June 1, 2022
By Dwight Akerman, OD, MBA, FAAO, FBCLA, FIACLE
There is good reason to slow the progression of juvenile-onset myopia. Once considered a simple refractive error with few, if any, long-term eye health consequences, myopia increases the risk of serious, sight-threatening complications later in life, including retinal detachment, myopic macular degeneration, PSC cataracts, and glaucoma.
When should myopia management be implemented, and on which children? Progression is highly likely once a child is identified as pre-myopic or myopic. The goal of myopia management is to limit axial length and refraction as much as possible but certainly to keep the axial length below 26 mm and Rx less than -6.00D. At a minimum, lifestyle advice and visual hygiene guidance should be provided to all pre-myopic and myopic children. This advice encompasses outdoor exposure, close work time, and working distance.
Unfortunately, eye care professionals often take a wait-and-see approach to myopia management and simply prescribe single-vision spectacles, which do nothing to slow myopia progression. Reasons vary, but practitioners often blame a child’s immaturity, lack of motivation, inability to handle or wear contact lenses safely, non-compliance, and patient/parent personal preference as reasons for not proactively prescribing available proven myopia interventions to children, especially those aged 10 or younger.
Because myopia control spectacles (perhaps in combination with other therapies such as topical low-dose atropine or dual-focus/EDOF single-use contact lenses) are often the best choice for myopic children, it’s reassuring to know that U.S. practitioners will have new, efficacious options in the future.
Three innovative spectacle lens designs are on the horizon that provide excellent myopia control. All of these lens designs have demonstrated a significant reduction in axial length and Rx progression in randomized controlled trials. None of these novel spectacle technologies are FDA approved in the U.S. for myopia progression control, nor are they available in the U.S. as of this writing, although they are approved and available in Canada. These spectacle lenses include (in alphabetical order):
A more comprehensive discussion of these technologies can be found in Dean Psarakis’ article ‘Myopia Control with Innovative Spectacle Lenses.’
These innovative spectacle technologies promise to play a critical role in addressing the global myopia pandemic. They will be an exciting addition to our myopia control armamentarium when available.
Best professional regards,
Dwight H. Akerman, OD, MBA, FAAO, FBCLA, FIACLE
Chief Medical Editor