New guide provides path for myopia control from monitoring to treatment
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Johnson & Johnson Vision released a new guide for eye care professionals and patients with research-based recommendations for assessing, monitoring and treating myopia, especially in children.
The guide — Managing Myopia: A Clinical Response to the Growing Epidemic — is the result of a 1-year collaboration among optometric organizations, including the American Optometric Association (AOA), American Academy of Optometry (AAO), Association of Schools and Colleges of Optometry and the Singapore Optometric Association, according to a press release from J&J Vision.
“With the COVID-19 pandemic, 65% of households report the use of online learning for children, increased digital screen use linked to near work, compounded by the fact that social distancing measures have limited the time children spend outdoors,” Robert C. Layman, OD, AOA president-elect, said during a virtual event hosted by J&J Vision. “This crisis can have far-reaching eye health and vision implications on generations to come.”
He noted that each diopter increase in myopia results in a 67% increased risk for myopia macular degeneration, along with higher risks for retinal detachment, staphyloma, primary open-angle glaucoma and cataract.
“There is no safe level of myopia. It behooves us to address this with all of our finest clinical tools available,” he said.
Key points from the guide include:
- Monitor myopia in children between the ages of 6 to 12 months at least once before age 3 to 5, then annually through age 17.
- Secure treatment as early as possible to slow progression.
- Find the right treatment, which can depend on a combination of practitioner advice, parental preference and the child’s capabilities and maturity.
- Monitor myopia progression at least every 6 months once treatment is established to assess barriers to use, compliance and risky behaviors.
- Understand that the best gauge of myopia control efficacy is cumulative absolute reduction in axial elongation or refractive error.
The virtual event concluded with a question-and-answer session in which Layman and others provided further recommendations for addressing myopia.
Layman addressed the importance of sustaining myopia control methods, as research has shown that refractive changes can continue through 18 years of age. He said that in his practice he continues monitoring college-age patients who do heavy near work until their prescription has stabilized.
David Berntsen, OD, PhD, FAAO, representing the AAO, said researchers are currently looking at whether there is any rebound effect with stopping treatment.
Kathryn Richdale, OD, PhD, FAAO, associate professor at the University of Houston College of Optometry, added that the goal in evaluating patients every 6 months to 1 year is to talk with patients about their vision.
Ken Tong, BScOptom, president of the Singapore Optometric Association, recommended testing binocular vision in patients with even as little as 0.75 D of myopia to determine whether wearing spectacles all the time is helpful with close reading or may stress accommodation.
Moderator Noel Brennan, MScOptom, PhD, FAAO, clinical research fellow for J&J’s myopia control platform, asked the panelists what three things eye care professionals need to do to tackle the global myopia epidemic.
“Education will help most,” Richdale said. “Educate yourself on control and treatment modalities, your staff so they feel comfortable talking to patients, and the community.”
“Also educate teachers in schools and develop practice protocols for staff,” Layman added.
“Switch the mindset of ECPs,” Tong said. “We must see myopia as a disease. The progression of myopia must be handled aggressively. The government must get involved; that’s when a lot of initiatives get carried out.”
“Myopia is a disease, and there isn’t a safe level of myopia,” Berntsen said. “The time to worry about myopia is when the child first becomes myopic, not when they’re getting close to –5 D. There’s a difference between simply managing the myopia vs. correcting the refractive error.”
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