IH is a 9-year-old female of South Asian (Pakistani) heritage, who presented with her father complaining about struggling to see the board at school. Since her previous visit 9 months prior, she had progressed from hyperopia to myopia – showing a right eye 1.25DS and left eye 1.00DS myopic shift, for a current refraction of R&L -0.75DS.
|Right eye (DS)||Left eye (DS)|
(9 months ago)
Click through the images below to learn more about the case and communication approach.
Clinical communication: the challenges and solutions
The key concerns when managing IH were as follows:
- That it is important for the patients to understand that this a management strategy, not just a way to 'sell' contact lenses/spectacles.
- IH's parent were understanding of the concerns and management options available but were concerned about IH wearing contact lenses at this age.
The discussion points which helped to address these concerns were:
- One of IH's parents is a contact lens wearer, so we had a discussion about children in contact lenses and how studies have shown that children are not at any increased risk of adverse events compared to teens or adults, with low overall rates of adverse events.
- The various contact lens options were discussed in terms of their benefits, from wearing and managing orthokeratology at home to the simple-to-manage and healthy option of daily disposable contact lenses. It was also mentioned that the longest continuous study on myopia control contact lenses in children is the six-year MiSight 1 day study.
- Raising the issue that myopia progression rates are increasing worldwide (appearing to be worsened by COVID restrictions) and that IH's potential future level of myopia, based on current growth, brought with it increased risk of ocular health issues compared to a lower final level of myopia possible with myopia control.
Long-term eye health, for me, is always the most important concern when discussing myopia management with a parent. The fact that it will ideally mean less changes in prescription seems to be an added bonus.
It is important to determine which management options are viable. You need to consider whether the patient's refraction is 'in range' and if they will be able to manage the modality. Other factors to consider include lifestyle and hobbies, and how the chosen treatment will impact standard of living. With IH, due to her lower prescription and young age, it was felt that any of the currently available modalities would be suitable for her to start her myopia management journey. Therapeutic options were discussed and at this stage they included myopia control design contact lenses and spectacles.
IH was keen for contact lenses. However, her parents decided on myopia control design spectacle lenses as they still had reservations about the contact lens option. IH was comfortable with the spectacles, and was advised that full-time wear was required. Meanwhile, contact lens options were kept in view for the future.
Keyur's key learning points
- Myopia management is a family journey and you have to manage the patient as well as the parent or carer.
- It is important to take the family's opinions into consideration (especially with younger patients) as they may have particular ideas or concerns which can be easily discussed or allayed.
- It is important to make the patient and parents aware that there can be multiple options for myopia management, and that it is possible to change from one treatment option to another if needed or desired. In this case, ensure that parents are aware where different treatments may have different levels of evidence or outcomes for myopia control efficacy.
About Keyur Patel
Keyur is an optometrist and the clinical director at Tompkins Knight & Son Optometrists in the United Kingdom. As well as the British qualification he has a U.S. Doctor of Optometry and has practiced in multiple settings from Academia to Hospital in both countries. Currently he works in private practice and continues sessions at a community glaucoma clinic as well as sharing interesting ocular images on his Instagram (@optomegeek). Keyur's areas of special interest are myopia management, specialist contact lenses and ocular therapeutics. Keyur is a Fellow of the College of Optometrists, American Academy of Optometry and the British Contact Lens Association.
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FDA Indications for use (US only): MiSight® 1 day (omafilcon A) soft (hydrophilic) contact lenses for daily wear are indicated for the correction of myopic ametropia and for slowing the progression of myopia in children with non-diseased eyes, who at the initiation of treatment are 8-12 years of age and have a refraction of -0.75 to -4.00 diopters (spherical equivalent) with ≤0.75 diopters of astigmatism. The lens is to be discarded after each removal.