The management of myopia requires the attention of ophthalmologists


Disclosures: Thompson claims to be Euclid Systems’ chief medical advisor.

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As eye surgeons, we tend to rightly focus on surgery.

However, it remains essential to keep abreast of developments in all areas of eye care, such as myopia management, so that we can provide our patients with the best care, as well as offer advocacy, support and education in our communities.

Myopia epidemic

Myopia needs your attention. While the eyes of the world are on a pandemic, a silent epidemic is taking hold. It is estimated that the myopia epidemic will affect half of the world’s population by 2050. Too often, myopia is seen as a simple refractive error that can be easily corrected with glasses or contact lenses. But for some patients, myopia is a disease that causes physical changes to the structure of the eye, which can increase the risk of retinal complications, cataracts and glaucoma. Myopia can increase the risk of myopic macular degeneration up to 845 times, retinal detachment 2.4-24 times, and primary open-angle glaucoma 2-2.5 times. Additionally, even low amounts of myopia are associated with an increased risk of developing a posterior subscapular cataract.

Vance Thompson
Vance Thompson

Today, there are many safe and effective options for slowing the progression of myopia, including orthokeratology (ortho-K) contact lenses, various types of soft multifocal contact lenses, eyeglasses, and topical pharmaceutical agents. such as atropine. Although I do not fit contact lenses or prescribe medication to slow the progression of myopia, I remain informed of all developments in this field so that I can advise my patients with myopia – who in many cases are parents or potential parents of children with myopia. myopia – and refer them to eye care providers who specialize in the management of myopia. I recommend that all my fellow eye surgeons look for signs of axial lengthening and ask about eye rubbing and “pillow diving” so that at-risk patients can be referred as soon as possible to reduce the risks of developing anterior and/or posterior chamber visual disturbances later in life.

Myopia Management Options

I am a proponent of all options that can help slow the progression of myopia. Depending on a patient’s lifestyle and preferences, one of these options, or a combination of interventions, will meet their needs. For example, ortho-K lenses are attractive to patients who do not want to wear glasses or contact lenses during the day. Ortho-K lenses are worn overnight to flatten the central cornea and temporarily reduce a specific amount of myopia while the patient sleeps. These dual-benefit lenses provide clear vision without the need for daytime vision correction, and they also reduce the progression of myopia in children. Ortho-K lenses slow the growth of axial length compared to single vision gas permeable contact lenses, single vision soft contact lenses and single vision glasses. Studies supporting the safety and effectiveness of this treatment are available, and as the incidence of myopia increases and it is realized that, if left untreated, myopia can lead to from serious sight-threatening illnesses, Ortho-K is gaining the global seriousness that previously eluded it. in its evolution.

Microbial keratitis has long been a concern with ortho-K lenses because they are worn overnight. These concerns are worth heeding, but the incidence is low, especially with good care and careful handwashing techniques. According to a recent study, the risk of microbial keratitis appears similar to rates associated with daily soft contact lens wear. It should also be noted that unlike extended wear contact lenses, ortho-K lenses are not worn during the day, exposing the eye to normal oxygenation. When ortho-K lenses are handled correctly, the benefits outweigh the risks.

Unlike ortho-K lenses, soft multifocal contact lenses are worn during the day. Soft multifocal contact lenses, like Ortho-K, are theorized to slow the progression of myopia by creating myopic defocus in the periphery, which sends a “signal” to slow eye growth. Soft multifocal contact lenses have been shown to slow the progression of myopia in children by almost 50%, which is similar to ortho-K lenses.

Myopia control experts suggest that myopia management glasses may be appropriate for patients – or their parents – who are not yet ready to commit to contact lenses. Although soft multifocal contact lenses and ortho-K have been shown to have better myopia control efficacy than progressive addition glasses and bifocal glasses, innovative spectacle lens technology for control of myopia, such as those based on a peripheral defocus theory, that the peripheral retina receives from myopic glasses defocus as a signal to slow or stop eye growth is worth exploring (keeping in mind keep in mind that glasses specific to the management of myopia are not yet approved by the FDA).

Atropine drops are another viable option that has been shown to be effective in slowing the progression of myopia. The suggested dose is usually 0.05% to 0.025% to minimize the risk of potential side effects, including photophobia. The efficacy of atropine is well documented in the literature, as are concerns about treatment regression upon discontinuation of the drops.

Each of these myopia management options has particular advantages for certain patients. However, combination therapy also has its place in the management of myopia. For example, spectacle lenses can be an important adjunctive therapy for soft contact lens wearers, as well as when atropine is prescribed as first-line therapy. Additionally, recent studies show an additive effect when combining low-dose atropine with ortho-K.

Co-management opportunities

As the incidence of myopia continues to grow, and the research and development of effective solutions reflects this growing need, myopia management represents an ideal intersection in which ophthalmology and optometry can work together. For example, the measurement of axial length is essential to optimize the best treatments for the management of myopia. With that in mind, if an optometrist is getting into ortho-K treatment, this is a great opportunity to work with an ophthalmologist who has biometrics technology.

Taking a holistic approach to eye care, when it comes to managing myopia, means staying informed about treatment strategies for progressive refractive errors and discussing these issues with our patients so they can be aware of the dangers of friction. eyes, “pillow diving” and other behaviors that put pressure on the eyes. It also involves bringing information about the myopia epidemic and myopia management to the community through interaction with local media sources and events such as eye health fairs. Working together to slow myopia around the world is a great opportunity for ophthalmologists and optometrists to improve global eye health.

About Marion Alexander

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