Welcome to Part 2 of the news update of the 2020 Global Specialty Lens Symposium, held in Las Vegas. Read on for updates on the risk-to-benefit comparison of myopia control, how to talk myopia successfully with parents and how to integrate myopia control into your practice. Click the link at the bottom to check out Part 1 on Teens, Treatments and Treatment Zones.
Successfully integrating myopia management into practice
Lyndon Jones (pictured far left), from the University of Waterloo in Canada, chaired the half-Canadian and half-USA panel, from left to right: three Optometrists, Ariel Cerenzie, Sheila Morrison and Tina Goodhew; and one patient educator, Tara O’Grady, who works in a large practice to facilitate shared decision making with parents and patients on myopia strategies. Wow, I tell you, every practice needs a Tara! Here are some gems from the session, not in chronological order but in seating order so you can put faces to the clever comments:
Ariel: Many parents don’t understand myopia, and even if they’re myopic they may have forgotten what it was like when they progressed. Show them the blur effects! For example, hold up +3 lenses to demonstrate -3 (parental Rx dependent!), and then show them this is what it could be in another year (extra +1 OU) and another two years (another +1 OU) if we don’t intervene. (Around 1D/yr is the mean SVD spectacle corrected 7-8 year old myope, Donovan et al 2012).
Sheila: Create resources for your patients, and leverage the resources that are available to save you time. (Thanks for the Myopia Profile mention here, Sheila!) Resources also affirm that this isn’t just your unique idea; especially important if this is new information to the parent, and is backed up by evidence. Sheila also talked about follow up, and how to have the conversation when the child inevitably does progress to say “we expect to see some change; children grow and we expect to see some growth, but it’s really good to see that this is a small amount of change.”
Tina: In discussions, consider also the practical issues of myopia progression - for higher myopia, even getting out of bed in the morning requires glasses; can lead to career restrictions and reduce suitability for LASIK and / or lead to poorer acuity outcomes.
At this point Lyndon mentioned that recently the Chinese Fire Service and Army have had to reduce the criteria for their unaided vision requirements for recruits, as they are really starting to struggle to find lower myopes!
Tara: There are three main problems with myopia which we need to address in patient / parent education;
- The functional effect of blur
- The progressive nature
- The long term abnormal health state of the eye
We need to establish that we have these problems, and the impact this has on the child’s life, so then we can suggest solutions. Consider the solution to each part of the myopia problem, so you can reach a decision together with the parent.
Risk-to-benefit comparison of myopia control
Mark Bullimore (pictured in action above) presented some powerful data on the risk-to-benefit comparison of myopia control. He makes it look simple, but there’s loads of maths behind these numbers! As you might recall, Mark and Noel Brennan published last year entitled ‘Myopia Control - why 1 diopter matters’ based on their calculations on current studies showing an absolute effect of available treatments of 1D.
The bottom line from this new data?
- The high safety profile of contact lenses, particularly in children aged 8-12 (perhaps the safest wearers and our targets for myopia control intervention) means that the there are 5,000 to 10,000 years of vision loss PREVENTED by myopia control of 1D, compared to the risk of vision loss CAUSED by contact lens myopia control, which is 7-100 times less likely. The different incidences at the bottom of the first image are indicative of different levels of risk for various modalities.
- For which lens modality these correspond to, we’ll need to ask Mark as I know the incidence rates of MK without vision loss by modality
- Controlling myopia and reducing the final level of myopia by 1D results in reduced pathology risks as shown in the image.
This is more and more evidence for the WHY of myopia management. For more information on why each dioptre matters, check out our blog post. Mark's summary slide is also below. I know you all appreciate this imperative, but there’s still much work to do to get our colleagues on board. Spread the word! Myopia management is preventative eye health management.
Talking myopia with parents
Brett O’Connor (pictured above), an Optometrist practicing in Florida USA, spoke about having myopia discussions with parents. I especially liked these two slides on what parents need to know versus what they don’t need to know. Brett said we can come back from conferences full of nerdy excitement about the latest research but we can’t throw it all at our patients and their parents! (Although some of them do want to deep dive, then you’ve got to constrain your nerdy excitement in the best interests of your schedule!)
Another important point Brett made was for clinicians getting started - don’t be embarrassed that you haven’t offered this before, especially if you’re talking to a younger sibling where the older myopic sibling wasn’t offered the same options. Brett advised to:
- Start with the good news - that the child’s eyes are healthy. Then go through the four points for discussion as follows. Be brief and not too scientific in your language.
- Your child's myopia has increased
- Myopia increases due to excessive eye growth
- Having a longer eye may increase risk of future eye disease
- Safe treatments which slow eye growth are available.
- Create excitement - fitting a child with contact lenses for an avoidance reason (to avoid long term eye health problems) is less energising for the child and parent than fitting for a ‘pull’ reason of the functional and life benefits contact lenses bring. Of course both are important, but start with and emphasise the positives at every step along the way.