An overview of myopia management

Johnson & Johnson MedTech global director of myopia professional education, Dr Monica Jong, outlined the extent of the international burden myopia poses – and how myopia management solutions can mitigate this – during her 100% Optical presentation.

During her talk, A new approach to myopia management, Jong shared that there remains hesitation among some members of the optical profession around myopia management.

A paper by Professor James Wolffsohn et al in May 2023 outlined how single vision spectacles are still the most commonly prescribed option for young progressing myopes – with a third of practitioners selecting this option.

Jong shared that many practitioners would like more training on the topic of myopia management.

“We hear this feedback all the time around the world,” she said.

Commenting on the burden posed by myopia globally, Jong shared that by 2050 it is estimated that half of the world’s population will have myopia, while one billion people will have high myopia.

In 2015, the World Health Organization recognised myopia as a public health issue, Jong said.

“Today myopia may be considered an epidemic,” Jong said.

She outlined eye diseases that are associated with high levels of myopia, including retinal detachment (an elevated risk of 30%), posterior subcapsular cataract (21%), myopic macular degeneration (67%) and primary open angle glaucoma (20%).

Jong shared that the effect of the elevated risk of these eye conditions is not limited to older age groups.

“We keep thinking these diseases happen when you get older, but actually it is happening in the younger, working-age population,” she shared.

Jong reminded practitioners to engage with patients about the quality of life benefits of myopia management.

“That should be at the forefront of the conversation when you talk to patients about myopia management,” she said.

Jong added that there is a misconception among some practitioners that children are not suitable for contact lenses and fitting contact lenses in children requires much more chair time.

“Children can wear contact lenses successfully… the risks are a lot lower than you think,” she said.

Jong highlighted that if practice staff receive training in contact lens fitting, the additional chair time for patients aged eight to 12 is only 12 minutes on average.

In terms of prevention, Jong emphasised the importance of advising young patients to spend two hours outside each day.

“That can halve the number of new cases of myopia,” she said.

This is important because the age of myopia onset is most predictive of a child’s final level of myopia and their risk of high myopia.

However, once a child has myopia it is time to be offering more than lifestyle advice.

“Once a child develops myopia you’ve got to be doing more than just giving them time outside,” Jong said.

She observed that there is seasonal variation in myopia progression, with children tending to progress more in winter than summer.

“The light outside seems to impart a protective effect,” Jong said.

Jong shared that while the mainstream media has highlighted a possible association between using digital devices and myopia, a causative link has not yet been established.

However, Jong recommends that practitioners continue to advise their patients to limit screen time until more is known on the topic.

Jong shared that while there are still some practitioners who under-correct myopic patients, there is no evidence to support this strategy.

It’s about what works for your patient and what is most appropriate

Myth busting

Turning to myths around myopia management, Jong addressed the idea that optometrists should be choosing a treatment option based on the highest average efficacy.

She emphasised that it is important to consider the patient profile, including clinical and lifestyle factors, alongside the efficacy of the management option.

“It’s about what works for your patient and what is most appropriate,” she shared.

Orthokeratology may be a good option for children who are active or take part in swimming, Jong said.

“For patients, being glasses-free during the day can be a key selling point,” she said.

In terms of myopia control soft contact lenses, there are now long-term studies with data across a six-year period that demonstrate effectiveness both for new and existing wearers, Jong said.

While myopia control spectacles have also been found to be effective, Jong shared that patients must wear the spectacles for 12 hours a day, seven days a week, in order to gain the best treatment effect.

“It is good that we have got myopia control spectacles because it really does represent the lowest possible entry barrier to myopia control,” Jong added.

Jong shared that, today, both myopia management contact lenses and spectacles provide a good level of vision.

“Given all of the treatments available, we can be taking action on myopia management. Do we really need to be prescribing single vision spectacles?” she said.

Turning to the potential for a rebound effect – where patients progress at a higher than expected rate when they stop the management modality – Jong shared that there was no observable rebound effect among 14 to 18-year-olds who wore dual focus soft contact lenses.

More evidence is needed around whether ortho-k creates a rebound effect, while studies with myopia control spectacle lenses were not suggestive of rebound effect.

For atropine, there was a significant rebound effect in those who received 1% atropine. However, this effect became clinically insignificant in patients prescribed 0.05% or lower concentrations of atropine.