MAYopia Day 2023: what you missed

MAYopia Day opened with a session by Elizabeth Lumb, global director, professional affairs, myopia, for CooperVision, reflecting on how far the profession has come with myopia management, six years on from a presentation Lumb gave at 100% Optical in 2017, titled Time to stop talking and start doing.

To illustrate what has changed in myopia management over time, Lumb shared the story of her niece who was six in 2017, with “great vision and no hints of being a myope at that time,” and who went on to develop myopia.

Lumb discussed the risk factors that can increase a child’s chance of myopia progression, sharing findings from the 2010 CLEERE study, which identified that children with a refractive status of +0.75D or less at the age of six were at high risk of becoming myopic.

Parental history of myopia also played a role, and the study found that if a six-year-old child has two myopic parents and is + 0.75D or less, they have a 75% chance of being myopic by the age of 13.

Lumb confirmed: “Ultimately, what we do know is that it’s the refractive status at the age of six that is the best single predictor of the risk of a child developing myopia in their teens or even sooner.”

Resources have been developed to support conversations around myopia and risk of progression, such as MyKidsVision.org, the PreMo charts established by Ulster University, and mEye Guide by Ocumetra.

Shifts in the approach

Lumb looked back on the profession’s approach to myopia management in 2019, sharing attitudes reflected in Global trends in myopia management attitudes, which indicated that practitioners were increasingly aware of the significance and seriousness of myopia control, but proactivity in delivering interventions remained stable.

Data from surveys in 2022 indicated a positive trend downwards in single vision correction, though this is still the primary correction prescribed. (Read more on myopia management attitudes in OT’s interview with Professor James Wolffsohn, chief scientist of the International Myopia Institute.)

A significant shift since 2019, Lumb emphasised, was the appearance of myopia control spectacle lenses, while contact lenses have seen an upwards shift in fitting for myopia management.

However, more could be done, Lumb said: “It seems we’re doing a nice job of getting children into contact lenses. They just need to be the right ones for their condition, so there’s still some work to do in that area I think.”

The study also found that eye care professionals felt combination treatments (such as atropine and myopia control spectacle lenses) were most effective.

Lumb cautioned against a temptation to “wait and see” if a child progresses before discussing myopia management: “If you see a child that is myopic – they have already progressed. Waiting is the enemy of success.”

Discussing Maddie’s experience of finding motivation to wear her myopia control contact lenses a challenge in 2020, as successive lockdowns interrupted her usual activities, Lumb pointed to research that illustrated the role of wear time, as well as a study reflecting EssilorLuxottica’s Stellest lens which highlighted the importance of compliance, describing “full time” wear as 12 hours a day.

“The best intervention is the one those children are going to wear,” Lumb said.

Considering how the profession’s approach to myopia has changed, Lumb pointed out that in 2021, the World Council of Optometry recommended a standard of care for myopia management, while the evidence base around myopia management continued to grow.

Making a difference

Lumb cited the paper, Myopia control: why each diopter matters, as solidifying the reasons for slowing myopia progression, summarising the findings as: “if you can take a dioptre of myopia off the table, then you can reduce the risk of myopic maculopathy by 40%.”

A reduction of 40% is "huge” for any health care system, Lumb argued, “As an individual it makes a difference, but of course as a wider population, it makes a significant impact. We all have a role to play in trying to make that happen.”

Professional associations have updated guidance around myopia management in recent years, including the AOP and College of Optometrists, as well as organisations in ophthalmology.

Considering where myopia management is in 2023, Lumb concluded by suggesting that manufacturers have provided a range of interventions to suit children, while academics and researchers have provided an evidence base to support the profession.

“I think it’s up to us as ECPs to make sure this really happens in terms of managing myopia,” she concluded.

Watch the full lecture.

The second session of the day, led by Professor Mingguang He, explored Repeated low-level red light therapy: shining a light on myopia.

He is the chair professor of experimental ophthalmology at the Hong Kong Polytechnic University, and a professor of ophthalmic epidemiology at the University of Melbourne.

The inventor of repeated low-level red-light (RLRL) therapy, He is the chief medical officer of medical technology provider Eyerising International.

Environmental factors and sunlight

He began by looking back at research into the impact of environmental factors brought on by industrialisation on people’s lifestyles and the education system, particularly in places such as Hong Kong, Singapore, Korea and China, and how these contributed to an increase in the prevalence of myopia.
Emphasising the prevalence of myopia in the population, He said: “Myopia is such a big problem.”

“In a lot of clinical practices or offices we’re being asked by parents of our patients, the children, why they need a myopia control strategy, because for a lot of parents their idea is just to have spectacles, but now we have so many strategies,” he added. This requires communicating the importance of controlling myopia, to reduce the risks in later life associated with becoming highly myopic.

Research published in 2015 indicated that, in school settings, spending an extra class (or approximately 40 minutes) outdoors a day, delayed myopia onset in 20% to 25% of the children in the study.

Further myopia prevention studies showed a prophylactic effect of sunlight intervention linked to an increased duration of sunlight exposure.

This led to a question, He said: “If sunlight exposure is so important, and is free of charge, how can we maximise the benefits of the prophylactic effect of sunlight exposure?”

In China, He has worked with Professor Nathan Congdon to develop a prototype ‘sunlight classroom’ to further extend children’s exposure to sunlight by three to four times. But this is an expensive solution.

Researchers then considered whether a local retinal intervention could be used as an alternative way to deliver light to the retina and create a treatment effect.

The device

He introduced Eyerising International’s myopia management device, which can be used to deliver RLRL therapy in the patient’s own home.

The treatment is delivered in two sessions per day, of three minutes duration, with at least a four-hour gap between sessions, and for five days a week. The light is generated by a laser semi-conductor at a low-level single wavelength of 650nm ± 10nm.

The device features the administration system, and a small computer which is connected to the internet.

Parents and guardians are required to login to the device before the treatment can be activated,
A built-in sensor ensures the light is stable, He said, and the device only allows the system to run for the treatment parameters specified.

A US Food and Drug Administration (FDA) marking assessment is underway for the device. One criteria for the assessment is that trials must be run through the American National Standards Institute’s light safety assessment by an FDA-accredited lab.

This light safety assessment has been completed, finding the device was safe to use, He shared.

The device has obtained CE marking and is approved for use in the UK.

The research

He shared the results of a one-year multicentre randomised controlled trial carried out in four major hospitals in China, with 264 children with myopia aged between eight and 13.

The participants were randomly divided into two groups: a control group provided single vision spectacles, and an intervention group who were myopia-corrected but also used the RLRL therapy.

The study found that after one year, the intervention group experienced a treatment efficacy of nearly 70%.

The researchers compared the effect of the treatment across different severities of myopia, finding “a much greater treatment efficacy” in those with higher levels.

A similar effect was observed in spherical equivalent measurements, while an association between efficacy and compliance was also identified.

In the control group, choroidal thinning was observed as myopia progressed, while the intervention group experienced consistent choroidal thickening.

Hear He describe the full details of the study and results in the webinar.

A post-trial follow-up study has been carried out to identify sustained effects and rebound effects.

The study found that children from the control group of the first trial who were transferred to the treatment in the follow-up experienced a flattening of axial elongation.

Meanwhile, children who had been in the intervention group but chose to stop treatment were observed to experience “modest” rebound effect on axial elongation, of a similar level to the control group in the first year.

Discussing the possible treatment mechanism, He suggested that the RLRL treatment can sustainably increase choroidal thickness, and as a vascular tissue, this in turn increased blood flow, alleviating scleral hypoxia and “help control axial elongation and myopia progression.”

Further studies into RLRL are underway.

Watch the full webinar here.

Session three of MAYopia Day, which was sponsored by Hoya and delivered by optometrist, researcher and inventor, Dr Trusit Dave, explored the clear communication that is required when implementing myopia management into practice. It also delved into new technologies and strategies that can be used to identify suitable patients.

Dave started offering myopia management “inadvertently” two decades ago through orthokeratology, adding that “in terms of what we do now” it has been seven years. During this time, following studies and insight, Dave said that peer-reviewed research has answered most of the questions he had about myopia management.

Having delivered a presentation of the same title at the inaugural MAYopia Day last year, Dave informed attendees he would use the session to update them on what has changed in the last 12 months.

“This is a rapidly changing area in terms of technology,” he said, explaining he would “utilise the answers delivered through research in order to answer the questions that we face in a clinical scenario, offering a patient-centred approach to myopia management.”

As part of a patient-centred approach, Dave explained that the key questions practitioners need to answer, as well as the ones that patients are interested in, are based on the when, what, why and how: When should I get treatment? What are the options? Why should I attend follow-ups, and how do I explain the risks and allow patients to make an informed decision on treatment?

Dave highlighted: “One core competency underpins all of these four questions and that is our ability to communicate with empathy, and a sprinkle of enthusiasm in our approach.”

The first steps

Exploring the question, ‘When should a child get treatment?,’ Dave explained this will depend on a number of elements, including what the optometrist finds through accurate refraction.

Refraction in children is variable due to the fact that accommodation can be unstable, he said. The optometrist has the choice to do a subjective or cycloplegic refraction. He chooses to refract every child with a cycloplegic on their first visit.

Highlighting the importance of the first refraction being performed under cycloplegia, Dave shared details of a study of 11,000 children aged 10–11, which found the children to be over minused by 0.65D on average.

Sharing his routine in practice, following refraction Dave uses an autorefractor and takes around 20 readings as he finds this more accurate than asking questions, and takes an average.

“Once we have an accurate refraction, we can clarify the patient’s requirements,” he said.

Touching on the assessment of patients classified as pre-myopic Dave spoke about the three categories considered as part of risk stratification: ocular refraction, environment, and genetics.

He highlighted the importance of history taking in this process, using genetics as an example. He added that research also shows a child’s risk of developing myopia is reduced by 50% when they spend two hours outside a day – emphasising to attendees the importance of asking questions about both lifestyle and hobbies, as well as sharing environmental advice.

Dave emphasised that near work activity is also a risk factor that should be explored and discussed. “We know that over the last 10–¬15 years mobile devices have flooded the market, and children are glued to their phone and homework is delivered on tablets,” he said.

Drawing on his own experiences in practice, Dave shared that he is often challenged in regard to nature versus nurture, to which he explained: “Genetics takes hundreds of years to develop, but our environmental influences can impact more quickly.”

Moving on, Dave considered the question: ‘How do we predict myopia in this pre-myopic group?’

In the past he has utilised a range of myopia calculators that are available on the market. Through these platforms, an optometrist can input a child’s age, refraction and history and will be given an interactive graph that plots progression. Expressing a word of warning when using the calculators to communicate with and educate patients and their parents, he emphasised that these tools deliver the average progression for a child and are not a prediction of individual progression.

Dave touched on the use of artificial intelligence (AI) and deep learning systems, discussing how they could be leveraged to support myopia management in the future. Highlighting work being done within Singapore National Eye Hospital, he shared findings from a study where researchers used deep learning systems to see if they could predict which children would go on to develop high myopia five years before it manifested.

While the study used three AI algorithms, Dave highlighted that it was particularly interesting because one of the algorithms used fundus images alone to learn. Sharing the findings, Dave explained that with a sample of 189 eyes, 16 went on to develop high myopia, with the algorithm correct predicting 14 of them. He added that of 173 eyes in the study that did not develop high myopia, the algorithm correctly predicted 148.

“This paper fascinated me,” Dave said, emphasising: “This is really early work, but there is no doubt in my mind that with larger cohorts and a deep learning system which represent populations closer to our home, in the future we will really be able to address myopia management and target it much more appropriately.”

Treatment and follow-ups

Exploring the question of ‘Why treat?,’ Dave said that for him it was because “every dioptre matters.”

“The important message that we must get to parents is why we need to treat patients with myopia management,” he said.

Dave believes this is answered in what he describes as a “thought-provoking paper” by Mark Bullimore and Noel Brennan, for which the take-home message was that every dioptre matters. “I use this statistic every time I am examining patients: for every dioptre we reduce, we lower the risk of myopia macular degeneration by around 40%,” Dave said.

While exploring ‘Why treat?’ with attendees, Dave referenced the importance of myopia management when considering health care efficiencies. Data shows, he said, that “for every five to seven patients we treat with myopia management, we save one patient five years of visual impairment.”

Using comparable data to highlight this effectiveness, Dave shared that for fatal heart attacks in asymptomatic adults ages 40 or older treated with statin medications, you must treat 217 patients to save one.

“So ask yourself, is not offering myopia management really an option?” he said.

When it comes to attending follow-up appointments, Dave explained to attendees that the principal reason of importance was to see if the treatment was working, while being able to check compliance, discuss changes to activities and reasserting information about devices, outside time and near work was also key.

Consent

Drawing the session to a close, Dave used the final section of the webinar to explore informed consent, covering why this is important.

Dave explained that informed consent is built on five components: information disclosure, competence, voluntariness, comprehension and consent.

“You need to do all of these things before you can offer the consent form,” he said.

Alongside this, in order to ensure patient understanding, Dave shares with his patients a playlist of online patient animations and videos which he asks patients to work through and answer questions on at the end. He stores this as a form of consent alongside the signed consent form.

Watch the webinar in full online.

Clinician-scientist, optometrist and peer educator, Dr Kate Gifford, the co-founder of Myopia Profile, delivered the fourth session of the day with a focus on myopia controlling spectacle lenses.

Gifford sought to explore three principles of myopia management through the session:

1. Understanding the short-term and long-term benefits
2. Prescribe optical treatments first
3. Start early and continue through childhood.

The long-term benefit of myopia management is “the message that really sings to us as eye care professionals,” Gifford said.

Reflecting on the potential for myopia management, in reducing a patient’s progression, to reduce their lifelong risk of myopic maculopathy, she said: “There’s a really big impact we can have in our patient’s long-term eye health.”

Gifford’s suggestions for communicating benefits

The here and how: “The short-term benefit of myopia control is that your child will spend less time with blurry vision between eye exams.”

The long-term message: “Myopia control can help to protect their eye health in the long-term by reducing the child’s lifelong risk of eye health and vision problems which can occur in adulthood.”

Optical treatments

Gifford explained the reasons that she feels eye care professionals should prescribe optical treatments first.

Outlining the commercially available options for myopia management, Gifford overlaid the options onto a graph, comparing reduction in eye growth over time in studies. This graph can be seen on the webinar recording.

Emphasising the similarity in efficacy between types of treatments, Gifford cited a study by Brennan et al which concluded that: “No single method of treatment shows clear superiority with the best of orthokeratology, soft multifocal contact lenses, spectacles and atropine showing similar effects with some caveats.” 

Talking to parents about myopia management interventions:

“There are specific types of spectacles and contact lenses that can both correct myopia and slow down its progression.”

Proactive approaches

Gifford’s third principle was to start myopia management early and continue through childhood.

“If you have a child with myopia and are wondering when to start, whether to wait for progression, the answer is – we should start now,” she said.

Emphasising the risk factors of myopia seen in younger ages, (Donovan et al 2012, Brennan et al 2021), Gifford encouraged treating all children under the age of 16, and being especially proactive for those under 12, who are in their fastest period of myopia progression.

To illustrate the need to continue myopia management throughout childhood, Gifford summarised research that suggests 50% of myopes stop progressing by the age of 15, based on refraction, and 16, based on axial length, while around 75% of myopes appear to stabilise in their refraction by the age of 18.

A 2022 study indicated that 40% of young myopes progress by at least 0.50D between the ages of 20 and 28.

“If we have the opportunity to do so, we want to try and continue myopia control into the early 20s to cover that entire period of likely myopia progression,” Gifford said, adding: “If we have used an optical treatment, why wouldn’t we keep going?”

Next gen

Discussing the opportunity of spectacle lenses for myopia management, she said: “I’ve called it the next generation because I think what spectacles do is create the opportunity for us to offer this treatment to more myopes, to potentially younger myopes, and perhaps those who aren’t ready for contact lenses now but might be in the future.”

Three new spectacle lens designs for myopia management have been introduced in the last three years and Gifford compared how each lens design works to support myopia management.

The defocus incorporated multiple segments (DIMS) spectacle lenses, features lenslets in a honeycomb array and is utilised by Hoya’s Miyosmart.

Highly aspherical lens target (HALT) technology also uses lenslets, but in a concentric ring formation, and is used by Essilor’s Stellest.

Diffusion optical technology (DOT) utilises microdots spaced irregularly and designed on the concept of working as diffusers to module contrast across the retina, in SightGlass Vision’s DOT lens.

Gifford then explained the different theories of myopic defocus: peripheral focus, on-axis defocus, and simultaneous defocus, sharing: “Our understanding of defocus theories in myopia has moved on from not just thinking about the peripheral retina, to the concept of simultaneous defocus.”

The DIMS and HALT lenses create part of the image on the retina, and part in front of the retina, while the HALT lens then creates a volume of defocus, instead of a single point of defocus.

Research is underway to explore the best locations for defocus, Gifford said.

SightGlass Vision’s DOT lenses, which do not use lenslets, operate on a theory of retinal contrast – an approach based on genetic findings of how the retina responds to contrast in myopia.

Rather than creating defocus in the traditional sense, the lens is designed to smooth out high contrast, Gifford shared.

Summarising the benefits of myopia management spectacle lenses, Gifford highlighted strong evidence of myopia control efficacy, as good as contact lens treatments and the best level of atropine.

Gifford also shared that studies suggest the DIMS and HALT lenses appear to have minimal impact on acuity and binocular vision, while early indications suggest the case will be similar for the DOT lens.

The lenses are easy to prescribe and fit, Gifford said: “I think it’s as simple as this: pick something from our top tier of treatments – anything other than single vision – where it suits that child and fits your scope and setting of practice.”

When deciding between spectacle lens interventions and contact lenses, she acknowledged the benefits of contact lenses that cross both function and psychological improvements.

“When it comes to spectacles, we know the safety profile is beyond reproach really. They are suitable for children of all ages and for wide prescription ranges,” she continued.

“We’re looking at having equivalent options on the table in terms of efficacy, and being able to individualise the treatment for that child and what’s going to suit them and their family best,” she added.

Finally, Gifford reinforced the message that full-time wear is key for whichever management option is selected.

Watch the full lecture.

Session five focused on how practitioners can best communicate with patients and monitor the progression of their myopia in practice. It was hosted by optometrist and therapeutics and dry eye expert, Sarah Farrant, and sponsored by Topcon Healthcare.

The lecture opened with a discussion of the growing global prevalence of myopia, and why urgent intervention is required to manage this condition.

Farrant emphasised that myopia is a chronic, progressive disease, and that 50% of the world’s population is predicted to be myopic by 2050. Of these, 10% may develop sight-threatening conditions.

Optometrists who encounter a condition on a regular basis may forget how serious it is, Farrant believes.

“We rarely think, as a profession, of myopia as a disease,” she said.

In her presentation, Farrant referenced Johnson & Johnson Vision’s Managing myopia: a clinical response to the growing epidemic report, which called myopia ‘the biggest threat to eye health of the 21^st century.’

“There isn’t really any safe level of myopia,” she said.

It is easy to think that patients and their parents are as familiar with myopia as clinicians are, Farrant emphasised, adding that this is often not the case – but that retrieval of information can be greatly improved with effective follow-ups.

A communication structure

Farrant outlined a structured approach to communicating with patients. When discussing myopia, practitioners should highlight the:

• Benefits
• Evidence
• Risks
• Expectations
• Future treatment.

She reminded practitioners that keeping a record of conversations and ensuring consent is given is also vital, as is being careful not to scare patients or make them feel like they are bullied into treatment.

Specific questions around screen time and time spent outdoors are important questions that differ from those that might be asked in a regular sight test, Farrant said.

She added that addressing the patient before the parent can help build rapport.

Farrant went on to discuss the importance of axial length measurement in detection and treatment, and how best to convey this.

Some parents will have few questions while others will want to know more details of the research, Farrant said, adding that conversations need to be individualised for each patient. Parents should be clear on what the management plan is, and written information should be provided, along with details of the next appointment.

Case studies, including that of Farrant’s own pre-myopic eight-year-old daughter, were shared.

The reasons that myopia progression might be faster than it should be, including non-compliance, user error, and the child’s visual environment, among other potential factors, were also discussed.

Future options in this case could include changing the treatment plan, evaluating expectations, and reviewing the child more regularly, Farrant shared.

“It’s about accepting that we can’t anticipate everything – some children will progress more than we anticipate, and more than we hope and plan for,” she said. “But if we weren’t treating them, the results would likely be significantly worse for that child.”

The lecture ended with a series of questions from delegates, on subjects including how practitioners can feel confident embarking on their myopia management journeys.

Sarah Farrant’s top communication tips

• Use visuals
• Measure axial length to support your clinical explanations
• Educate the patient first
• Discuss future outcomes.

Watch the full lecture.

The penultimate session of MAYopia Day 2023 focused on the myths that surround myopia, and was hosted by Dr Monica Jong, global lead for professional education on myopia at Johnson & Johnson Vision US, and former executive director of the International Myopia Institute.

Jong’s talk covered four areas: the certainties around myopia, followed by the probabilities, the possibilities and the myths.

The certainties included the expected prevalence of myopia by 2050 (50% of the world’s population, or five billion people, with one billion expected to have high myopia), as well as the fact that myopia prevalence has doubled over the past 25 years.

As Farrant emphasised in her earlier lecture, Jong pointed out that there is no safe level of myopia.

Systematic reviews and analyses have shown that vision impairment in children affected by myopia can lead to depression and anxiety, Jong shared.

Children with myopia experienced “significantly higher scores of depression than normally sighted children,” highlighting the importance of early detection and treatment, Jong’s presentation outlined.

Research has also proved that orthokeratology and vision correction can improve quality of life, Jong said, including increased participation in activities.

The probabilities

Jong opened the ‘Probabilities’ section of her talk by quoting Benjamin Franklin, who said that “an ounce of prevention is worth one pound of a cure.”

Delaying the onset of myopia by one year in East Asian children is worth two to three years of myopia control, Jong shared. She noted that this might be lower in other groups.

Asian children with myopia progress around 30% faster than European children, Jong said.

She added that when children start school can influence the development of myopia, with those who start earlier more likely to develop the condition in their early years.

Two hours of outdoor time daily has halved the number of new cases of myopia in children in Taiwan and China, Jong said, so “asking your patients about lifestyle and giving lifestyle counselling in addition to myopia management is really helpful.”

She added: “There is still a lot to understand, but we do know that being outdoors is definitely able to delay the onset of myopia.”

A large investment in equipment is not required for practitioners just starting out on their myopia management journey, Jong believes.

“Accurate refraction is all you need to start,” she said, adding that if needed support staff can help with axial length measurement.

Jong shared a QR code with session attendees, encouraging them to scan it in order to download a ‘Monitoring myopia’ table, which could be helpful when offering management in practice.

Making sure parents know that their child’s myopia will progress even with treatment and that it will not be cured is important, Jong said.

Myths around management

Moving onto the myths section of the talk, she reminded practitioners that any treatment plan should be based on patient factors.

“Choosing the treatment based on lifestyle is much more important than choosing based on efficacy alone,” she said, using a series of tables and studies to demonstrate why this is the case. All of these studies can be viewed in the lecture’s video recording, which is accessible below.

Approaching the end of the lecture, Jong reminded practitioners that “all of us have a role to play in myopia management.”

She continued: “As a practitioner, you can start immediately with what you have. We should consider detecting myopia early, delaying its onset. There are evidence-based treatments available, in the form of spectacles, soft contact lenses such as ortho-K, as well as low dose atropine.”

Jong also emphasised that giving lifestyle advice is also encouraged, as is monitoring children and educating them about their myopia.

While practitioners might not want to describe myopia as an ocular disease to their patients, Jong believes that this is how it should be treated.

Every child should be treated holistically, she said, adding: “Practitioners, all of you, are on the front line, and you play a key role: to change the trajectory of myopia.”

Johnson & Johnson Vision will, in the future, release a full portfolio of treatments for myopia, Jong concluded.

The session was sponsored was by Johnson & Johnson Vision.

Watch the full lecture.

Optometrist and CooperVision professional affairs consultant, Indie Grewal, discussed how compliance is a key element of success in myopia management.

He outlined cases of non-compliance and shared how technology and improved communication can enhance patient adherence.

“The success or failure of any myopia management intervention comes down to how and when the messages are delivered to both the patient and the parent,” Grewal emphasised.

The optometrist shared that public knowledge of myopia remains low and eye care professionals should regularly discuss the topic with the patients they see.

Grewal outlined how all habits have three major components – there is a trigger for a particular behaviour, a routine and a reward.

He added that the reward is how the brain decides whether to remember that habit for the future.

Grewal believes that these high-level principles can be applied to myopia management.

In relation to pre-myopes, he shared that questionnaires, wearable technology and leaflets have the potential to improve the compliance of children with spending at least two hours outdoors.

Grewal highlighted that children are increasingly being dropped off outside a school or the bus stop.

He noted that his practice is looking at offering a smart watch that measures daily steps to children who join his eye care scheme.

“This will hopefully encourage children to spend more time outdoors,” Grewal shared.

He added that there is potential for prizes to be offered each month to the child who does the most steps and the child whose step count is most improved.

Grewal highlighted that delaying the onset of myopia can help to lower the final level of myopia that an individual progresses to.

“As eye care professionals we have the potential to kick myopia down the road – to delay or even prevent its onset,” Grewal emphasised.

Grewal shared three case records from his clinic where non-compliance resulted in an increase in myopia.

In terms of actions that his practice has taken to improve compliance, Grewal shared that staff put leaflets in with every contact lens collection to reinforce the benefits of myopia management for ocular health.

A check is performed for spare lenses so that the practice can monitor how many lenses a child is using.

Grewal highlighted that emailed reminders give tips on wearing contact lenses safely and the need to wear contact lenses for 10 hours a day, six days a week at a minimum.

“We use persistent and consistent messaging,” Grewal shared.

He added that staff show parents how the myopia management strategy is affecting their child’s myopia.

“We have graphs showing progression slowing down. That is a really positive way of getting parents involved in a child’s myopia care,” Grewal observed.

Grewal discussed the role of electronic reminder systems in improving compliance with myopia management.

He shared that compliance can drop off in adolescence when young people become more independent.

“It is really important to continue messaging going into those teenage years,” Grewal said.

Grewal concluded his presentation by emphasising that parents and children learn by seeing and doing.

“That is what helps in building compliance and creating a good habit,” he said.

Watch the full lecture.