The Montreal Experience: A Retrospective Study Part I—Basic Principles and Treatment Algorithm
CONTEXT: Authors have refined myopia control strategies (MCS) from their experience treating more than 800 children who were followed at the Montreal School of Optometry Clinic (CUV). They developed a treatment algorithm known as the Montreal Experience (ME). Contrary to many other MCS, treatment mo...
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2021-08-01
|
| Series: | Applied Sciences |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2076-3417/11/16/7455 |
| _version_ | 1797524763458928640 |
|---|---|
| author | Langis Michaud Patrick Simard Remy Marcotte-Collard Mhamed Ouzzani Loraine T. Sinnott |
| author_facet | Langis Michaud Patrick Simard Remy Marcotte-Collard Mhamed Ouzzani Loraine T. Sinnott |
| author_sort | Langis Michaud |
| collection | DOAJ |
| description | CONTEXT: Authors have refined myopia control strategies (MCS) from their experience treating more than 800 children who were followed at the Montreal School of Optometry Clinic (CUV). They developed a treatment algorithm known as the Montreal Experience (ME). Contrary to many other MCS, treatment modalities are selected after careful evaluation of a patient’s parameters (rate of progression, age of myopia onset, corneal parameters, pupil area), the risk factors for ocular pathology (growth charts), and taking into account the patient’s lifestyle and potential compliance. This represents a customized approach for each patient. PURPOSE: To evaluate the efficacy of MCS used following ME algorithm; the primary outcome relates to axial length progression over 24 months. METHODS: This is a retrospective study, conducted after approval of University IRB. Data were extracted from the file of each patient who: (1) consulted CUV between January 2017 and December 2018 and (2) were kept under the same MCS (same design/concentration). Clinical population is composed of 298 patients (35% Caucasian; 45% Asian; 20% others), with a median age of 11 (range 5–18). The treatment options were orthokeratology (OK-4 designs; <i>N</i> = 140), multifocal soft contact lenses (SMCL; 5 designs; <i>N</i> = 128), and low-dose atropine (LDA 0.01% to 0.25%; <i>N</i> = 42). RESULTS: Results are analyzed through sophisticated statistical models, designed for this purpose. At the end of a stepwise selection process that sequentially removed model terms that were not statistically significant, nine model terms remained: month, modality, the interaction of month and modality, refraction (SEQ), the interaction of SEQ and modality, gender, age, the interaction of age and month, and the interaction of age and modality. A total of 298 files were kept for analysis. Participant age varied from 9.7 to 12.5 years old. Baseline AL varied from 24.9 to 25.3 mm and SE refraction was −3.7 + 1.7 D on average. This study population was divided between Caucasian (34%), Asian (44%), and other ethnic origins (22%). Overall results indicate that results vary according to modality and months only. There is no statistical difference based on age, gender, and SEQ. All methods used were effective to slow the natural AL growth. Evolution was the lowest when using smaller treatment zones OK lenses (0.249 mm) and the highest (0.376 mm) for those treated with LDA. This OK advantage was statistically significant versus other modalities at 1 and 2 years. CONCLUSION: The Montreal Experience reveals that personalized MCS may be effective to manage myopia efficiently. It shows AL evolution comparable to the documented natural evolution of emmetropes, especially when using customized or smaller treatment zone OK lens design. Future work on other populations will confirm this tendency. |
| first_indexed | 2024-03-10T09:02:10Z |
| format | Article |
| id | doaj.art-2f8684eacafb4937a7416b10473799c8 |
| institution | Directory Open Access Journal |
| issn | 2076-3417 |
| language | English |
| last_indexed | 2024-03-10T09:02:10Z |
| publishDate | 2021-08-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Applied Sciences |
| spelling | doaj.art-2f8684eacafb4937a7416b10473799c82023-11-22T06:41:58ZengMDPI AGApplied Sciences2076-34172021-08-011116745510.3390/app11167455The Montreal Experience: A Retrospective Study Part I—Basic Principles and Treatment AlgorithmLangis Michaud0Patrick Simard1Remy Marcotte-Collard2Mhamed Ouzzani3Loraine T. Sinnott4École d’optométrie, Université de Montréal, Montréal, QC H3T 1P1, CanadaÉcole d’optométrie, Université de Montréal, Montréal, QC H3T 1P1, CanadaÉcole d’optométrie, Université de Montréal, Montréal, QC H3T 1P1, CanadaDépartement de Physique, Section Sciences et Techniques, Faculté Sciences Exactes et Appliquées, Université d’Oran 1, Oran 31000, AlgeriaCollege of Optometry, The Ohio State University, Columbus, OH 43210, USACONTEXT: Authors have refined myopia control strategies (MCS) from their experience treating more than 800 children who were followed at the Montreal School of Optometry Clinic (CUV). They developed a treatment algorithm known as the Montreal Experience (ME). Contrary to many other MCS, treatment modalities are selected after careful evaluation of a patient’s parameters (rate of progression, age of myopia onset, corneal parameters, pupil area), the risk factors for ocular pathology (growth charts), and taking into account the patient’s lifestyle and potential compliance. This represents a customized approach for each patient. PURPOSE: To evaluate the efficacy of MCS used following ME algorithm; the primary outcome relates to axial length progression over 24 months. METHODS: This is a retrospective study, conducted after approval of University IRB. Data were extracted from the file of each patient who: (1) consulted CUV between January 2017 and December 2018 and (2) were kept under the same MCS (same design/concentration). Clinical population is composed of 298 patients (35% Caucasian; 45% Asian; 20% others), with a median age of 11 (range 5–18). The treatment options were orthokeratology (OK-4 designs; <i>N</i> = 140), multifocal soft contact lenses (SMCL; 5 designs; <i>N</i> = 128), and low-dose atropine (LDA 0.01% to 0.25%; <i>N</i> = 42). RESULTS: Results are analyzed through sophisticated statistical models, designed for this purpose. At the end of a stepwise selection process that sequentially removed model terms that were not statistically significant, nine model terms remained: month, modality, the interaction of month and modality, refraction (SEQ), the interaction of SEQ and modality, gender, age, the interaction of age and month, and the interaction of age and modality. A total of 298 files were kept for analysis. Participant age varied from 9.7 to 12.5 years old. Baseline AL varied from 24.9 to 25.3 mm and SE refraction was −3.7 + 1.7 D on average. This study population was divided between Caucasian (34%), Asian (44%), and other ethnic origins (22%). Overall results indicate that results vary according to modality and months only. There is no statistical difference based on age, gender, and SEQ. All methods used were effective to slow the natural AL growth. Evolution was the lowest when using smaller treatment zones OK lenses (0.249 mm) and the highest (0.376 mm) for those treated with LDA. This OK advantage was statistically significant versus other modalities at 1 and 2 years. CONCLUSION: The Montreal Experience reveals that personalized MCS may be effective to manage myopia efficiently. It shows AL evolution comparable to the documented natural evolution of emmetropes, especially when using customized or smaller treatment zone OK lens design. Future work on other populations will confirm this tendency.https://www.mdpi.com/2076-3417/11/16/7455myopiacontrolorthokeratologysoft multifocal lenses |
| spellingShingle | Langis Michaud Patrick Simard Remy Marcotte-Collard Mhamed Ouzzani Loraine T. Sinnott The Montreal Experience: A Retrospective Study Part I—Basic Principles and Treatment Algorithm Applied Sciences myopia control orthokeratology soft multifocal lenses |
| title | The Montreal Experience: A Retrospective Study Part I—Basic Principles and Treatment Algorithm |
| title_full | The Montreal Experience: A Retrospective Study Part I—Basic Principles and Treatment Algorithm |
| title_fullStr | The Montreal Experience: A Retrospective Study Part I—Basic Principles and Treatment Algorithm |
| title_full_unstemmed | The Montreal Experience: A Retrospective Study Part I—Basic Principles and Treatment Algorithm |
| title_short | The Montreal Experience: A Retrospective Study Part I—Basic Principles and Treatment Algorithm |
| title_sort | montreal experience a retrospective study part i basic principles and treatment algorithm |
| topic | myopia control orthokeratology soft multifocal lenses |
| url | https://www.mdpi.com/2076-3417/11/16/7455 |
| work_keys_str_mv | AT langismichaud themontrealexperiencearetrospectivestudypartibasicprinciplesandtreatmentalgorithm AT patricksimard themontrealexperiencearetrospectivestudypartibasicprinciplesandtreatmentalgorithm AT remymarcottecollard themontrealexperiencearetrospectivestudypartibasicprinciplesandtreatmentalgorithm AT mhamedouzzani themontrealexperiencearetrospectivestudypartibasicprinciplesandtreatmentalgorithm AT lorainetsinnott themontrealexperiencearetrospectivestudypartibasicprinciplesandtreatmentalgorithm AT langismichaud montrealexperiencearetrospectivestudypartibasicprinciplesandtreatmentalgorithm AT patricksimard montrealexperiencearetrospectivestudypartibasicprinciplesandtreatmentalgorithm AT remymarcottecollard montrealexperiencearetrospectivestudypartibasicprinciplesandtreatmentalgorithm AT mhamedouzzani montrealexperiencearetrospectivestudypartibasicprinciplesandtreatmentalgorithm AT lorainetsinnott montrealexperiencearetrospectivestudypartibasicprinciplesandtreatmentalgorithm |