Myopia, or nearsightedness, has become a growing global health concern, particularly among children and adolescents. The rise in cases also increases the risk of associated complications, such as retinal detachment, glaucoma, and myopic maculopathy, which can have serious long-term consequences for vision. As we confront our modern understanding of myopia, there is a pressing need to incorporate advanced technologies into our management protocols.
Optical biometry, a non-invasive technique that accurately measures key ocular dimensions, aligns with our evidence-based philosophy for myopia management. It provides clinicians with precise data, facilitating early detection of myopic progression, personalized treatment plans, and ongoing evaluation of treatment efficacy.
This editorial delves into the integration of optical biometry into myopia management protocols and explores its benefits, applications, and potential impact on clinical practice.
Understanding optical biometry
Optical biometry employs light waves to measure critical ocular parameters such as axial length (AL), anterior chamber depth (ACD), lens thickness (LT), and corneal curvature.1 These parameters provide essential information about the eye's structure, and understanding their changes over time can inform myopia management strategies.
Among these measurements, axial length is of particular significance, as it is correlated with myopia progression.2 As the AL increases, the risk of developing associated ocular pathologies—including retinal disease and dry eye—also rises.3,4 Therefore, tracking axial length accurately and consistently is crucial for identifying patients at risk of rapid progression and for guiding interventions aimed at slowing that progression.
1. Early detection and monitoring
One of the key advantages of incorporating optical biometry into myopia management is its ability to detect myopic progression at an early stage. Normative axial elongation over a lifetime is from approximately 15.1mm at birth to 23.6mm in adulthood, with some variability due to the growth of other ocular structures, such as the crystalline lens and cornea.5
Research indicates that axial length changes often occur before clinical symptoms of myopia become apparent.6 Early detection is vital, as it allows for timely interventions that can slow down or even halt further progression.
By regularly monitoring axial length through optical biometry, practitioners can establish a baseline and detect even small changes that might otherwise go unnoticed. The ability to track axial length with precision has made biometry an essential tool for the early identification of at-risk patients.
2. Personalized treatment plans
Myopia progression is not uniform among individuals; it is influenced by a range of genetic, environmental, and behavioral factors. Given this variability, a one-size-fits-all approach to myopia management is unlikely to yield the best results. This is where optical biometry can play a pivotal role in developing personalized treatment plans.
Biometry allows clinicians to monitor each patient’s unique axial length growth patterns, providing objective data that can inform tailored interventions. For example, children who experience axial elongation while on one therapy for myopia management (such as atropine) may benefit from a horizontal shift to another or adjunct therapy using both optical and pharmaceutical intervention.
We do know that the literature is somewhat conflicted about the efficacy of adjunct therapy (i.e., are two treatments better than one?). However, research may be promising.7 This individualized approach is critical for optimizing treatment outcomes.
Literature by Bullimore and Brennan underscores the importance of personalized treatment strategies by discussing the importance of slowing myopia of all magnitudes and implementing the use of effective treatments.8 Personalized care also improves patient compliance, as both the patient and their family can better understand the rationale behind specific interventions when presented with clear data showing the progression or stabilization of myopia.
3. Evaluation of treatment efficacy
In addition to early detection and treatment customization, optical biometry is invaluable for evaluating the efficacy of myopia management interventions. Establishing baseline measurements of axial length at the outset of treatment enables clinicians to assess the impact of various strategies over time. Follow-up biometry assessments provide quantitative data on whether a particular intervention is successfully slowing axial elongation.
Orthokeratology, for instance, is a popular method for controlling myopia progression. Without tools like optical biometry, evaluating the long-term efficacy of such treatments would be challenging without removing the treatment temporarily, which is impractical for both the patient and the practitioner.9 Optical biometry offers an efficient solution, allowing clinicians to continuously track changes without disrupting the treatment protocol.
Moreover, biometry can identify non-responders—patients who do not exhibit the expected reduction in axial elongation despite undergoing treatment. For these patients, clinicians can quickly adjust a management plan.
Practical considerations for integrating optical biometry
1. Training and equipment
Successfully integrating optical biometry into myopia management requires both the appropriate technology and comprehensive training for practitioners and their teams. High-quality biometry devices are essential for capturing accurate measurements, and understanding how to operate these machines is just as important as knowing how to interpret the data they provide.
Training ensures that staff can efficiently use the technology, while continuing education programs keep clinicians up to date with advancements in optical biometry. As new devices and techniques emerge, it will be essential for practices to remain adaptable, continuously improving their skills and protocols to make the most of this technology.
2. Establishing a protocol
To ensure consistency and efficiency in myopia management, practices must establish standardized protocols for conducting optical biometry assessments. These protocols should specify how often assessments are conducted—typically every 6 to 12 months, depending on the patient's age, risk factors, and rate of progression.6
Protocols should also include guidelines for interpreting changes in axial length and adjusting treatment accordingly. Clear thresholds for intervention can streamline decision-making, allowing for prompt responses when significant changes are detected.
3. Communication with patients and families
Effective communication is critical for ensuring patient compliance and long-term success in myopia management.10 Optical biometry provides an excellent tool for educating patients and their families about myopia progression. By showing families objective data, such as axial length measurements and comparisons with normative values for similar demographics, practitioners can foster a collaborative environment.
When patients and their caregivers are actively involved in understanding the treatment process, adherence to treatment plans improves. Regular communication helps ensure that follow-up appointments are scheduled on time and adjustments to the management plan are made when necessary.
For a deeper dive into how optometrists can connect with pediatric patients and communicate myopia treatment expectations with guardians/parents, check out The Myopia Talk: How To Craft Patient Communication with Parents/Guardians.
Conclusion
Incorporating optical biometry into myopia management protocols offers a transformative opportunity to improve patient care. The precise measurements provided by biometry facilitate early detection, enable personalized treatment plans, and allow for ongoing evaluation of treatment efficacy.
Given the rising prevalence of myopia worldwide, embracing this technology is critical for optimizing management strategies and improving outcomes for patients. The integration of optical biometry is more than just a technological upgrade—it represents a shift toward a more data-driven, personalized approach to eyecare.
As we continue to refine our understanding of myopia and its management, the insights gained from optical biometry will undoubtedly shape future clinical practices, leading to more effective and patient-centered care.
