Mr. Presbyope is a 61-year-old new patient in your practice. His chief complaint is, “These glasses are two years old, and I can’t read with them as good as when I got them. I guess my arms are too short.” Not surprisingly, your examination reveals that he needs an increase in his add of +0.50D. You also note that his intraocular pressure (IOP) is 26 mmHg OD and OS, his cup-to-disc ratios (C/Ds) are 0.6 OD and OS, and his screening visual field was unreliable.
During your case presentation, you say something like, “It’s not that your arms are too short. We need to make the bottom of your progressive lenses a little stronger, as you’ve likely needed before. We can take care of that today care of that today. After I do that, your reading vision will be great. But there is something else that I want to discuss with you today. Your eye pressure is...”
From here, most of us will diverge on the exact words. But, at the end of our presentation, we will all say something like, “The next step would be for you to come back for some more tests,” or, “I’m going to refer you to a colleague who can do some more tests.” But none of us would simply prescribe a new pair of progressives and stand idly by while the patient’s condition likely continues to deteriorate.
Myopia management is (or at least should be viewed) exactly the same.
Parallels with Myopia
Minnie Myope is a 9-year-old new patient in your practice. Her chief complaint is, “These glasses are about a year old, and I can’t see the whiteboard as good as I did when I got them.” Not surprisingly, your examination reveals that she needs an increase in power of –0.50D. While her IOPs and C/Ds are normal, she, like Mr. Presbyope, has an obvious pathology separate from her acuity problem—namely, she’s a myopic child. With this knowledge, just like your thought process for Mr. Presbyope, all sorts of sirens and alarm bells should be going off in your head. But, for some reason, in too many practices, those myopia warning klaxons remain silent.
As with glaucoma patients, practitioners can no longer stand idly by and watch these kids get worse. Once you recognize the similarities between the above cases, your viewpoint will change.
The key similarities are:
- Both patients presented with optical chief complaints. The only difference was where they were having trouble seeing.
And, yes—the glaucoma patient did present with an optical complaint. This is important, because it underscores that glaucoma patients do not complain about glaucoma just as myopic kids don’t complain about their axial length. Both patients presented with an obvious visual symptom.
- Next, both diseases are slowly progressing and can potentially result in serious, permanent vision loss if left untreated. If you don’t believe that myopia is a disease, then I’m not sure that I can help you. With myopia, kids’ eyes are bigger than they should be, which is an obvious structural defect that, if left untreated, gets worse and produces specific symptoms. That’s a disease by definition.
- Both patients are unaware that they have either disease.
- There is no cure for either of these diseases.
- Both diseases can be managed, but neither can be reversed. Whatever amount of optic nerve that glaucoma patients have lost cannot be restored. Children’s myopic eyes cannot be shrunk down to their previous size.
- Both patients require optical correction to correct their vision, not their disease state.
- There are readily available treatment regimens for both, with solid science to support their use.
It’s Time to Do Something About Myopia
And finally, knowing what you know about them, you have a professional, ethical, and moral obligation to do something about both diseases. Doing nothing is not an option. You would never do nothing with glaucoma, and you should never do it with myopia. CLS