How can we set myopia control expectations?
In this article:
There is a clinical imperative now to both correct and control childhood myopia - the recent World Council of Optometry (WCO) Resolution has stated that optometrists should incorporate a standard of care for myopia management into their practices. This starts with a conversation on myopia risks, and continues into enacting myopia management strategies.
How do you select a myopia control strategy?
With numerous spectacle, contact lens and pharmacological interventions for myopia control, how do you select which is best? A recent analysis entitled Efficacy in Myopia Control makes this simple. Through a detailed, comparative analysis of the absolute effects of myopia control treatments, it appears that the best of each of the treatment categories offer similar efficacy, with most of the effect being observed in the first year of treatment and similar results thereafter.1
This makes things simple. Pick the treatment you have available - other than single vision and ideally not of the 'less effective' interventions - which best suits the child and also fits your scope of practice.
You can personalize myopia control therapy by selecting treatments based on the clinical and lifestyle considerations of the individual patient. This diagram, from the Johnson & Johnson Vision Managing Myopia Guide, is designed to help guide collaborative decision making between the practitioner, parent and patient.
How do you set expectations for myopia control?
There are some key messages on this from the literature.
How can we gauge success of myopia control?
Utilizing the latest knowledge on efficacy, we can judge the success of a treatment against the efficacy in randomized controlled trials, and when referenced to the average progression observed in age-matched children wearing single vision correction - representing an 'untreated' condition. There are two key points here.
If a child's myopia progression across a year is substantially less than these 'averages' by age and ethnicity, this likely represents an acceptable myopia control result.
What if the treatment is not working?
By virtue of providing averages, some children will progress faster or slower than the average, even when a myopia control strategy has been implemented. If a treatment doesn't appear to be slowing myopia as much as expected, consider factors such as the frequency and usage of the treatment. Is the patient compliant, and are they comfortable and satisifed with the treatment? Ensure that their goals for their vision correction are achieved as well as providing suitable myopia control intervention.
Read more on managing myopia control outcomes
Meet the Authors:
About Kate Gifford
Dr Kate Gifford is a clinical optometrist, researcher, peer educator and professional leader from Brisbane, Australia, and a co-founder of Myopia Profile.
This content is brought to you thanks to unrestricted educational grant from
- Brennan NA, Toubouti YM, Cheng X, Bullimore MA. Efficacy in myopia control. Prog Retin Eye Res. 2020 Nov 27:100923. (link) [Link to Myopia Profile paper review]
- Bullimore MA, Brennan NA. Myopia Control: Why Each Diopter Matters. Optom Vis Sci. 2019;96(6):463-465. (link)
- COMET Group. Myopia stabilization and associated factors among participants in the Correction of Myopia Evaluation Trial (COMET). Invest Ophthalmol Vis Sci. 2013 Dec 3;54(13):7871-84. (link)
- Bullimore MA, Jones LA, Moeschberger ML, Zadnik K, Payor RE. A Retrospective Study of Myopia Progression in Adult Contact Lens Wearers. Invest Ophthalmol VIs Sci 2002;43:2110-3. (link)
- Parssinen O, Kauppinen M, Viljanen A. The Progression of Myopia From Its Onset at Age 8-12 to Adulthood and the Influence of Heredity and External Factors on Myopic Progression. A 23-year Follow-Up Study. Acta Ophthalmol 2014;92:730-9. (link)
- Gao C, Wan S, Zhang Y, Han J. The Efficacy of Atropine Combined With Orthokeratology in Slowing Axial Elongation of Myopia Children: A Meta-Analysis. Eye Contact Lens. 2021 Feb 1;47(2):98-103. (link)
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