The AOA Guide

several myopia control therapies have shown efficacy of over 0.3 mm (around 0.75 D) over two to three years of treatment.

Recommended myopia treatments

Choosing the right treatment will depend on the individual patient's lifestyle, age, maturity, and refractive error. Below are some treatments highlighted in the guide.

by Hazlin Hassan

What you need to know about myopia management

Eye care professionals now have the opportunity to slow myopia progression rather than just correct the visual symptoms — this is according to the AOA’s Guide to Managing Myopia: A Clinical Response to the Growing Epidemic.*

Orthokeratology: Gas-permeable lenses worn overnight to temporarily reshape the cornea, allowing clear vision during the day without correction. This treatment is preferred for athletes and those who often do water activities.

Atropine Eye Drops: These allow complete parental control of treatment. Concentrations of 0.025% to 0.05% have demonstrated effective myopia control and limited side effects of photophobia and reduced accommodation. Atropine must be supplemented with glasses or contact lenses and could be combined with other myopia control therapies.

The American Optometric Association (AOA) warns of a rise in myopia cases among children, with numbers having nearly doubled over the past 20 years in both eastern and western societies. Prevalence among young adults is above 80% in many Asian regions, and 50% in the US and parts of Europe, the guide noted.

The AOA guide to managing myopia, created in collaboration with the Singapore Optometric Association, the American Academy of Optometry, and Johnson & Johnson Vision, aims to emphasize the gravity and effects of uncontrolled myopia progression globally, as well as support eye care professionals with the latest clinical guidance in myopia management.

Myopia facts from the AOA

Children in the first wave of high myopia prevalence (those born after 1970) are now on the cusp of experiencing sight-threatening complications as adults.

There is no safe level of myopia as the elongated eye is susceptible to pathological complications with significant risks to eye health and vision, such as retinal detachment, myopic macular degeneration, primary open-angle glaucoma, and cataracts.

“Any degree of myopia increases the risk of sight-threatening complications, with some complications leading to blindness in adulthood. Each diopter increase in myopia results in 67% increased risk of myopic macular degeneration (MMD),” the AOA guide said.

Over 30% of MMD occurs in people less myopic than -6.00 D.

However, the good news is that

Soft Multifocal Contact Lenses: Originally designed to improve near vision in presbyopic patients, some have been shown to slow myopia progression. Younger children can wear these lenses and do not appear to be at increased risk of infection compared to older wearers.

Myopia Control Spectacles: Specifically designed to slow myopia progression, these spectacles are a safe and easy option for a range of prescriptions.

A significant duty of care

Mr. Muhammad Syimir Shahrul Izam, optometrist at Thomson Hospital Kota Damansara, Malaysia, said: “The booming myopia cases worldwide should be a warning for every optometrist to realize that myopia control should not be considered as an alternative or option in practice. In fact, it is a significant duty of care, especially when managing young patients.”

“The variety of myopia management options available at present is of clinical excitement to eye care practitioners, giving us the chance to provide patients with preventive care while correcting their vision to its best,” he continued.

According to the AOA Guide, increased time outdoors can delay

Contributing Doctors

Dr. Carmen Abesamis-Dichoso received her Doctor of Optometry from the Central Colleges of the Philippines in 1989, and earned her Master of Arts in Teaching from the Central Colleges of the Philippines in 2001. Her specialties include special contact lens design for keratoconus, children and high astigmatism; and visual assessment of the mentally challenged, autistic, ADHD, cerebral palsy and learning disabilities. In addition, Dr. Abesamis-Dichoso has been an orthokeratology practitioner in the Philippines since 2005. Since 1998, she has been self-employed in a private practice at Medical Plaza Makati. She was awarded Outstanding Optometrist of the Year in 2017 by the Optometric Association of the Philippines. Currently, Dr. Abesamis-Dichoso serves as the International Affairs Committee chair of the Optometric Association of the Philippines; director of the Special Olympics Opening Eyes in the Philippines; program manager of Optometric Association of the Philippines Vision Screening Program and provision of eyeglasses with the United Nations Development Program in 10 areas and four Regions in the Philippines; and chairperson of the Special Olympics Healthy Athletes Program in the Philippines. Dr. AbesamisDichoso is a fellow of the American Academy of Optometry; a founding fellow at the Philippine College of Optometrists; a fellow of the International Association of Contact Lens Educators; an AsiaPacific Regional advisor for the Special Olympics Opening Eyes; treasurer at the Asia-Pacific Council of Optometry; and is an Asia- myopia’s onset and may slow its progression. Mr. Muhammad Syimir couldn’t agree more. He noted that behavioral factors such as longer duration of near work and minimal time outdoors cause the elongation of the eyeball, consequently causing myopia.

If one or both parents are moderately or highly myopic, the tendency for their children to have myopia is higher as well, he added. “This combination of genetic and behavioral factors add weight to myopia progression among children these days, with children as young as three to six years old being prescribed spectacles.”

Mr. Muhammad Syimir also stressed the importance of early diagnosis, as earlier intervention often leads to better outcomes. “Optometrists should spend more time talking about myopia control to the parents. Parents are encouraged to bring their children for an eye examination as early as three years of age or earlier if the parents notice any behavioral changes, such as holding something very close, sitting very near to the TV, excessive blinking or eye rubbing, and abnormal head tilting,” he continued.

“Looking back 20 years ago, myopia management was not an option. Having family members who are all myopic and needing spectacles from a young age myself, I could relate to how being highly myopic deteriorates the quality of life. Optometrists nowadays have the opportunity to carmen.dichoso@gmail.com syimir_shahrul@yahoo.com ryan@malayaoptical.com further enhance children with better quality of life in the future,” he shared.

Pacific Council of Optometry (APCO) representative for the World Council of Optometry, in addition to being a member of the Legislation, Registration and Standards Committee. She has also authored numerous published papers and is a popular lecturer at industry meetings.

Mr. Muhammad Syimir Shahrul Izam is an optometrist who has been practicing for the last eight years. He graduated from the University of Bradford, UK, in 2015 with a BSc (Hons) in Optometry. He is passionate about eye care in children and is currently practicing at Thomson Hospital Kota Damansara in Selangor, Malaysia, providing and promoting myopia management. He is also a member of the Association of Malaysian Optometrists. Previously, he was working as an optometrist and clinical supervisor at SEGi University, Malaysia, and enjoyed sharing his clinical tips and experiences with optometry students. During his leisure time, Mr. Syimir enjoys traveling and exploring new places as well as keeping fit.

Mr. Ryan Ho first undertook a Bachelor of Science in Microbiological Sciences at the University of Kansas, USA, in 1996 before studying Optometry at the International University College of Technology Twintech, Malaysia, in 2008. He is a skilled optometrist with over 15 years of experience. He obtained his first degree in B.Sc. at the University of Kansas, USA, and continued to pursue his passion for his Bachelor of Optometry (Hons) in Malaysia. His opinions on the treatment of Ortho-k, monovision, progressive lens fitting, and myopia in children have been well sought after on national television stations, such as RTM, TV3, and national newswires, as well as publications such as Bernama, The Star, and more. He has helped build Malaya Optical from a family-owned business of three generations to become a two-time award winner of the prestigious Brand Laureate Award. While he is busy running his retail practices, online store, and building an eyewear brand, Mr. Ho makes sure to spend quality time with his family as they are the inspiration behind this brand. During his leisure time, Mr.Ho enjoys riding his road bike on numerous road adventures.

Being proactive rather than reactive in treating myopia

Dr. Carmen Abesamis-Dichoso, an optometrist in Makati City, Philippines, said demand was so high during the height of the pandemic that her practice had to set up an additional unit to focus on managing pediatric myopia.

“We always ask patients, myopic or not, especially young parents with children, to bring them to the clinic for a full eye exam. Most of the time, their kids have myopia and are not aware of it,” she said.

In her experience, single-vision glasses and contacts do not work. “In fact, they make myopia worse. We should be proactive rather than reactive in treating myopia, especially in kids younger than six years old,” she added.

Dr. Abesamis-Dichoso recommends the best strategy depending on the patient's lifestyle and what the parents prefer. “The efficacy of each therapy is discussed based on evidence in the literature and clinical experience, and also how well the patient (and the parent) will comply with the prescribed regimen, especially in cases of orthokeratology and soft contact lenses,” she shared.

Meanwhile, Mr. Ryan Ho, owner and senior optometrist of Malaya Optical in Malaysia, hailed the AOA guide as “exactly what we need as an independent optometrist, and this would help set the standards for myopia management. Children today are spending more time on activities that involve close-up work, such as reading, studying, and using electronic devices. This can lead to eye strain and fatigue, which may contribute to the development of myopia,” he noted.

He also agrees with the AOA guide that lack of time spent outdoors is a big factor. “Spending time outdoors has been shown to be protective against myopia. However, many children today are spending less time outdoors due to the technological and digital age compared to the past, which may contribute to the increase in myopia prevalence,” he continued.

While Malaya Optical currently uses myopia control prescription lenses and orthokeratology to treat myopia, Mr. Ho said it is “very exciting to have soft multifocal contact lenses as part of our new arsenal against myopia progression in children. We would be very enthusiastic about exploring such contact lenses and learning more about them. It's always best to have a few options to treat and control myopia,” Mr. Ho concluded.

Reference

* Managing Myopia: A Clinical Response to the Growing Epidemic. Available at: https://s3-uswest-2.amazonaws.com/covalentcreative/jjv/ media/documents/Managing_Myopia_Clinical_ Guide_Dec_2020.pdf. Accessed on March 25, 2023.

Orthokeratology, one of the oldest and most reliable forms of myopia control, is also turning over exciting new leaves. “With companies implementing new computer-guided software, exciting developments in ortho-K make fitting lenses easy and more accessible,” Dr. AlemanMoheeputh shared, a noted fan of the tech in her practice. “At the end of the day, ortho-K is my go-to.”

The future fantastic

Of course, this wave of new and updated technologies is just the first crank of the wheel opening the floodgates. Repeated low-level red light (RLRL) is another therapy with a growing body of evidence5,6 for the reduction of axial length progression, and the anticipation for more is palpable.

“RLRL is one of the emerging technologies I am also curious about researching further,” Dr. Aleman-

Moheeputh said. “The clinical trials show promising results as an excellent, safe, and effective option for myopia management.”

Overall, with updates to old favorites like ortho-K, new myopia control twists on classics like contact and spectacle lenses, and newcomers

References

like RLRL, the future for myopia control blazes brightly. And with multiple modalities that can even be combined, optometrists have the tools to take the fight against myopia instead of staying on the back foot. All of which is good news for the growing legions of myopia sufferers, especially children, worldwide.

1. Chamberlain, P, Bradley A, Baskar A, et al. Long-term Effect of Dual-focus Contact Lenses on Myopia Progression in Children: A 6-year Multicenter Clinical Trial. Optom Vis Sci. 2022;99(3):204212.

2. Walline JJ, Walker MK, Mutti DO, et al. Effect of High Add Power, Medium Add Power, or SingleVision Contact Lenses on Myopia Progression in Children: The BLINK Randomized Clinical Trial. JAMA. 2020;324(6):571-580.

3. Lam CSY, Tang WC, Tse DYY, et al. Defocus incorporated multiple segments (DIMS) spectacle lenses slow myopia progression: a 2-year randomised clinical trial. Br J Ophthalmol. 2020;104(3):363-368.

4. Yam, JC, Jiang Y, Tang SM, et al. Low-Concentration Atropine for Myopia Progression (LAMP) Study: A Randomized, Double-Blinded, Placebo-Controlled Trial of 0.05%, 0.025%, and 0.01% Atropine Eye Drops in Myopia Control. Ophthalmology. 2019;126(1):113-124.

5. Dong J, Zhu Z, Xu H, He M. Myopia Control Effect of Repeated Low-Level Red-Light Therapy in Chinese Children: A Randomized, Double-Blind, Controlled Clinical Trial. Ophthalmology. 2023;130(2):198-204.

6. Jiang Y, Zhu Z, Tan X, et al. Effect of Repeated Low-Level Red-Light Therapy for Myopia Control in Children: A Multicenter Randomized Controlled Trial. Ophthalmology. 2022;129(5):509-519.