October 2, 2023
By Dwight Akerman, OD, MBA, FAAO, FBCLA
A recently published review article by Bullimore and Brennan (2023) provides a comprehensive review of the current understanding of juvenile-onset myopia, its treatment, and evaluation of success.
The authors argue that there is no safe level of myopia, and the risk of eye diseases such as myopic macular degeneration increases with the level of myopia. They make a case for treating all myopic children, emphasizing the need for cycloplegic autorefraction and optical biometry in measuring refractive error and axial length.
The authors discuss the factors influencing juvenile-onset myopia progression and the tools available for interpreting progression rate. They stress the importance of setting attainable treatment goals. The review also highlights the need for effective methods to delay or avoid onset, treatments to slow progression in existing myopes to limit the final degree of myopia, and interventions to stop or slow the development of complications.
One key takeaway from the article is that slowing myopia by one diopter should reduce the likelihood of a patient developing myopic maculopathy by 40%. This treatment benefit accrues regardless of the level of myopia.
The article is well written and provides valuable insights into juvenile-onset myopia. It underscores the importance of early intervention and comprehensive treatment strategies. The authors did not discuss potential side effects or challenges associated with the various myopia therapies.
In conclusion, Bullimore and Brennan’s article offers an insightful overview of juvenile-onset myopia. It emphasizes the need for early treatment and careful monitoring, providing valuable guidance for clinicians, researchers, and policymakers in this field.
Juvenile-Onset Myopia — Who to Treat and How to Evaluate Success
Mark A. Bullimore & Noel A. Brennan
The risk of eye diseases such as myopic macular degeneration increases with the level of myopia, but there is no safe level of myopia, and the burden of lower degrees of myopia remains considerable. Effective treatments are available that slow progression and thus limit the final degree of myopia. In this review, the rationale for slowing progression is summarized, and a case made for treating all myopic children. Measurement of refractive error and axial length is reviewed, stressing the precision of optical biometry but also the need for cycloplegic autorefraction. The factors influencing progression are considered and the available tools for interpretation of progression rate are discussed. Finally, the need to set attainable treatment goals is emphasized.
Bullimore, M. A., & Brennan, N. A. (2023). Juvenile-onset myopia—who to treat and how to evaluate success. Eye, 1-5.