EYECARE PRACTITIONERS (ECPs) recognize that the myopia pandemic has significant short- and long-term vision implications for patients, and more providers than ever are offering myopia management services. When should we begin myopia management if our goal is to maximize the impact of our efforts?
A PARADIGM SHIFT
Having provided myopia management services to patients for about 10 years, I sometimes get the opportunity to speak with other ECPs who are new to myopia management and curious about getting started. Practitioners often ask whom they should treat, eager to factor in elements such as family history, ethnicity, environmental considerations, and past rate of progression to establish a “yes/no” formula for myopia management.
Since virtually all myopic children will experience progression and there is not a reliable way of determining when it will stabilize, it is important to understand that every myopic child is a candidate for myopia management. With that said, there is a growing body of evidence suggesting that one factor is the most critical to account for when considering myopia management.
AGE AND MYOPIA PROGRESSION
Many factors have been shown to be associated with myopia, but retrospective studies often evaluate the impact of these factors on myopia incidence rather than progression. Once a child is already myopic, only factors influencing the rate of myopia progression matter clinically.
Considerations such as parental history, near-work activities, and time spent outdoors have not been conclusively linked with rate of myopia progression, and any impact from these factors is likely small (Jones-Jordan et al, 2021). Asian ethnicity is often linked to faster rates of myopia progression, but an important nuance is that children of Asian ethnicity tend to become myopic at younger ages (Rudnicka et al, 2016).
It well-established that younger children experience more rapid eye growth than older children, even in the absence of myopia. In one cohort, emmetropic children between ages 6 and 8 experienced about 0.18mm of eye growth per year, compared to only 0.06mm during ages 12 to 14 (Zadnik et al, 2004). We also know that younger myopes experience more rapid myopia progression on average (Nixon and Brennan, 2020). Therefore, it is no surprise that children diagnosed with myopia at younger ages tend to have higher ultimate levels of myopia and greater incidence of high myopia (Hu et al, 2020).
START YOUNG
Reducing the final level of a child’s myopia by just one diopter greatly reduces his or her lifetime risk of sight-threatening comorbidities (Bullimore and Brennan, 2019). However, no treatment options have been shown to completely halt myopia progression. To have the greatest impact, ECPs should start myopia management young, when progression rates are highest and many years to combat excessive eye growth lie ahead.
For non-myopic children and pre-myopes, this means discussing lifestyle modifications such as spending a few hours outside each day, in hopes of delaying or preventing myopia onset. For myopic children, this requires initiating an effective myopia management solution as soon as the patient becomes myopic. For some ECPs, it may take a fit or two to become comfortable prescribing contact lenses in younger children, but the end result for these patients is worth the effort.
REFERENCES
1. Jones-Jordan LA, Sinnott LT, Chu RH, et al; CLEERE Study Group. Myopia Progression as a Function of Sex, Age, and Ethnicity. Invest Ophthalmol Vis Sci. 2021 Aug 2;62:36.
2. Rudnicka AR, Kapetanakis VV, Wathern AK, et al. Global variations and time trends in the prevalence of childhood myopia, a systematic review and quantitative meta-analysis: implications for aetiology and early prevention. Br J Ophthalmol. 2016 Jul;100:882-890.
3. Zadnik K, Mutti DO, Mitchell GL, Jones LA, Burr D, Moeschberger ML. Normal eye growth in emmetropic schoolchildren. Optom Vis Sci. 2004 Nov;81:819-828.
4. Nixon A, Brennan N. Managing Myopia: A Clinical Response to the Growing Epidemic. 2020 Dec. Available at: s3-us-west-2.amazonaws.com/covalentcreative/jjv/media/documents/Managing_Myopia_Clinical_Guide_Dec_2020.pdf. Accessed 2024 Mar 25.
5. Hu Y, Ding X, Guo X, Chen Y, Zhang J, He M. Association of Age at Myopia Onset With Risk of High Myopia in Adulthood in a 12-Year Follow-up of a Chinese Cohort. JAMA Ophthalmol. 2020;138:1129-1134.
6. Bullimore MA, Brennan NA. Myopia Control: Why Each Diopter Matters. Optom Vis Sci. 2019 Jun;96:463-465.
