CONCLUSIONS. the prevalence of reduced vision in low-middle income urban São Paulo school children was low, most of it because of uncorrected refractive error. Cost-effective strategies are needed to address this easily treated cause of vision impairment.Universidade Federal de São Paulo, Dept Ophthalmol, Vis Inst, BR-04023062 São Paulo, BrazilNepal Netra Jyoti Sangh, Kathmandu, NepalNEI, NIH, Bethesda, MD 20892 USAUniversidade Federal de São Paulo, Dept Ophthalmol, Vis Inst, BR-04023062 São Paulo, BrazilWeb of Scienc