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April 2024
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SPOTLIGHT ON EDUCATION Part 2: The Art of Choice: Tailoring Myopia Control Treatments to Your Patient’s Individual Needs

Increasing Myopia Prevalence, Risk Factors & Health Implications

  • Predicted to be half of the world’s population by 2050
  • 10% of the population will be highly myopic
  • Asians progress faster
  • Near work and screen time increases progression; take a 20 sec break looking at distance every 20 minutes you are doing near work
  • ≥ 2 hours outdoors is beneficial
  • Myopia at age 7 – 9 has 54 – 80% of developing high (≥ 5D) myopia
  • ≥ 6D of myopia = 2.5x risk of glaucoma; 21.5x risk of retinal detachment; 40.6x risk of myopic maculopathy
  • According to survey research, 25% of the children in the US are myopic but only 33% of the parents know what that term means or how it can affect their children’s future eyesight

Myopia Control Treatment Options

Low Dose Atropine

  • ATOM Study: .01% was optimum to slow progression although only mild reduction in axial length while having least side effects
  • LAMP: found .05% optimal to slow progression with minimal side effects
  • Pros: Any age as parents can monitor dosage; patients who don’t want contact lenses; can use concurrently with any of the contact lens options
  • Cons: possible side effects (pupil dilation/light sensitivity & near blur); no vision correction

Multifocal Soft Lenses

  • Blink Study: High add power for more effective than low add
  • MiSight (CooperVIsion) only FDA approved design; up to -7D but no toric options
  • Candidates; older, mature children; better initial comfort; high Rx’s are available; some off-label higher Rx/toric options
  • Con’s: Not good for young children with poor hygiene; those very involved with water sports; they do need to know how to handle the lenses

Orthokeratology

  • Results of studies are quite positive and are both repeatable and reliable
  • Candidates: good for all ages; benefit of no correction during the day especially with athletes; patients can be younger since parents can assist with A & R.
  • Challenges: The initial comfort and adaptation period; not always a candidate if high Rx of high cylinder; more chair time/follow-ups; upfront expense

Combination Therapy

  • Orthokeratology and .01% atropine found to be beneficial in initial treatment of low myopes versus orthokeratology alone
  • BAM Study: MF soft lenses had same efficacy as MF soft lenses + .01% atropine

Spectacles

  • Several spectacles were described
  • Not available in the US yet but exhibit very good promise

Cases

  • 10 y/o white male -1.25D Rx; plays contact sports
  • 6 y/o Asian female 3D myope (increased 2D in past 12 months); avid reader and plays soccer
  • 12 y/o male 4D myope (increased 0.75 in past 12 months); avid swimmer
  • The treatment options and recommendations for each case are presented

Final Clinical Pearls

  • Check BV status: atropine can impact this
  • Always check topographies to determine orthokeratology candidacy
  • Consider hobbies, especially water sports
  • All options have similar efficacies
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