MYOPIA MANAGEMENT is highly rewarding and constantly evolving. As fresh evidence becomes available and new technologies and treatment options arise, eyecare practitioners managing myopia continually have the opportunity to refine their protocols and expand their reach. Here are some ways to take a myopia program to the next level.
Studies have generally found a strong correlation between myopic refractive error change and axial elongation (Chen et al, 2023; Chamberlain et al, 2019). In light of this, and in consideration of the reality that most eyecare practitioners do not have immediate access to a biometer, the ability to measure axial length should not be regarded as a prerequisite to manage myopia. However, there are several reasons to consider leveling up your myopia practice with an optical biometer.
First, optical biometry provides an objective and highly precise measurement of eye growth that does not require cycloplegia. Since optical biometers do not contact the eye, this measurement can be taken as part of a workup without affecting your refractive testing. Furthermore, since it is generally believed that the comorbidities associated with myopia are most strongly correlated with excessive eye length, biometry may provide practitioners better insight into an individual patient’s risk compared to refractive error alone.
Refractive astigmatism is extremely common in young myopes. While smaller amounts do not present much of a challenge when prescribing for young myopes, higher amounts can deter some practitioners from recommending proactive myopia care. Familiarization with treatment options for progressive myopes with astigmatism is a great way to expand reach.
Low-dose atropine and bifocal or progressive spectacles are two treatment options which are not functionally limited by refractive astigmatism (Huang et al, 2016). For patients who have moderate (and sometimes higher) astigmatism who desire to be glasses-free, orthokeratology or soft multifocal lenses are possible treatment options.
Toric orthokeratology designs provide improved centration in these patients. However, since these designs employ a spherical central zone, ensure there is not significant internal astigmatism before proceeding. Toric multifocal lenses are available, but it is also worth noting that some spherical multifocal designs can provide excellent visual acuity even above –1.00D of cylinder.
The more patients reached, the greater the impact of the myopia management program on the community. Learning to market effectively can help eyecare practitioners engage as many patients as possible.
Think of the marketing approach as a pyramid (Figure 1) and always begin at the base by optimizing the conversation with patients and parents already seen in the exam room on a daily basis. Once the exam room discussion has been mastered, work on expanding the reach to drive demand for the clinic. CLS
- Chen Z, Zhang Z, Xue F, et al. The relationship between myopia progression and axial elongation in children wearing orthokeratology contact lenses. Cont Lens Anterior Eye. 2023 Feb;46:101517.
- 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.
- Huang J, Wen D, Wang Q, et al. Efficacy Comparison of 16 Interventions for Myopia Control in Children: A Network Meta-analysis. Ophthalmology. 2016 Apr;123(4):697-708.