February 1, 2023
By Dwight Akerman, OD, MBA, FAAO, FBCLA, FIACLE
Eye care practitioners (and parents of myopic children) often ask, “What is the best myopia treatment?” When I speak with colleagues about myopia management, it becomes evident that there is confusion about which treatment is best for an individual child.
Myopia management refers to proactively implementing a strategy to delay the incidence of myopia or slow the progression of childhood myopia. From a treatment perspective, myopia management is defined as slowing axial elongation, which also reduces the rate at which the dioptric value of the refractive error increases. We cannot predict whose eyes will grow fastest, even based on the previous year’s eye growth, so myopia care should be discussed with the parents of all myopic children.
Evidence suggests that myopia intervention should start as soon as a child develops pre-myopia or myopia of -0.50D. There is strong evidence that myopia will progress fastest in children younger than 12 and continue into the late teenage years. However, according to the COMET Study, almost one in four myopes will continue progressing beyond age 18.
Various treatments such as topical low-dose atropine, novel spectacle designs, center-distance multifocal/dual-focus soft lenses, and orthokeratology have been proven in randomized controlled trials to slow axial elongation in myopic children significantly. Keep in mind that the percentage reductions in axial length or Rx progression quoted in manufacturer promotional literature are averages for highly compliant children who participated in their clinical trial.
It is evident from numerous surveys that many eye care professionals practice an abbreviated version of myopia management. Often, ECPs prescribe only one or perhaps two modalities. Including a full array of myopia interventions in your practice is best because no single modality works for all children.
Clinicians should strive to deploy a comprehensive myopia management strategy that involves decision-making based on age, lifestyle, familial risk, axial length, position on the axial length growth chart, progression rate, risk of high myopia, potential side effects, and individual preferences. This personalized approach ensures optimal long-term myopia management.
So, what is the best myopia treatment? We cannot predict which myopia management treatment will work best for an individual child. The intervention that best matches their lifestyle may be the most appropriate option to maximize treatment compliance. Continual patient/parental education regarding the purpose of myopia treatment and outcome expectations is imperative to motivate children to follow the eye care professional’s recommendations appropriately. Frequent touch points allow the eye care professional to re-educate the child and parents on the importance of adhering to the prescribed treatment regimen.
Best professional regards,
Dwight H. Akerman, OD, MBA, FAAO, FBCLA, FIACLE
Chief Medical Editor