Controlling Myopia Progression in Your Practice

There has been anecdotal evidence for overnight contact lens wear slowing down myopia progression since the age of PMMA lenses in the 1960s, but it has only been in the last 15 years that rigorous trials establishing the efficacy of myopia control have emerged.

Now the field is thriving, as Dr. Glazier and his new website myopiainstitute.com can attest. This is an exciting time to become involved in myopia control, as rates of near-sightedness are on the rise across the globe especially in Asian cultures, where prevalence can exceed 90% in urban millennials.

Even if specialty contact lens fits aren’t your strong suit, this exciting area represents a unique niche in which to set yourself apart in the eyes of your patients.

The Effects can be Substantial

If you were anything like me when you got into optometry school, you had probably heard of myopia control once or twice, but you weren’t exactly sure how it worked or how much control could be expected.

As myopia control was minimally discussed during my didactic learning at Berkeley, I didn’t really understand the treatment until my clinical instructors gave me research papers to expand my knowledge base on the topic. As it turns out there are three main modalities that have been discussed in the literature, and all of them have been found to have similar rates of efficacy – between 40 and 60% reduction. Not too shabby!

The Modalities

The first, and most common modality in our myopia control clinic at Berkeley, is that of CRT lenses, in which children wear gas-permeable lenses overnight that flatten the central cornea, correcting vision for the following day, and steepen the peripheral cornea, providing peripheral myopic defocus and slowing down the rate of axial length elongation.

I won’t get into the specifics of fitting CRT lenses in this article, but with the right fitting set and your trusty topographer, it should only take a few visits to get the child’s vision corrected well after a full night of wear.

The second type of treatment involves distance center multifocal contact lenses. These work much the same way as CRT lenses-correcting the central cornea for distance vision while providing peripheral corneal myopic defocus-this time in the form of a near add.

The last mainstay treatment is that of atropine therapy. In our clinic, we use diluted (0.01%) atropine, with one drop dosing every bedtime. Many parents like this method since they don’t have to worry about monitoring their children’s contact lens habits. Of course, the big drawback here is that refractive correction during the day is still needed.

While the exact mechanism for how these treatments work is still up for update within the literature, I encourage you to do more research on each one. The ATOM studies by Chua et al. in particular are a great introduction to atropine therapy, while “Orthokeratology practice in children in a university clinic in Hong Kong” by Chan et al. is a great intro to myopia control with CRT.

Identify Potential Patients

But what are the keys to establishing a myopia control patient base in your practice? The first step involves pinpointing suitable patients. Children who are myopic before the age of 10, children who have two myopic parents (especially high myopes), and children who present displaying large myopic shifts (> 0.75 diopters in a year) are all excellent candidates for treatment.

Many parents may be of the opinion that having a highly myopic prescription is just an inconvenience for their child, but you as the doctor need to educate them on the potential dangers of high axial length myopia.

Patients don’t realize that having a highly myopic prescription means they are at greater risk for both retinal detachments and glaucoma. By planting the seed via patient education as soon a child seems to be a good candidate for therapy, they are more likely to come back to you seeking the treatment when their child’s prescription seems to increase again and again every year.

Consultation is Key

Since many of our patients will have never heard of myopia control, an extended patient consultation is a must. At our clinic in Berkeley, we devote a full half-hour to explaining the treatment and answering any questions that parents have.

This may seem like a lot of time to devote to one patient in your office, but make no mistake myopia control can be a revenue generator. Keep in mind that these therapies are generally not covered by insurance plans, meaning these patients will be cash pay.

With an optimistic mind and a calm bedside manner for patient consultation, you can establish a myopic control clinic in your private office if you choose. Go the extra mile, read through the available literature, and be the hero by offering this cutting-edge service to your progressively myopic patients.