Once you get patients enrolled in myopia management, monitoring their myopia progression and knowing when it’s time to move on from treatment are crucial next steps. As research continues to look at factors like the rebound effect—the phenomenon that occurs when patients discontinue myopia treatment and begin progressing again—understanding the latest evidence-based findings can help you make the best decisions for your patients.
EVALUATING TREATMENT EFFICACY
As discussed in the section on selecting the most appropriate treatment, two of the key measurements required for initiating—and monitoring—myopia management are refractive error and axial length.
Refractive error is key to diagnosing myopia. Additionally, as children are enrolled in myopia management treatment, measuring their refractive error gives practitioners and parents a way to evaluate and assess their visual performance.
Axial length measurements, on the other hand, can be pivotal in guiding treatment protocols and gauging clinical efficacy of the treatments involved for myopia management. In general, axial length measurements are touted for their ease, repeatability and accuracy—especially when treating young patients on a regular basis. It’s also important to note that changes in axial length are often aligned with changes in refractive error, making both important and valuable parts of monitoring myopia.
A general rule of thumb can be to measure axial length every six months and conduct a cycloplegic refraction annually.
C.A.R.E.
Monitoring the efficacy of the myopia treatment is another critical component. It isn’t uncommon for manufacturers to tout the percentage of their product’s myopia management effect in marketing materials. For instance, companies might say: In a randomized controlled trial, myopia management intervention #1 reduced axial length elongation by 0.16 mm compared to the control group after one year. The manufacturer’s marketing literature asserted this as a 50% decrease in axial length progression relative to the control.
In a recent paper by Brennan et al.,1 the researchers developed the C.A.R.E. metric – Cumulative Absolute Reduction in Axial Elongation.
The paper highlights the following key findings:
WHEN DO YOU STOP TREATMENT?
How do you know when it’s time for patients to move on from myopia management treatment? There are clinical and practical things to consider when “graduating” patients from a myopia management program.
Erin S. Tomiyama, OD, PhD, FAAO, of Anaheim, California, and Kathryn Richdale, OD, PhD, of Houston, Texas, believe the ultimate decision belongs to the patient and the parent.
“Practitioners may suggest stopping myopia management based on limited refractive or axial length progression over the previous year or two,” the pair explained. “Parents get the most bang for their buck when the child is younger, and their progression is occurring at a faster rate. As children get older and naturally start to slow in progression, the relative amount of myopia management efficacy dwindles with age over time.”
Drs. Tomiyama and Richdale explained that myopia stabilization is ultimately the key consideration for discontinuing myopia management treatment. However, the cost of the treatments are always a factor for parents, as is the regularity of follow-up visits. As many patients start treatment when they’re younger, by the time they’re in high school and going off to college, keeping up with treatment may not be feasible.
THE IMPACT OF REBOUND
Many practitioners may worry about the patient’s myopia continuing to progress once they stop actively using myopia management treatments.
In a recent study by Mark Bullimore, MCOptom, PhD, FAAO, and Noel Brennan, Optom, MSCOptom, PhD, FAAO,2 the pair evaluated PubMed studies that included the terms “rebound” and “myopia control.” Their work found that different myopia treatments are likely to yield different levels of rebound. Low-dose atropine was associated with the highest rebound effect; on average, patients experienced ≥0.14 mm of axial length growth after ending treatment. On the other hand, myopia management spectacles and soft multifocal contact lenses showed no signs of rebound. Orthokeratology landed in the middle, with patients experiencing +0.03 to +0.14 mm of axial length growth after ending treatment.
References
1 https://www.sciencedirect.com/science/article/pii/S1350946220300951 Efficacy in myopia control, Progress in Retinal and Eye Research
2 https://onlinelibrary.wiley.com/doi/10.1111/opo.13403 Efficacy in myopia control—The impact of rebound, Ophthalmic and Physiological Optics
Related Articles
Graduating Patients from Myopia Management
Are Axial Length & Percentile Curves the New Standard?
Ensuring an Accurate Refraction in Children
How Should Clinicians Assess the Real-World Efficacy of Myopia Treatments?
Putting Myopia Control Efficacy into Context
Read more articles in the Getting Started with Myopia Management series. Be sure to check back as the series will be updated regularly with more content.
