How do you know when to initiate myopia management treatments? In short, the answer is as soon as possible. However, two recent surveys—one conducted by Jobson Optical Research in 2024 and one conducted by the American Optometric Association (AOA) Research & Information Committee—have found that early intervention isn’t always happening.
Jobson’s survey found that 32% of ODs surveyed recommend initiating treatment for myopia as soon as a child is diagnosed as a fast progressor, or -0.75D progression or higher per year. Twenty percent said that they wait until the child is diagnosed with -1.00D or more of myopia. Similarly, the AOA’s survey found that nearly 75% of eye care professionals (ECPs) believe an annual progression of 0.50D to 0.75D is warranted before beginning myopia management treatments.
CONTROLLING PROGRESSION REDUCES RISKS
Many ECPs are familiar with the phrase coined by researchers Mark Bullimore, MCOptom, PhD, FAAO, and Noel Brennan, Optom, MScOptom, PhD, FAAO, in their popular research paper entitled, “Myopia Control: Why Each Diopter Matters.1” In the report, Dr. Bullimore and Dr. Brennan explain that even a 1.00D increase in myopia can increase the risk of myopic maculopathy by 67%. Similarly, reducing myopia progression by 1.00D can lower the risk of myopic maculopathy by 40%.
This indicates that the “wait and see” approach that many ECPs take is likely to lead to greater myopia progression. It could also lead to an increased risk of ocular health risks down the road. Instead, ECPs should be starting myopia management treatments at the first signs of onset.
Melanie Frogozo, OD, FAAO, from Alamo Eye Care in San Antonio, Texas, can relate to the parents of her patients. She started her daughter with low-dose atropine eye drops to control her myopia progression when she was 3 years old. She’s passionate about ECPs—and parents—understanding the possibilities that are out there for even the youngest patients.
“We should be starting children on myopia management treatments as early as possible,” she explained. Other eye care providers were sometimes surprised when I started my daughter on low-dose atropine at 3, or started patients on contact lenses at 7. Ultimately, where there’s a will, there’s a way. The earlier we start these treatments, the better the outcomes are for children.”
MEASURING MYOPIA PROGRESSION
To start identifying myopia management candidates, there are two key factors to measure in your pediatric patients: refractive error and axial length.
Experts have indicated that a refractive error of -0.50D is the definitive indicator of myopia onset. However, because of the repeatability, reliability and consistency of axial length measurements, many leading organizations in the eye care industry favor axial length over refractive error in terms of monitoring myopia progression.
In clinical trials that assess the efficacy of myopia treatments, the Food and Drug Administration (FDA) requires reports of both refractive error and axial length. However, the organization has favored changes in axial length as a primary target for treatment success. Similarly, the International Myopia Institute (IMI) believes that reducing axial elongation should be the metric ECPs utilize to assess myopia management efficacy.2
EQUIPMENT SHOULDN’T STOP YOU
Measuring axial length requires an optical biometer—a device that isn’t always commonplace in ECPs’ offices. However, a phoropter is ubiquitous in the modern eye care practice to assess patients’ refractive error. The financial aspect of purchasing a new device may seem daunting—or even unrealistic for many practices. Equipment shouldn’t stop you from seeing and treating myopia management patients.
James Loughman, PhD, and Ian Flitcroft, DPhil, leaders in the field of myopia management, are firm believers in successful myopia management with just a refractive error measurement.
“There are too many young progressing myopes to be managed only by the limited number of eye care practitioners who currently have access to axial length measurement,” the pair explained. “To help the greatest number of myopic children, we don’t want to create artificial impediments.”
References
1 Myopia Control: Why Each Diopter Matters, Optometry Vision Science
2 Clinical Myopia Control Trials and Instrumentation Report, Investigative Ophthalmology & Visual Science February
Related Articles
Don’t Wait: Past Progression Does Not Predict Future Progression
The Importance of Measuring Axial Length in Myopia Management
Starting the Myopia Management Journey
Starting Myopia Management Early Yields Greatest Outcomes
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.
