Myopia control is vital for children with fast myopia progression. What are the key risk factors for faster myopia progression? What clinical findings indicate a more proactive myopia management strategy may be required? This case describes risk factors and evidence-based treatment options for fast myopia progressors.
The Erasmus Medical Group in the Netherlands set out four steps in their myopia management protocol: providing visual environment advice, identifying high-risk myopes by axial length and treating them with atropine 0.5%, managing other myopes with optical treatments or lower-concentration atropine, and ceasing treatment in the late teens once axial length is stable. The described use of axial length percentile growth charts for diagnosis, choice of treatment, monitoring and cessation is a world-first.
Once the myopia management message has been communicated to the parent and patient – information on expectations, efficacy and safety – and the initial correction has been selected, there are three key areas of clinical focus.
When setting myopia control expectations both at outset and follow up, it is important to compare the child’s observed myopia progression to ‘average’, and to then judge the expected outcomes of treatment. Bringing their lifestyle, motivations and abilities into consideration is also important. Here we explore how to use resources in practice to set expectations and gauge success along the way.
Should we change myopia control strategy when there is myopia progression? Before making the decision, it’s important to evaluate the evidence base in judging treatment success, and considering the best course of management based on both myopia correction as well as myopia control.
When should we start myopia control for a low myope, especially if they have no symptoms? What patient factors should be considered, and what myopia control treatment options are most suitable?
If a child is wearing spectacles or using atropine as their primary myopia control treatment, which contact lens should we choose for sports? Is a myopia controlling contact lens needed if it will only be for occasional wear? Here we discuss the options and clinical considerations based on the individual patient.
Communicating the reasons, benefits and options in myopia management can be complex. Using pictures in health communications has been shown to improve patient attention, recall and comprehension of information and adherence to treatment. The Managing Myopia Guidelines Infographics are designed to guide you through the process of explaining myopia control using simple messaging and pictures. We explain the four key messages of myopia management here.
How can you tell if your myopia management strategy has been a success? Our new Myopia Profile ‘Managing Myopia Guidelines’ infographics translate research into practice, providing advice on gauging success by both refraction and axial length outcomes. Given that refraction is universally measured in clinical myopia practice, there is particular emphasis on understanding how much refraction change after a year of treatment indicates whether expected efficacy for that intervention has been attained.
Children can be tricky to refract. Here is a challenging refraction case discussed by colleagues – while not a case of a myope, it describes useful clinical principles for prescribing for children, especially children under 6 who require particular consideration to ensure normal visual development.
