One of the biggest topics in the contact lens field has been the movement toward the management of progressive myopia in children. Open any relevant journal or attend an industry conference and you will likely find an article or a lecture on this topic. What is not talked about much is the management of myopia in adults.
What do you do with someone after the horse is already out of the barn? The overwhelming number of people over the age of 25 who had a progression of their myopic error to qualify for the ICD-10-CM Codes in the H44.2 (degenerative myopia) rubric have never had the kinds of myopia management interventions that we see affect kids today. The evidence base just was not there yet.
High myopia is defined by the American Association for Pediatric Ophthalmology and Strabismus (AAPOS) and the International Myopia Institute (IMI) as a spherical equivalent of –6.00D or more when ocular accommodation is at rest (AAPOS, 2021; Wolffsohn et al 2019). The World Health Organization (WHO) defines “high myopia” as –5.00D or more in either eye (WHO, 2015).
Why It Matters
Why do we care? Well, having high myopia can reduce your patients’ quality of life, psychosocial development, and school performance (WHO, 2015). High myopia departs from functional normalcy to an extent that safety in an emergency is reduced without correction. It doesn’t take a rocket scientist to know that fumbling around for your –8.00D glasses when the house is on fire is a bummer.
Further, there are pathological consequences of high myopia that are evident. High myopia can cause serious, sight-threatening conditions such as myopic macular degeneration, increased risk for choroidal neovascularization, increased risk of glaucoma, increased risk of cataract formation, and increased risk of retinal detachment (WHO, 2015).
Each of these risks must be assessed in terms of the standard of care. Can you really care for the adult high myope if you do not have the latest in visual field equipment? The latest optical coherence tomography? Gonio lens? The latest understanding of the diagnostic assessment of glaucoma? The ability to perform scleral depression competently? A widefield retinal camera? Emergency coverage for those after-hours retinal detachments like the one I had at 3 a.m.?
The adult high myope will need the latest in high-index aspheric spectacle lenses and free-form progressive lenses. Does your optical offer those lenses? Are you skilled at prescribing specialty contact lenses for high myopia? I can’t tell you how many people show up in my office because another practitioner said they can’t prescribe for these people or that there are no products to help them.
As someone who is a high myope and who had cataract surgery at 52, a myopic macular degeneration diagnosis at 55, and a retinal detachment and a glaucoma diagnosis at 60, I feel a great deal of sympathy and empathy for the adult high myopes. However, you don’t have to be a –11.00D to know that no one wants to wear glasses that are so thick that the temples cannot be closed (been there in my teens).
You must educate yourself on the available extended range and custom contact lens products that can greatly improve the quality of life of your patients. Your optical must carry the specialty lens products that improve the quality of vision through glasses that the high myope needs. You also need a good working relationship with your local low vision provider. One of the most important things you can do for the adult high myope is refer for low vision services when they are needed, and not three years later. I don’t do low vision, so I refer those patients out as soon as they need it. Primum non nocere...“to do good or do no harm.” Both are important. CLS
- American Association for Pediatric Ophthalmology and Strabismus. Progressive (High) Myopia. 2021 Apr. Available at https://aapos.org/glossary/progressive-high-myopia . Accessed March 9, 2022.
- Wolffsohn JS, Flitcroft DI, Gifford KL, et al. IMI-Myopia Control Reports Overview and Introduction. 2019 Feb;60:M1-M19.
- WHO/Brien Holden Vision Institute. The Impact of Myopia and High Myopia. Presented at the Global Scientific Meeting on Myopia. Sydney. Available at https://www.who.int/blindness/causes/MyopiaReportforWeb.pdf . Accessed March 9, 2022.