Most studies of myopia control interventions recruit participants between 6 and 14 years of age who have –1.00D to –5.00D of myopia. Any patient who is outside of these ranges falls into the realm of “typical results may not apply.” Therefore, a balance must be struck between proactive management and appropriate informed consent.

Key Areas of Myopia Management

Young Adults Although the volume of research is small on late teenage and young adult myopia progression, the large-scale Correction of Myopia Evaluation Trial (COMET Group, 2013) indicated that the mean age of myopia stabilization was 15.60 ± 4.1 years, with mean final refraction of –4.87D ± 2.01D. Only 48% of children had stable myopia by age 15 years, with 77% by age 18, 90% by age 21, and almost all by age 24. This indicates that proactive myopia management should continue into early adulthood.

Further data indicate that around 20% of myopes in their 20s will progress by at least 1.00D in that decade (Bullimore et al, 2002; Pärssinen et al, 2014). Hence, we have a population needing intervention but minimal evidence base for how to intervene.

The best management option for this group is likely to be provided by contact lenses, in both correcting and attempting control of myopia. Only orthokeratology (OK) exhibits any data on young adult myopia control in the literature; two small studies provide this indication, but neither are controlled. The first reported that 12 months of OK wear in eight young adult myopes (18 to 29 years) stabilized axial length (Gifford et al, 2020). Prior progression was not quantified for comparison, and there was no other adult control group. Another study reported similar results in a case series of three adults wearing OK over three years (González-Méijome et al, 2016).

Very Young Myopes In young children who have high myopia (> 5.00D to 6.00D), it is imperative to consider associated systemic syndromes. One study on children under 10 years with > 6.00D of myopia reported that only 8% had “simple myopia” with no other associated ocular or systemic conditions; more than half (54%) had an underlying systemic general health condition (Marr et al, 2001). On initial diagnosis, at minimum, co-manage with pediatrics and ophthalmology. Then, optimize vision correction to avoid amblyogenesis, and educate caregivers on the importance of lifelong eye health monitoring.

Atropine eye drops have been studied in children of Asian ethnicity from age 4 years (Yam et al, 2019), and current clinical trials investigating commercially prepared, proprietary formulations in ethnically diverse groups are recruiting from 3 years of age (e.g., CHAMP: Study of NVK-002 in Children with Myopia [NCT03350620], The Safety and Efficacy of SYD-101 in Children with Myopia [STAAR; NCT03918915], and microdosed atropine studies [NCT03942419]).

High Myopes Proactive, lifelong retinal health monitoring is required for myopes > 5.00D and axial length longer than 26mm (Tideman et al, 2016). Contact lenses are likely to provide the best option for these patients, given their known benefits for high ametropia. Children and teens fit with lenses have shown significant improvement in quality of life, regardless of age and level of refractive error (Walline et al, 2007).

In Summary

Attempt at myopia control in these special populations must come with the caveat that there are no controlled studies on efficacy applying to these patients’ situations. Still, unknowns shouldn’t prevent proactive management. Any reduction of the final myopic refraction (Bullimore and Brennan, 2019) or axial length (Tideman et al, 2016) has the potential to reduce lifelong risk of ocular pathology and vision impairment. CLS

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