This article was originally published in a sponsored newsletter.

Recent data in a national survey published by the American Optometric Association reported that 69% of ECPs actively provide myopia management services for children.¹ The data also showed that the majority (87%) of ECPs discussed myopia treatment protocols with parents when their children were as young as 5 to 8 years of age. Survey respondents were 464 ECPs in 41 states and Washington D.C.

While randomized controlled trials have been the “gold standard” in scientific research,² they may not always be practical or applicable. Thus, to further our understanding of the clinical efficacy of various available myopia management treatment strategies, a large-scale US-based retrospective review, known as the Clinical Algorithm for Myopia Progression (CAMP) study,³ was conducted to evaluate patients who underwent myopia management in a real-world practical setting during a three-year period. Cycloplegic spherical equivalent refraction and axial length (AL) were used as the key measured variables. The study aimed to provide guidelines and insights regarding application and treatment algorithms for children at risk of myopia progression to the eyecare community and optimize clinical management individually in a real-world myopia practice.

Among all treatment modalities available, ortho-k was the most-prescribed (55% of the 342 subjects). Of the total subjects, 78% of children with orthokeratology lenses required no changes or switches of treatment regimen, compared to 68% and 22% of patients treated with soft multifocal lenses (SMFCL) and low-dose atropine alone, respectively, in the three-year period.

This key finding adjusted my clinical mindset and approach for parents who appear hesitant to use orthokeratology for their children. Using the CAMP study data, I now confidently share with parents and patients that children wearing orthokeratology lenses can successfully stay with the same treatment modality and have a positive user experience. Most of my patients, who are as young as 5 to 6 years of age, are self-sufficient and can handle ortho-k lens care proficiently and independently after training. The CAMP study debunks the misconception that ortho-k is difficult or unsafe for children and shows that it is more than simply a “specialty lens tool.” Ortho-k directly helps patients’ adherence and stamina, and further enhances children’s quality of life and self-esteem.^4,5

In addition, orthokeratology shows outstanding ability to halt AL progression. More than half (56%) of patients wearing orthokeratology lenses in the CAMP study achieved minimal AL progression of 0.10mm or less in the first year, and the halting effect of AL progression was retained comparably with 53% and 56% management in years 2 and 3, respectively.

The Cumulative Absolute Reduction in axial Elongation (CARE) values were preferred and applied to illustrate the head-to-head comparison of myopia control effects using an age- and ethnicity-matched virtual control group. The CARE value for orthokeratology was the highest among all three treatment modalities used – i.e., 0.32mm during a three-year period. This result was indicative of better myopia control impact compared to SMFCL (0.20mm) and atropine (0.23mm) in two- and three-year periods, respectively, which showcased how orthokeratology can effectively yield sustainable control of AL progression. Furthermore, the sustained clinical efficacy of orthokeratology yields practical advantages for clinicians and patients. When the cornea is uniquely molded or reshaped by ortho-k lenses, it renders refractive error, which is an unreliable metric of measuring the true status of myopia progression. AL serves as a more precise benchmark because it is not subject to the influences of ortho-k. Also, no washout procedure in which patients must discontinue wearing ortho-k lenses until their cornea returns to the pre-treatment status is warranted.

These findings are particularly relevant and impactful for practitioners when it comes to clinical decision-making for patients with orthokeratology lenses. Orthokeratology isn’t merely “just another tool”; rather, it stands out as the top contender and preferred treatment modality for the goal of myopia management. When I examine young patients who develop early-onset myopia that exceeds the norms of emmetropization, I am driven to begin an in-depth conversation with their parents to advocate for starting orthokeratology with them.

With the robust evidence and clinical benefits shown in the CAMP study, orthokeratology can be a life-changing tool for myopia management for children. I am constantly amazed by the intricacy and transformative impact that orthokeratology brings for the young generations.

REFERENCES

1. Health Policy Institute. Doctors of optometry are embracing managing myopia, not just talking about it. AOA. November 30, 2022. Accessed April 6, 2023. https://www.aoa.org/AOA/Documents/Advocacy/HPI/Doctors-of-Optometry-Embrace-Myopia-Managment.pdf

2. Hariton E, Locascio JJ. Randomised controlled trials - the gold standard for effectiveness research. BJOG. 2018 Dec;125(13):1716.

3. Cooper J, Aller T, Smith EL 3rd, Chan K, Dillehay SM, O'Connor B. Retrospective Analysis of a Clinical Algorithm for Managing Childhood Myopia Progression. Optom Vis Sci. 2023 Jan 1;100(1):117-124. 

4. Mohd-Ali B, Low YC, Mohamad Shahimin M, et al. Comparison of vision-related quality of life between wearing Orthokeratology lenses and spectacles in myopic children living in Kuala Lumpur. Cont Lens Anterior Eye. 2023 Feb;46(1):101774.

5. Lipson MJ, Boland B, McAlinden C. Vision-related quality of life with myopia management: A review. Cont Lens Anterior Eye. 2022 Jun;45(3):101538.