Putting efficacy into context: do controlled trials on efficacy of myopia control translate to a clinical population?

Concerns surrounding the global increase in the prevalence of myopia have led to the development of various optical and pharmacological interventions which aim to slow axial elongation within the myopic eye. This is of particular importance when considering that myopia, particularly high myopia, increases the risk of diseases such as maculopathy and subsequent visual impairment.

Children recruited to clinical trials must meet a set of stringent inclusion and exclusion criteria. Typically, children with high amounts of myopia and moderate to high amounts of astigmatism are excluded. Additionally, preschool (younger than 6 years) and post primary school (older than 12 or 13 years) children are typically excluded from trials as are those with binocular vision issues. This leads to the question of how applicable research trials are to a more diverse clinic population, that is, the real world, particularly when compliance is not monitored as a stringent requirement as within clinical trials, and where motivation and commitment among parents and children may be less than in a clinical trial. The application of clinical trial data in myopia management is a topic which has been investigated within a case series of patients and with a larger clinic population further presented and undergoing further analysis. Here we want to consider how efficacy is portrayed in literature, the variation it results in for treatment effect and the applicability of research on efficacy of intervention from clinical trials to clinical practice.