Myopia Management

In your clinic, how do you identify children who are potentially at risk of developing myopia?

1.     You see, kids are supposed to be farsighted, and as they grow that farsightedness neutralize to zero. That’s ideally the case, so children who are not far sighted at their initial exam, grow up to be nearsighted teenagers. A child who is less than +0.75D farsighted at the age of 6, is at high risk for becoming nearsighted as they grow

2.     Genetics also plays a factor, if one or both parents are nearsighted, the child has a higher chance of becoming nearsighted.

3.     How we use our eyes is a determining factor as intense near work can make children nearsighted. Children who spend less than 90 minutes daily outdoors and more than two to three hours a day spent on near work such as computers, books, phones… etc

4.     particular binocular vision conditions which are uncovered during an exam are linked to myopia development such as esophoria, intermittent exophoria, accommodative lag, and high AC/A ratios
What factors determine the success of myopia management?

1.     Starting early: together we break habits that don’t support our goal. It is easier to teach a 7 years old to put down the phone and go play than to convince a 15 years old to do the same thing. Starting parent education early, even before the children are nearsighted, pays off at the end.

2.     Picking the right treatment plan: there are many treatment plans for myopia management, I pick based on the kid’s ability to adhere to the treatment plan and the level of parent involvement. My goal is to be on the same page as the child and teach them to be independent with the treatment plan, so they can take care of their contact lenses, insert and remove them with no help from mom or dad. And they don’t have to be constantly reminded to “not hold the phone too close”

3.     Dedication is key, this is a long term plan. Contact lenses designed for myopia management do not work if used occasionally. Eye drops for myopia management do not work if used once in a blue moon.

4.     Adjusting the plan as we go along: I recently started demanding that my kids (11 and 14) charge their phones and all their devices in my room overnight. That is something I had to implement to protect their eyes and their overall health. I get creative ideas from other parents as well: for example, a friend of mine now assigns the chore of walking the dog to her teenage son and that’s how she gets him to spend more time outdoors.

How soon do you recommend myopia management?

1.     Children who are pre-myopic or have risk factors: change habits and educate parents, follow ups every 6 months to ensure that the prescription is stable, and we don’t need to add anything else to their myopia management plan.

2.     Once the child becomes myopic I enroll them in myopia management using contact lenses. if the parents are very near-sighted, and the child is an avid reader, I follow them very closely and might start combination therapy (contacts and drops). Myopia progresses faster in young children so early intervention is key *

3.     My goal is to keep the prescription symmetrical in both eyes and below -3.00D as that reduces their risk for ocular complications. If they’ve already passed -3.00D, I manage the case more aggressively than if they were, for example, -0.50 D

When do you typically end your myopia management intervention or is this a life-long commitment?

50% of nearsighted children progress after age 16.

Approximately 25% of myopes progress after the age 18.

20% of myopes can progress by at least one diopter in their 20s. **

There is no way to tell exactly if your child will stabilize at the age of 14 or will continue to progress into their 20’s. The safest approach is to continue myopia management until the age of 18, If the patient has high visual demands at that age (going to school full time and working a desk job) then we can continue the treatment until the age of 20.

If the patient elects to discontinue at the age of 18, then 6 months follow ups on the prescription to ensure stability would be helpful.

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