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.

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.

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.

Long -term effects of optical defocus on eye growth and refractogenesis.

Introduction: The aim of this paper was to study the effect of binocular and alternating monocular myopic constant defocus prescribed in spectacle format on myopia onset and progression in children. Material and methods: 129 children aged 5­12 years were divided into 4 groups: 48 children aged 5­8 years (1st group) with emmetropia and risk factors of myopia development were prescribed the continuous wearing of plus lenses to induce myopia of 1.0 D. 46 children aged 7­11 years (2nd group) with low myopia from −0.75 to −2.25 D were prescribed 2 pairs of spectacles for alternating continuous wearing. One eye was corrected for distance to obtain residual myopia in spectacles of about 0.50 D, and the fellow eye was corrected to obtain residual or induced myopia of about 1.50 D. The children changed spectacles every day. Control data were obtained from 15 children aged 6­9 years (1st control group) with pseudomyopia with no correction administered, and 20 low myopic children aged 7­12 years (2nd control group) wearing conventional spectacle correction. Autorefractometry before and after cycloplegia and ultrasound biometry were performed. Results: A hyperopic shift caused by thinning of the crystalline lens and deepening of the anterior chamber in all patients of the 1st group was observed after 1 month and persisted over the follow -up period. Horizontal diameter (HD) increased more than 3 times as much as the axial length (AL). No cases of myopia onset were observed during the 9 -year follow -up period. 36 (81.8%) children of the 2nd group had stable refraction over the 4 year follow up, an insignificant increase in the AL and a significant increase in the HD were revealed. A 3-year follow -up revealed an increase in cycloplegic refraction in both control groups; the AL increased significantly, while the HD showed an insignificant increase. Conclusions: Permanent low myopic defocus of the image in binocular spectacle format inhibits eye growth and refraction shift to myopia in children with low hyperopia, emmetropia and low myopia. The method of alternating monolateral low myopic defocus arrests the myopia progression in 81.8% of children with low myopia for 4 years and 66% for 7 years.

Sclera as the target tissue in progressive myopia.

UNLABELLED: Introduction: The aim of the study was to study the eye corneoscleral shell and connective tissue (CT) system in children with acquired and congenital progressive myopia, and to identify the informative diagnostic criteria of weakened supporting function of the sclera. MATERIAL AND METHODS: 155 children aged 9-17 were examined: 18 had emmetropia or hyperopia, 20--low, 32--moderate and 85--high myopia. 32 children had complicated myopia (CM) due to peripheral retinal degeneration (PRD). Corneal hysteresis (CH), scleral acoustic density (SAD), X-ray vertebral topography, plantography, joint hypermobility, serum cortisol (SC), and autonomic balance were measured. RESULTS: Corneal hysteresis, mmHg and SAD, rel. units (mean ± SE) were lower if myopia was higher: in low myopia, CH was 13.0 ± 0.3, in moderate myopia, 11.9 ± 0.3#, in high myopia, 10.7 ± 0.3#; SAD was resp. 215.9 ± 5.2, 204.9 ± 3.7# and 192.8 ± 5.8# (#: p < 0.05 with regard to low myopia). The lowest CH (10.3 ± 0.4) and SAD (186.5 ± 7.3) were found in acquired CM. Congenital myopia with PRD showed CH and SAD greater than in acquired CM (p < 0.05). Serum cortisol (nmol/L) in hyperopia was 335.8 ± 40.9 and dropped with higher myopia: in low myopia--290.7 ± 58.6, in moderate--250.9 ± 26.4, in high--243.9 ± 20.5. The lowest SC was found in acquired CM, consistent with CH and SAD. Connective tissue dysplasia progressed with higher myopia: it was found in 76.9% of children with low, 82.4% with moderate, 89.2% with high acquired myopia, and 91.7% with congenital myopia. Biomechanical defects of CT and hormonal imbalance were combined with vegetative nervous system (VNS) imbalance: in high myopia only 20.5% of children were eutonic, 61.5%--sympathicotonic and 17.5% parasympathicotonic. CONCLUSIONS: School age children with progressive myopia showed biomechanical abnormalities of the corneosclera, along with CT dysplasia, decreased SC and imbalanced VNS, more pronounced in acquired complicated myopia. Our findings contribute to the understanding of myopia pathogenesis and to the diagnostic/prognostic evaluation of myopic children, in particular when deciding whether sclera-strengthening intervention is needed.

Effects of poly(2-hydroxyethyl methacrylate) and poly(vinyl-pyrrolidone) hydrogel implants on myopic and normal chick sclera.

There has been generally little attention paid to the utilization of biomaterials as an anti-myopia treatment. The purpose of this study was to investigate whether polymeric hydrogels, either implanted or injected adjacent to the outer scleral surface, slow ocular elongation. White Leghorn (Gallus gallus domesticus) chicks were used at 2 weeks of age. Chicks had either (1) a strip of poly(2-hydroxyethyl methacrylate) (pHEMA) implanted monocularly against the outer sclera at the posterior pole, or (2) an in situ polymerizing gel [main ingredient: poly(vinyl-pyrrolidone) (PVP)] injected monocularly at the same location. Some of the eyes injected with the polymer were fitted with a diffuser or a -10D lens. In each experiment, ocular lengths were measured at regular intervals by high frequency A-scan ultrasonography, and chicks were sacrificed for histology at staged intervals. No in vivo signs of either orbital or ocular inflammation were observed. The pHEMA implant significantly increased scleral thickness by the third week, and the implant became encapsulated with fibrous tissue. The PVP-injected eyes left otherwise untreated, showed a significant increase in scleral thickness, due to increased chondrocyte proliferation and extracellular matrix deposition. However, there was no effect of the PVP injection on ocular elongation. In eyes wearing optical devices, there was no effect on either scleral thickness or ocular elongation. These results represent "proof of principle" that scleral growth can be manipulated without adverse inflammatory responses. However, since neither approach slowed ocular elongation, additional factors must influence scleral surface area expansion in the avian eye.