Myopia management requires the attention of ophthalmologists – Tips & Results


Source/Disclosures


Disclosure: Thompson reports that he is a senior medical consultant for Euclid Systems.


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

However, it remains crucial to keep abreast of developments in all areas of ophthalmology, such as B. Myopia Management, so we can provide the best care to our patients and provide advocacy, support and education in our communities.

myopia epidemic

Myopia needs your attention. While the world has its eyes on a pandemic, a silent epidemic is spreading. It is estimated that the myopia epidemic will affect half of the world’s population by 2050. Too often, myopia is thought of 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 in 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 by up to 845 times, retinal detachment by 2.4 to 24 times, and primary open-angle glaucoma by 2 to 2.5 times. In addition, even low levels of myopia are associated with an increased risk of developing posterior subscapular cataracts.

Vance Thompson
Vance Thompson

Today, there are numerous safe and effective options to slow 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. While I don’t fit contact lenses or prescribe medication to slow the progression of myopia, I keep myself up to date with all developments in this area so that I can better support my patients with myopia – who in many cases are the parents or potential parents of children with myopia are – can advise myopia – and refer them to ophthalmologists who specialize in myopia management. I encourage all my eye surgeons to look for signs of axial elongation and ask questions about eye rubbing and pillow diving so that at-risk patients can be referred as early as possible to reduce the likelihood of developing anterior and/or posterior chamber vision problems later Life.

Myopia management options

I’m 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. Ortho-K lenses are interesting, for example, for 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 certain amount of myopia while the patient is asleep. 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 axial length growth compared to single vision gas permeable contact lenses, single vision soft contact lenses and single vision glasses. Studies are available demonstrating the safety and effectiveness of this treatment, and with the increasing incidence of myopia and the realization that myopia, if left untreated, can lead to serious vision-threatening diseases, Ortho-K is gaining momentum worldwide , which eluded him earlier in his development.

Ortho-K lenses have long had a concern about microbial keratitis due to their overnight wear. These concerns are worth respecting, but incidence is low, especially with good care and careful handwashing techniques. According to a recent study, the risk of microbial keratitis appears to be similar to rates associated with daily soft contact lens wear. It should also be borne in mind that unlike long-wear contact lenses, Ortho-K lenses are not worn during the day, which exposes the eye to normal oxygenation. When Ortho-K lenses are managed properly, the benefits outweigh the risks.

Unlike Ortho-K lenses, soft multifocal contact lenses are worn during the day. Soft multifocal contact lenses such as Ortho-K are thought to slow the progression of myopia by creating myopic defocusing in the periphery that sends a ‘signal’ of slow eye growth. Soft multifocal contact lenses have been shown to slow the progression of myopia in children by almost 50%, which is comparable 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 wear contact lenses. While soft multifocal contact lenses and Ortho-K have been shown to provide better myopia control than varifocals and bifocals, innovative myopia control lens technology such as B. those based on a theory of peripheral defocusing, causing the peripheral retina to become myopic defocusing as a slowing or stopping signal for eye growth, are worth investigating (note that myopia management-specific eyewear has not yet been developed by FDA approved).

Atropine drops are another viable option that has proven successful in slowing myopia progression. The recommended dose is usually 0.05% to 0.025% to minimize the risk of possible side effects, including photophobia. The effectiveness of atropine is well documented in the literature, as are concerns about treatment regression when the drops are discontinued.

Each of these myopia treatment options has particular strengths for selected patients. However, combination therapy also has its place in myopia management. For example, eyeglass lenses can be an important adjunctive treatment for soft contact lens wearers, as can when atropine is prescribed as a first-line treatment. In addition, recent studies show an additive effect when combining low-dose atropine with Ortho-K.

co-management opportunities

As myopia becomes more prevalent and the research and development of effective solutions reflects this growing need, myopia management presents an ideal interface for ophthalmology and optometry to work together. For example, measuring axial length is key to optimizing the best treatments for myopia management. When an optometrist expands into Ortho-K treatment, this is an excellent opportunity to work with an ophthalmologist who has biometrics technology.

A comprehensive eye care approach to myopia management means keeping up to date with progressive refractive error management strategies and discussing these issues with our patients so that they are aware of the dangers of eye rubbing, “pillow diving” and others Behaviors are aware of putting pressure on the eyes. This includes 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.

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