How are you dealing with the new pandemic? Not coronavirus—myopia. If you are not aware or prepared, you need to be. It is imperative that we know how we should be dealing with parents and myopic children. The pandemic of myopia is upon us and is growing in prevalence (Holden et al, 2016). It seems to me that, as with many things, we think that we can make it go away by ignoring it. By turning a blind eye to the condition, eyecare practitioners seem to think that we can keep it as just a refractive error rather than bringing it into the disease category.
It is no secret to eyecare practitioners that cataracts, glaucoma, retinal detachments, and myopic maculopathy increase in patients who have higher refractive error. For the most part, these visual impairments occur later in life, but the refractive error—and the related disease—that contributes to them occurs early. In the Australian Blue Mountain Eye Study (2002), 43% of the cases of myopic maculopathy occurred in subjects who had less than 5.00D of myopia. It has also been shown that patients who have very low amounts of refractive error still carry substantial risk (Flitcroft, 2012)—while not as high, it is still high enough to warrant a discussion with parents/patients.
In their brilliant 2019 clinical perspective, Bullimore and Brennan made the case for why each diopter matters. Their review of five large-scale studies of 21,000 patients yields incredible similarities and striking statistics. They demonstrated that slowing myopia progression by 1.00D during childhood should lower the risk of myopic maculopathy by 40% regardless of the refractive error of the child.
Many practitioners have pushed off the discussion “until next year.” Either they tell parents about the importance of myopia cessation treatment but delay initiating it, or they tell themselves that they want to wait and see whether patients progress over the coming year. How many of us have this conversation either with parents or in our heads time and again and just keep kicking the tire down the road? Practitioners need to realize that apathy advocates myopia progression.
With that in mind, I urge you to do four things this week:
- Contact an orthokeratology vendor. Look for one that gets you fitting a lens quickly and easily. One that has incredible service to help you be successful. If you feel that a company will not help you quickly get started, hang up the phone and call number two on your list.
- Select a soft lens manufacturer that offers a distance-center multifocal contact lens. There are several options from which to choose. Figure out what you need to fit the lens, and do it.
- Look for a pharmacy that can make 0.05% atropine. Ask how to prescribe it to your patients, and be ready.
- Identify five myopic children whom you have not seen in the last six months. Call the parents, get them into the office, and take care of them. This builds your confidence and gets you on your way.
If you are leaving myopia for next year, you are behind. You are advocating progression. Today—now—is the time for us to practice modern myopia management. CLS
For references, please visit www.clspectrum.com/references and click on document #303.