Editor’s Perspective

The Time to Act is Now

January 3, 2023

By Dwight Akerman, OD, MBA, FAAO, FBCLA, FIACLE

According to a recently published survey conducted by the American Optometric Association (AOA)  Research & Information Committee (RIC), 69% of AOA-member optometrists surveyed provide myopia management services to children and adolescents.

During the summer of 2022, AOA RIC fielded a survey seeking real-world data relative to doctors’ experiences with myopia management to understand the extent to which U.S. optometrists provide myopia management services. The survey results included responses from 464 optometrists from 41 states and the District of Columbia. 

Several trends were observed regarding optometrists’ opinions on when to start treating a patient with myopia. A large majority of 73% believed that annual progression of 0.50D to 0.75D is warranted before intervening with myopia control. Responding optometrists also rated refractive error as the most critical risk factor in warranting myopia management, followed by the rate of progression/change. When asked when they begin discussing the condition and its management with parents of children with myopia, 87% of optometrists reported initiating the conversation between the ages of 5 and 8 (average age: 5.5 years).

Additional findings include:

  • 75% of optometrists believe myopia is a disease in need of treatment.
  • 93% of optometrists who provide myopia management practice in metropolitan areas; 71% of those practice independently.
  • FDA-approved soft contact lenses were the preferred treatment method. Off-label soft multifocal contact lenses were the second most preferred management method.
  • 33% of myopia management candidates defer treatment; 80% of these patients defer treatment due to costs.

While most optometrists seem to be embracing myopia management based on these results, it can’t be overlooked that nearly a third of optometrists in this survey — most from non-metropolitan areas — still don’t offer myopia management. A plethora of other market research suggests that only a small percentage of eye care professionals actually practice full-scope myopia management. Prescribing a complete armamentarium of treatments for myopic children means practicing at the highest level and fulfilling one’s duty of care.

It is also clear that more education is required, even among optometrists currently practicing myopia management. For example, 73% of the optometrists responding to this survey believed that an annual progression of 0.50D to 0.75D is warranted before intervening with myopia control. Progression is faster in younger children, those of East Asian descent, and those with a parental history of myopia. However, nearly all young myopes progress, which argues in favor of managing all myopic children, irrespective of their estimated progression rate. Only managing the supposedly “fast progressors” will ignore large numbers of children who could benefit from myopia management.

Myopia is the most significant threat to eye health in the 21st century. While the eye health benefits of lowering a child’s ultimate level of myopia are profound, the practice and financial benefits of providing myopia management are also significant. I urge you to commit to the highest level of care and prescribe the most appropriate evidence-based interventions to children at risk of progressive myopia.

Let’s get proactive about myopia management in 2023!

Best professional regards,

Dwight H. Akerman, OD, MBA, FAAO, FBCLA, FIACLE
Chief Medical Editor

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