Latest on Interventions for Myopia Management from IMC 2024

The 2024 International Myopia Conference (IMC) hosted in Sanya, China from 25th to 28th of September presented a wealth of insights into the latest technological, pharmacological, and optical advancements aimed at tackling myopia progression and mitigating associated risks. With a focus on both established and emerging treatments, this year’s presentations underscored the growing importance of personalized care, high-tech diagnostics and innovative pharmacological strategies in myopia management.

A key theme at IMC 2024 was the use of artificial intelligence (AI) and high-tech devices to enhance myopia research and treatment. These innovations represent a paradigm shift toward personalized myopia management, enabling practitioners to predict myopia onset more accurately and tailor interventions to individual patients.

Haotian Lin’s presentation highlighted the potential of big data and AI in myopia control, focusing on environmental analyses to identify key risk factors and predictive models for early myopia diagnosis. By simulating neural networks, Lin’s team uncovered patterns that support faster, more precise diagnostic outcomes. Additionally, he explained if the NVDI of schools (normalized difference vegetation index - a measure of greenness of environment) were increased by 0.3 or more, this could reduce myopia prevalence by 4% annually, highlighting the influence of environmental modifications in myopia prevention.

Aaron Nicholls introduced the Visual Environment Evaluation Tool (VEET), a wearable device supported by Reality Labs (a Meta subsidiary) that measures light exposure and working distance. Unlike traditional devices, VEET is spectacle-mounted and provides real-time, localized data on visual habits, allowing parents or practitioners to monitor a patient’s visual environment without using intrusive cameras. This level of precision is invaluable for studying how specific environmental factors contribute to myopia, and Reality Labs has partnered with the American Optometric Foundation to fund new myopia studies using VEET. 

Weiwei Dai also presented on Clouclip, an innovative device that clips onto children’s glasses to monitor their reading habits and lighting conditions. This technology not only aids in detecting poor visual habits but also gives real-time feedback, alerting wearers to adjust their reading distance. Such digital interventions represent a new wave of preventive tools that could improve myopia management outcomes in real time, especially when integrated with machine learning models to predict refraction needs based on environmental data.

Three studies presented at IMC 2024 explored the effects of low-concentration atropine on myopia in children. Yuanting Yang’s study showed that 0.05% atropine slowed myopia progression over six months and improved choroidal vascular thickness and blood flow. The LAMP2 study, presented by Xiu Juan Zhang, found that 0.05% atropine reduced myopia onset in Hong Kong children by 50% over two years, particularly in those with lower hyperopic reserves and myopic parents. Lastly, Ernest Kyei Nkansah’s indicated that 0.01% atropine was effective for axial, but not corneal, myopia in blue-eyed European children, suggesting targeted treatment based on myopia type. Together, these findings support the clinical significance of tailoring atropine treatments to individual myopia profiles for optimal outcomes.

Research on alternative drugs, such as the caffeine derivative 7-Methylxanthine (7-MX), also generated significant interest. Klaus Trier presented long-term data from Denmark, where 7-MX has been used since 2009 as an oral treatment for myopia. In a cohort of 314 children, with an average daily dose of 1.3 tablets, results indicated a dose-dependent reduction in myopic progression over six years, suggesting that 7-MX may offer a viable alternative to atropine for managing early-onset myopia. This study’s findings reflect the potential for new, more diverse pharmacological options tailored to individual patient needs.

Innovations in optical devices, such as spectacle and contact lenses designed to control myopia progression, were another major focus at IMC 2024. The conference showcased the latest developments in optical solutions, with discussions on design improvements, efficacy, and patient outcomes associated with these technologies.

David Atchison looked at the effects on peripheral and foveal vision of light incident obliquely through DIMS and HALT lenses. He found that peripheral optics associated with both lenses are detrimental to peripheral vision but not for the rotating eye in foveal vision, when looking through the treatment zones of either lens. How this impacts myopia treatment is unknown.

Jennifer Hill’s interim findings on Diffusion Optics Technology (DOT) lenses provided additional insights into optical interventions’ potential for sustained impact. Six months after DOT lens cessation, patients demonstrated no rebound effect, with treatment benefits retained. Hill’s study underscores DOT lenses’ long-term efficacy, suggesting that they offer a stable option for young children without the risk of rebound. Moreover, Zhi Chen shared the six-month results of a DOT lens trial in a Chinese cohort, where DOT lenses were compared with single-vision lenses. With significantly reduced axial elongation and myopic progression observed in DOT lens wearers, the findings reinforce the lenses’ efficacy and align with the CYPRESS study results, which demonstrated similar benefits in North American children.

IMC 2024 highlighted the potential of light-based therapies as innovative interventions in myopia management. The conference featured several studies examining how various wavelengths and intensities of light could impact myopia progression, offering a mix of promising results and safety considerations: 

• Bright Light Therapy (BLT) for Myopia Control: Ying Han presented a study on Bright Light Therapy (BLT), using a home-based desktop device emitting natural light levels. The device aims to replicate the benefits of outdoor exposure for myopia control, in combination with atropine and defocus lenses. While full one-year data is expected in the coming year, preliminary insights suggest potential in preventing myopia progression by integrating BLT into daily routines for schoolchildren.
• Repeated Low-Level Red Light Therapy (RLRL): RLRL, which utilizes low-intensity red light, has shown promise in preliminary findings presented by Neema Ghorbani Mojarrad. In a UK-based study, patients using RLRL as a primary or supplementary myopia treatment reported no adverse events over six months, with compliance challenges mainly due to unfamiliarity and financial constraints. The therapy is designed to stimulate choroidal thickening and increase blood flow, which may help slow axial elongation in myopic eyes.
• Safety and Standards for Red Light Devices: Lisa Greenfield Ostrin evaluated multiple red light laser devices, categorizing their safety levels. Class 1 devices, like Future Vision and Airdoc, were deemed safe, while Group 2 devices, including Eyerising and Sky-n1201, exceeded maximum permissible exposure (MPE) limits, warranting caution. These findings stress the importance of standardized safety guidelines for light-based myopia treatments, especially for prolonged use.
• Cyan Light as an Intervention: Ranjay Chakraborty discussed research on cyan light (490-520nm), which provides a balanced spectrum that spreads light energy across wavelengths, in contrast to blue light. Tests showed that cyan light led to a reduction in axial length (AL) and an increase in choroidal thickness (ChT) in young adults and children. The positive effects were stronger in emmetropic (non-myopic) children, suggesting cyan light’s potential as a protective measure against myopia onset rather than progression.
• Violet Light and the OPN5 Gene: Kazuo Tsubota explored the effects of violet light and its interaction with the OPN5 gene, which may play a role in myopia progression and choroidal health. While violet light-blocking lenses are commonly used, Tsubota's research suggests that violet light could have therapeutic effects, slowing progression and supporting ocular health without the adverse effects often associated with blue light. Ongoing studies involve violet light-emitting spectacle frames, and there is interest in violet light’s potential benefits for other conditions, such as Parkinson’s disease.
• Dopavision's MyopiaX: Ian Flitcroft presented findings from a 16-month trial on a digital device designed to stimulate dopamine release in the retina by illuminating the retinal blind spot. Known as MyopiaX, this device showed promising results in European children, reducing myopia progression without significant side effects. While MyopiaX is still in its experimental stages, it represents an exciting new direction in light therapy that targets specific neurochemical pathways to slow myopia.

IMC 2024 also featured groundbreaking research in scleral biomechanics, focusing on interventions designed to stabilize or strengthen the sclera to prevent excessive axial elongation, a major risk factor for high myopia. These experimental treatments, although still in the early stages, hold potential for managing progressive or high myopia where traditional treatments may be less effective.

Sally A. McFadden and Craig Boote described novel crosslinking methods which are activated by different wavelengths of light (already investigated for corneal CXL), which may have higher efficacy than riboflavin and UVA light for scleral crosslinking. Initial ex-vivo, in-vitro and animal model data leads to questions on who to treat, where and when to apply. The mechanisms involve microstructural changes of collagen remodelling, where high myopia results in scleral collagen lamellar realignment and mass redistribution.

Building on this research, Fengju Zhang presented data from a study on scleral cross-linking in guinea pigs, where scleral treatment in the eye’s equatorial region improved biomechanical properties and reduced axial elongation. While still in the experimental phase, these findings could lead to new treatments for high myopia, particularly in cases where standard interventions are insufficient. Zhang emphasized that cross-linking’s potential as a preventive treatment for complications associated with high myopia is promising, though further research is needed to determine its long-term safety and efficacy.

The IMC 2024 conference underscored a new era in myopia management, driven by technological, pharmacological, and clinical innovations that promise more effective, individualized treatment pathways. From AI-powered diagnostic tools and pharmacological solutions to advanced optical designs and biomechanical treatments, these innovations are reshaping the way eyecare practitioners approach myopia control.

As we continue to refine these tools and therapies, the future of myopia management looks increasingly promising. With targeted interventions and ongoing research, these advancements hold the potential to slow myopia progression more effectively, reduce associated risks, and improve long-term outcomes for patients worldwide. By integrating these breakthroughs into clinical practice, eyecare practitioners can offer a more holistic and personalized approach to managing this growing global health challenge.