This article was originally published in a sponsored newsletter.

Myopia management will remain a hot topic in 2023. Spectacle modalities coming to the U.S., additional contact lenses with U.S. Food and Drug Administration approval, and pharmaceuticals are all on the horizon, but are we doing enough? Delaying the onset of myopia by one year is equivalent to three years of myopia management. So, my sights are set on preventing the onset of myopia, not just slowing the worsening of prescriptions and eye growth.

Full disclosure, my true motivation for myopia management is entirely selfish. I am trying to stop my two boys from becoming “super myopes” like their dad. As a –10D myope, my husband is in an elite club. He holds the record for “longest eyeballs” at my office. He had his first laser retinopexy in optometry school. The myopia fun continues now in his 40s with visually significant cataracts. In short, the Flitcroft tables are not theoretical in my house; I see the statistics unfolding in real time.¹

I remember my excitement listening to early myopia management lectures at the American Academy of Optometry meeting in 2014, and the Five-Year Clinical Trial on Atropine for the Treatment of Myopia 2 study² results, as well as U.S.-based compounding pharmacies, were discussed soon after. I decided to start all children who had progressing myopia on low-dose atropine (0.01%). These children were under 10 years old and had progressed more than 1.00D the previous year. Watching their progression flatten to “normal rates” seemed miraculous. They returned for their yearly eye exam with 20/25 vision, instead of 20/60 or worse. Like my husband’s experience, the benefit for these children wasn’t theoretical either; I saw the proof in my own patients.

Then, the spark that ignited with my atropine patients started to glow brighter. These patients tolerated the drop well, had minimal side effects, and their progression was slowed, so I wondered whether it could slow the onset of myopia too. My boys were 6 and 9 years old and had, at most, +0.50D on cycloplegic retinoscopy. It was now or never! The Low-Concentration Atropine for Myopia Progression study³ had just been released, and the Pediatric Eye Disease Investigator Group Amblyopia Treatment Studies⁴ found that weekend atropine was effective for amblyopia. With an n = 2, I started my boys on 0.05% atropine once a week. Luckily, my husband tolerated my crazy ideas and consented to our off-off-label treatment.

My boys are coming up on their fourth year of myopia management. Limiting their screen time obsession and prioritizing 90 minutes of outdoor time is a daily challenge, but it is working so far. We have pushed back the onset of their myopia. I am optimistic that research will offer guidance on myopia prevention so my patients can have similar opportunities to alter the trajectory of their myopia.

1. Flitcroft DI. The complex interactions of retinal, optical and environmental factors in myopia aetiology. Prog Retin Eye Res. 2012 Nov;31:622-660.

2. Chia A, Lu Q-S, Tan D. Five-Year Clinical Trial on Atropine for the Treatment of Myopia. Ophthalmology. 2016 Feb;123:391-399.

3. Yam JC, Jiang Y, Tang SM, et al. Low-Concentration Atropine for Myopia Progression (LAMP) Study: A Randomized, Double-Blinded, Placebo-Controlled Trial of 0.05%, 0.025%, and 0.01% Atropine Eye Drops in Myopia Control. Ophthalmology. 2019 Jan;126:113-124.

4. Repka MX, Cotter SA, Beck RW, et al; Pediatric Eye Disease Investigator Group. A randomized trial of atropine regimens for treatment of moderate amblyopia in children. Ophthalmology. 2004 Nov;111:2076-2085.