The Long and Short of Myopia Management

uncontrolled, it might turn into a bad complication, such as cataract, glaucoma, retinal detachment, and myopic maculopathy.

Aparent with a myopic child will most likely walk into an optometry clinic to get the needed intervention. But single-vision lenses are proven to worsen myopia. In fact, single-vision lenses are used as control for research involving strategies and methods to control myopia.

During the 2015 BCLA conference in Liverpool, UK, Prof. Pauline Cho presented strong evidence on how orthokeratology can control myopia progression through myopic defocus — to which the late Prof. Brien Holden asked: "Why are we not doing it?!”

Why aren’t we, indeed?

Based on experience, the following are some of the challenges and reasons why optometrists are still reluctant to practice myopia control — and ways we can work around them.

First, it requires investing time. ODs have to leave their clinics and relearn, learn, and refresh their professional skills. But this has been remedied by the pandemic where online training is possible and sometimes costs nothing. The World Council of Optometry, for example, has put together a series of myopia management online education courses through generous industry support.

Second, the cost of acquiring new tools and equipment is high. When I started myopia management, I didn’t have the latest machine and technology — I used what I have in my clinic: retinoscope, RetiRacks, prism bars, occluders, penlight, Worth four dot, ophthalmoscope, etc. I took small steps by prescribing bifocal executive lenses and orthokeratology. My first topography was a secondhand one I bought from eBay. As my practice grew, the industry supported me by extending good terms very friendly to my cash flow.

Third is chair time — it takes a lot of time to explain to the patient and their family the new tools and technology that we use or why we need to do certain tests and examinations. Anything that’s novel takes time to accept. But patients appreciate that we take the time to explain to them their condition and how, if left

Last but not least is availability and cost of a myopia control strategy. Some countries are fortunate to have all the latest innovations in myopia control strategies available to them. But the majority of developing countries do not even have affordable contact lenses. These are a hindrance for the practitioners. Even if available, the cost of these contact lenses is not affordable to patients because of economic reasons. However, the industry, scientific researchers, and investigators never stop designing, testing, and validating new technologies that are geared toward accessibility and affordability.

Some of the latest innovations and strategies for myopia control are customized, such as orthokeratology lenses for myopia with astigmatism made of highly flexible material and higher Dk — like the SEED ortho-K lenses. Another newbie we can add to our toolkit is the Rodenstock Mycon lenses. MiSight dailies by CooperVision and NaturalVue EDOF have shown very promising results. Hoya MiyoSmart has a good two-year study showing efficacy almost close to that of orthokeratology. Stellest lenses by Essilor claim they slow down myopia progression by 67% compared to single vision lenses. SightGlass is another technology that uses DOT (diffusion optics technology) — a two-year study shows these lenses slow down myopia by 56% when worn full-time.

As I write this piece, I am pretty sure someone might be thinking of a ‘peel’ or an ‘eye drop’ that would potentially stop myopia altogether. Who knows?

For now, there’s a mountain of work to be done, and optometrists must be at the forefront of the continuing search for a solution to the global myopia crisis, dubbed as the ‘other pandemic’.

As always, please enjoy our Myopia Issue.

Best,

Dr. Carmen Abesamis-Dichoso OD, MAT, FIACLE, FPCO, FBCLA, FAAO