IMI at the International Myopia Conference 2022, Rotterdam.
The IMC conference held 4-7th September, Rotterdam, Netherlands attracted over 700 clinicians and researchers from around the globe. The conference sessions and posters covered an expansive range of topics including myopia prevalence in different parts of the word, experimental and animal models, management strategies, imaging and biometry, risk profiles, complications, genetics and public health.
The conference ended with a lively IMI debate session chaired by IMI’s chief scientist Professor James Wolffsohn and included a panel of IMI’s leading scientists including Professors Ian Flitcroft, Christine Wildsoet, Padmaja Sankaridurg and the conference host Caroline Klaver. Professor Wolffsohn provided a glimpse into the next IMI white paper series to be released in early 2023 and together with the panellists provided an overview of key take home messages from the conference. See below for some of the conference highlights presented by our panel.
The IMI panel presentations were followed by lively audience participation on unresolved areas in relation to outdoor time and the role of the choroid in myopia development. Professor Wolffsohn noted “it was great to opportunity to reflect at the end of some intense days of new findings and challenging theories, with the audience fully engaged in the debate.”
Here are some interesting highlights from the sessions as summarised from our panellists and our IMI program director Dr Nina Tahhan:
At IMC, we heard from our IMI travel award winner Patricia Ioschpe Gus from Brasil that there has not been much research on the prevalence of myopia in her country. She conducted a multi-centre study in 330 schools and found myopia prevalence 17% and high myopia 2.1%. The risk was higher in females and each additional hour of screen time per day increased the chance of myopia by 6.5%. The last prevalence study conducted decades ago in Brazil reported a 9% prevalence. Hence, we see a rise in prevalence occurring as has been report in other parts of the world.
Eva Lazuka-Nicoulaud identified that children with uncorrected myopia in Kosovo were more impacted with learning, were squinting, sitting closer to the board and more socially frustrated.
Rakhee Shah demonstrated that there was an increase in myopia post-covid in the UK in 4–5-year-olds.
We heard from our host Professor Caroline Klaver about the generation R study in the Netherlands; 28% of Dutch children were myopic by 17 years of age, it is more common in females, more common in non-Europeans than native Dutch and those with lower socio-economic status at greater risk.
Leila Eppenberger discussed the rate of myopia in Swiss military recruits – this appears to be unchanged between 2008 – 2017 in 18–25-year-old males.
Tim Fricke challenged us in our thinking about how to analyse and monitor population-level data. Simply reporting mean and standard deviation of data can be an inadequate method due to the skew and kurtosis we see in refractive error data on a population level. It is also challenging to compare different studies when they use different refractive cut-points. Tim describes a novel way to describe population data which can overcome some of those obstacles. He shows us how mixing together 3 symmetric distributions can more accurately describe refractive error population data.
This session was ended by some more challenging thoughts from Professor Ian Morgan who suggests that the default for emmetropization is not moving to emmetropia, it is a preference for slight hyperopia. His belief is that emmetropization doesn’t reflect refractive development – creating a hyperopic reserve is the tendency and hence we should consider myopia control with pre-myopia. Some of the audience, including our panelist professor Ian Flitcroft, commented that it might appear this way under cycloplegia, but the natural state refractive error tends towards the range of an emmetropic refraction! Food for thought!
Huge cohort of aging myopes
Inadequacy of treatments
Predictive factors of visual loss (anisometropia vs mechanics vs background genetics)
Public health problems need public health solutions
Ophthalmology vs Optometry vs Telemedicine
What have we learnt new or that has up ended our ‘beliefs”?
– Understanding and improving efficacy- treatment effect in fast vs slow progressors, responders, reversal of eye growth, peripheral refractive errors- uniform change in peripheral refractive error profile with DIMS test group.
– Use of appropriate control arm in clinical trials; use of age matched controls including virtual controls
– Still need agreement on appropriate metric to define efficacy- percentage reduction, absolute treatment effect, physiological growth:
The in depth analysis of genetic findings will tech us more about the pathways involved in Myopia. Genetic analysis for Myopia in the clinic will not become a routine procedure.
Myopic complications, visual impairment and blindness are the main drivers for our science. More matchmaking between science and clinics is needed.
Imaging, biometry, near work and risk profiles – take home messages by Professor James Wolffsohn
Imaging and biometry
Myopia management strategies