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

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.

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.

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.

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.

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.

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.