近视控制报告综述和介绍（英文版）.pdf

Special Issue IMI Myopia Control Reports Overview and Introduction James S. Wolffsohn, 1 Daniel Ian Flitcroft, 2 Kate L. Gifford, 3 Monica Jong, 4 Lyndon Jones, 5 Caroline C. W. Klaver, 6 Nicola S. Logan, 1 Kovin Naidoo, 7 Serge Resnikoff, 4 Padmaja Sankaridurg, 4 Earl L. Smith III, 8 David Troilo, 9 and Christine F. Wildsoet 10 1 Ophthalmic Research Group, Aston University, Birmingham, United Kingdom 2 Childrens University Hospital, University College Dublin and Dublin Institute of Technology, Dublin, Ireland 3 Private Practice and Queensland University of Technology, Queensland, Australia 4 Brien Holden Vision Institute and School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia 5 Centre for Ocular Research j.s.w.wolffsohnaston.ac.uk. Submitted: October 16, 2018 Accepted: October 20, 2018 Citation: Wolffsohn JS, Flitcroft DI, Gifford KL, et al. IMI Myopia control reports overview and introduction. Invest Ophthalmol Vis Sci. 2019;60:M1M19. doi/ 10.1167/iovs.18-25980 With the growing prevalence of myopia, already at epidemic levels in some countries, there is an urgent need for new management approaches. However, with the increasing number of research publications on the topic of myopia control, there is also a clear necessity for agreement and guidance on key issues, including on how myopia should be defined and how interventions, validated by well-conducted clinical trials, should be appropriately and ethically applied. The International Myopia Institute (IMI) reports the critical review and synthesis of the research evidence to date, from animal models, genetics, clinical studies, and randomized controlled trials, by more than 85 multidisciplinary experts in the field, as the basis for the recommendations contained therein. As background to the need for myopia control, the risk factors for myopia onset and progression are reviewed. The seven generated reports are summarized: (1) Defining and Classifying Myopia, (2) Experimental Models of Emmetropization and Myopia, (3) Myopia Genetics, (4) Interventions for Myopia Onset and Progression, (5) Clinical Myopia Control Trials and Instrumentation, (6) Industry Guidelines and Ethical Considerations for Myopia Control, and (7) Clinical Myopia Management Guidelines. Keywords: myopia control, myopic progression, clinical guidelines, definition, interventions 1. PREVIOUS GUIDANCE ON MYOPIA CONTROL W hile eye care professionals have put forward views on how to slow myopia progression for centuries, the first evidence-based review to make clinical recommendations appears to have been in 2002, based on the only 10 randomized controlled trials to have been conducted at that time. This report concluded that bifocal spectacle lenses and soft contact lenses are not recommended for slowing the progression of myopia in children, nor is the routine use of atropine eye drops. 1 Since that time, more than 170 peer-reviewed articles on myopia control have been published, making it difficult for clinicians to keep abreast of the latest findings and how they should affect the optimum management of their patients. Few, if any, professional bodies have issued documented guidance on the treatment of myopia (in contrast to the correction of the refractive error). While eye care practitioners from across the globe seem concerned about the increasing levels of myopia in their practices, especially in Asia, and report relatively high levels of activity in controlling myopia, most still prescribe single-vision spectacles and contact lenses to their progressing myopes. 2 Hence, there is a need for evidence-based interven- tion strategies, informed by animal model and genetic studies, with agreement on how myopia should be defined, validated by well-designed and ethically applied clinical trials. The Interna- tional Myopia Institute (IMI) reports represent the work of more than 85 multidisciplinary experts in the field, who set out to critically review, synthesize, and summarize the research evidence to date (Table 1), and serve to inform both clinical practice and future research. 2. THE IMI REPORT GENERATION PROCESS As highlighted in the accompanying editorial, the foundation of the IMI was an outcome of the World Health Organization associated global scientific meeting on Myopia, held at the Brien Holden Vision Institute in Sydney, Australia, in 2015. As part of the IMIs mission to address identified key issues related to myopia, they approached a group of experts to produce two white papers in November 2015, one focused on Myopia Interventions (optical, pharmaceutical, and behavioral/environ- mental) and the other on Definitions and Classification of Copyright 2019 The Authors iovs.arvojournals j ISSN: 1552-5783 M1 This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. Downloaded from iovs.arvojournals on 03/02/2019 TABLE 1. International Myopia Institute (IMI) Report Subcommittee Members IMI Defining and Classifying Myopia Daniel Ian Flitcroft, MBBS, PhD Childrens University Hospital, University College Dublin and Dublin Institute of Technology, Dublin, Ireland Mingguang He, MD, PhD Centre for Eye Research Australia; Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, Australia Jost B. Jonas, MD Department of Ophthalmology, Medical Faculty Mannheim of the Ruprecht-Karis-University Heidelberg, Mannheim, Germany Monica Jong, PhD Brien Holden Vision Institute and School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia Kovin Naidoo, OD, PhD African Vision Research Institute, University of KwaZulu-Natal, Durban, South Africa Kyoko Ohno-Matsui, MD, PhD Tokyo Medical and Dental University, Tokyo, Japan Jugnoo Rahi, MBBS, PhD Institute of Child Health, University College London and Great Ormond Street Hospital for Children, London, United Kingdom Serge Resnikoff, MD, PhD Brien Holden Vision Institute and School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia Susan Vitale, PhD, MHS National Eye Institute, National Institutes of Health, Bethesda, Maryland, United States Lawrence Yannuzzi, MD The Vitreous, Retina, Macula Consultants of New York; The LuEsther T. Mertz Retina Research Center, Manhattan Eye, Ear, and Throat Hospital, New York, New York, United States IMI Experimental Models of Emmetropization and Myopia David Troilo, PhD SUNY College of Optometry, State University of New York, New York, New York, United States Earl L. Smith III, OD, PhD College of Optometry, University of Houston, Houston, Texas, United States Debora Nickla, PhD Biomedical Sciences and Disease, New England College of Optometry, Boston, Massachusetts, United States Regan Ashby, PhD University of Canberra, Health Research Institute, Canberra, Australia Andrei Tkatchenko, MD, PhD Department of Ophthalmology, Columbia University, New York, New York, United States Lisa A. Ostrin, OD, PhD College of Optometry, University of Houston, Houston, Texas, United States Tim J. Gawne, PhD College of Optometry, University of Alabama Birmingham, Birmingham, Alabama, United States Machelle T. Pardue, PhD Biomedical Engineering, Georgia Tech College of Engineering, Atlanta, Georgia, United States Jody A. Summers, PhD College of Medicine, University of Oklahoma, Oklahoma City, Oklahoma, United States TABLE 1. Continued Chea-su Kee, BSc Optom, PhD School of Optometry, The Hong Kong Polytechnic University, Hong Kong, Special Administrative Region, China Falk Schroedl, MD Department of Ophthalmology and Anatomy, Paracelsus Medical University, Salzburg, Austria Siegfried Wahl, PhD Institute for Ophthalmic Research, University of Tuebingen, Zeiss Vision Science Laboratory, Tuebingen, Germany Lyndon Jones, PhD, DSc, FCOptom Centre for Ocular Research however, it was Sek Jin Chew in collaboration with Josh Wallman who was instru- mental in reviving the conference in 1990. The site-hosting organization and organizing committee change for each meeting, thus ensuring diversity at many levels. Chew and Wallman re-established the IMC meetings, using local organiz- ing committees beginning in 1990, adopting the numbering based on the original Myopia International Research Founda- tion sponsored meetings. Experts in the field (as identified by the IMI and IMC) were approached for expressions of interest to contribute to one of the reports of their choice. An inclusive approach was adopted, while limiting the number of participants from any one research group to ensure a balanced representation. Discussion between the chairs resulted in report selection for each individual, based on their expertise. The then IMI steering board (David Friedman, Mingguang He, Jonas Jost, Ohno- Matsui Kyoko, Kovin Naidoo chair, Jason Nichols, Serge Resnikoff, Earl Smith, Hugh Taylor, Christine Wildsoet, James Wolffsohn, Tien Wong) and the chairs met at ARVO in May 2017 in Baltimore. The steering committee was responsible for developing the specific aims and mission, along with the strategy for these reports, and agreed on the topics, conflict of interest policy, chairs, and committee members. The chairs (Table 3) presented to a special session at the IMC in Birmingham, United Kingdom, in September 2017 and the report committee membership was expanded based on further interest and feedback. The report committees also met to finalize their papers outline and to allocate the workload immediately after the meeting. Shortly after this meeting an agreement was put in place to publish all the reports in a special issue of Investigative Ophthalmology range, 3 6 years) has increased significantly from 2.3% to 6.3% over 10 years. The incidence of myopia increases dramatically in at-risk populations from approximately 6 years of age. 24 Previous studies have linked this change with the beginning of primary school education, and a link between the intensity of the education system and myopia onset has been deter- mined. 10,24,25 The annual incidence of myopia onset is reasonably constant between the ages of approximately 7 and 15 years in Chinese populations and, by the age of 18 years, some 80% of the urban-based Han population in China is myopic, regardless of geographic locality. 17,2628 Singapore, Hong Kong, Taiwan, South Korea, and Japan show similar patterns, although incidence may be higher in Singapore, Taiwan, and Hong Kong at younger ages. 2937 A systematic review and meta-analysis by Rudnicka et al. 37 has reported an increase of 23% in the prevalence of myopia over the last decade among East Asians. In Western societies and countries other than those mentioned above, the incidence of myopia onset during childhood years, and thus the corresponding prevalence, is much lower. 37 Most of the myopia cases identified in one study in the United Kingdom was considered to be late onset (16 years or older). 38 Figure 1 illustrates the marked difference in prevalence between East Asian and white children from the meta-analysis of Rudnicka et al. 37 Of ethnicities reported in the meta-analysis, populations in south Asian, black populations in Africa, and Hispanics tended to have lower prevalence than Western white populations, with South-East Asians, black populations not in Africa, Middle Eastern/North African populations, Native Hawaiians, and American Indians showing higher prevalence than white populations, but still much lower than East Asians. 37 FIGURE 1. Modeled prevalence of myopia by age for East Asian and white children and teenagers from a systematic review and quantitative meta-analysis fitted to the year 2005. Graph created from data in Table 3 of Rudnicka et al. 37 TABLE 3. Report Committees, Chairs, and Harmonizers Report Subcommittee Chair(s) Harmonizer(s) Defining and Classifying Myopia Ian Flitcroft Earl Smith Experimental Models of Emmetropization and Myopia David Troilo provided in the public domain by the National Institutes of Health, Bethesda, MD, USA) and replotted, and the best fit line for Asians was taken from the equation provided in their article. Data for Chua et al. 48 were obtained by averaging progression rates for given ages from their Figure 2. IMI Myopia Control Reports Overview and Introduction IOVS j Special Issue j Vol. 60 j No. 3 j M6 Downloaded from iovs.arvojournals on 03/02/2019 3.4 High Myopia One of the major ethical challenges for practitioners is accurate identification of those at risk of becoming highly myopic or, at the very least, of those whose myopia is progressing at an unacceptably fast rate. Few analyses are available on this topic, but the breakdown by Chua et al. 48 probably represents the most comprehensive data available. They have found age of onset of myopia to be the strongest predictor of high myopia among Singaporean children. 48 As expected, duration of myopia progression was also important in predicting high myopia. For children with high myopia at age 11 years, there was an 87% chance that the child became myopic at 7 years of age or younger or had a duration of myopia progression of 4 years or more. Reports from other countries (Denmark, Argentina, United Kingdom) reliably reproduce this observa- tion. 5557 However, in contrast to the report by Chua and colleagues, 48 Williams et al. 57 have found that age of onset only accounts for a modest proportion (approximately 15%) of the variance in severity of myopia. 3.5 Adult-Onset Myopia and Progression Most of the myopia cases in one study in Britain were considered to be late onset (16 years or older). 38 Although myopia onset past the adolescent stage of life is of clinical interest and has shown an association with environmental factors, 58 eye care practitioners are generally more concerned from an ethical standpoint with identifying patients at risk for development of higher degrees of myopia, which typically involves juvenile-onset myopia and its associated potential to progress to sight-threatening pathology. The prevailing perception is that myopia stabilizes in the late teenage years. 41 Certainly, annual progression in most myopic patients slows with time and for many myopes whose condition has progressed through the teenage years, myopia will stabilize before they reach 20 years of age. However, there are patients whose myopia will continue to progress through adult years. 5860 These patients include those doing intense near work, especially students, and those who have higher degrees of myopia. Continued assessment of refraction and initiation of treatment in patients showing continued progres- sion are warranted. Higher levels of myopia will result from continued progression through adulthood, placing these individuals at higher risk for development of myopia-associated pathologies. 3.6 Genetic and Environmental Risk Risk factors for myopia onset have been identified and included in a number of multivariate