Clinicians share approach to myopia control

NEW YORK – Four practitioners who specialize in contact lenses detailed their pearls for controlling myopia in children, here at the Global Contact Lens Forum.

“Forty-four percent of the U.S. is myopic, according to the Brien Holden Vision Institute, and the numbers are staggering in other parts of the world,” S. Barry Eiden, OD, FAAO, told attendees here at the Vision Expo East session. “We have to stop thinking of it as refractive error; it’s a disease.”

Eiden said in his practice, there is no need to explain this to his Asian patients; “they know it’s a disease,” he said. “The Caucasians don’t get it. We’re trying to increase education, especially to that demographic in our practice.”

Eiden outlined known strategies for managing myopia, including gas-permeable lenses, undercorrection, soft multifocals, atropine and corneal reshaping.

“GP lenses are an old idea, and undercorrecting doesn’t work,” he said. “Soft multifocals are weak, but encouraging. Atropine works, and corneal reshaping works. We incorporate all three as options.

“We have myopia management packets and include information on ways to manage myopia,” Eiden continued. “The whole paradigm of myopia in our practice in the last 3 to 5 years has dramatically changed. We started with corneal refractive therapy and extended to atropine, and now the third piece of the puzzle is looking at soft multifocals.”

Clark Newman, OD, FAAO, said that spectacle correction may slow down myopia, but it has temporary effects.

“Choose the patients who are progressive for myopia control,” he said. “We select those kids and tell them we have to slow down their rate of progression. Choose your patients carefully.”

Louise Sclafani, OD, FAAO, added: “When you fit a child for the first time, it’s important to get parents to understand you’re watching progression. We use multifocals.”

Robert Davis, OD, FAAO, said he presents a hierarchy of options in his practice.

“Wearing an orthokeratology lens at night is a tremendous advantage over not wearing a contact lens during the day,” he said. “Some patients can’t wear lenses at night due to comfort, but we’ve used ortho-K with a piggyback lens to address this. Some doctors use Voltaren (diclofenac sodium ophthalmic solution 0.1%, Novartis) to ease comfort. We include 0.025% atropine, which has a very low reaction rate, just to make sure the reaction is stable.”

Eiden added that a compounding pharmacy will need to dispense the 0.025% atropine.

Davis said he provides the pharmacist with a patient’s name, and the compound is mailed to him.

“You can’t stockpile it,” he noted. – by Nancy Hemphill, ELS, FAAO

Disclosures: Davis is a consultant, lecturer or conducts research for or has a financial interest in Alden, EyeVis, Fusion, SpecialEyes and SynergEyes. Eiden is a consultant, lecturer or conducts research for or has a financial interest in Alcon, Alden, Bausch + Lomb, Brien Holden Vision Institute, CooperVision, Paragon, EyeVis Eye and Vision Research. SpecialEyes and SynergEyes. Newman is a paid consultant for Alcon, Allergan, AMO and Bausch + Lomb. He has done clinical research for Alcon and is on the board for the Gas Permeable Contact Lens Institute. Sclafani consults, lectures or conducts research for Alcon, Allergan, Bausch + Lomb, CooperVision and Vistakon.