September 16, 2024
By Dwight Akerman, OD, MBA, FAAO, FBCLA, FIACLE
Photo Credit: Getty Images
In their article “Can we really distinguish ‘responders’ from ‘non-responders’ to myopia control interventions?” Brennan, Nixon, Cheng, and Bullimore challenge the conventional classification of individuals undergoing myopia control interventions as ‘responders’ and ‘non-responders.’ They base their analysis on published data from the first year of the Low-concentration Atropine for Myopia Progression (LAMP) study, where Yam et al. conducted a robust placebo-controlled trial of three different low concentrations of atropine with a large sample size. The authors analyzed and published mean axial elongation and myopia progression rates by age group and calculated efficacy in terms of absolute reduction in myopic progression and axial elongation for each concentration of atropine within different age groups.
Their analysis revealed that the efficacy of atropine concentrations remained consistent across a wide range of underlying overall progression. Surprisingly, faster progressors, commonly labeled as non-responders, achieved a similar reduction in axial elongation and myopia progression as the slower progressors, typically referred to as responders, within the various atropine treatment groups. This observation led the authors to question the validity of using the terms responders and non-responders in the context of myopia progression interventions.
The authors argue that the traditional dichotomy of responders and non-responders in myopia control interventions is not supported by evidence. They suggest that those designated as such may simply be slower or faster progressors who, on average, achieve the same benefit from treatment. This challenges the existing language and concepts used in myopia control and prompts a rethinking of how individuals undergoing myopia control interventions are conceptualized and categorized.
This study highlights the limitations of using the terms responders and non-responders in the context of myopia control interventions. Their research emphasizes the importance of considering individual variations in progression rates and questions the validity of these labels in clinical practice. The article urges the vision care community to reconsider the language and concepts used in myopia control, with the aim of improving the effectiveness of interventions and providing more accurate and personalized care for individuals with myopia.
In conclusion, Brennan, Nixon, Cheng, and Bullimore’s study challenges the traditional classification of individuals as responders and non-responders in myopia control interventions. By demonstrating the invariant nature of efficacy across different progression rates, the authors question the appropriateness of these labels in clinical practice. This critical evaluation prompts a rethinking of how we conceptualize and categorize individuals undergoing myopia control interventions, potentially leading to more personalized and effective treatment approaches. Their work adds significant value to the field of myopia control and encourages a shift towards more individualized and effective care for individuals with myopia.
Abstract
Can We Really Distinguish ‘Responders’ from ‘Non-Responders’ to Myopia Control Interventions?
Noel A Brennan, Alex D Nixon, Xu Cheng, Mark A Bullimore
Purpose: It is common to hear talk of ‘responders’ and ‘non-responders’ with respect to myopia control interventions. We consider the reality of distinguishing these sub-groups using data from the first year of the Low-concentration Atropine for Myopia Progression (LAMP) study.
Methods: The first year of the LAMP study was a robustly designed, placebo-controlled trial of three different low concentrations of atropine using a large sample size (N > 100 randomized to each group). The authors subsequently published mean axial elongation and myopia progression rates by age group. We used these data to calculate efficacy in terms of both absolute reduction in myopic progression and absolute reduction in axial elongation for each of the different atropine concentrations at each age group. We then compared these efficacy data to the overall progression for each of the two progression metrics.
Results: Plotting efficacy as a function of overall myopia progression and axial elongation for each of the different atropine concentrations demonstrates the invariant nature of efficacy in terms of clinically meaningful reduction in progression despite a substantial range of underlying overall progression. That is, faster progressors (the so-called non-responders) achieved similar reduction in axial elongation and myopia progression as the slower progressors (the so-called responders) within the various atropine treatment groups.
Conclusion: The use of the terms responders and non-responders during myopia progression interventions is not supported by evidence. Those designated as such may simply be slower or faster progressors, who, on average achieve the same benefit from treatment.
Brennan, N. A., Nixon, A. D., Cheng, X., & Bullimore, M. A. (2024). Can we really distinguish ‘responders’ from ‘non-responders’ to myopia control interventions?. Ophthalmic & Physiological Optics: The Journal of the British College of Ophthalmic Opticians (Optometrists), 10.1111/opo.13379. Advance online publication.
DOI: https://doi.org/10.1111/opo.13379
