This article was originally published in a sponsored newsletter.

When considering the best possible outcomes for children who have myopia or those who are at risk of developing it, practitioners evaluate risk factors and choose the most appropriate treatment strategies and devices. Each of these options must be analyzed for benefits and vulnerabilities, with plans to mitigate risks. Extensive evaluation of myopia control therapies has shown that they are effective and safe.^1,2

Still, safety can be questioned in a few areas of myopia management. For example, meibomian gland loss has been associated with soft contact and corneal GP lens use.³ In a recent study, the stability of tear film and meibomian gland status were not significantly affected by wearing orthokeratology lenses for 12 months; however, a two-year study reported that orthokeratology wearers showed higher meiboscores (higher atrophy) of lower eyelids.⁴ Also, benzalkonium chloride (BAK) is used in compounded low-dose atropine eye drops and may cause epithelial toxicity when administered chronically.⁵

In the realm of environmental factors that may affect myopic progression, screens and digital devices have been a topic of great interest. In a 2016 article, smartphone use in children was strongly associated with pediatric dry eye disease.⁶ Extended screen time in a young population was associated with dry eye symptoms and poorer blinking rate, which led to suggestions from some researchers that the implementation of official guidance for safe screen use may help to prevent dry eye.⁷ Presently however, no such guideline is clear for use of digital devices in the myopia control clinic.

These studies bring up an important question: Should practitioners pay more attention to the risk of future dry eye in children for whom we are currently prescribing myopia control therapies?

Preventive rather than reactionary measures would ideally serve our children in our myopia management clinics. Further studies are needed, and questions we should consider include:

1) Is dry eye disease a present problem in our pediatric populations?
2) Do therapies used for myopia control increase the risk for dry eye?
3) Should practitioners create screening and treatment protocols for children and youth who use screens and/or therapies for myopia control?

The journey to optimize patient outcomes for children and youth in the myopia management clinic has seen great gains in knowledge, but when one question is answered several others will always ensue.

References

1. Logan N, Bullimore M. Optical Interventions for Myopia Control. Eye (Lond). 2023 Sep 22. [Online ahead of print]
2. Jawaid I, Saunders K, Hammond CJ, Dahlmann-Noor A, Bullimore MA. Low concentration atropine and myopia: a narrative review of the evidence for United Kingdom based practitioners.Eye (Lond). 2023 Sep 16. [Online ahead of print]
3. Harbiyeli I, Bozkurt B, Erdem E, et al. Associations with meibomian gland loss in soft and rigid contact lens wearers.Cont Lens Anterior Eye. 2022 Feb;45:101400.
4. Lee J, Hwang G, Ha M, Kim H-S, Han K, Na K-S. Evaluation of the meibomian glands using the tear interferometer wearing orthokeratology lenses.BMC Ophthalmol. 2022 Mar;22: 133.
5. Walsh K, Jones L. The use of preservative eye drops.Clin Ophthalmol. 2019 Aug 1;13:1409-1425.
6. Moon J, Kim K, Moon N. Smartphone use is a risk factor for pediatric dry eye disease according to region and age: a case control study.BMC Ophthalmol. 2016 Oct 28;16:188.
7. Muntz A, Turnbull PR, Kim AD, et al. Extended screen time and dry eye in youth.Cont Lens Anterior Eye. 2022 Oct;45:101541.