February 2023 Virtual event Presentation

Global Trends in Myopia Management Attitudes and Strategies in Clinical Practice, 2022 Update

Global Trends in Myopia Management
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Yasmin Whayeb

By Yasmin Whayeb BSc (Hons) MCOptom, United Kingdom

About the presentation

Surveys conducted by Wolffsohn et al. in 2015 and 2019 showed the increasing myopia prevalence to cause a high level of concern amongst eye care practitioners, and a self-reported high level of engagement in myopia management. Despite this, the vast majority of respondents across both surveys still prescribed single vision refractive correction to young myopes. Between March and October 2022, an updated internet-based survey available in thirteen languages was distributed through various professional bodies to reach eye care practitioners across the globe. Over three thousand responses were received, spread across Africa, Asia, Australasia, Europe, North America, and South America. Presented by Yasmin Whayeb, optometrist and PhD student at Aston University United Kingdom, this session presents the updated self-reported attitudes and practices of eye care practitioners towards myopia management across the globe, exploring topics such as: the awareness of increasing myopia prevalence, perceived efficacy and adoption of available strategies, and reasons for not adopting specific strategies.

FAQ from the event

A European specific question: in the survey, are there any countries behaving differently to others when it comes to myopia management?

Attitudes and behaviours appeared fairly consistent throughout Europe actually.

What is your view on how COVID has impacted children with mypia?

From what I understand, it is clear that COVID has had a significant impact on myopia; there is a research paper from China showing the shift in myopia during lockdown; this may be one of the reasons why we see in the survey that practitioners are starting myopia control interventions in children at a younger age.

Why do you think eye care professionals who have gone to the trouble of fitting single vision contact lenses on a myopic child do not choose myopia management options?

Two reasons, I imagine. One is cost, as myopia control contact lenses are more complex, they are also more expensive. The survey does show that one of the biggest reasons for practitioners to not prescribe myopia management interventions is cost. A second reason could be the necessary wear time. With single vision lenses, the rationale might be to wear them during sports only, whereas with myopia control lenses, they would have to wear them for the majority of the time during the day.

Is the lower concern over cost in North America and Australia shown in the survey lower due to insurance or reimbursement programs being more of a standard?

Absolutely this could be a factor. I do not have full insights into insurance options and other coverage and so forth across the world but it is indeed something we ought to consider to advance myopia management.

Are there any questions in the 2020 survey which you wished you had asked but did not? Or perhaps, are there any questions, you would have liked to have phrased differently in order to perhaps get a different response?

Yes, definitely! Upon viewing the practitioners’ responses, it would have been interesting to see how their attitudes vary depending on the modality of, in particular, soft contact lenses and the minimum age for prescribing soft contact lenses.

It would also be interesting to see how instrumentation vary arcoss the world. In the survey, it appears many practitioners have engaged in myopia management because of a consideration around axial length; but from looking at the results we do not know if they ARE using axial length or if they simply would have had they had the opportunity to do so.

You mention in your presentation that children appear to be as safe in contact lenses as adults, what is the evidence sitting behind that statement?

First of all, I totally understand why some parents and practitioners would be concerned about putting children into contact lenses, however, there are research showing that wearing contact lenses can increase both children’s confidence as well as their ability to carry out different activities. Indeed, particularly, daily disposable contact lenses have a fairly low risk of ocular complications associated with contact lens wear.

There are three research papers in particular:

Robin Chalmers found that with soft contact lenses the risk of microbial keratitis was very similar to that of adults which is very low.

Mark Bullimore did a great paper on orthokeratology, using overnight rigid lenses, and again found that there is not a significantly greater risk of microbial keratitis and other associated risks for children compared to adults.

We also need to consider the life-long risk of myopia versus the risk related to contact lens wear. Kate Gifford did a lovely paper exploring the risk related to longer axial lengths versus the risks associated with contact lens wear; she actually found that the life-long risk of untreated myopia is significantly greater than the short-term risk of contact lens related complications in children.

I know one of your areas of interest is factors influencing choroidal thickness change. Please tell us some more about it and its relationship to myopia management.

There is some indication that choroidal thickness may influence myopia progression and myopia management.

What we know is if we induce myopic defocus on the retina the choroid will thicken in order to push the retina toward the image plane to try and bring the retina back to the focal point. This can happen fairly quickly, it can happen within an hour. Some research has found that some myopia management interventions can cause choroidal thickness such as orthokeratology.

There are also some indications that choroidal thickness can act as a predictor of long-term axial elongation.

References

 James S. Wolffsohn, Yasmin Whayeb, Nicola S. Logan, Rebecca Weng, the International Myopia Institute Ambassador Group*; IMI—Global Trends in Myopia Management Attitudes and Strategies in Clinical Practice—2022 Update. Invest. Ophthalmol. Vis. Sci. 2023;64(6):6.
https://iovs.arvojournals.org/article.aspx?articleid=2785573

Chalmers RL, McNally JJ, Chamberlain P, Keay L. Adverse event rates in the retrospective cohort study of safety of paediatric soft contact lens wear: the ReCSS study. Ophthalmic Physiol Opt. 2021 Jan;41(1):84-92.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7839756/

Li, Z., et al., Change in subfoveal choroidal thickness secondary to orthokeratology and its cessation: a predictor for the change in axial length. Acta Ophthalmologica, 2019. 97(3): p. e454-e459. https://pubmed.ncbi.nlm.nih.gov/30288939/

Bullimore MA, Mirsayafov DS, Khurai AR, Kononov LB, Asatrian SP, Shmakov AN, Richdale K, Gorev VV. Pediatric Microbial Keratitis With Overnight Orthokeratology in Russia. Eye Contact Lens. 2021 Jul 1;47(7):420-425.
https://pubmed.ncbi.nlm.nih.gov/34050085/

Gifford KL. Childhood and lifetime risk comparison of myopia control with contact lenses. Cont Lens Anterior Eye. 2020 Feb;43(1):26-32
https://pubmed.ncbi.nlm.nih.gov/31796370/

Wang, J., et al., Progression of myopia in school-aged children after COVID-19 home confinement. JAMA ophthalmology, 2021. 139(3): p. 293-300. https://pubmed.ncbi.nlm.nih.gov/33443542/

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Prepared by the World Council of Optometry Myopia Management Resource Committee 2023.
The World Council of Optometry Myopia Management Standard of Care initiative is a collaborative partnership between World Council of Optometry and CooperVision.

Soft Dual Focus or Multifocal Contact Lenses

Spectacle Lenses for Myopia Control

Orthokeratology

Atropine

When to wear it

Children who are physically active
Ideal for very young wearers
Children disliking glasses and/or inclined to not wearing them full-time

Considerations

Shown to improve confidence and ability to participate in activities.

Typically more availability for astigmats.

No wearing time during waking hours.

Optical correction is still needed.

* Excluding children frequently engaged in water sports.