Effect of defocus incorporated multiple segments (DIMS) spectacle lenses on myopia progression in children: a retrospective analysis in a German real-life clinical setting.

OBJECTIVES: This retrospective analysis evaluates the treatment success of "Defocus Incorporated Multiple Segments" (DIMS) spectacle lenses in a real-life clinical setting in Germany. MATERIALS AND METHODS: Axial length (AL) and objective refraction of 166 eyes treated with DIMS at baseline and 12-month follow-up were analyzed. Annual AL growth rate within the range of physiological growth rate was considered a successful treatment. Myopia progression of ≥ -0.5 D/yr accounted as treatment success. Differences in percentages of treatment success of subgroups depending on baseline AL and age against treatment success of the total population were investigated. RESULTS: Considering all eyes, treatment success regarding AL growth and myopia progression was achieved in 46% and 65%, respectively. Male eyes with moderate AL showed treatment success in a higher proportion (73%, p < 0.01; 89%, p < 0.01); eyes with high AL showed treatment success in a lower proportion (25%, p < 0.01; 51%, n.s.). Female eyes showed the same trend but without statistical significance (moderate AL: 49%; 68%; high AL: 40%; 62%). Younger children showed treatment success in a lower proportion (male: 11%, p < 0.01; 38%, p < 0.05; female: 25%, p < 0.01; 42%, p < 0.01). Older children showed treatment success in a higher proportion (male: 60%, p < 0.05; 78% p < 0.05; female: 53%, n.s.; 77% p < 0.05). CONCLUSIONS: Eyes with moderate baseline AL and of older children showed treatment success after 12 months of DIMS treatment. Eyes with a high baseline AL and of younger children showed treatment success in a smaller proportion, therefore combination treatment should be considered. In future studies, males and females should be assessed separately.

Natural History of Visual Acuity and Microperimetry-Based Functional Outcome Measures of the Macula in Patients with Geographic Atrophy: A Retrospective Chart Review Study in Germany.

Background/Objectives: Geographic atrophy (GA) is an advanced form of age-related macular degeneration (AMD) leading to the progressive and irreversible loss of visual function. Characteristics of GA include atrophic lesions resulting from the loss of photoreceptors, retinal pigment epithelium, and choriocapillaris. During GA progression, atrophic lesions typically advance from the macular periphery to the center, affecting foveal light sensitivity and visual acuity. This study analyzed changes in light sensitivity and visual acuity during the natural course of GA progression using the topographic analysis of structural and functional changes based on Early Treatment Diabetic Retinopathy Study (ETDRS) charts, multimodal imaging, and microperimetry assessment. Methods: Medical chart data of GA patients between 2014 and 2022 from the Internationale Innovative Ophthalmochirurgie GbR (I.I.O.) research center (Düsseldorf, Germany) were retrospectively analyzed. All patient eyes fulfilling the phase 3 OAKS study inclusion criteria were included and followed up for 60 months. The imputation of missing measurements and dropouts was performed by linear mixed models. Results: A total of 20 GA eyes from 13 GA patients were included in the study. At the index, 53.8% of patients had bilateral GA, with 70.0% of the eyes showing multifocal GA and 30.0% subfoveal encroachment (SFE). A total of 35.0% of the eyes had 2-5, and 15.0% over 20, areas of atrophy. Over time, the GA lesion size increased from 6.4 mm2 to 11.8 mm2 (1.08 mm2/year). After an average observation time of 2.9 years, 78.6% of the initially unaffected study eyes developed SFE. The percentage of study eyes without visual impairment decreased from 55.0% to 30.0%, with mean normal-luminance best-corrected visual acuity (NL-BCVA) reducing from 63.7 to 55.7 ETDRS letters. The share of absolute scotoma points in microperimetry assessment increased from 15.7% to 43.5% while overall average macular sensitivity declined from 15.7 dB to 7.4 dB. Conclusions: The substantial deterioration of macular outcomes and visual function was comprehensively detected. The results were a documentation of structural and functional aspects of the natural progression of GA for a 60-month follow-up, providing a typical outline for AMD patients with GA.

Prevalence of Geographic Atrophy in Advanced Age-Related Macular Degeneration (AMD) in Daily Practice.

PURPOSE: To investigate the prevalence of geographic atrophy (GA) in advanced age-related macular degeneration (AMD) and the proportion of eyes that would meet the indication criteria for treatment with the first intravitreal anti-C3 agent (pegcetacoplan). METHODS: This retrospective cross-sectional study included all AMD patients who visited the Macular-Retina-Centre Oberkassel in 2021. Eyes were classified according to AMD stages. Eyes with GA were divided into two groups regarding foveal involvement. Baseline factors were compared between eyes with foveal GA (FGA) and eyes with non-foveal GA (NFGA) to identify predictive factors for foveal involvement. RESULTS: A total of 2033 eyes from 1027 patients were included. AMD stage was early in 296 (14.5%) cases, intermediate in 368 (18.1%) cases, and advanced in 1249 (61.4%) cases. A total of 1204 (60%) eyes had GA [932 (77%) FGA and 272 (23%) NFGA], while 125 eyes (27.4% from eyes with advanced dry AMD) met the indication criteria for treatment with intravitreal pegcetacoplan. The proportion of eyes with neovascular AMD was significantly higher in the FGA group compared to the NFGA group [598 (64.2%) vs. 152 (55.8%), p = 0.01]. CONCLUSIONS: At least a quarter of eyes with advanced AMD would be suitable for the upcoming intravitreal pegcetacoplan therapy. Foveal involvement of GA in advanced AMD seems to be more likely in neovascular AMD than in dry AMD.

A Comparison of Optical Biometers Used in Children for Myopia Control.

PURPOSE: To assess the reproducibility (i.e., inter-device reliability) of the biometers Topcon MYAH, Oculus Myopia Master, and Haag-Streit Lenstar LS900 with the Carl Zeiss IOLMaster 700 and the intra-subject repeatability in myopic children in order to reliably detect axial growth for myopia management. METHODS: Twenty-two myopic children (11.1 ± 2.4 yr) with a spherical equivalent of - 3.53 ± 2.35 D were examined with each of the biometers to assess axial length (AL) and corneal parameters (steepK, flatK, meanK, vectors J0, J45), and16 of these children agreed to a second round of measurements. Reproducibility of the first measurements between the IOLMaster and every other biometer was assessed employing a Bland-Altman approach and paired Student's t-test. Repeatability was assessed as intra-subject standard deviation and was used to estimate the minimum time interval required between two AL measurements to reliably detect axial growth of an eye of at least 0.1 mm/year. RESULTS: Repeatability for AL measurements was as follows: IOLMaster: 0.05 mm, Myopia Master: 0.06 mm, Myah: 0.06 mm, Lenstar: 0.04 mm; the respective minimal time interval for axial growth assessment in myopia management was estimated as 5.6, 6.6, 6.7, and 5.0 months, respectively. Best reproducibility of the AL measurement was found between IOLMaster and Lenstar [95% Limits of Agreement (LoA) for reproducibility - 0.06 to 0.02]. As regards to the measured means, Lenstar gave measures of AL that were longer than with the IOLMaster by 0.02 mm (p < 0.001). Myopia Master measures of meanK were significantly lower (by 0.21 D with p < 0.001) than the values from the IOLMaster. As for J0, all biometers deviated significantly from IOLMaster measurements (p < 0.05). CONCLUSION: Generally good agreement was observed between all the biometers. When assessing myopia progression in children, a time frame of at least 6 months between the AL measurements is advisable in order to reliably determine any deviation from a normal growth pattern.

[Post-SMILE-What myopes know about their secondary emmetropic eyes]. / Post-SMILE ­ Was Myope über ihre sekundär emmetropen Augen wissen.

BACKGROUND: Small incision lenticule extraction (SMILE) is popular among young myopic adults for long-term correction of myopia; however, the excessive axial lengths of myopic eyes and the associated risks for more serious eye diseases later on remain with surgical correction of the refractive error. These risks are greater the higher the myopia is. Are patients well informed about this and to what extent does further eye growth occur even after SMILE? MATERIAL AND METHODS: Myopic young adults who underwent binocular SMILE before 2019 were given the opportunity to have their eyes examined at a follow-up visit (biometry using IOL-Master 700 [Zeiss, Oberkochen, Germany], subjective refraction, examination of the anterior and posterior segments of the eye using the slit lamp) and to participate in a survey. Patients with a preoperative axial length ≥ 25.5 mm and a preoperative axial length < 25.5 mm (high myopia) were statistically evaluated separately. RESULTS: A total of 44 patients (age 30.39 ± 2.39 years) appeared at the visit and the SMILE was 3.18 ± 0.82 years ago: The spherical equivalent at the follow-up visit was -0.05 ± 0.21 dpt in the weaker myopes and -0.18 ± 0.23 dpt in the high myopes. Of the respondents 27% estimated that SMILE would reduce the risk of retinal detachment and cataract, with 80% of high myopes underestimating the individual risk of retinal detachment. Also, 57% said they would not see an ophthalmologist until within 1 week if they had symptoms consistent with acute retinal detachment, and only 27% would go to an emergency room immediately. In general, 59% reported having normal health awareness and 41% reported going for annual ophthalmological check-ups. CONCLUSION: The collected axial lengths and refractions show no relevant change in the eyes regarding progression of myopia; however, the patients' statements in the survey point out that most patients are not aware of the risk of serious eye diseases (retinal detachment, cataract). Therefore, repeated risk education and close postoperative care are needed, especially in preoperatively highly myopic patients.