Myopia treatment must be individualized
You may have seen my article in April 2019 discussing how I manage myopia in my practice. Myopia is a serious global health concern. Today, well over 1 billion people around the world are struggling with the condition. This number is only expected to increase in the future, especially among school-age children, reaching nearly 5 billion by 2050. In the U.S. alone, over 40% of Americans are nearsighted, according to the Brien Holden Vision Institute.
The vast majority of eye care practitioners (ECPs) agree that myopia is one of the main concerns impacting children’s eyesight today, and two-thirds of ECPs say the presence of myopia in their practice has increased at an alarming rate over the last 5 to 10 years, the institute says.
To address this global epidemic, myopia management is coming to the forefront of optometry. Reasons for the upward trend can be attributed to different factors, but it is occasionally the result of a combination of these factors.
Genetics
Family history plays an important part in determining both a child’s risk for onset of myopia and progression.
If neither parent is nearsighted, the chance that a child will develop nearsightedness is lower. If one parent has myopia, a child’s risk for developing myopia increases to three times, and this risk doubles to six times if both parents are myopic.
Environment
Time spent outdoors is another important factor impacting the prevalence of myopia in children. The amount of time spent outdoors, exposure to sunlight, dopamine levels and vitamin D intake all have an impact on the risk for developing myopia. Research shows spending more time outdoors reduces the risk for onset of myopia in children (Kinoshita et al.).
Essentially, when the parents are myopic, the more likely their children will be — and the more time children stay indoors and use digital devices, the more likely they are not only to develop myopia but also for it to progress.
Risks of myopia
Importantly, more than half of ECPs agree that myopia, if left untreated, will increase the chances for developing irreversible vision loss later in life (Kinoshita et al.). Children who are myopic, even at low levels, are at increased risk for developing glaucoma and retinal detachments, among other conditions, compared to children who do not have myopia. This risk increases as the myopia level increases.
Overall, myopia progression has been associated with sight-threatening conditions later in life such as glaucoma, retinal detachments and myopic maculopathy and degeneration.
How I manage myopia
In my practice, if the patient is emmetropic but at increased risk for myopia, I focus on reducing risk. For example, I may advise the patient to limit their screen time or spend more time outdoors.
If the patient is myopic, the equation becomes a bit more complex.
Multiple factors contribute to determining the ideal management strategy, including the patient’s risk for progression, the degree of refractive error, and the preferences of the patient or their parent or guardian. To prescribe the correct strategy, it is important to consider the patient’s suitability, risk for progression and preference, the effectiveness of the strategy and the patient’s ability to have access to it.
There is a wide range of management methods, including contact lenses, both center-distance multifocal and extended depth of focus; orthokeratology; progressive addition spectacles; executive bifocals; peripheral defocus spectacles; low-dose atropine drops or a combination (eg, low-dose atropine and multifocal contact lenses).
I am very excited to welcome CooperVision’s MiSight 1 day lens to my myopia management clinic. This represents a powerful additional tool in my armamentarium and another way to fight this global epidemic, but it will certainly not be the only tool. Every patient requires individual and thorough assessment to determine the optimum result.
References:
Holden BA, et al. Ophthalmology. 2016;doi:10.1016/j.ophtha.2016.01.006.
Kinoshita N, et al. Jap J Clin Ophthalmol. 2018;doi:10.1007/s10384-018-0608-3.
For more information:
Elise Kramer, OD, FAAO, FSLS, who is residency-trained, practices at Weston Contact Lens Institute and specializes in ocular health and disease, ocular surface disease, and regular and specialty contact lens fitting. Over the last few years she has created a unique scleral lens practice.
Collapse
Read more about