One year ago, a healthy, asymptomatic 9-year-old female came into the office for an eye exam. The child’s father has myopic and astigmatic refractive error. Her older sister wears glasses to correct myopia and astigmatism. The patient had healthy ocular findings. Her refractive error was –0.50D sphere OD and OS. When I demonstrated the refractive correction for the patient, she noted a significant improvement in her vision.

I discussed myopia with the patient and her mother and the likely progressive nature of the condition. I discussed traditional correction options and ways that we can now manage the trajectory of myopia progression (most off-label) to reduce the level of myopia that patients will eventually develop.

Available Options

Orthokeratology One method that has been well studied with regard to reducing myopia progression is orthokeratology. Research shows that orthokeratology has demonstrated close to a 50% reduction in myopia progression (Li et al, 2017). Furthermore, orthokeratology provides the additional benefit that vision correction devices are not needed during the day.

Multifocal Lenses Multifocal lenses have also demonstrated success in reducing myopia progression (Walline et al, 2013). Although the mechanism is still being explored, peripheral defocus seems to play a pivotal role (Zhu et al, 2019).

One soft lens recently received U.S. Food and Drug Administration (FDA) approval for myopia management. This lens both corrects a patient’s refractive error and contains treatment zones that work to reduce myopia progression over time. The FDA submission included data showing a reduction in myopia progression of more than 50% over a three-year time period (Chamberlain et al, 2019).

Atropine Various concentrations of atropine have been studied to measure the effects on myopia progression over time. As with any medication, the optimal treatment is the one with the lowest concentration, which would ideally minimize any side effect profile. Yam et al (2019) compared 0.01%, 0.025%, and 0.05% atropine and found that although all concentrations were effective at reducing myopia progression, 0.05% atropine was most effective at reducing axial length elongation.

The Verdict

After a discussion with the patient and her mother, we decided to proceed with orthokeratology. It is now a year later, and the patient’s refractive error has not changed. She wears the lenses successfully every night and enjoys the visual freedom that orthokeratology provides. Additionally, both her mother and her father feel good about the fact that they are influencing their child’s level of future refractive error and are managing this condition as opposed to simply correcting it.

If simply correcting myopia is the new normal, we don’t want to be normal. CLS

Disclosure: The patient in this article is Dr. Brujic’s daughter.

For references, please visit www.clspectrum.com/references and click on document #302.