Use of Atropine for Prevention of Childhood Myopia Progression in Clinical Practice.

OBJECTIVE: The most effective strategy to reduce myopia-related complications is to prevent myopia progression during childhood. This review article examines the latest published evidence on the use of atropine in childhood myopia control and discusses practical aspects of applying the findings to clinical practice. Future directions including possible forms of combination therapy are examined. METHODS: A literature search with a focus on randomized controlled trials (RCTs) and meta-analyses on the subject was conducted. Observational studies with control groups were also reviewed to discuss issues regarding feasibility of using atropine for myopia control in clinical practice. RESULTS: Five RCTs and 2 meta-analyses were found. The studies all found beneficial effects of atropine in myopia control, as well as a clear but perhaps clinically insignificant dose-response relationship between atropine and myopia progression rates. Available evidence however is focused on predominantly Chinese populations, and there is a current lack of guidance on timing of therapy initiation, duration of therapy, and treatment cessation. For future directions, combining atropine with other forms of myopia control would be worth considering. CONCLUSIONS: Atropine is robust option for childhood myopia control. Further evidence including RCTs in different populations as well as the upcoming 5-year atropine for the treatment of myopia 2 trial results will provide much needed answers for wider acceptance of its use.

FACTORS INFLUENCING NEED FOR RETREATMENT AND LONG-TERM VISUAL OUTCOME AFTER INTRAVITREAL BEVACIZUMAB FOR MYOPIC CHOROIDAL NEOVASCULARIZATION.

PURPOSE: To evaluate the efficacy and the predictive factors associated with the need for retreatment and long-term visual outcome after intravitreal bevacizumab for myopic choroidal neovascularization (CNV). METHODS: Retrospective cohort study of 93 eyes with subfoveal or juxtafoveal myopic CNV treated initially with either 3-monthly or single intravitreal bevacizumab injections followed by pro re nata retreatment. The efficacy was evaluated by the best-corrected visual acuity (BCVA) during follow-up visits. Backward stepwise multiple linear regression analyses were performed to evaluate the potential predictive factors on final BCVA, change in BCVA, and number of injections. Multiple logistic regression was performed to evaluate the potential predictive factors for retreatment. RESULTS: The mean follow-up duration was 25.12 ± 11.18 (SD) months. The mean logMAR BCVA at baseline was 0.72 ± 0.58 logMAR (20/100 Snellen equivalent) and was maintained at 0.39 ± 0.46 logMAR (20/50 Snellen equivalent) at the last follow-up (P < 0.001). The mean number of injections was 3.53 ± 1.70 (range, 3-10), and a total of 25 eyes (26.9%) received retreatment. Patients who received single loading injection had significantly lower mean total number of injections (1.50 ± 0.73 vs. 3.96 ± 1.53). Both subfoveal and juxtafoveal myopic CNV eyes had significant improvement in BCVA (0.28 ± 0.43 vs. 0.22 ± 0.32 [20/40 vs 20/30 Snellen equivalent], P = 0.506), and juxtafoveal myopic CNV eyes had significantly better BCVA at baseline and at the last follow-up than the subfoveal group. Treatment-naive eyes had significant improvement from baseline BCVA, and the amount of improvement was significantly more than those who received previous photodynamic therapy (0.31 ± 0.43 vs. 0.06 ± 0.11 [20/40 vs 20/25 Snellen equivalent], P < 0.001). Multivariate stepwise regression analysis showed that the baseline CNV size (P < 0.05), baseline BCVA (P < 0.001), and duration of symptoms (P < 0.05) were significant predictive factors for final BCVA, and BCVA improvement. Multiple logistic regression analysis identified that CNV size (P = 0.014) and follow-up duration (P = 0.017) were significant predictive factors for retreatment. No significant association was found for number of injections. CONCLUSION: Intravitreal bevacizumab seems to be an effective treatment for both subfoveal and juxtafoveal myopic CNV in the long term. Patients presented with shorter duration of symptoms and smaller CNV size before treatment as significant prognostic factors that predict better visual outcome. Eyes with longer follow-up duration and larger baseline CNV size may have higher risk for retreatment.

Bevacizumab for neovascular age-related macular degeneration in Chinese patients in a clinical setting.

AIM: To determine the outcome of non-investigational treatment with intravitreal bevacizumab (IVB) in neovascular age-related macular degeneration (AMD) patients. METHODS: Retrospective chart review of 81 eyes with neovascular AMD followed-up for at least 12mo and received 3-monthly loading IVB injections. Re-treat was based upon the individual clinician's judgment. Best-corrected visual acuity (BCVA) and optical coherence tomography measurements of central foveal thickness outcomes were evaluated at 12, 24mo. RESULTS: Eighty-one eyes (of 75 patients) completed 12mo of follow-up and 44 eyes (of 41 patients) completed 24mo of follow-up. The mean baseline logMAR BCVA significantly improved from 0.94±0.69 to 0.85±0.68 at 12mo (P<0.001) and from 0.91±0.65 to 0.85±0.60 (P=0.004) at 24mo. The proportion of eyes that lost <15 logMAR letters at 12mo was 90.1% and at 24mo was 81.8%. IVB was effective in improving visual acuity in both treatment naïve and previous photodynamic therapy (PDT)-treated subgroups. Treatment naive patients required significantly fewer injections than patients with prior PDT. Multiple regression analysis identified that poorer baseline visual acuity was associated with greater improvement in visual acuity (P=0.015). CONCLUSION: Fewer injections in clinical practice may result in suboptimal visual outcomes compared with clinical trials of IVB in neovascular AMD patients. Poor baseline visual acuity and prior PDT treatment may also improve vision after IVB. The safety and durability of effect was maintained at 24mo.