Myopiagraph is a software for Myopia management

Myopiagraph is a web-based tool for eye length imaging. It is designed to provide a cost and time effective comprehensive myopia analysis to enable optimal myopia management for many clinicians and thus for many children. As Brennan states, “Since eye length is the preferred method for detecting and tracking myopia progression, energy should be directed toward providing cost-effective tools for this purpose and physicians should work toward integrating optical biometry into practice [7].

Why is myopia management important?

The risk of eye disease increases per diopter and per millimeter of eye length. This consists of myopic macular degeneration, macular hole, retinal detachment, retinal splitting, open-angle glaucoma, and cataracts [1].

The prevalence of myopia has greatly increased internationally and a further increase is expected. The number of patients with visual loss due to severe myopia could increase 7-fold from 2000 to 2050, making myopia the leading cause of permanent blindness [2].

For this reason, myopia-inhibiting therapy with low-dose atropine eye drops, peripheral defocus glasses, multifocal contact lenses, or with orthokeratologic contact lenses is recommended for myopia progression. The potential benefits of slowing myopia progression and thus reducing the risk of vision loss outweigh the risks of therapy. The number of patients who should receive therapy to prevent 5 years of vision loss ranges from 4.1 to 6.8, whereas less than 1 in 38 patients will experience vision deterioration from myopia-inhibiting therapy [3]. The slowing of myopia increase with one diopter should lower the risk of myopic macular degeneration with 40% probability [4].

Why is eye length measurement important in myopia management?

Eye length is according to many studies, the most important parameter to monitor in pre-myopia and in-myopia [5]. Furthermore, it is recommended to set eye length as primary therapeutic goal for myopia management instead of refraction [1]. The recommendation is based on the fact that ocular morbidity depends much more on eye length than on refraction [7]. It is most vividly seen in myopic maculopathy. The most important risk factor for myopic macular degeneration in adults was found to be not refraction less than -5.0D, but rather eye length greater than 25.3mm in women and 25.9 in men [6].

Furthermore, myopia inhibiting therapies, such as atropine and orthokeratology can cause refractive changes independent of eye length, therefore change of refraction is not always suitable for monitoring myopia progression [7].

The growth rate of eye length depends on age, gender and ethnicity, therefore eye length should be presented on published eye length growth curves for assessment [1].

1. CCW Klaver et al. (2020), DOI: doi.org/10.1111/opo.12676
2. BA Holden et al. (2016), DOI: doi.org/10.1016/j.ophtha.2016.01.006
3. MA Bullimore et al. (2021), DOI: doi.org/10.1016/j.ophtha.2021.04.032
4. MA Bullimore et al. (2019), DOI: 10.1097/OPX.0000000000001367
5. J Nemeth et al. (ESO&IMI, 2021), DOI: 10.1177/1120672121998960
6. S Hashimoto et al. (2019), DOI: 10.1016/j.oret.2019.04.023
7. NA Brennan et al. (2021), DOI: doi.org/10.1016/j.preteyeres.2020.100923

How to assess eye length?

Eye length measurement is recommended every 6 or 3 months depending on the risk [1].

Eye length values allow:

• Risk estimation: High risk is expected at the >75th percentile [2]. Above 26mm eye length even annual mydriasis is recommended to exclude retinal changes [3].

• Indication for therapy: At the >75th percentile, less need for therapy is expected and therefore more therapy should be sought [2]. At the >75th percentile, progression can be assumed [4], as well as increased annual eye length gain and therefore myopia-inhibiting therapy should be started [1].

• Support for therapy choice: Depending on the risk, one should start with monotherapy or immediately with combination therapy.

• Monitoring of therapy response: A good therapy response is assumed if the percentile position remains stable or decreases if necessary. If percentile position continues to increase, therapy intensification is recommended [1]. If the annual eye length increase is physiological, our therapy target is reached, if the growth rate is still higher than the 50th percentile, the therapy should be intensified [1,5,6].

1. J Saw (2023), www.myopiaprofile.com/articles/back-to-basics-axial-length-measurement
2. CCW Klaver et al. (2020), DOI: doi.org/10.1111/opo.12676
3. KL Gifford et al. (2019), DOI: doi.org/10.1167/iovs.18-25977
4. JWL Tideman et al. (2018), DOI: doi.org/10.1111/aos.13603
5. J Nemeth et al. (ESO&IMI, 2021), DOI: 10.1177/112067212199896
6. NA Brennan et al. (2021), DOI: doi.org/10.1016/j.preteyeres.2020.100923

Why is Myopiagraph special?

Myopiagraph was specifically designed to meet the needs of treating ophthalmologists so that it fits best into their daily routines. It does not require the purchase of a new specialized device, saving cost and time to launch. Patient data, including eye length and refraction values and even general risk factors, can be pre-filled by assistants. The attending physician can evaluate eye length using displayed growth curves and color-coded numerical analysis on the patient’s own computer. It is possible to view all findings at once from one place without having to go to a specific measuring device in the pre-examination room. The medical evaluation and therapy recommendation can be quickly filled in and transferred to a report. The report can be stored in the electronic file or printed.

Operation is simple and fast. Myopiagraph even allows preliminary findings of eye length and refraction values to be easily and quickly loaded into the program as an Excel spreadsheet, which allows assessment for longer periods without loss of time from the consultation. An Excel spreadsheet of these values can be easily saved from most electronic medical records.

Eye length values of Caucasian children are color-coded on the well-known graphs of Tideman [1] and Truckenbrod [2], whereas those in Asian children are color-coded on the curve of Sanz Diez [3]. The mapping is done exactly as it is known from the diagrams from the studies, including the percentile curve number. The visualization not only ensures a more accurate risk assessment of myopia and thus a better initial therapy planning and an accurate therapy success control, but it also acts as a strong motivator to children and parents when they see the eye length and the associated risk in a more understandable way.

Myopiagraph is a web-based software, therefore you should not worry about the waiting time for a device delivery and space requirements of a device. Measurement data can be viewed from multiple locations within an organization, which can mean relevant travel time savings for patients.

1. JWL Tideman et al. (2018), DOI: doi.org/10.1111/aos.13603
2. C Truckenbrod et al. (2021), DOI: doi.org/10.1111/opo.12817
3. P Sanz Diez et al. (2022), DOI: 10.1038/s41598-022-08907-5

Data security and compliance

What measures are taken to ensure the security of patient data in Myopiagraph?

Data security measures We take data security seriously and have partnered with Hetzner Online, a certified provider with ISO/IEC 27001 certification. This certification ensures that Hetzner maintains a robust Information Security Management System (ISMS) covering the infrastructure, operations and customer support of its data center parks at all locations, including Nuremberg, Falkenstein and Helsinki. This means that Hetzner is committed to maintaining strict information security standards to protect the security, confidentiality and integrity of your patients’ data. Access to our systems is limited to authenticated users, which provides an additional layer of security.

How often are security assessments and audits performed to verify that patient data is protected?

Security audits and assessments: We place great emphasis on continuous improvement of information security. Hetzner’s ISO 27001 certification requires regular audits to verify that the information security management system (ISMS) is up-to-date and effective. This means that we not only start with robust security measures, but also continually strive to evaluate and improve our security practices. Your patients’ data remains protected through consistent assessments and updates to our security protocols.

What steps are taken to ensure that only authorized personnel have access to patient information in Myopiagraph?

Access control measures: Myopiagraph takes strict access control measures. Only authenticated and authorized personnel have access to patient information in our system. This ensures that patient information is kept confidential and secure, and minimizes the risk of unauthorized access or a breach of privacy. Protecting the integrity of your practice’s data is our highest priority.