Most eye care practitioners don’t routinely measure axial length in clinical practice, mainly due to lack of access to the instrumentation and its expense. This is not the only reason, though, that axial length (AXL) measurement is a bit of a problematic measure for gauging myopia management success in a clinical setting.
This article groups common clinical treatments in an effort to explore what we do and don’t know regarding myopia control efficacy. It highlights the need to balance the available evidence with emerging knowledge when discussing options for myopia control with patients and their carers.
When selecting an optical treatment for myopia management, contact lens options appear to be the most consistent, with OrthoK and multifocal soft contact lenses offering around a 50% efficacy for controlling refractive and axial change in myopia.1 And it’s not just the important benefit of modifying lifelong risk of vision impairment through successful myopia control which should be top of mind – contact lens wear for myopic children can offer significant immediate benefits to their self-perception and satisfaction with vision correction.
A key barrier to contact lens wear in children is parental and practitioner concern about safety. The research indicates, though, that children may be the safest contact lens wearers – here we describe the statistics and how to approach clinical communication.
Let’s cut to the chase – until further notice, you can consider low dose (0.05%) atropine, soft multifocal CL’s and OrthoK as all quite similar in terms of their myopia control efficacy, being around 50% on average. A network meta-analysis of sixteen different interventions studied for myopia control showed these options to all have similar efficacy when their refractive and axial length outcomes were put on a level playing field.
We have a convincing evidence base for several optical, one pharmacological and visual environment solutions to reduce the progression of childhood myopia, but nothing guarantees 100% efficacy. Because of this, even in when under a successful myopia management strategy, a child’s myopia may still progress.
It is commonly understood that myopia prevalence is growing globally. By 2050, it is predicted that half of the world’s population – five billion people – will be myopic, with nearly one billion at risk of myopia related ocular pathology. The late Brien Holden was a champion of ensuring myopia is placed on the world health agenda – high myopia is strongly linked to higher risk of cataract, retinal detachment and myopic maculopathy, and increasing rates of vision impairment and blindness due to the latter are already evident in Asian countries.
This one hour lecture, delivered to final year QUT optometry students in August 2017, covers the ‘why’ of myopia control.
For you and I, as eyecare practitioners, it means to balance the needs of our patients, our work, our families, and our work/life balance in harmony.
In this short video, I introduce Myopia Profile, explain how I use it in practice, and describe two typical childhood myopia cases.
