Jackson is one of the sweetest kindergarten kids you’ll ever meet. He’s kind and articulate, he loves school, and I (Dr. Mai) am super proud of him. I also happen to be his dad as well as an eyecare practitioner who is deeply immersed in myopia management.
Myopia certainly is not rare, and it’s growing in pandemic proportions. But I’m often surprised by how lackadaisically some colleagues approach myopia management. Some do not even consider myopia to be a disease worth managing at all.
Some eyecare practitioners do recognize myopia as a problem, but they fail to properly educate patients and parents about why and how to manage it. And some practitioners do eventually treat myopia, but they wait until it gets irrevocably worse when a child comes back for a routine eye exam and has progressed. What other conditions are we happy to watch get worse while we do nothing?
When Does Treatment Start?
Enter my son Jackson (Figure 1). He has a big problem for such a little guy. You see, I have an axial length of 27mm and –9.00D of myopia. Jackson also is Asian, loves to read, and his mom is also myopic. So he’s got significant risk factors stacked against him that increase his odds of progressive myopia.
Jackson has been hyperopic his entire life. When he was checked at 4 years old, he was still at +0.50D. But this year at 5 years old, he measured plano (cyclopleged), which is statistically big trouble for his age. His axial length is nearly 24mm as well. So, even though we treat other parents’ kids all day long, what’s a father (first) and an eyecare practitioner (second) to do with his own kid? When is a kid “myopic enough” to convince you to pursue myopia management treatment?
Jackson is certainly less hyperopic, but could you say that being less hyperopic equates to being more myopic—and thus, myopia progression has occurred? Also, we know that an axial length of 24mm at only 5 years old is statistically way above average. Would you consider a large axial length in the absence of refractive error myopia?
What if it’s your child? Is it myopia now? As practitioners, we likely don’t feel the mixture of guilt (“We should have spent more time outside!”) and sadness that parents feel when they hear that their child’s perfect eyesight might never be the same. As a parent, it’s a crushing blow.
It Doesn’t Hurt to Start Early
So, Jackson’s long eyes and history of “less hyperopia” are now being treated with atropine. Six months after starting treatment, he is luckily still plano OD and OS. Both eyes have grown 0.05mm, which is quite expected for his age. He tolerates the drops like a champ and even asks for them nightly. For now, we are staying the course.
Will this become the standard of care going forward? Who knows. But at our practice, we embrace a global commitment to give children better vision for life. Jackson still has great eyesight—and my goal is to keep it that way until he reaches adulthood. CLS