The big short
Eye care professionals share their views on why the profession needs to take myopia seriously
Why embrace myopia management? There is the lifetime risk of pathology linked to myopia, warnings that levels of short-sightedness could rise to close to close to five billion people by 2050, and the World Council of Optometry’s resolution urging a shift in focus from solely correcting vision to educating patients about myopia and exploring management options.
Aside from all this, for many eye care professionals (ECPs), myopia management comes down to the patient in the chair.
“I always try to ask myself, ‘What would I do if this patient was a member of my family?’” optometrist Craig McArthur explains to OT.
“I have a four-year-old son, Noah. If he develops myopia, I would immediately start him on the most appropriate myopia management strategy,” he added.
In the past, hesitancy has surrounded myopia management because of a perceived lack of evidence supporting the different interventions that are available.
But now research exploring the mechanisms behind myopia and the different management strategies is accruing at an increasingly rapid rate.
This evidence has given regulatory authorities the confidence to approve a range of options to manage the progression of the condition.
Optometrist, Dr Kate Gifford, described myopia management as combining the best of primary eye care – correcting vision while also helping to safeguard eye health for the future.
“Given that our optical interventions for myopia management offer the ability to both correct and control myopia, with strong efficacy, it makes absolute sense for us to move from simply prescribing single vision correction to utilising options which correct and help to protect vision,” she emphasised.
For optometrist, Sarah Farrant, myopia management has the potential to transform the way that the profession practises. “It is such an exciting option given we can actively engage with, rather than passively manage, the unfolding problem,” she highlighted to OT.
I always try to ask myself, ‘What would I do if this patient was a member of my family?
Farrant added that the established evidence base behind myopia management supports the view that ECPs should at least be giving patients the opportunity to make an informed decision about myopia management options.
Professor Kathryn Saunders shared her view that myopia management is a “natural progression” for optometric practice.
“We have been diagnosing and correcting myopia forever. It is exciting now to think that we can not only correct this increasingly common condition, but influence its trajectory with the aim of keeping prescriptions as low as possible, which is more convenient for patients as well as improving long-term ocular health outcomes,” she shared with OT.
She noted the importance of ECPs ensuring that management options are supported by robust research and that the limitations of different management options are understood.
“There is a growing body of evidence available to ECPs to support them in implementing myopia management strategies, including providing advice on anti-myopia lifestyle modifications, such as spending more time outdoors, for those children at risk of myopia but not yet myopic and eye growth data with which to compare and monitor patient’s eye size and their response to intervention,” Saunders observed.
The pandemic and myopia
Research published following the outbreak of the COVID-19 pandemic has illustrated the impact that rapidly altered lifestyles has had on the development of myopia in children.
In an article published in the British Journal of Ophthalmology, scientists from Hong Kong and Singapore highlighted that the annual incidence of myopia more than doubled following the pandemic.
The researchers reported that 68% of children within the study group reduced their time outdoors following COVID-19, while screen time increased 2.8-fold.
Optometrist Indie Grewal shared that during the pandemic children were using digital devices to study as well as to socialise.
“We have seen a lot of children who haven’t been myopic previously becoming myopic. We have seen changes in children who are in myopia management strategies that were perhaps larger than we would have expected,” he said.
Professor James Wolffsohn noted that nine recently published studies have so far identified an increase in myopia progression during the pandemic.
“One study found this myopic progression was reversed partially after lockdown, suggesting that both accommodative spasm and structural changes contributed to this accelerated rate.”