As options for myopia management expand and the evidence basis grows, treatments can be tailored to suit the individual child, their lifestyle, their families and their myopia risk factors. Here's how to approach considering the individual in myopia management.
Choose a strategy based on the child's lifestyle
Lifestyle factors, personal preferences and motivations are key to understand before embarking on a prescribing strategy, especially in view of similar efficacy of several treatments.1 Children who are highly active sporting enthusiasts or who don't enjoy wearing their spectacles may be best suited to contact lens options. Parents who are concerned about contact lens wear in children may require additional communication on Contact Lens Safety in Kids. Children with mild ocular allergies may potentially be better suited to orthokeratology (ortho-k) than soft contact lenses: 10 years of follow up in children wearing either option found no difference in adverse events between the groups, but less eyelid changes in the ortho-k group.2
Another important consideration is the home environment. Busy parents, or children who go across multiple households may not have the capacity for ortho-k wear, where consistent nightly wear and careful transport of the lenses themselves are required. In these cases, disposable myopia control soft contact lenses would be ideal, where supplies can be kept in multiple places. Alternatively, a parent who desires full supervision and control over contact lens wear may prefer ortho-k.
Take a detailed lifestyle history from the child and family to better understand their position. Ask about their hobbies, interests and activities. Parental experience with vision corrections can also be helpful in directing clinical discussions.
Look at the risk factors for each individual
The first and largest risk factor for myopia progression is the child's current age. Younger children require a more proactive approach to myopia management, given that progression is fastest in younger children.3
Experts advise that all myopic children should be proactively managed for their myopia, especially children under age 12 who are at risk of faster progression and reaching high myopia.1 Given that only half of children show axial elongation stability by age 16,4 myopia management should ideally continue throughout the teenage years.
Other risk factors should also be considered carefully in directing myopia management. These include the following.
- Family history of myopia. Children with myopic parents have a higher likelihood of both becoming myopic5 and demonstrating faster myopia progression6
- Prior progression. In children aged 7 to 9 years of age at baseline, those with slow progression in the first year (less than -0.50D) had slowest mean progression in the following two years (mean -0.41D/year). The children with fastest progression in the first year (more than -1.25D) had the fastest subsequent two year progression (mean -0.82D/year). This was a stronger predictor than baseline level of myopia or age of myopia onset.7
- Visual environment. At least 120 minutes per day of outdoor time has been shown to decrease risk of myopia onset in randomized controlled trials.8 While the link between outdoor time and myopia progression is mixed,9 there is meta-analysis support for the link between near work and myopia,10 where increased time spent and closer working distances at near are related to myopia onset11,12 and progression.13
The first two of these can't be modified, while the third one can. In all three cases, understanding these risk factors can help with both parental communication on the necessity for myopia management as well as appropriately setting expectations for outcomes.
A child with two myopic parents, myopia progression of at least -1.25D in the prior year and low time spent outdoors coupled with high near work time needs the most proactive myopia management strategy.
How does this impact your clinical practice?
- Get to know your patients: they are more likely to stick to treatments that suit and enhance their lifestyle
- Consider risk factors: whilst some are modifiable and some aren't, all play into the decision making and communication in myopia management.
Read more about determining myopia management strategies
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- 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 Science Review]
- Hiraoka T, Sekine Y, Okamoto F, Mihashi T, Oshika T. Safety and efficacy following 10-years of overnight orthokeratology for myopia control. Ophthalmic Physiol Opt. 2018 May;38(3):281-289. (link)
- Chua SY, Sabanayagam C, Cheung YB, Chia A, Valenzuela RK, Tan D, Wong TY, Cheng CY, Saw SM. Age of onset of myopia predicts risk of high myopia in later childhood in myopic Singapore children. Ophthalmic Physiol Opt. 2016 Jul;36(4):388-94. (link)
- Hou W, Norton TT, Hyman L, Gwiazda J; COMET Group. Axial Elongation in Myopic Children and its Association With Myopia Progression in the Correction of Myopia Evaluation Trial. Eye Contact Lens. 2018 Jul;44(4):248-259. (link)
- Jones-Jordan LA, Sinnott LT, Manny RE, Cotter SA, Kleinstein RN, Mutti DO, Twelker JD, Zadnik K; Collaborative Longitudinal Evaluation of Ethnicity and Refractive Error (CLEERE) Study Group. Early childhood refractive error and parental history of myopia as predictors of myopia. Invest Ophthalmol Vis Sci. 2010 Jan;51(1):115-21. (link)
- Saw SM, Nieto FJ, Katz J, Schein OD, Levy B, Chew SJ. Familial clustering and myopia progression in Singapore school children. Ophthalmic Epidemiol. 2001 Sep;8(4):227-36. (link)
- Matsumura S, Lanca C, Htoon HM, Brennan N, Tan CS, Kathrani B, Chia A, Tan D, Sabanayagam C, Saw SM. Annual Myopia Progression and Subsequent 2-Year Myopia Progression in Singaporean Children. Transl Vis Sci Technol. 2020 Dec 7;9(13):12. doi: 10.1167/tvst.9.13.12. PMID: 33344056; PMCID: PMC7726587. (link)
- Ho CL, Wu WF, Liou YM. Dose-Response Relationship of Outdoor Exposure and Myopia Indicators: A Systematic Review and Meta-Analysis of Various Research Methods. Int J Environ Res Public Health. 2019 Jul 21;16(14):2595. (link)
- Xiong S, Sankaridurg P, Naduvilath T, Zang J, Zou H, Zhu J, Lv M, He X, Xu X. Time spent in outdoor activities in relation to myopia prevention and control: a meta-analysis and systematic review. Acta Ophthalmol. 2017 Sep;95(6):551-566. (link) [Link to Myopia Profile Science Review]
- Morgan IG, Wu PC, Ostrin LA, Tideman JWL, Yam JC, Lan W, Baraas RC, He X, Sankaridurg P, Saw SM, French AN, Rose KA, Guggenheim JA. IMI Risk Factors for Myopia. Invest Ophthalmol Vis Sci. 2021 Apr 28;62(5):3. (link)
- Li SM, Li SY, Kang MT, et al. Near Work Related Parameters and Myopia in Chinese Children: the Anyang Childhood Eye Study. PLoS One. 2015;10(8):e0134514. (link)
- Huang HM, Chang DS, Wu PC. The association between near work activities and myopia in children—a systematic review and meta-analysis. PloS one. 2015 Oct 20;10(10):e0140419. (link) [Link to Myopia Profile Science Review]