Gold Standard in Myopia Interventions: Asia-Pacific Myopia Management Symposium 2024 Recap #2

Defining the gold standard for myopia management involves a multi-faceted approach—grounded in clinical evidence, patient-centred care, and tailored treatment plans—that effectively manage myopia progression while supporting long-term eye health. The 2024 Asia-Pacific Myopia Management Symposium (APMMS), held in Seoul, Korea in late October and championed by CooperVision, showcased the latest in clinical research, expert consensus, and hands-on insights for tackling myopia progression. This second instalment in our APMMS 2024 recap series dives into the current gold standard of interventions and emerging treatments for myopia management. 

• Read the APMMS 2024 Recap #1 on Paradigm Shifts in Understanding Myopia HERE
• Read the APMMS 2024 Recap #3 on The Future of Myopia Management HERE.

A gold standard in myopia management is essential because it establishes a benchmark for the most effective, safe, and consistent interventions to control myopia progression. Having a gold standard also fosters consistency in treatment across practices, helping to build trust among patients and caregivers by ensuring reliable, predictable outcomes. At APMMS 2024, key considerations discussed were:

• Evaluating Treatment Efficacy: Kate Gifford (pictured in the cover image above) described various methods for assessing myopia control efficacy, including absolute axial length reduction, saving 1 dioptre, and typical efficacy percentages reported from randomized controlled trials (RCTs). Newer metrics include comparisons to emmetropic eye growth and determining years of delayed eye growth compared to untreated myopia. Top performing interventions across all efficacy metrics (using at least 12 months of published RCT data) include myopia control spectacles with lenslets or diffusers (DIMS, HALT, DOT),^1-3 dual-focus soft contact lenses (MiSight 1-day),⁴ orthokeratology,⁵ and 0.05% (or higher concentrations of) atropine.^6-8 Emerging treatments like Ringboost⁹ and catenary optics multifocal soft contact lenses,¹⁰ CARE spectacle lenses¹¹ and repeated low-level red-light (RLRL) therapy¹² are promising but need more data on long-term efficacy and safety.
• Advances in Atropine Therapy: Historical data showed atropine's efficacy in slowing myopia, with recent RCTs suggesting that 0.05% is optimal.^6-8 The LAMP study revealed greater control with 0.025% and 0.05% than 0.01%, with a similar low side effect profile.⁶ Consistent formulation of atropine is critical for efficacy, as indicated by varying pupil size impacts across trials.^6,13
• Optimizing Orthokeratology: Best practices in ortho-k include fitting, lens appearance, and topography assessment, along with important hygiene practices like avoiding tap water. Guidelines for assessing refractive progression using axial length data were presented, using baseline myopia and axial length change ratios (see Table 1), helping practitioners predict likely myopia trajectories without ceasing ortho-k wear to measure refraction.
• Insights from Long-Term Studies: Long-term studies are essential for evaluating both the sustained efficacy and safety of myopia interventions, offering a complete picture of their impact over time. The 7-year MiSight 1 day clinical trial, the longest-running soft contact lens myopia control study in children, showed in excess of 50% control in refractive error and axial length progression, with no rebound effect after discontinuation.¹⁴ Additionally, safety data from this and subsequent studies support the long-term daily disposable hydrogel contact lens wear, with a study finding no negative impact on endothelial cell density, cell area, hexagonal cell percentage, or central cell thickness after 10 years of wear.¹⁵ This robust evidence supports MiSight 1 day as a safe, effective, and reliable long-term solution, highlighting the critical role of extended studies in establishing the “gold standard” for myopia interventions. 
• Combination Therapy Success: Sun-Young Shin from Seoul St. Mary's Hospital, Korea, presented a study on combining 0.05% atropine with MiSight 1 day lenses for myopia control in 142 children aged 7-13 years. While atropine alone reduced progression to 0.50D or less per year for 85% of patients, those with continued rapid progression (at least 0.75D or 0.25mm per year) received the combined treatment, slowing their progression to 0.28D and 0.13mm in the following year. Children with low to moderate myopia (<6D) experienced the greatest benefit.

Establishing a gold standard in myopia management is vital to ensuring that treatments are both effective and consistently applied. The discussions at APMMS 2024 highlighted the importance of rigorously assessing myopia control efficacy, understanding atropine concentrations and formulations, optimizing orthokeratology practices, and leveraging insights from long-term studies.

Table 1: Ratios for prediction of refractive progression using axial length data ratios, as presented by Dr Tzu-Hsun Tsai from National Taiwan University Hospital, Taiwan, at the 4th Asia Pacific Myopia Management Symposium, Seoul, Korea in October 2024. Dr Tsai cited generating these ratio guidelines from extensive clinical data, to support her colleagues in understanding ortho-k refraction trends without the need for a ‘wash-out’ period of ceasing ortho-k wear. 

Newer therapies for myopia management are still being explored. Among emerging pharmaceutical options, 7-methylxanthine (7-MX), a non-selective adenosine antagonist and caffeine derivative taken orally, appears promising due to its low toxicity and effectiveness in reducing myopia progression in both clinical and experimental studies.¹⁶ Light-based interventions are also being investigated; growing data on repeated low-level red-light (RLRL) therapy cites efficacy for wider populations, including those with high myopia¹⁷ and in combination for those with fast axial length progression under ortho-k monotherapy treatment.¹⁸ Blue light stimulation is also being examined for its ability to influence dopamine release, crucial for regulating eye growth, though further evidence is needed to confirm long-term efficacy and safety.¹⁹ Understanding the full potential of these new interventions and their implications for clinical practice remains essential we continue to investigate safe, effective methods for managing myopia progression.

Given the well-established benefits of myopia management,²⁰ gold standards for treatments should act as a guideline for clinicians to help provide the most effective interventions for their myopic patients. Understanding the evidence empowers clinicians to assess each treatment themselves. With newer therapies under investigation, this skillset remains crucial, allowing practitioners to evaluate emerging data critically and integrate innovative treatments safely into their practice.