August 9, 2019
By Dwight Akerman, OD, MBA, FAAO
Chief Medical Editor, Review of Myopia Management
Some eye care practitioners historically have believed that myopia is a genetic anomaly, whereas others have concluded that myopia is environmentally induced. However, human and animal studies conducted over the past four decades suggest that development of myopia is controlled by both environmental and genetic factors. Said differently, the genetic background of an individual determines the impact of environmental factors on refractive development.
In an editorial written by Cho and Boost1, the authors discuss that eye care professionals must consider a personalized approach to myopia control therapy because myopia develops at different rates in different children. In general, the rate of progression is faster in younger children (<9 years); and although this applies to most young children presenting with myopia, there are exceptions to this rule. The reverse also applies; myopia progresses more slowly in most older children progress, but a few continue to progress rapidly. Thus it is imperative to determine the rate of progression before deciding to begin a myopia control treatment.
Those children most likely to benefit need to be identified, and the case for intervention should be presented to parents/guardians. It is important to carefully explain the process of myopia progression to parents and children, to ensure that they understand that myopia can be managed, rather than just corrected.
In general medicine, we have seen the rise of personalized therapy, based on genetic and lifestyle differences, and its benefits to patients who would otherwise be subjected to a standardized “blanket” therapy. Practitioners must consider individual needs, lifestyle and ocular characteristics, such as rate of progression, in making their recommendations to provide an optimal service to their myopic children and to allow the parents to make an informed decision.
Practitioners are often faced with making a choice of management strategy for parents with myopic children, especially those presenting at a younger age. Do they choose single-vision spectacles or recommend an intervention therapy? There is increasing evidence that such interventions can slow the increase in refractive error, and some can reduce the rate of axial elongation. This latter effect may be of greater importance, as serious ocular problems, such as glaucoma, retinal detachment, myopic maculopathy and cataract, are associated with abnormal axial length and are most commonly seen in high-myopic patients.
- Cho, P., & Boost, M. V. (2018). Blanket therapy, one size fits all, or personal tailoring for myopia control? Contact Lens and Anterior Eye, 41(5), 403-404.
Dwight Akerman, OD, MBA, FAAO, is the chief medical editor of Review of Myopia Management