This article was originally published in a sponsored newsletter.

Communication is key in myopia management and can be a defining factor in its success or failure. One year ago, I met 8-year-old Julie and her highly myopic mother. Julie is athletic; she runs track and swims regularly. When she was only 5 years old, she started wearing her first pair of glasses: plano –1.50 x 90 in both eyes. Now, her prescription is OD –2.00 –1.00 x 90, OS –2.75 –0.75 x 90.

When she progressed by –0.75D over six months and didn’t like the idea of using atropine, her orthoptist referred her for some form of optical intervention. Her axial length was measured at 24.46mm and 24.51mm, putting her above the 98th percentile of the growth chart.¹

Julie and her parents researched their options and decided they wanted to try orthokeratology (ortho-k). In the Netherlands, ortho-k is not advised for children younger than age 12 due to the possible risks involved, but optometrists are allowed to use their discretion when deciding whether ortho-k is appropriate for individual patients. Julie was deemed qualified to take on the responsibility so, after reviewing all the available interventions and discussing ophthalmology’s views on ortho-k, we decided to go for it.

As anticipated, Julie turned out to be an all-star lens wearer—she has been highly compliant and 100% committed. Her parents noted that her self-esteem had gotten a huge boost, and she genuinely seemed happier since being able to swim and run without her glasses.

About six months into her treatment, her mother called. At a recent checkup at the hospital, the staff was unpleasantly surprised to learn that Julie was wearing ortho-k. The orthopist expressed reluctance to monitor her any further if she kept wearing her lenses and stated that it is impossible to monitor axial length progression when someone wears ortho-k. This opinion confused Julie’s mother, who was incredibly happy with her daughter’s lens wear, especially knowing we were treating her progressive myopia. The idea that axial length cannot be monitored while wearing ortho-k seemed to be a misunderstanding because central cornea epithelial thickness is only reduced by approximately 6 to 7 microns.²

The bigger issue here is the mixed signals parents get from the ophthalmology and the optometry sides of myopia management. Julie and her parents are still committed to ortho-k. And, after further consultation with the hospital, they’re now letting me monitor her axial length.

Fitting an 8-year-old with ortho-k is a decision that must not be taken lightly or without full consent. In this particular case, clear communication prevented a breakdown in trust and a possible contact lens dropout.

Fast forward one year and 9-year-old Julie is still a happy wearer with stabilization of her axial length, 20/20 vision, and complete freedom in sports and play. Hopefully, as evidence on myopia management strategies and contact lens safety evolve further, practitioners can further broaden the discussion about kids and contact lenses and appreciate all the benefits they can bring.

References

1. Tideman JWL, Polling JR, Vingerling JR, et al. Axial length growth and the risk of developing myopia in European children. Acta Ophthalmol. 2018 May;96:301-309.
2. Zhang J, Li J, Li X, Li F, Wang T. Redistribution of the corneal epithelium after overnight wear of orthokeratology contact lenses for myopia reduction. Cont Lens Anterior Eye. 2020 Jun;43:232-237.