Panel: Explain risks of untreated myopia progression
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LAS VEGAS — Eye care providers have a responsibility to explain to parents the risks of progression if their child’s myopia is left untreated, according to panelists at Vision Expo West.
“We know the long-term issues of a severely myopic eye,” Janelle Davison, OD, owner and CEO of Brilliant Eyes Vision Center in Smyrna, Georgia, said during a panel discussion on myopia control at the Global Contact Lens Forum.
“You have to take the parent and patient with you into the future,” she said. “The biggest risks are myopic macular degeneration, retinal detachment and overall visual impairment.”
“Many of the risks are longer term, but there are also short-term issues,” panelist Lyndon Jones, BSc, PhD, DSc, FCAHS, FCOptom, DipCLP, DipOrth, FAAO, FIACLE, FBCLA, director of the Centre for Ocular Research & Education at the University of Waterloo, said.
“We have great data showing that kids who are myopic may struggle with sports,” he said. “If they choose to have refractive surgery when they’re older, the lower the prescription, the better the outcomes.”
“Quality of life is so important,” Davison said. “Even our youngest patients deserve this. One benefit of recognizing myopia and treating it is the effect it will have on their active lives.”
Jones added: “Ethically, you can’t not do something if you see a child progressing. If you don’t do something, send them to someone who can.”
The panel, which also included Sheila Morrison, OD, MS, FSLS, who practices at Mission Eye Care in Calgary, Alberta, Canada, and Jason E. Compton, OD, FAAO, owner of Compton Eye Associates in New York, additionally discussed the importance of explaining to parents the risks associated with myopia treatment modalities.
“Always discuss evidence-based safety with any medical device,” Morrison said. “Weighing the risks and benefits plays a role in our decision-making. You don’t want patients to come back to us with a complication and have them say they didn’t know.”
Davison noted that dry eye has become an issue in younger patients.
“Kids have phones at early ages; they’re on devices all the time,” she said. “This impacts not only myopia, but also the ocular surface. We have to address the ocular surface and have a protocol for younger patients. A lot of our treatments are not necessarily suited for young children.”
Jones added: “We know that contact lenses in conjunction with digital devices massively affect the blink rate. We’re seeing significant meibomian gland dropout in very young kids.”
Long-term atropine may be another concern, according to Jones.
“When you get low-dose atropine compounded, it’s preserved with [benzalkonium chloride (BAK)],” he said. “We have very young kids with potentially years of being exposed to high doses of BAK. You would not do that with your other patients.”
Compton stressed the importance of clinicians keeping up-to-date in the area of myopia management.
“We can’t rely on our understanding of 5 years ago,” he said. “The data is continually changing; the way we practice myopia management is continuing to evolve.”
For example, orthokeratology is safer today, the effective dose of atropine is lower and new-generation spectacle lenses are showing efficacy, he said.
“This is the fastest moving field we’ve ever seen,” Jones added.
The panelists agreed on the importance of parents signing an informed consent for myopia management.
“They need to be able to understand the implications of what they’re about to be involved in,” Jones said. “If you’ve used a center-distance multifocal for myopia control, you’re using a product off-label. You’ve used your professional judgment to prescribe it that way. You must tell the patient if you’re using something off-label. This type of prescribing happens all the time, especially in pediatric patients.”
“I don’t only think FDA,” Compton said. “My consent will say everything.”
“All of the various treatments have been shown to be mostly equally effective,” Davison said. “But efficacy also involves patient compliance, patient action, appropriate treatment selection to match a patient’s ocular shape, refractive error and lifestyle.”
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Davison J, et al. Global Contact Lens Forum: Myopia Control, the good, the bad and the ugly. Presented at: Vision Expo West; Sept. 27-30, 2023; Las Vegas.
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