It feels like now more than ever I am seeing more children with myopia. And even more alarming, I am finding significant myopia at younger ages. While the reward for helping a kid see is great, I get a knot in my stomach knowing that the journey they are on can lead them down a path of possible retinal disease and even blindness. So, it is time to take some action.
These are the top three myopia management methods I will be prescribing this year.
1) Daily Multifocal Soft Contact Lenses
This is one of my favorite myopia management methods for two reasons.
First, parents and kiddos know what contact lenses are and find it an attractive option for activities and school. There is more common knowledge around contact lenses, which makes the explanation quicker and talking with the parent about their child's myopia more effective. In addition, many parents and students are nervous about comments from their child’s peers about glasses or how glasses may impact sports and activities.
Contact lenses remove the glasses component for many occasions. While a back-up pair of glasses is always needed, they don’t have to be relied upon for everyday use.
Second, the care and keep of contact lenses is more manageable. I know that these multifocal soft contact lenses won’t be sitting in contact lens solutions that may not have been changed (always change your contact lens solution daily!) or in a case that may not have been changed (make sure you change your case at least every 2-3 months). These lenses have minimal time for bacteria buildup or any possibility for being mishandled. Parents also have their minds put at ease knowing if a child rips a lens, there are a plethora of lenses to replace it.
As a practitioner, it is very easy to begin prescribing daily multifocal soft contact lenses.
The current daily lenses on the market have only one add power to choose from. Prescribing a high add manages myopia the best, so they have taken out the guessing game of which daily multifocal soft contact lens to use. The two lenses that are available on the market currently are CooperVision MiSight and NaturalVue lenses. It feels like there is lots of innovation in the category right now. It is definitely an option you don’t want to sleep on!
2) Low Dose Atropine
Atropine is the OG treatment of myopia management, and it has stood the test of time because it works well and is safe and effective. A big win for atropine is that it is a method that can be “tried” to see how the child handles the treatment. Parents can be concerned about how their child will perform with a myopia management treatment and can be reluctant to jump into the expenses of insertion and removal training of contact lenses, but it is more effective than only using a pair of progressive or bifocal glasses. There is research around peripheral defocus as well as a pharmaceutical method of action that slows the growth of axial length.
The medical benefits of low dose atropine to slow myopia management are great, and its treatment style may help ease a parent's concern as well. Atropine can be more affordable and can be stopped if a child does not tolerate the treatment. Another perk of Atropine is that it can be an effective treatment for patients who may have physical limitations that can impact wearing contact lenses.
I want to remind you, though, that the kiddo may need Transitions lenses or sunglasses when they go outside while they use the atropine. Since the pupil is dilated and cannot constrict to light, we want to protect the retina and lens from UV rays. Not only do we need sun protection, but bifocal glasses are needed to help with any up-close work. Having a discussion with the parent about indicators of difficulties reading is important, since many times kiddos won’t bring up when they are struggling with near work.
There is some concern about side effects of atropine even at a low dose. I suggest having the patient instill their first dose in office to make sure the patient has no immediate side effects or allergic reactions. This also gives you a chance to coach the parent on how to instill the drops and how the child is able to function with their atropine instilled.
Before you begin prescribing low dose atropine, make sure you have a pharmacy that is able to fill your prescription. I suggest imprimisRX as an online compounding pharmacy that can quickly fill your patients’ needs.
3) Bifocal Glasses
Bifocals are not usually the first treatment choice when it comes to myopia management—and I get it. It is not as effective as atropine or distance-centered multifocal contact lenses. If I really want to slow myopia progression, my brain doesn’t immediately jump to bifocals as my most impactful myopia management treatment.
The one advantage that bifocals do have, however, is their consistency with the kiddos’ current treatment. Many times parents are unsure of myopia management treatments. The global acceptance of myopia management is relatively new, so many parents have never heard of current myopia management techniques. There could be some hesitancy around atropine or contact lenses from parents. There is a lot of time and financial investment into both of these myopia management techniques.
Beginning with bifocal glasses, you are still slowing the progression of myopia (even if it is in a smaller percentage) and can ease the parent and child into myopia management.
This is also a great way to help your patients who may be on Medicaid. Bifocals are covered under many Medicaid plans, making them accessible to patients who may be unable to afford other myopia management programs.
There is also a debate around flat top bifocals, round top bifocals and progressive lenses. While progressive lenses allow for the most cosmetically appealing and continuous visual ease, they can be the most expensive glasses option. Round top bifocals are the middle ground between a progressive and a flat top bifocal. They’re cosmetically more appealing, but do still have distinct distance and near segments. A flat top bifocal brings affordability, ease of use but is the least cosmetically appealing option. Studies find that any type of bifocal or progressive works, but make sure that whatever you choose, the patient feels successful using the lens.
The most effective treatment: the one you’re using
For me, the most effective treatment is the treatment that is being used. While I gravitate towards these three treatments, there are plenty others that are equally effective in managing myopia and are better options for your patient. So prescribe the most impactful treatment that the kiddo and parent will be able to successfully complete. The other important piece of myopia management is what you feel most comfortable prescribing.
“Each doctor has their own strengths, so utilize the myopia management style that you feel you can complete successfully.”
Myopia management is such a satisfying way to help your young patients have great vision for the rest of their lives, so jump on in and start prescribing myopia management treatments today!
Disclosure: Dr. Kate Hamm OD works for EssilorLuxottica. These views are her own and do not necessarily reflect her employer’s view.
