From Pre-Myopia to Myopia: The Patient Journey

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December 1, 2023

By Dr. Melinda Toomey, BAppSc (Optom), MOptom, GradCertOcTher, MBA, PhD

Managing myopia is a multifaceted process that requires a comprehensive and personalized approach. Early detection, risk assessment, regular monitoring, and long-term reviews are essential to this journey

While traditionally viewed as a benign refractive error, myopia can lead to several sight-threatening conditions. Myopia, a complex ocular condition, typically emerges in childhood and progresses during adolescence into early adulthood. An interplay of several risk factors, such as lower than age-normal levels of hyperopia during emmetropization, myopic parents, Asian ethnicity, accommodative-convergence issues, less outdoor time, and prolonged reading at a very close working distance is implicated in the development of myopia.¹

Even at low to moderate levels, myopia can lead to significant complications, although high myopia poses the highest risk for complications and visual impairment.² People with myopia have an increased risk of developing cataracts, glaucoma, and retinal detachment.² Excessive axial elongation may lead to sight-threatening complications such as posterior staphyloma, myopic maculopathy, and optic neuropathy.³ Managing a patient’s journey from pre-myopia to myopia requires practitioners to be aware of and address key points to promote eye health and potentially slow the progression of myopia.

Early Detection and Risk Assessment
Practitioners must be vigilant in identifying pre-myopic signs in children and recommending preventative measures. Pre-myopia is “a refractive state of an eye of ≤ +0.75D and > -0.50D in children where a combination of baseline refraction, age, and other quantifiable risk factors provide a sufficient likelihood of the future development of myopia to merit preventative measures.”³ Intervention is crucial during the pre-myopic stage to slow myopia progression. Pre-myopia is identified through a risk assessment of a child’s family history of myopia, lifestyle factors (e.g., near work, screen time, outdoor activities), and results from a comprehensive eye examination, including cycloplegic refraction.¹

Awareness, Education, and Communication
Public awareness of myopia is limited, with it being seen primarily as a benign condition easily corrected by spectacles, contact lenses, or refractive surgery.⁴ Concerningly, parents perceive myopia as an optical, cosmetic, and expensive inconvenience.⁴ Therefore, practitioners should educate parents and children about the risk factors for myopia, the potential consequences of myopia, the need for regular eye examinations, modifiable lifestyle factors, and the different options for and expected efficacies of myopia control. This information should be communicated regularly to parents and children using lay terms to promote understanding. Written and online materials can supplement in-office verbal communication and serve as a reference between visits.¹ Additionally, practitioners should maintain open and transparent communication with children and their parents to address any concerns or questions related to myopia management.

Personalized Care
Each patient’s myopia journey is unique, and practitioners should create customized treatment plans that consider the child’s estimated rate of progression, risk factors, and clinical results.¹ Treatment algorithms hold promise as they allow for the stratification of patients based on their risk factors and aid in selecting the most suitable treatment modality or a combination thereof for each child, taking into account both clinical judgment and patient preference.⁵ Furthermore, they provide a framework for modifying treatment based on therapeutic response and compliance, using objective measures.⁵

Follow-up, Adherence, and Long-term Perspective
Regular follow-up allows for timely adjustment to treatment strategy, ensuring optimal outcomes and mitigating potential risks. To determine an appropriate follow-up schedule, consider the chosen treatment’s efficacy, potential complications, and the patient’s adherence to the treatment plan.¹

Adherence, the degree to which a patient’s behaviors align with their practitioner’s recommendations,⁶ is vital in myopia management as it directly influences the success of myopia control treatments.⁷ To promote adherence, practitioners should adopt the SIMPLE approach: Simplify treatment regimen, Impart knowledge to the patient, Modify patient beliefs, Practice positive patient communication, Leave the bias by tailoring education to the patient’s level of understanding, and Evaluate adherence.⁸ As well, due to the ocular health complications of myopia that may arise over time, myopia care is not a one-time solution but a lifelong journey. Thus, children and their parents should be educated on the importance of long-term regular reviews to monitor for complications. 

Thus, managing myopia is a multifaceted process that requires a comprehensive and personalized approach. Early detection, risk assessment, regular monitoring, and long-term reviews are essential to this journey. By promoting adherence to treatment plans and maintaining open communication with patients, practitioners can effectively manage myopia and mitigate its potential complications. Remember, myopia management is not a sprint but a marathon, requiring sustained effort and commitment from practitioners and patients alike.

 

Dr. Melinda Toomey is a clinician-researcher and Research Fellow at the University of Queensland. Her research focus includes patient-centered care, evidence-based practice, ocular diseases, and ocular therapeutics. She is also a Fellow of the American Academy of Optometry.

 

References

1. Gifford KL, Richdale K, Kang P, Aller TA, Lam CS, Liu YM, et al. IMI – Clinical Management Guidelines Report. Invest Ophthalmol Vis Sci. 2019;60(3):M184-M203.
2. Haarman AEG, Enthoven CA, Tideman JWL, Tedja MS, Verhoeven VJM, Klaver CCW. The Complications of Myopia: A Review and Meta-Analysis. Invest Ophthalmol Vis Sci. 2020;61(4):49.
3. Flitcroft DI, He M, Jonas JB, Jong M, Naidoo K, Ohno-Matsui K, et al. IMI – Defining and Classifying Myopia: A Proposed Set of Standards for Clinical and Epidemiologic Studies. Invest Ophthalmol Vis Sci. 2019;60(3):M20-M30.
4. McCrann S, Flitcroft I, Lalor K, Butler J, Bush A, Loughman J. Parental attitudes to myopia: a key agent of change for myopia control? Ophthalmic Physiol Opt. 2018;38(3):298-308.
5. Cooper J, Aller T, Smith EL, 3rd, Chan K, Dillehay SM, O’Connor B. Retrospective Analysis of a Clinical Algorithm for Managing Childhood Myopia Progression. Optom Vis Sci. 2023;100(1):117-24.
6. Sabaté E. Adherence to long-term therapies: evidence for action. World Health Organization; 2003.
7. Sankaridurg P, Bakaraju RC, Naduvilath T, Chen X, Weng R, Tilia D, et al. Myopia control with novel central and peripheral plus contact lenses and extended depth of focus contact lenses: 2 year results from a randomised clinical trial. Ophthalmic Physiol Opt. 2019;39(4):294-307.
8. Atreja A, Bellam N, Levy SR. Strategies to enhance patient adherence: making it simple. MedGenMed. 2005;7(1):4.