This article was originally published in a sponsored newsletter.

Myopia management is a rapidly evolving field. One area that still requires some thought is setting goals. As explained in a recent publication,¹

“Much like a glaucoma specialist might set a target IOP,² myopia management should involve setting goals. A first goal could be aiming for below average annual progression or axial elongation for the child’s age and race. Studies of successful modalities have shown that nearly all treated children progress by less than the mean in the untreated group.³ This goal is thus attainable and reasonable. A more aggressive goal might be to reduce progression to less than half the age- and race-matched mean value.”

Still, there is always more to learn about myopia control targets and target intraocular pressure (IOP) in glaucoma. Here are a few points from an article authored by two eminent specialists:⁴

Refute the notion of a rigid, single number.  Flexibility is key when determining targets. Target IOP should lie in a tight range. Tonometry varies by ± 1 mmHg and diurnal variation is greater.⁴ For myopia control, practitioners should acknowledge the variability on axial length and refractive error measurements, particularly the latter.⁵

Assess adherence.  If a patient’s target IOP is 15mmHg and IOP at this visit is 18mmHg, should the target change or should more drops be added? Neither. Rather, practitioners should try to assess whether the patient has been adhering to the prescribed treatment.⁴ Regarding myopia control, practitioners should determine whether the child is using the drops regularly or wearing their correction full time.

Incorporate degree of injury.  The target range for lowering IOP should be between 20% for low-risk eyes and 50% for high-risk or badly damaged eyes. The degree of injury present must be part of the target IOP selection. Therefore, worse damage equals a lower target.⁴ For myopia control, younger myopes or cases of higher myopia might lead us to set more aggressive goals and implement combination therapy.

Let me know how you set goals: mark.bullimore@broadcastmed.com.

References

1. Bullimore MA, Brennan NA. Juvenile-Onset Myopia—Who to Treat and How to Evaluate Success. Eye (Lond). 2023 Sep 14. [Online ahead of print]
2. Lichter PR, Musch DC, Gillespie BW, et al. Interim clinical outcomes in the Collaborative Initial Glaucoma Treatment Study comparing initial treatment randomized to medications or surgery. Ophthalmology. 2001 Nov;108:1943-1953.
3. Chamberlain P, Peixoto-de-Matos SC, Logan NS, Ngo C, Jones D, Young G. A 3-year Randomized Clinical Trial of MiSight Lenses for Myopia Control. Optom Vis Sci. 2019 Aug;96:556-567.
4. Sit AJ, Quigley HA. Target IOP: To Set or Not to Set? Glaucoma Today. 2018 November/December. Available at glaucomatoday.com/articles/2018-nov-dec/target-iop-to-set-or-not-to-set. Accessed Sep. 15, 2023.
5. Brennan NA, Toubouti YM, Cheng X, Bullimore MA. Efficacy in myopia control. Prog Retin Eye Res. 2021 Jul;83:100923.