Ready, Set, Myopia Management: A Quick-Start Action Plan

Myopia is increasing worldwide at an alarming rate and is projected to afflict over 50% of the world’s population in 2050.¹

Currently, the rate of myopia in North America is 40 to 45%, while some East Asian communities already experience an over 90% incidence.

This means there will be five billion people with myopia across the globe, with one billion of those suffering from pathologic myopia.^1-3

The value of early intervention for myopia

Even a brief look at these statistics on myopia prevalence proves why integrating myopia management into your practice is likely to bring one of the longest-lasting benefits you can offer to your patients.

Being confident in diagnosing this disease, accurately gauging its rate of progression, and managing it accordingly is undeniably important, yet there is still a hesitancy among some eyecare practitioners (ECPs) to adopt myopia management.

However, by delving into common concerns, offering practical strategies for implementing myopia management, and providing real-life success stories, we will empower you to kickstart this aspect of your practice to serve this growing population better.

Reducing roadblocks to myopia management

As myopia is considered to be a complex condition of both genetics and environment, there are a range of common concerns that potentially hold practitioners back. These include the logistics of achieving an accurate and ongoing assessment, the time and effort required to get certified, and discomfort with the depth and breadth of parental education.

This article will outline strategies on how to implement myopia management; however, if you would like to learn more about the clinical aspects, assessment, and specific treatment options, there are several articles available on these topics.

Prepare now for future success with myopia

Incorporating myopia management into a primary care optometry practice involves several steps under a cohesive strategy to enact a successful implementation. One of the first steps is to ensure that both you and your staff are well-educated on the topic.

As myopia is a quickly evolving eyecare specialty, it is imperative to keep up-to-date with the latest research and developments in myopia management while keeping abreast of the different treatment options and any changes in guidelines. Education is key.

Six actionable steps toward myopia mastery

Attend training programs, workshops, or seminars pertaining to myopia management.
Garner certification for myopia management treatment lenses.
Collaborate with experts in the field. Experienced myopia specialists can provide invaluable insights and guidance, so connect with experienced practitioners who have had successful implementations in their offices.
Become proficient with imaging devices to enable you to incorporate technologies like corneal topography and A-scan into your protocol, as these enhance efficiency and provide valuable data for monitoring and tracking progress.
Hold workshops and training sessions within your practice to ensure that the entire staff is well-versed in myopia facts, protocols, and technologies. This strategy allows your office to provide a unified front.
Develop educational materials for patients and their parents about the risks of myopia progression and all the available management options. This can include brochures, website content, and in-office displays.

Taking a proactive approach to myopia management

Perhaps the number one thing practitioners can embrace before embarking on adding myopia management to their practice is a proactive approach.

Practitioners looking to add myopia management into their practice are recommended to not only engage in discussions about myopia management with their pediatric patients who are already myopic but also to be proactively discussing myopia management with pre-myopia pediatric patients or patients at risk of developing myopia in the future.

Moreover, it is also important to extend this conversation to adult myopic patients who have or are planning to have children. Most adults tend to schedule eye exams for their children only when they encounter vision issues.

Therefore, it is important to initiate early education about the importance of annual eye exams by conversing with adult myopic patients who have children or are planning to have children. This early conversation not only introduces the concept of preventive measures—such as spending time outdoors to delay myopia onset—but also lays the framework for discussions on myopia control.

By engaging parents and children in these early conversations, they can be well prepared for starting potential treatment options in the event that the child becomes myopic in the future.

7 steps for implementing myopia management

Having a strategy in place for introducing myopia and its management can dramatically decrease the amount of time necessary to educate parents and patients.

It is highly recommended in these conversations to cover the need, benefits/risks, process, and expected outcomes of myopia management. Encourage an open line of communication, as you might be the first provider to present this information to them.

The seven steps below are intended to simplify and streamline this process.

1. Introduce the diagnosis.

At the end of your exam of any individual under the age of 20 with known risk factors such as two myopic parents, Asian ethnicity, less than 0.75 diopter of hyperopia at age 5, or any amount of myopia after that age, averaging less than 2 hours outdoors daily, or with 5+ hours of screen exposure daily, turn to the parent and simply state, “I have found something concerning.”

2. Explain the condition.

Explain that myopia has become an epidemic, steadily growing—especially in younger patients—and that new research has confirmed the association of myopia with the risk of permanent visual impairment as we become older.

3. Reiterate the importance of intervention.

Acknowledge that we have previously considered myopia an “inconvenience” consisting only of distance blur and thicker lenses in glasses, but we now know that higher levels of myopia are caused by excessive growth of the eye during childhood, causing stretching of the retina.

This stretching greatly increases the risk of diseases such as myopic maculopathy, glaucoma, and retinal detachment.

4. Recommend management options.

Advise that you are recommending myopia management to slow the rate of elongation of the eye during its growth phase (generally the first two decades of life).

Reassure parents that your office offers treatment choices to both correct any blur, as well as potentially slowing down both the stretching of the eye and prescription power increases by 50 to 60% while attempting to mitigate the risk of retinal diseases as the child ages.

5. Engage through email.

At this point, most parents need time to process this initial information. Rather than engaging their questions at the initial exam, offer to send them an email (or a written document from your office) further explaining treatment options and costs.

It is critical to include links to research supporting your statements using LAMP, ATOM 1 and ATOM 2, CHAMP, CLEERE, and CLAMP studies/summaries for reference.

6. Communicate a clear call to action.

Include a call to action at the end of the email asking the parent to schedule a myopia management evaluation. Also, state that additional questions, concerns, and a full discussion of best treatment options can be addressed at that time.

7. Follow-up.

Create a reminder for your staff to reach out to the parents in 2 weeks and offer to schedule the evaluation.

Common contact lens concerns with pediatric myopic patients

Common concerns frequently raised by myopia patients and their parents include two main questions, both regarding contact lenses:

Are contact lenses safe for children to wear?
Are children old enough to wear contact lenses?

When it comes to addressing these concerns, education plays a key role. Mark Bullimore's 2017 review on “The Safety of Soft Contact Lenses in Children” illustrated that the incidence of corneal infiltrative events (CIEs) in children is no higher than in adults, and there have been no reports of microbial keratitis in young children.⁴

This reassuring data can be attributed, in part, to the increased parental oversight of contact lens care and hygiene. Understanding these facts can help alleviate parental anxieties.

Contact lens modalities for pediatric myopic patients

Having a thorough discussion about the different contact lens modalities can also help to decrease patient and parental anxieties regarding contact lens wear. In the context of orthokeratology, all wear and care of the contact lenses are done at home, providing parents with complete oversight over the process.

For soft contact lens wear, daily disposable contact lens options are my preferred choice for both children and adults. Inadequate cleaning and improper storage of contact lenses can lead to eye infections, and daily disposable contact lenses help mitigate the risk of infections resulting from poor wear and care habits.

During contact lens fitting appointments, make it a priority to thoroughly discuss proper cleaning, care, and disposal of contact lenses with the patient and their parents to minimize the risk of infection.

Key considerations for young myopic contact lens wearers

Additionally, it is helpful to provide guidance on how to respond in case of a "red eye" issue. This comprehensive approach ensures that both the patient and the parent feel at ease with the process and are equipped with the knowledge and tools to ensure successful and healthy contact lens wear.

One common misconception is that children are too young for contact lens wear. It's important to note that there is no established minimum age requirement for beginning contact lens wear in eyecare.

While many parents who wear soft contact lenses themselves often mention that they began wearing contact lenses in high school or college, contact lenses can indeed be worn at any age. For instance, soft contact lenses are a recognized treatment option for infants with aphakia.

The key to successful contact lens wear in children is their maturity level and motivation. Age alone should not be a barrier to trying contact lenses. In discussions about the various myopia control options available, it is important to approach the decision as a collaborative effort involving both the child and their parents.

Children who are motivated to wear contact lenses tend to be successful in safely wearing them, while those who lack motivation are often less successful in the contact lens fitting process.

Myopia management success stories

Karen Molina, OD, shared the following patient case to illustrate the transformative impact myopia management can have on a child's life.

“My favorite myopia management success stories revolve around the progress achieved in controlling the rapid progression of myopia. One particular patient comes to mind, an 11-year-old Asian female who had been experiencing an annual increase of 1 diopter of myopia for a duration of 2 years despite undergoing treatment with multifocal soft contact lenses.

When she eventually saw me, she was a 5-diopter myope, surpassing both her parents' prescriptions at such a young age despite myopia treatment. Given her ocular history, the patient, her parents and I collectively decided to transition to a combination of orthokeratology and a low-concentration atropine.

Over the 3 years that I've been managing her case, her myopia has remained stable without any changes to her prescriptions. This represents a remarkable departure from her prior ocular history of annual, rapid myopia progression.

Transitioning from the constant cycle of follow-up appointments due to blurry vision complaints from prescription changes to having follow-ups focused on confirming stable vision and progression is truly life-changing for a family.

Seeing the joy and relief on my patient's and her parents’ faces when I deliver the news that her prescription is holding steady is an immensely heartwarming experience that reinforces my love for what I do as a myopia management practitioner.”

Nick Chu, OD, provided a similar account that demonstrated the life-changing capabilities of myopia management.

“One of my fondest memories from the initial implementation of myopia management in our practice involved a 6-year-old child whose parents had a high degree of myopia. During this visit, the child presented with mild nearsightedness, prompting us to prescribe glasses.

Alongside this, we provided them with our myopia management educational materials. Opting for a semi-annual follow-up, the parents returned 6 months later only to discover their child’s prescription had more than doubled in that short timeframe.

Recognizing the urgency, both parents agreed to initiate a myopia management plan. Fast forward 2 years, and not only did we witness no further progression, but we also noted a reduction in the child’s axial length measurements.

The positive impact we’ve had on this child’s vision has been incredibly rewarding, and the memory of the joyous smiles on the child’s and parents’ faces is a motivating force as our practice continues to excel in the myopia management space.”

Final thoughts

It’s time for us all to acknowledge that we should be concerned about myopia progression. Compelling research demonstrates that the increasing number of children developing myopia at a young age can lead to an increasing number of patients with high myopia and, therefore, increasing incidence of visual impairment.

By focusing on education, implementing a protocol, and fostering effective communication, ECPs can strive to integrate myopia management into their practice to enhance patient outcomes by potentially stabilizing and reducing progression.