In late 2019 popular professional magazine Contact Lens Spectrum published a special edition entitled Bringing Myopia Management into Focus. Read on to get an overview of the fantastic content, and click the prior link to read the full text.
The Size of the Myopia Problem
Kate opens her editorial article by discussing the growing scale of the myopia epidemic. She speaks about how this issue is different for different countries, with East Asia particularly affected with a rate increase of 23% from 2010 to 2015. By age 15, around 69% of children in East Asia are myopic. She encourages eye care practitioners to consider three facets of myopia care - the value of 1D, acknowledging that the axial length of the eye is the key measure and finally what steps practitioners should take to control myopia in practice.
Myopia Management: A Paradigm Shift
Maria cautions about the socioeconomic and even national security implications of having an overwhelming amount of a country's young population being myopic; for example, China has consequently had to change their recruitment to allow refractive errors up to -6.00D in their army recruits, for lack of lower myopes. Singapore has established the Singapore National Eye Centre’s Myopia Centre to address their growing problem through public health measures. She also raises the incredible question “do conventional single-vision spectacles do no harm? The answer may be surprising to many practitioners.
Myopia Management Options: Who, When, What and How
“The core message of the International Myopia Institute Clinical Management Guidelines report is simply to do something - something more than prescribing a single-vision correction to a progressing myope” discusses Kate before going on to discuss whom you should focus on. She urges you to consider the pre-myope, young children, and how to explain efficacy to parents. This is followed by clinical decision making flowcharts to help you choose the best treatment outcomes, followed by an explanation of mechanisms of myopia control.
Myopia Control and Contact Lenses: A Clinical Review
Mark A. Bullimore
Mark opens his article discussing the nuances of off-label prescribing of orthokeratology in the United States. He discusses the efficacy of orthokeratology and soft multifocal contact lenses and their various safety profiles. He demonstrates the low rate of microbial keratitis in children, which appears to be lower than that in adults, and concludes that while there is a risk of adverse events, the risk of vision loss later in life in unchecked myopia progression is significant.
Image credit - Mark Bullimore, Myopia Control and Contact Lenses: A clinical review.
"Prevalence of myopic maculopathy by level of myopia".
The Role of the Parent in Myopia Management
Katherine discusses her passion for educating parents about myopia control and the complexity of generating understanding on such a wide-ranging topic. She warns that “parents need a significant amount of time to process the concept of myopia control, so be sure to allow sufficient time in your schedule to educate them.” Katherine covers these key discussion points: the great outdoors, atropine, orthokeratology and peripheral plus power soft lenses; but underpinning all of this, having parents fully committed to myopia control. She also provides an example parent info sheet on treatment options.
Implementing Myopia Management: a how-to guide
Melanie discusses a comprehensive list of myopia definitions, highlighting the importance of ensuring practice staff confidence in their understanding of myopia. She discusses the equipment required to implement a consistently, highly structured myopia management service in your practice and how to promote it to your patients.
Image credit - Melanie Frogozo, Implementing Myopia Management: A how-to guide, "In patients with higher amounts of myopia and astigmatism, consider prescribing daytime-wear GP lens designs with front surface center-distance multifocals. This young patient is wearing a scleral multifocal design."
Coopervision’s Role in How Myopia is Managed
Jason J. Nichols
Dr Nichols interviewed Dan McBride, the President of Coopervision Inc. He discusses the MiSight lens, which achieved landmark FDA approval for myopia control in November 2019, and is currently available in Europe, Asia and Oceania. Dan highlights how all practitioners, even paediatricians and general practitioners, need to get on board with the evidence-based management of myopia. He also discusses his vision for the contact lens field in the short and longer term. Coopervision sponsored this special issue of Contact Lens Spectrum, to highlight this important, growing field of patient care.
The Economics of Myopia Control
Clarke D. Newman
Clarke speaks to the privilege of optometrists able “to stand between our patients and these [eye] diseases” by treating progressive myopia. He discusses the ethical complication of optometrists being reliant on myopia as a chronic condition for our income streams, but how to realistically approach this. Clarke covers cost analysis considerations for implementing myopia management in your practice. The need for close monitoring of children wearing contact lenses is also discussed.
Going from Zero to Hero
David L. Kading
The warning from David is clear; whilst the consequences of myopia may not be initially apparent, it is a “ticking time bomb” for patients as they age into their 50s, 60s and 70s. He discuses how to create “eager” myopia management patients, stepping through his clinical communication process.
The Benefits of Contact Lenses for Children
Melanie discusses the “Contact Lenses in Paediatrics (CLIP) study,” which shows that children only take 15 minutes more to fit in comparison to teens. Children have many motivations towards lens wear, and it can have many positive outcomes such as overcoming self-perception of “less attractiveness, introversion and shyness” in spectacle wearing children.
Myopia Management with Orthokeratology
Michael J. Lipson
Michael discusses that any degree of myopia is a risk factor for pathology, and so management such as orthokeratology should be and can be considered in children even as young as 8. He discusses the advantages and disadvantages of Ortho-K and the gratifying outcomes for both practitioners and patients.
For Myopia Management Sometimes Smaller is Better
David L. Kading
David discusses the case of Sam, whose myopia was still progressing despite effective OrthoK correction. He suggests reducing the size of the treatment zone, and how this worked effectively for Sam.
Image credit - David L. Kading, For Myopia Management, Sometimes Smaller is Better, "Large Treatment Zone with small add power."