Several methods for slowing myopia progression have demonstrated clinical efficacy (Wen et al, 2015; Li et al, 2017; Chia et al, 2016); as there is no clear consensus indicating that one method is superior over another, practitioners may find themselves wondering which modality to pursue. This decision can be difficult to make in the exam room. Here are some tips to help select the best option for each patient.

Orthokeratology

The best proactive myopia management solution is ultimately the one that facilitates maximum comprehension and adherence by patient and family. In terms of adherence, orthokeratology (ortho-k) is often an excellent choice because children must wear the lenses overnight to have clear daytime vision. Initial comprehension of ortho-k can be a challenge, however, because many are unfamiliar with this technology.

Good ortho-k candidates include patients who want to be glasses-free as well as those who are not optimal candidates for soft lenses because of lens intolerance or handling issues. Successful ortho-k patients often demonstrate maturity and accept that there will be an adaptation phase with regard to lens comfort. In my experience, patients who refuse to allow intraocular pressure to be measured or who defer to their parents to communicate for them are less likely to have the motivation necessary to succeed with ortho-k.

Ortho-k may also pose a cost barrier for some families, particularly in the first year of therapy, which may prevent some patients from being able to pursue this method.

Soft Multifocal Contact Lenses

Distance-center soft multifocals are available in a variety of designs and modalities, making them an excellent choice for many patients. In general, soft lenses are easier to explain to patients and families, because almost all have heard of them before entering your office.

Patients seeking their first contact lens fit are ideal candidates; they already demonstrate a desire to wear soft lenses, and their parents are generally already on board. Practitioners simply need to explain the importance of using a multifocal lens and can then proceed as normal with contact lens fitting. Of note, I find that these patients very seldom complain of any visual compromise when transitioning into multifocal contact lenses. On the other hand, patients who have previously worn spherical or single-vision toric lenses tend to be more likely to notice subjective visual compromise in multifocal lenses.

Patients who demonstrate no interest in—or an aversion to—the concept of contact lenses are generally not optimal candidates for multifocal lenses. However, some of these patients do express an interest in ortho-k after further education.

Atropine Therapy

In general, low-dose atropine therapy is a good choice for children who cannot or choose not to wear contact lenses. Atropine provides the opportunity to slow myopia progression without the need for specialized optical correction. Because it can be difficult to accurately gauge compliance with atropine, I find that this method is best when patients have at least one parent or guardian who demonstrates active engagement with and understanding of the myopia management discussion.

Children who refuse instillation of dilating drops in-office can pose a challenge when it comes to atropine therapy, although with a bit of coaching, most children can ultimately tolerate a nightly eye drop.

Combination Therapy and Beyond

With spectacle interventions for myopia management in development and continuing research on combination therapy, clinicians should keep up-to-date and consider incorporating these advancements into their treatment protocols as indicated and available (Cheng et al, 2014; Tan et al, 2019). The myopia epidemic shows no signs of retreating, and it is our responsibility as eyecare practitioners to use proactive myopia management to provide the best care for our patients. CLS

For references, please visit www.clspectrum.com/references and click on document #298.