Myopia: A growing challenge
The global myopia pandemic continues to rapidly progress. It is predicted that by 2050, approximately 50 percent of the world’s population will be affected, and one in ten myopic people will likely develop high myopia.1
Left untreated, high myopia can lead to drastic consequences in adulthood—which underscores the importance of detecting the development of myopia in children and adolescents as early as possible so appropriate treatment can be initiated and severe progression prevented.
Expanding myopia management capabilities with Lenstar Myopia
Lenstar Myopia combines the simple and precise measurements of Haag-Streit’s 900 biometer and the sophisticated, yet easy-to-use, EyeSuite Myopia software for comprehensive myopia management. The close collaboration between Haag-Streit and recognized experts and scientists from the field formed the foundation of Lenstar Myopia and has enabled its continued development since launching in 2020.
By adopting Lenstar 900’s proven Automated Positioning System (APS) technology, Lenstar Myopia offers simple and fast measurements at a single click of the joystick, saving time and increasing patient comfort—which is especially beneficial when measuring children’s eyes. This feature is combined with Lenstar’s superior measurement technology, which provides a wealth of data to enable accurate predictions about the onset and progression of myopia.
Building trust with parents using Lenstar Myopia
Rich with visuals and customized for each patient, the Myopia Report provided by Lenstar Myopia helps build trust with parents and enhances discussions about the importance of myopia management. This report provides parents with education on myopia, their child’s risk factors, a progression analysis, and treatment plan options.
By using Lenstar Myopia in your practice, you can:
- Monitor ongoing myopia progression
- Enjoy a compact and comprehensive software platform
- Customize reports according to patient risk factors and biometrics
- Educate parents with The Myopia Report, with state-of-the art visuals and graphs
- Utilize the latest axial length growth curves from myopia experts with Age-Matched Myopia Control (AMMCÆ)
Myopia diagnostics and management: Tracking refraction, axial length, and treatment efficacy
Rupa K. Wong, MD is a pediatric and strabismus specialist at Honolulu Eye Clinic, where she shares a practice with her husband, who is a cornea specialist and refractive cataract surgeon. She said when they moved to the area in 2008, opening a practice together was the only option, since Hawaii’s eyecare industry is composed of a lot of solo independent practitioners.
“Nobody was hiring. Nobody needed a pediatric ophthalmologist and nobody needed a cornea specialist, so if we wanted to continue practicing, we had to open a practice together to share costs,” she explained. “We purchased a practice from a retiring ophthalmologist and he already had an optometrist as an employee, who is fantastic. So, we inherited our wonderful director of contact lens services who has been with us for 15 years.”
Why is myopia management attractive as a practice focus?
Dr. Wong said two things attracted her to myopia management: her family and the region in which they live.
“My husband is fifth-generation Chinese, and he has a lot of high myopia in his family and a lot of retinal detachments,” she explained. “Once we started having kids—we have three children—this was on my radar since I didn’t want the same for them. He has a lot of wonderful qualities, but his high axial length and refractive error aren’t something I wanted for my kids.”
Additionally, Dr. Wong said that living in Hawaii means a lot of her patients are of Asian ethnicity.
“We know they are faster progressors,” she explained. “I was really paying attention to the research coming out of Asia on myopia management because they've been the pioneers in this realm.”
She said the combination of those two major factors led her to start offering myopia management in 2014.
“I was the first in the state to do so,” Dr. Wong said. “I started trying to educate, giving talks to both optometrists and ophthalmologists about the research and why we should all adopt these strategies.”
How is Lenstar Myopia making a difference in myopia management?
Dr. Wong said using the Lenstar Myopia technology has been “wonderful” because it measures the axial length of the eye, which is the primary concern in the pediatric population.
“We're worried about that elongation of the eyeball, that axial elongation,” she explained. “That's really what we want to prevent. I tell my patients’ parents, ‘I don't really care how thick the glasses are. What I really care about is slowing that progression.’"
Dr. Wong said that’s why being able to use Lenstar Myopia has been “fabulous.”
“It really charts the patient’s status and allows me to educate the parents in a much more robust fashion than I could before I used it,” she explained.
How important is it to establish baselines for refraction and axial length?
Dr. Wong said that establishing baselines for refraction and axial length is important in myopia management to help guide treatment options.
“Some people might not respond to low-dose atropine, some people might not respond to the contact lens, so if you don't have a baseline measurement, you can’t determine whether the treatment is effective,” she explained. “I do baseline measurements of axial length and refractions for every single patient and then I repeat them every six months. I need to know if the treatment is slowing the progression of the axial elongation.”
She said the printed charts available with Lenstar Myopia are very helpful in this context.
“You can see graphs of a treated versus untreated eye and the predicted growth if treatment isn’t provided,” Dr. Wong explained. “That's so helpful at getting the parents on board because although eye drops and contact lenses can be hard, seeing the difference treatment is making is a game changer.”
What’s the difference between refractive myopia and axial myopia?
Dr. Wong said refractive myopia is related more to the curvature of the cornea and how light is being focused in front of the retina. However, axial myopia is related to the length of the eyeball.
“If the eyeball is too long, that’s what causes light to be focused in front of the retina—not so much because the cornea is really curved,” she explained. “As parents and as eyecare providers, we’re concerned about axial myopia because its progression can be halted with treatment strategies.”
She added that axial myopia, not refractive myopia, is responsible for myopia’s eye health complications—such as retinal detachments, myopic maculopathy, cataracts, and glaucoma. In that context, Dr. Wong said educating the parents early on is key.
“A lot of them have had LASIK, so they feel their myopia is cured,” she said. “But obviously, it's not cured if their eyeball is still long. So, it starts with those initial conversations to educate parents about axial myopia and the long-term risks associated with it. Once you do that, prevention makes a lot more sense compared to treatments with refractive surgery fifteen or twenty years down the road.”
Dr. Wong said that’s one reason the printout provided by the Lenstar Myopia software is so valuable.
“My technicians print it out as soon as they do the measurement on the child, and it’s very easy to understand,” she explained. “It provides curves similar to the growth curves, which most parents are accustomed to seeing when they go to the pediatrician. I point out the axial length curve and let them know that’s what’s really important. It also graphs the refractive error, so we look at both of those curves. We scan the printout into the chart and then give it to the patient and parents. They take it home so they can really pour over it, and they love being able to do that.”
Dr. Wong said the nomograms provided by Lenstar Myopia are also quite helpful—since they predict outcomes based on specific treatment approaches.
“You have all of these different graphs and it helps parents feel more confident about making a decision that's right for their child,” she explained. “Speaking as a parent, that’s so important. You want to be able to do what’s right for your kids, and this really empowers parents by helping them feel confident that they’re making good decisions.”
She said the printout also includes other types of summaries that aren’t necessarily tied to clinical interventions—such as outdoor time.
“Some things are very easy and can be instituted at home, like reduction in near-vision work or increased outdoor time,” Dr. Wong said. “All of that is included in the printouts and we give all of it to the parents—along with a folder I’ve made with some of the literature and a summary of different treatment strategies. I do that because I think baseline education should be the norm.”
What should be evaluated to determine if the treatment approach needs to be adjusted?
Dr. Wong said that although there are certain standards published in the literature to help guide treatment decisions, she takes a very patient-centered approach that integrates individual risk factors.
“I follow a generalized protocol—but I also look at ethnicity, how much time they're spending outdoors, how much time they’re spending up close, and their family history,” she explained. “I integrate all of those factors into the threshold I have for progression of their myopia. Similar to treating patients with glaucoma who have different target pressures, I take a very individualized approach to treating patients with myopia.”
Dr. Wong underscored the importance of considering family history and other factors when making treatment decisions.
“If I know this child is outdoors playing soccer five hours a day and has no one in their family who has had a retinal detachment, I may not be as aggressive at trying to slow the myopia,” she said. “I want that to happen, but I might not offer the combination treatment that I would for someone with a family history in which every single family member has had a retinal detachment.”
What’s the most rewarding aspect of myopia management?
Dr. Wong said seeing the stabilization of myopia progression in her patients is one of the most gratifying aspects of providing myopia management.
“When we've taken a kid who is a minus five and helped them to remain stable over five or six years instead of progressing, it’s amazing,” she said. “That wouldn’t have happened if these treatment strategies hadn’t been instituted really early on, which is something I’ve also seen in some of my own family members. That's really rewarding because that makes a huge difference in their risk profile for vision-threatening consequences down the road. So, we've really changed the nature of their vision and of their lives.”
Dr. Wong said that type of impact is why she enjoys working in pediatric ophthalmology.
“Working with adults is wonderful, too—they’re both rewarding in their own way,” she said. “But pediatrics is exciting because we can institute changes that make a big difference. They may seem really small and they’re not super sexy—like using lasers and such. But, we’re creating profound change for our patients.”
She also underscored the need for more education for parents, which is one reason she is very active on social media.
“I did a poster and we found that 49 percent of parents were not even told about myopia management, so we have more work to do in terms of patient and parent education,” Dr. Wong said.
