The second annual Global Myopia Symposium (GMS) took place virtually from Sept. 16 to 19, 2021. The GMS Planning Committee included Chair Jason Nichols, OD, MPH, PhD; Kate Gifford, PhD, BAppSc(Optom)Hons; Lyndon Jones, PhD, DSc, FCOptom; Jeff Walline, OD, PhD; Shalu Pal, OD; and, new this year, Oliver Woo, OD, from Australia. This year, the Asian Optometric Congress (AOC) joined the GMS and kicked off the meeting. A total of 44 international speakers provided 30 hours of education, which included 20 COPE-approved continuing education (CE) hours, four general sessions, seven workshops, and seven sponsored sessions. Ten industry partners supported the meeting.

Myopia is a global pandemic that requires a global solution. The 2021 GMS had more than 1,400 registrants from 80 countries, contributing to the effort to have an international impact on reducing myopia.

ASIA OPTOMETRIC CONGRESS TRACK

The AOC Track was organized by Dr. Woo. In the first session, Lu Fan, MD, OD, described a large-scale epidemiological study among students from primary to high schools in Wenzhou, China. This study enrolled 1 million subjects, with a participation rate approximating 100%. Next, Chi-Ho To, PDip(Optom), PhD, described his team’s journey from identifying how the developing eye responds to complex optical inputs to the creation of a defocus incorporated multiple segments (DIMS) spectacle lens for myopia control.¹ Kah Meng Chung, BOptom, MSc, PhD, reviewed the optimal myopia management strategies based on the scientific literature.

The second hour began with Li Lian Foo, MD, FRCOphth, MMed (Ophth), GDFM, BEng (1st class honors), discussing the importance of managing axial myopia from an ophthalmologist’s perspective. She reviewed myopic macular degeneration as well as lacquer cracks, staphylomas, and macular neovascularization, emphasizing that the irreversible nature of globe elongation underscores the need for timely childhood myopia control. Richard Wu, BSc, OD, PhD(can), discussed understanding corneal topography to better design standard or toric overnight orthokeratology (ortho-k) lenses for the Asian population. The session concluded with Koh Liang Hwee, BSc(Hons)Optom, PhD, who reviewed myopia management options and emphasized early intervention.

The final session of the AOC track was an excellent panel discussion that provided a range of perspectives and experiences of the following clinicians from six different countries: Prof. Bruce Lan, Dr. Wu, Helen Eng, Thok Chuan Tan, Charlie Ho, and Alex Ong.

THE BUSINESS OF MYOPIA

This session, moderated by Dr. Pal, provided tips on implementing myopia management in practice. Upon registration, attendees submitted questions that created the content of this presentation.

Anita Gulmiri, OD, considered each step in the examination and explored the equipment needed to deliver proper care. She also discussed what practitioners can do if they do not own certain pieces of equipment.

Ashley Wallace-Tucker, OD, discussed the challenge of finding time within your examination flow to incorporate a new service. She advised having a team to help and an exit strategy to pivot the conversation to a team member to avoid running behind. Also, invite patients back for a full consultation if time is limited, and have resources ready to solidify your conversation at home.

Bhavin Shah, BScOptom (Hons), MCOptom, used the following mnemonic to identify the steps needed to explain myopia and its management to parents:

• I = Identity: What is myopia?
• Can = Cause: What are the causes?
• Treat = Treatment: What are the treatment options?
• Every = Effect: What are the effects of myopia?
• Terrific = Timeline: What will happen over time?
• Myope = Management: What does the management entail?
• Confidently = Consequence: What are the consequences of myopia management?

He explored the need to understand the parent-child relationship, parental beliefs about myopia and eye care, the emotions behind parental decisions, and how practitioners can build trust with parents and patients.

Brett O’Connor, OD, challenged attendees to look within their own patient base to start building a myopia clinic. Educating patients and their parents is a powerful and easy marketing strategy. Treating them and asking them to help spread the word is the next step in growing your clinic. He also covered external marketing strategies including social media, websites, conversations with other healthcare providers, and potential referral sources.

THE INTERNATIONAL PERSPECTIVE

Dr. Gifford took the lead on bringing together a panel of experts from Australia, Canada, the Netherlands, Singapore, and the United States (Figure 1). A global view of treatment trends kicked off the discussion, including how they have changed over the last four years.^2,3

The World Council of Optometry (WCO) President, Peter Hendicrott, DipAppSc(Optom), MAppSc, PhD, GradCertOcTher, described the WCO Resolution: The Standard of Care for Myopia Management by Optometrists that was released in 2021.⁴ It entails three pillars—mitigation, measurement, and management of myopia as well as education about myopia to both practitioners and the public.

The panelists described optometry practice around the world related to myopia management. Australia and Canada have access to all myopia management options except for the newest spectacle lens designs. Both Singapore and the Netherlands have access to every tool available but can prescribe atropine only in partnership with ophthalmology. The United States has the highest number of optometrists, but they are limited in their ophthalmic lens choices for myopia management. Brief video clips from practitioners in Dubai, Ecuador, India, Israel, Italy, New Zealand, the Philippines, Puerto Rico, South Africa, Spain, and the United Kingdom shared the state of myopia management in their countries.

MYOPIA: HAVE WE GOT NEWS FOR YOU

This general session moderated by Dr. Jones was named after a long-running British TV Show. The four speakers summarized findings from the 2021 International Myopia Institute papers.^5-9 Kathryn Richdale, OD, PhD, reviewed the definitions of pre-myopia, low myopia, high myopia, and pathological myopia and noted that < 20% of myopia is explained by heritability. Prof. Bullimore reviewed findings from recent clinical trials that can assist practitioners with myopia management in clinical practice.¹⁰ James Wolffsohn, MBA, PhD, reviewed the impact of various environmental factors (such as near work and time outdoors) on myopia onset and progression. Finally, Nicola Logan, MCOptom, PhD, MEd, discussed the possible roles of accommodation and binocular vision in myopia onset and progression.⁹

TREATMENT SHOWDOWN

Dr. Walline, in an entertaining audience interaction session, brought together panelists from various countries to debate myopia treatment options. Each panelist was assigned one of four treatment choices: ortho-k, spectacles, soft contact lenses, or atropine. A case was presented, and panelists each had one minute to explain why their treatment was the best option for that child. They fought with, questioned, and put down each other, all in the name of fun, to win the argument. Audience members then voted for their favorite treatment option. Seven cases were presented.

An argument could be made for almost every modality in any case. It’s best to choose a treatment that maximizes patient compliance; listen to them, and provide a solution that fits their lifestyle.

ASK THE EXPERTS

GMS 2021 concluded with a roundtable discussion chaired by Prof. Bullimore. An international panel comprised of Drs. Gifford, Pal, Walline, and Woo answered questions from the chair and participants. The panelists discussed people who had influenced them on their myopia journey, how their practice is divided among different management options, and where they send colleagues and patients for information.

BREAKOUT SESSIONS AND WORKSHOPS

In addition to the General Sessions, GMS attendees could choose from breakout sessions and workshops—too numerous to review comprehensively here. Four sessions discussed measuring axial length. Karen Walsh, BSc(Hons), PGDip, MCOptom, and Deborah Jones, BSc, FCOptom, highlighted the different technologies with video content. Cheryl Chapman, OD, discussed why axial length is important and how its measurement can distinguish your practice. Philip Cheng, BOptom, presented specific cases emphasizing when axial length measurement informed his treatment decisions.

IT’S NOT TOO LATE TO LEARN

If you missed the 2021 Virtual GMS or want to see a session again, the education program will be available on demand through the end of 2021 with login or free registration at www.gmsymposium.com . CLS

REFERENCES

1. Lam CSY, Tang WC, Tse DY, et al. Defocus Incorporated Multiple Segments (DIMS) spectacle lenses slow myopia progression: A 2-year randomised clinical trial. Br J Ophthalmol. 2020 Mar;104:363-368.
2. Wolffsohn JS, Calossi A, Cho P, et al. Global trends in myopia management attitudes and strategies in clinical practice. Cont Lens Anterior Eye. 2016 Apr;39:106-116.
3. Wolffsohn JS, Calossi A, Cho P, et al. Global trends in myopia management attitudes and strategies in clinical practice - 2019 Update. Cont Lens Anterior Eye. 2020 Feb;43:9-17.
4. World Council of Optometry. World Council of Optometry Resolution: The Standard of Care for Myopia Management by Optometrists. 2021. Available at https://worldcouncilofoptometry.info/resolution-the-standard-of-care-for-myopia-management-by-optometrists . Accessed Oct. 27, 2021.
5. Jonas JB, Ang M, Cho P, et al. IMI Prevention of Myopia and Its Progression. Invest Ophthalmol Vis Sci. 2021 Apr 28;62:6.
6. Ohno-Matsui K, Wu PC, Yamashiro K, et al. IMI Pathologic Myopia. Invest Ophthalmol Vis Sci. 2021 Apr 28;62:5.
7. Sankaridurg P, Tahhan N, Kandel H, et al. IMI Impact of Myopia. Invest Ophthalmol Vis Sci. 2021 Apr 28;62:2.
8. Morgan IG, Wu PC, Ostrin LA, et al. IMI Risk Factors for Myopia. Invest Ophthalmol Vis Sci. 2021 Apr 28;62:3.
9. Logan NS, Radhakrishnan H, Cruickshank FE, et al. IMI Accommodation and Binocular Vision in Myopia Development and Progression. Invest Ophthalmol Vis Sci. 2021 Apr 28;62:4.
10. Bullimore MA, Richdale K. Myopia Control 2020: Where are we and where are we heading? Ophthalmic Physiol Opt. 2020 May;40:254-270.