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Xu Cheng, Noel A Brennan, Youssef Toubouti, Mark A Bullimore; Modelling of cumulative treatment efficacy in myopia progression interventions. Invest. Ophthalmol. Vis. Sci. 2019;60(9):4345.
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Multiple publications report treatment efficacy data for interventions to control myopia progression. Evidence (Brennan & Cheng, 2018 Eye & Contact Lens, e-pub ahead of print) suggests thati. efficacy is best described as absolute rather than relative reduction in axial elongation across the progression range, andii. relative treatment effect slows over time,indicating that quoted percentage treatment estimates are demonstrably misleading. Here, we perform different regression models to estimate maximum cumulative treatment efficacy of three interventions of interest.
We reviewed 56 studies reporting myopia control interventions. Analysis was restricted to unique data sets, treatments with efficacy greater than 40% at one timepoint in the first 12 months, studies reporting axial length data and treatments with a minimum of 10 data points contributing to the analysis (treatment effect in reduction of axial elongation by time). Eleven orthokeratology (OK), six soft multifocal contact lens (SMCL) and four spectacle (Spec) data sets remained for analysis. Pharmaceuticals and outdoor activity did not meet criteria for inclusion. Linear, exponential and logarithmic regression models were explored.
Logarithmic modelling provided the best overall fit (OK R2=0.74, SMCL R2=0.73, Spec R2=0.30). Projected average maximum absolute treatment efficacy is reduction of axial elongation by 0.47 mm at 7 years (see figure 1). Different treatments can be regarded as clinically equivalent. On average, 48% of the projected 7-year treatment efficacy occurred in the first year.
The projected best-case treatment effect over 7 years for any individual undergoing myopia control is 0.47 mm, which is equivalent to little more than one diopter. This estimate is lower than previously anticipated but can still provide meaningful reductions in risk of myopia-associated disease. This information is important to moderate expectations for practitioners and patients with respect to likely cumulative outcomes of myopia control treatments.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
Figure 1: Logarithmic fit to cumulative absolute myopia control efficacy for each of OK, SMCL and Spec data sets. (Broken lines represent extrapolation beyond the range of available data).
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