Could a caffeine metabolite slow it down?

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Researchers are exploring new treatments to slow myopia. Catherine Falls Publicity/Getty Images
  • More than a quarter of the world’s population is myopic, which is when people can see things clearly when they are close but blurry when they are far away.
  • Myopia may cause irreversible eye damage for some and can change with age.
  • There is no cure for myopia, but there are treatments that can help or manage it.
  • A metabolite of caffeine has emerged as a possible new treatment by slowing the progression of myopia in children.

The incidence of myopia, or myopia, is on the rise worldwide. The National Institutes of Health (NIH) estimates that 28% of the world’s population is myopic.

A reduced ability to see distant objects – such as blackboards or screens – makes learning more difficult, and in urban areas of East and Southeast Asia, around 90% of people who have chose to drop out of school suffer from myopia. In the United States and Europe, 30% to 50% of them suffered from myopia.

According to the NIH, uncorrected myopia is the leading cause of blindness worldwide.

In 2015, 124 million people worldwide had moderate to severe visual impairment or were blind, due to uncorrected myopia.

Myopia can also lead to irreparable loss of sight through the development of cataracts, glaucoma, macular degenerationand retinal detachment.

While myopia has long been corrected with glasses, vision researchers and doctors are also exploring pharmaceutical treatments that address the underlying problem.

A new observational study from Denmark suggests that a metabolite of caffeine, 7-methylxanthine – or 7-MX – can inhibit the development of myopia in children.

The study is published in the British Journal of Ophthalmology.

Myopia usually begins in children between the ages of six and seven and progresses until the age of 16 to 20. As lead author of the study, Dr. Klaus Trierwho is also an ambassador for the International Institute of Myopia, said Medical News Today“Children who begin to develop myopia before the age of 10 are at high risk of progressing to severe myopia.”

Dr. Curtis A. Onoof the board of directors of the American Optometric Association and Puget Sound EyeCare, which was not involved in the new study, said DTM on current treatments for myopia.

“The most studied drug for the control of myopia is atropine. Currently, many practitioners prescribe off-label atropine drops for myopia control. Pirenzepine is used in the treatment of peptic ulcers and has been shown to reduce ocular axial length. In addition, riboflavin with UV exposure, ketorolac tromethamineand BHVI2 are being studied for myopia control,” he said.

“Based on the results of this population-based study, the use of 7-MX may potentially give patients another way to control high-functioning myopia,” Dr. Ono said, adding, “This investigation and further studies on myopia control methods are essential as evidence that high levels of myopia are a public health problem and it is undeniable that high myopia can lead to health-threatening eye disorders ocular.

Myopia is a refractive error that occurs if the eye becomes abnormally long – this is called the axial length of the eye.

Normally one eye elongate from about 16.8 millimeters in an infant to about 23.6 mm in an adult. As it does, changes in other ocular elements such as the lens and cornea compensate for the difference, keeping the light focused on the retina. The retina converts light into messages which it sends to the brain.

With myopia, the axial length increases too quickly, exceeding the lens and cornea. Light is refracted so that its most focused point does not reach the retina, resulting in blurred vision.

Eye care professionals track myopia by measuring an individual’s increase in axial length. It is the growth of axial length in particular that 7-MX seems to slow down.

Doctors also measure the progression of myopia with vision tests, during which they test lenses to determine the degree of correction an individual needs. The strength of each lens is measured in dioptersor D. If someone needs 2 D of refractive correction, for example, they have a refractive error of -2.00.

Since 2009, 7-MX has been an approved treatment for myopia in Denmark. It is the only oral medication for the condition. During this time, it was only evaluated in a pilot clinical trial.

“Pilot trial showed 0.04 mm less axial elongation in the first year in children taking 400 mg daily compared to placebo“, Dr. Trier recalled.

“Current observational analysis,” he added, “suggests about 0.07 mm less axial elongation in the first year for children taking 1000 mg daily [of 7-MX]compared to children not taking 7-MX, and a cumulative reduction of 0.18 mm over 6 years.

Additionally, Dr. Trier also felt that 7-MX could work well with other treatments such as glasses. He said, “7-MX seems to improve farsightedness in rhesus monkeys fitted with lenses, a finding suggesting that 7-MX could potentially increase the effectiveness of optical devices designed to reduce the progression of myopia.

However, Dr. Trier noted a problem with 7-MX:

“The tablet currently in use is a simple immediate-release tablet which, due to the rapid elimination of 7-MX, is not able to maintain a stable blood concentration even when administered three times a day. .”

Dr Trier said that according to the Danish Medicines Agency (DMA), 1,171 children and adolescents have been reimbursed for the costs of 7-MX tablets for the treatment of progressive myopia since 2009.

“Currently, about 200 myopic children/adolescents on 7-MX are followed in my ophthalmology department. A few other ophthalmologists in Denmark also prescribe 7-MX,” he said. DTM.

“The majority of ophthalmologists in Denmark do not prescribe 7-MX on the grounds that there has not yet been a large randomized controlled trial to support the treatment effect. Hopefully the recently published observational study can help secure funding for such a trial,” he added.

So far, no reports have been filed with the Danish Medicines Agency on the side effects of 7-MX.

However, Dr. Ono said the FDA should conduct more research to approve 7-MX in the United States. He cited four things that should be assessed or happen:

  • long-term adverse reaction in a pediatric population
  • environmental and ethnic factors (because study participants were uniquely Danish)
  • the effectiveness of combination therapy with other known methods of myopia control
  • randomized controlled trials

“This line of treatment may have a positive impact on patients with myopia, as long as it is determined to be safe with minimal side effects,” Dr Ono said.

“An extended-release formulation given once or twice a day would theoretically be much more effective. Hopefully this new formulation will be tested in a randomized controlled trial, which could potentially lead to the availability of the treatment outside of Denmark. This project is currently awaiting investors.
— Dr. Klaus Treves

Dr. Ono recommended that “the child be seen by a doctor of optometry at least once a year, with particular attention to the course of refractive error and a full assessment of eye health (including including retinal checks),” adding that “patients can find a local doctor of optometry at American Optometric Association.

“We encourage parents to talk to their doctor and learn about different methods of controlling myopia – more outdoor activities, more eye strain with nearby work, exposure to natural light, atropine, soft multifocal contact lenses, spectacle lenses and ortho-keratology“, he clarified.

For many children, glasses are just one fashion accessory among many.

“From my point of view as a practitioner in a predominantly pediatric practice, children seem to be more open to correction by glasses, some wanting glasses when they don’t need them! I believe this is a result [of] children see their peers with glasses and adults/celebrities wearing corrective glasses,” Dr Ono said.

Contact lenses are the other option, he said.

“Wearing contact lenses has proven to be a safe alternative to eyeglasses when evaluated and fitted by a qualified doctor of optometry or other ophthalmologists. Contact lenses are fitted at an earlier age than before due to the availability of daily disposable lenses and the development of highly oxygen permeable materials, it is still crucial to educate both the patient and guardians on proper contact lens use and follow-up visits to ensure good eye health,” he added.

“The eye care community must continue to explore all avenues to reduce higher levels of myopia – above -6.00 refractive error [D] – which is associated with retinal detachments, macular degeneration and glaucoma.
— Dr. Curtis A. Ono

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