Strategies and attitudes on the management of myopia in clinical practice in Spain - 2022 update

Objective This study analyses strategies and attitudes on myopia management reported by eye care practitioners (ECP) from Spain in 2022. Methods A questionnaire was distributed to ECPs worldwide via the internet through professional associations. The questionnaire was distributed by email to all registered Spanish optician-optometrists. Questions examined awareness of increasing myopia prevalence; perceived efficacy; uptake of available approaches; and reasons preventing further uptake of specific approaches. Results Of 3,107 practitioners who participated in the study, 380 were Spanish ECPs. Using a 10-point scale, Spanish practitioners reported less concern about increasing pediatric myopia (8.3 ± 1.6) compared to ECP's worldwide (8.5 ± 1.9) (p < 0.001), but similar level of clinical activity in myopia control (7.8 ± 2.3 vs. 7.5 ± 2.5, respectively) (p > 0.05); however, around half of all prescribed treatments were single-vision distance spectacles/contact lenses both in Spain and in most regions, with Spanish practitioners prescribing less single-vision spectacles than African and Asian (p < 0.001), but more than Australasian practitioners (p = 0.04). No significant differences were found between Spain and the other regions in the perceived efficacy of combined therapy, orthokeratology, and outdoor time (p > 0.05), with the former being perceived as the most effective myopia control method followed by orthokeratology. No significant differences were found between Spain and the world's average in factors preventing the prescription of myopia control approaches (p > 0.05). Spanish practitioners reported that embracing myopia management has a positive, but lower impact on customer loyalty, practice revenue and job satisfaction compared with the other regions (all p < 0.001). Conclusions Myopia control is increasing, although around half of practitioners still prescribe single-vision distance spectacles/contact lenses to. ... . (AU)

Strategies and attitudes on the management of myopia in clinical practice in Spain - 2022 update.

OBJECTIVE: This study analyses strategies and attitudes on myopia management reported by eye care practitioners (ECP) from Spain in 2022. METHODS: A questionnaire was distributed to ECPs worldwide via the internet through professional associations. The questionnaire was distributed by email to all registered Spanish optician-optometrists. Questions examined awareness of increasing myopia prevalence; perceived efficacy; uptake of available approaches; and reasons preventing further uptake of specific approaches. RESULTS: Of 3,107 practitioners who participated in the study, 380 were Spanish ECPs. Using a 10-point scale, Spanish practitioners reported less concern about increasing pediatric myopia (8.3 ± 1.6) compared to ECP's worldwide (8.5 ± 1.9) (p < 0.001), but similar level of clinical activity in myopia control (7.8 ± 2.3 vs. 7.5 ± 2.5, respectively) (p > 0.05); however, around half of all prescribed treatments were single-vision distance spectacles/contact lenses both in Spain and in most regions, with Spanish practitioners prescribing less single-vision spectacles than African and Asian (p < 0.001), but more than Australasian practitioners (p = 0.04). No significant differences were found between Spain and the other regions in the perceived efficacy of combined therapy, orthokeratology, and outdoor time (p > 0.05), with the former being perceived as the most effective myopia control method followed by orthokeratology. No significant differences were found between Spain and the world's average in factors preventing the prescription of myopia control approaches (p > 0.05). Spanish practitioners reported that embracing myopia management has a positive, but lower impact on customer loyalty, practice revenue and job satisfaction compared with the other regions (all p < 0.001). CONCLUSIONS: Myopia control is increasing, although around half of practitioners still prescribe single-vision distance spectacles/contact lenses to young/progressive myopes. Combined therapy followed by orthokeratology were perceived as the most effective treatments. Embracing myopia management improved patient loyalty and job satisfaction.

Opportunities and threats to contact lens practice in Spain / Oportunidades y amenazas para la práctica de lentes de contacto en España

Objective: An international survey evaluated the opportunities and threats related to contact lens practice reported by eye care professionals worldwide. This study reports on the results specifically found in Spain and how these compare with those from other regions of the world. Methods: A questionnaire was distributed to eye care practitioners around the world through professional associations. The questionnaire consisted of 9, 5 and 12 questions about opportunities, interventions, and potential threats related to contact lens practice, respectively. Results: A total of 2,408 responses were obtained from practitioners worldwide, of which 436 responses were obtained from Spanish practitioners. Spain was found among the regions with the highest perception of opportunities (median: 6.5/10) along with Australasia, North America, Europe, and South America. Spanish (median: 7.3/10), along with South American practitioners, also reported the highest perception of threats. Continuously updating of knowledge/skills, recommending contact lens wearing options to potential patients, creating an efficient recall system for follow-up examinations and being competent in managing contact lens-related complications were reported as important interventions for contact lens practice growth by Spanish eye care practitioners. Conclusions: Spain is one of the regions in the world with the highest perception of both opportunities and threats regarding future contact lens practice. As such, Spanish practitioners consider it important to continuously update knowledge/skills and to recommend and educate patients on the benefits of contact lens wear. Online sales were found to be one of the most important concerns reported by both Spanish and eye care practitioners worldwide.(AU)

IMI 2023 Digest.

Myopia is a dynamic and rapidly moving field, with ongoing research providing a better understanding of the etiology leading to novel myopia control strategies. In 2019, the International Myopia Institute (IMI) assembled and published a series of white papers across relevant topics and updated the evidence with a digest in 2021. Here, we summarize findings across key topics from the previous 2 years. Studies in animal models have continued to explore how wavelength and intensity of light influence eye growth and have examined new pharmacologic agents and scleral cross-linking as potential strategies for slowing myopia. In children, the term premyopia is gaining interest with increased attention to early implementation of myopia control. Most studies use the IMI definitions of ≤-0.5 diopters (D) for myopia and ≤-6.0 D for high myopia, although categorization and definitions for structural consequences of high myopia remain an issue. Clinical trials have demonstrated that newer spectacle lens designs incorporating multiple segments, lenslets, or diffusion optics exhibit good efficacy. Clinical considerations and factors influencing efficacy for soft multifocal contact lenses and orthokeratology are discussed. Topical atropine remains the only widely accessible pharmacologic treatment. Rebound observed with higher concentration of atropine is not evident with lower concentrations or optical interventions. Overall, myopia control treatments show little adverse effect on visual function and appear generally safe, with longer wear times and combination therapies maximizing outcomes. An emerging category of light-based therapies for children requires comprehensive safety data to enable risk versus benefit analysis. Given the success of myopia control strategies, the ethics of including a control arm in clinical trials is heavily debated. IMI recommendations for clinical trial protocols are discussed.

Strategies and attitudes on the management of myopia in clinical practice in Spain

Objective: In 2019, an international survey was conducted to evaluate strategies and attitudes in the management of myopia in clinical practice worldwide. This study reports on the results found in Spain and how these results compare with those from other regions of the world.MethodsA self-administrated, internet-based questionnaire was distributed to eye care professionals around the world through professional associations. The questions examined were based on the available strategies and their use.ResultsA total of 173 Spanish optometrists, of the 1,336 practitioners from the five different continents who participated in the study, responded to the online survey. Spain, Asia and South America were found among the regions with the highest concern regarding the increased incidence of myopia (p ≤ 0.001). However, in these regions, the prescription of single-vision spectacles and single-vision contact lenses continues to be the main methods of visual correction prescribed to young myopic patients (p ≤ 0.001). Spanish practitioners, like those from other regions, considered orthokeratology to be the most effective treatment to control myopia progression (p ≤ 0.001). The major reasons why Spanish practitioners were not prescribing myopia control strategies were increased cost, inadequate information and unpredictable outcomes (p < 0.05).ConclusionsThe uptake of myopia control methods by Spanish practitioners is relatively low, despite the increase in the prevalence of paediatric myopia as well as increased concern and perceived clinical activity in the area in recent years. (AU)

Strategies and attitudes on the management of myopia in clinical practice in Spain.

OBJECTIVE: In 2019, an international survey was conducted to evaluate strategies and attitudes in the management of myopia in clinical practice worldwide. This study reports on the results found in Spain and how these results compare with those from other regions of the world. METHODS: A self-administrated, internet-based questionnaire was distributed to eye care professionals around the world through professional associations. The questions examined were based on the available strategies and their use. RESULTS: A total of 173 Spanish optometrists, of the 1,336 practitioners from the five different continents who participated in the study, responded to the online survey. Spain, Asia and South America were found among the regions with the highest concern regarding the increased incidence of myopia (p ≤ 0.001). However, in these regions, the prescription of single-vision spectacles and single-vision contact lenses continues to be the main methods of visual correction prescribed to young myopic patients (p ≤ 0.001). Spanish practitioners, like those from other regions, considered orthokeratology to be the most effective treatment to control myopia progression (p ≤ 0.001). The major reasons why Spanish practitioners were not prescribing myopia control strategies were increased cost, inadequate information and unpredictable outcomes (p < 0.05). CONCLUSIONS: The uptake of myopia control methods by Spanish practitioners is relatively low, despite the increase in the prevalence of paediatric myopia as well as increased concern and perceived clinical activity in the area in recent years.

Opportunities and threats to contact lens practice in Spain.

OBJECTIVE: An international survey evaluated the opportunities and threats related to contact lens practice reported by eye care professionals worldwide. This study reports on the results specifically found in Spain and how these compare with those from other regions of the world. METHODS: A questionnaire was distributed to eye care practitioners around the world through professional associations. The questionnaire consisted of 9, 5 and 12 questions about opportunities, interventions, and potential threats related to contact lens practice, respectively. RESULTS: A total of 2,408 responses were obtained from practitioners worldwide, of which 436 responses were obtained from Spanish practitioners. Spain was found among the regions with the highest perception of opportunities (median: 6.5/10) along with Australasia, North America, Europe, and South America. Spanish (median: 7.3/10), along with South American practitioners, also reported the highest perception of threats. Continuously updating of knowledge/skills, recommending contact lens wearing options to potential patients, creating an efficient recall system for follow-up examinations and being competent in managing contact lens-related complications were reported as important interventions for contact lens practice growth by Spanish eye care practitioners. CONCLUSIONS: Spain is one of the regions in the world with the highest perception of both opportunities and threats regarding future contact lens practice. As such, Spanish practitioners consider it important to continuously update knowledge/skills and to recommend and educate patients on the benefits of contact lens wear. Online sales were found to be one of the most important concerns reported by both Spanish and eye care practitioners worldwide.

Differences in Practitioner Experience, Practice Type, and Profession in Attitudes Toward Growing Contact Lens Practice.

OBJECTIVE: To investigate eye care practitioners' attitudes and perceptions toward potential interventions that can enhance contact lens (CL) practice across the world, and how this is influenced by their practice setting. METHODS: A self-administered, anonymized survey was constructed in English and then forward and backward translated into six more languages. The survey was distributed online via social media platforms and mailing lists involving reputed international professional bodies. RESULTS: In total, 2,222 responses from 27 countries with sufficient responses were analyzed (53% females, median age- 37 years). Most of the respondents were optometrists (81.9%) and 47.6% were from stand-alone/independent practices. Median working experience in CL prescribing was 11.0 years (IQR: 18.0, 4-22 years). Over two-third of them declared themselves to be very hopeful (22.9%) or hopeful (45.1%) about the future of their CL practice. Among the potential interventions proposed, continuous update of knowledge and skills and competently managing CL-related complications were rated the most important (median score: 9/10 for each). Practitioners working in national/regional retail chains expressed higher proactivity in recommending CLs (9/10) than those in local chains, hospitals, and universities (for all 8/10, P <0.05). National differences were also identified in eye care practitioner attitudes and perceptions ( P <0.05). CONCLUSIONS: The study provided important information to delineate a variety of elements characterizing CL practice across the world. These insights can serve as a basis to design strategies at national and international levels.

Keratoconus: An updated review.

Keratoconus is a bilateral and asymmetric disease which results in progressive thinning and steeping of the cornea leading to irregular astigmatism and decreased visual acuity. Traditionally, the condition has been described as a noninflammatory disease; however, more recently it has been associated with ocular inflammation. Keratoconus normally develops in the second and third decades of life and progresses until the fourth decade. The condition affects all ethnicities and both sexes. The prevalence and incidence rates of keratoconus have been estimated to be between 0.2 and 4,790 per 100,000 persons and 1.5 and 25 cases per 100,000 persons/year, respectively, with highest rates typically occurring in 20- to 30-year-olds and Middle Eastern and Asian ethnicities. Progressive stromal thinning, rupture of the anterior limiting membrane, and subsequent ectasia of the central/paracentral cornea are the most commonly observed histopathological findings. A family history of keratoconus, eye rubbing, eczema, asthma, and allergy are risk factors for developing keratoconus. Detecting keratoconus in its earliest stages remains a challenge. Corneal topography is the primary diagnostic tool for keratoconus detection. In incipient cases, however, the use of a single parameter to diagnose keratoconus is insufficient, and in addition to corneal topography, corneal pachymetry and higher order aberration data are now commonly used. Keratoconus severity and progression may be classified based on morphological features and disease evolution, ocular signs, and index-based systems. Keratoconus treatment varies depending on disease severity and progression. Mild cases are typically treated with spectacles, moderate cases with contact lenses, while severe cases that cannot be managed with scleral contact lenses may require corneal surgery. Mild to moderate cases of progressive keratoconus may also be treated surgically, most commonly with corneal cross-linking. This article provides an updated review on the definition, epidemiology, histopathology, aetiology and pathogenesis, clinical features, detection, classification, and management and treatment strategies for keratoconus.

A novel quantitative evaluation of deposits adhered to worn orthokeratology contact lenses.

PURPOSE: Total deposition and deposition along the reverse curve of heavily deposited worn orthokeratology (OK) lenses were quantitatively evaluated using two novel imaging methods. In addition, the cleaning efficacies of a contact lens cleaning solution for daily use and an intensive cleaner and protein remover solution were evaluated using the same two methods. STUDY DESIGN: Experimental study. METHODS: Twenty-six worn reverse-geometry OK lenses (MY Emerald, Technopia) were photographed for use in three experiments: (1) total deposition was assessed before and after cleaning with two cleaning solutions; (2) in addition to assessing total lens deposition, the feasibility of measuring the thickness of lens deposits along the reverse curve was assessed; and (3) after confirming it was possible to assess the thickness of lens deposits, the thickness of deposits was assessed before and after cleaning with a daily contact lens cleaning solution (O2 Care®, Menicon Co., Ltd.) and an intensive cleaner and protein remover (Progent®, Menicon Co., Ltd.). Total lens deposition was assessed as the total volume of cloudiness over the lens surface in terms of volume per unit pixel. Cross-sectional images were taken from worn OK lenses to assess the thickness of lens deposits on the reverse curve as the area of deposits/horizontal length. RESULTS: Significant differences in total deposition were found between the three cleaning conditions for the twenty worn OK lenses (mean total deposition ± SD for pre-cleaning = 0.209 ± 0.076; post-daily cleaning = 0.124 ± 0.078; and post-intensive cleaning = 0.045 ± 0.046) (p < 0.001). Mean total deposition and thickness of the deposits along the reverse curve for the three lenses from the second experiment were 0.310 and 6.0 mm, respectively. The mean thicknesses of lens deposits found in the third experiment under the 3 conditions were as follows: pre-cleaning = 3.4 µm; post-daily cleaning = 2.3 µm; and post-intensive cleaning = 0.0 µm. CONCLUSION: The two novel imaging methods used in this study detected significant amounts of deposits attached to worn OK lenses and were sensitive enough to detect a reduction in deposition following the use of the two cleaning solutions tested. Furthermore, these methods could visualize and quantify the thickness of lens deposits along the reverse curve.

Opportunities and threats to contact lens practice: A global survey perspective.

AIM: To understand the views of contact lens (CL) practitioners across the globe regarding what they perceive as opportunities and threats in CL practice. METHODS: A self-administered anonymised questionnaire, constructed in English and translated in six more languages, was distributed through reputed international professional bodies and academic institutions worldwide. The questionnaire included items on demographic characteristics, type of practice, and questions designed to explore practitioners' perspective on the future of their CL practice over the next five years. RESULTS: A total of 2408 valid responses were analysed. Multifocal CLs for presbyopia, CLs for myopia control, use of daily disposable (DD) CLs for occasional wear, and biocompatible materials to improve comfort were identified as promising areas of opportunities by practitioners (all 8/10). Respondents from North America, and Europe valued DDCLs for occasional wear moderately more favourable (Median: 9/10 for all) as compared to colleagues in Asia (Median: 8/10, p < 0.001), South America (Median: 8/10, p < 0.01), and Africa (Median: 8/10p < 0.01). Multifocal CLs for presbyopia was perceived as a better opportunity by practitioners in North America and Europe (Median: 9/10 for both), as well as in Australasia (Median: 8/10), in comparison to Asia, Africa, and Middle East (for all Median: 6/10, p < 0.001). Practitioners expressed concerns about the availability of CLs and CL prescriptions online without direct professional involvement (both 9/10). CONCLUSIONS: Overall, the most appealing opportunities for CL practice growth were identified in occasional use of DD CLs, biocompatible materials to reduce CL discomfort, multifocal CLs for presbyopia correction and management of myopia control with CLs. Lack of regulation in CL sales, especially online, seemed to be a constant threat. The insights from this study can be used to design targeted strategies to enhance CL practice across the globe and in specific geographical areas.

CLEAR - Contact lens wettability, cleaning, disinfection and interactions with tears.

Contact lens materials have undergone significant changes over the past 20 years, particularly with respect to the introduction of silicone hydrogel materials. Whilst this development addressed hypoxic issues, other important areas relating to contact lens success, notably comfort, require further research. Contact lens wettability remains a crucially important part of biocompatibility. Contact lenses can be made more wettable by incorporation of surfactants into blister packs, internal wetting agents, surface treatments or care solutions. However, there remains no clear association between contact lens wettability and comfort, making it challenging to determine the potential for these approaches to be of significant clinical benefit. Most contact lenses are used on a daily wear, reusable basis, which requires them to be disinfected when not worn. The ideal disinfecting solution would also improve comfort during wear. However, balancing these requirements with other factors, including biocompatibility, remains a challenge. Soft lens materials invariably take up and subsequently release certain components of disinfecting solutions onto the ocular surface. This may affect tear film stability and the normal ocular microbiome, and further research is needed in this area to determine whether this has any affect on comfort. Finally, contact lens materials sorb components of the tear film, and these interactions are complex and may change the biochemistry of the tear film, which in turn may affect their comfort. In conclusion, the interaction between lens materials, tear film and disinfection solution plays an important role in the biocompatibility of lenses. However, the exact role and whether this can be altered to improve biocompatibility and comfort during wear remains debatable. This report summarises the best available evidence to examine this complex relationship and the opportunities for practitioners to enhance in-eye comfort of contemporary lenses, along with providing suggestions for areas of study that may provide further information on this topic.

Optimizing correction of coma aberration in keratoconus with a novel soft contact lens.

PURPOSE: To report on a second-generation prototype contact lens (modified lens) with enhanced optics to correct coma aberration and compare its performance with that of the prototype contact lens (conventional lens) used to optimise correction of coma aberration in keratoconus (KC). METHODS: Both lenses were designed as a set of standardised soft contact lenses (SCLs) with asymmetric powers along the posterior surface. The modified lens differs from the conventional lens in that the optical zone is decentred superiorly by 0.7 mm. The on-eye performance was compared between the SCLs and no-lens wearing in terms of manifest refraction, corrected distance visual acuity (CDVA), ocular aberrations, subjective quality of vision, and on-eye lens position relative to the pupil. RESULTS: Thirty-four KC eyes were included. SCLs significantly decreased coma aberration compared to no-lens wear (none, 0.68 ± 0.27 µm; conventional lens, 0.37 ± 0.28 µm; modified lens, 0.19 ± 0.15 µm; P < 0.001), with the reduction in coma aberration being significantly greater with the modified lens than with the conventional lens (P = 0.018). No significant difference in manifest refraction or CDVA was found among the three conditions. Quality of vision was significantly better with the modified lens than with no SCL wear (P < 0.05) but no differences were found between the SCLs. The on-eye optical center position relative to the pupil was closer to the pupil centre using the modified lens than the conventional lens (P < 0.001). CONCLUSION: Optimisation of the location of the optical zone in a standardised asymmetric SCL improves correction of coma aberrations and on-eye optical centration.

International survey of contact lens fitting for myopia control in children.

PURPOSE: To determine the extent of contact lens fitting for myopia control (MC) in children (defined as ≤ 17 years of age) worldwide and to characterize the associated demographics and fitting patterns. METHODS: Survey forms were sent to contact lens fitters in 66 countries between January and March every year for eight consecutive years (2011-2018, inclusive). Practitioners were asked to record data relating to the first 10 contact lens fits performed after receiving the survey form. Data were analysed for those countries reporting ≥ 100 contact lens fits to children. RESULTS: Data were analysed for 535 MC fits and 23,295 other (non-MC) lens fits undertaken in 31 countries reporting ≥ 100 contact lens fits to children, with 52.1% of MC fits and 12.0% of non-MC fits being with rigid lenses (p < 0.0001). Overall, MC lenses represented 2.3% of all contact lens fits to children, with significant differences between nations (p < 0.0001), ranging from no MC fits recorded in the Czech Republic, Greece, Japan, South Korea and Puerto Rico, to 24.9% in Austria. There has been an increase in contact lens fitting for MC over the survey period (p < 0.0001). MC contact lenses were fitted to younger children compared to non-MC lenses (MC, median 13 years vs. non-MC, median 15 years) (p < 0.0001). There was no sex bias in the fitting of MC lenses (p = 0.89). CONCLUSIONS: MC lenses are currently being prescribed for younger children in equal measure in terms of soft vs. rigid lenses and males vs. females. The extent of MC fitting is low and varies between nations. The gradual increase in MC fitting throughout the survey period perhaps reflects growing concerns among practitioners over the myopia epidemic.

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 ±â€¯1.6; p < 0.001) in Asia and lowest (7.6 ±â€¯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 ±â€¯2.3; p < 0.001), the North American practitioners being the least active (6.3 ±â€¯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 ±â€¯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.

IMI - Industry Guidelines and Ethical Considerations for Myopia Control Report.

Purpose: To discuss guidelines and ethical considerations associated with the development and prescription of treatments intended for myopia control (MC). Methods: Critical review of published papers and guidance documents was undertaken, with a view to carefully considering the ethical standards associated with the investigation, development, registration, marketing, prescription, and use of MC treatments. Results: The roles and responsibilities of regulatory bodies, manufacturers, academics, eye care practitioners, and patients in the use of MC treatments are explored. Particular attention is given to the ethical considerations for deciding whether to implement a MC strategy and how to implement this within a clinical trial or practice setting. Finally, the responsibilities in marketing, support, and education required to transfer required knowledge and skills to eye care practitioners and academics are discussed. Conclusions: Undertaking MC treatment in minors creates an ethical challenge for a wide variety of stakeholders. Regulatory bodies, manufacturers, academics, and clinicians all share an ethical responsibility to ensure that the products used for MC are safe and efficacious and that patients understand the benefits and potential risks of such products. This International Myopia Institute report highlights these ethical challenges and provides stakeholders with recommendations and guidelines in the development, financial support, prescribing, and advertising of such treatments.

International survey of orthokeratology contact lens fitting.

PURPOSE: . To determine the extent of orthokeratology (OK) contact lens fitting worldwide and to characterize associated demographics and fitting patterns. METHODS: . Survey forms were sent to contact lens fitters in 45 countries between January and March every year for 14 consecutive years (2004 - 2017, inclusive). Practitioners were asked to record data relating to the first 10 contact lens fits or refits performed after receiving the survey form. RESULTS: . Data were obtained for 295,044 contact lens fits, of which 2,702 were with OK lenses and 292,342 were with other lens types (non-OK). Overall, OK lenses represented 1.2% of all contact lens fits, with significant differences between nations (p < 0.0001), ranging from no fits recorded in Brazil, Egypt, Indonesia, Iran, Lithuania, Nepal and the United Arab Emirates, to 6.0% in The Netherlands. There has been a slight overall increase in OK lens fitting over the survey period (p < 0.0001). OK lenses were fitted to younger persons (OK, 25.0 ± 12.8 years vs. non-OK, 39.8 ± 14.9 years) (p < 0.0001). A higher proportion of males (55%) were fitted with OK lenses versus non-OK lenses (30%) (p < 0.0009). There was a skewed distribution towards OK lenses being fit with higher oxygen permeable materials (p < 0.0001) and on a planned replacement basis (p < 0.0001). CONCLUSIONS: . OK contact lens prescribing is a niche activity, with this lens type typically being fitted in high oxygen permeable materials on a planned replacement basis to younger males. The slightly increasing rate of OK fitting, albeit at a very low level, may be attributed to practitioner interest in the reported myopia control properties of this lens type.

Short-Term and Long-Term Changes in Corneal Power Are Not Correlated With Axial Elongation of the Eye Induced by Orthokeratology in Children.

PURPOSE: To assess the relationship between short-term and long-term changes in power at different corneal locations relative to the change in central corneal power and the 2-year change in axial elongation relative to baseline in children fitted with orthokeratology contact lenses (OK). METHODS: Thirty-one white European subjects 6 to 12 years of age and with myopia -0.75 to -4.00 DS and astigmatism ≤1.00 DC were fitted with OK. Differences in refractive power 3 and 24 months post-OK in comparison with baseline and relative to the change in central corneal power were determined from corneal topography data in eight different corneal regions (i.e., N[nasal]1, N2, T[temporal]1, T2, I[inferior]1, I2, S[superior]1, S2), and correlated with OK-induced axial length changes at two years relative to baseline. RESULTS: After 2 years of OK lens wear, axial length increased by 0.48±0.18 mm (P<0.001), which corresponded to an increase of 1.94±0.74% ([2-years change in axial length/baseline axial length]×100). However, the change in axial elongation in comparison with baseline was not significantly correlated with changes in corneal power induced by OK relative to baseline for any of the corneal regions assessed (all P>0.05). CONCLUSION: The reduction in central corneal power and relative increase in paracentral and pericentral power induced by OK over 2 years were not significantly correlated with concurrent changes in axial length of white European children.

Short- and Long-Term Changes in Corneal Aberrations and Axial Length Induced by Orthokeratology in Children Are Not Correlated.

PURPOSE: To assess the correlation between changes in corneal aberrations and the 2-year change in axial length in children fitted with orthokeratology (OK) contact lenses. METHODS: Thirty-one subjects 6 to 12 years of age and with myopia -0.75 to -4.00DS and astigmatism ≤1.00DC were fitted with OK. Measurements of axial length and corneal topography were taken at regular intervals over a 2-year period. Corneal topography at baseline and after 3 and 24 months of OK lens wear was used to derive higher-order corneal aberrations (HOA) that were correlated with OK-induced axial length changes at 2 years. RESULTS: Significant changes in (Equation is included in full-text article.)root mean square (RMS) secondary astigmatism and fourth and total HOA were found with both 3 and 24 months of OK lens wear in comparison with baseline (all P<0.05). Additionally, significant changes in (Equation is included in full-text article.)and RMS tetrafoil were found at 3 months and in second-order RMS at 24 months of OK lens wear in comparison with baseline (all P<0.05). However, none of the changes in corneal aberrations were significantly correlated with the 2-year change in axial elongation (all P>0.05). Coma angle of orientation changed significantly pre-OK in comparison with 3 and 24 months post-OK as well as secondary astigmatism angle of orientation pre-OK in comparison with 24 months post-OK (all P<0.05). However, coma, trefoil, secondary astigmatism, and tetrafoil angles of orientation pre-OK or post-OK were not significantly correlated with the 2-year change in axial elongation (all P>0.05). DISCUSSION: Short-term and long-term OK lens wear induces significant changes in corneal aberrations that are not significantly correlated with changes in axial elongation after 2-years.