February 2022 Virtual event Presentation

How to Identify At-Risk Children: Predictive Factors

Video title slide: How to identify children at risk of developing myopia
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By Sara McCullough BSc (Hons), MCOptom PhD, Northern Ireland, Nicola Logan MCOptom, MEd, PhD, England & Carmen Abesamis-Dichoso OD, Philippines

About the presentation

Learn how to recognize risks of developing myopia in children based on presenting refractive status, axial length, and family history and to implement a clinical management protocol from Sara McCullough who works as a co-investigator on the Northern Ireland Childhood Errors of Refraction (NICER) study, the largest prospective study of eyes and vision in childhood in the UK and Ireland.

Hear Professor of Optometry and Director of Research for the Optometry and Vision Science Research Group, School of Optometry, Aston University, UK, NIcola Logan’s personal story of managing her daughter myopia using the NICER study tools and follow pratice owner and international speaker Carmen Abesamis-Dichoso’s real-life patient’s journey with myopia.

FAQ from the event

Could you explain the relationship between K (Keratometry) readings and your Risk Indicator? And how does this feed into the risk factors overall?

Dr. Sara McCullough: We have been working with Professor Philip Morgan at Manchester University and we have developed a calculation if you have Keratometry readings and refractive error can you make an estimate of axial length.

I saw a question from the audience asking: If you have a flatter K how does that relate to having an increased risk? Well, the reason why there is an increased risk is if you have a flatter K and if you have a less hyperopic refractive error then you’re likely to have a longer axial length; it’s not necessarily the flat K that makes a difference, it’s the flat K accompanied with a low hyperopic error that means that you’re most likely going to have a long axial length. The PreMO Risk Indicator is of course an estimate however.

Thank you, Dr. Nicola Logan, for sharing such a personal story about your daughter and her journey through myopia. I have two questions for you: The first part is, if you knew then what you know now would you have done anything differently? The second part is: How has this experience changed your actual practice of myopia management?

Dr. Nicola Logan: It’s always really interesting to reflect back on what you could have done differently because Erin is at the stage now where she needs an optical correction to see clearly in the distance and we’re not going to be able to reverse that in any way.

I guess I knew that myopia was likely due to her axial length data which I have been collecting for a long time; I actually have an older daughter, she has a shorter axial length and a more hyperopic refraction so I knew the development of myopia was likely. At the time, however, there was nothing really available to me to intervene in any other way apart from behavioral interventions; this is an evolving field and maybe a few years down the line we will have other options to try and delay or stop onset of myopia.

How has this knowledge changed my practice? I’m a lot more sympathetic in terms of conversations; a lot of parents feel it’s their fault that they have a myopic child and they question what they could have done differently. I can totally empathize with this feeling and I try to engage in a conversation around risks and balances; yes, you can try these optical or behavioral interventions, they may or may not work but this is what we have right now.

The PreMO Risk Indicator is to assess risk of becoming and progressing in myopia - what would you think if you saw a child’s axial length tracking along their centile and then it had a bit of a spike upwards?

Dr. Sara McCullough: That definitely is a sign that something is abnormal in terms of their eye growth; our results show that if you go up a percentile or if you were to cross centiles that is one of the significant risk factors for becoming myopic. If you see this it is an indicator that it would make sense to see the child again sooner, such as six months later, rather than leaving it for a year. At that stage, it might also be useful to give some advice to the parents about their child being likely to become myopic at the next visit and we might then need to have to think about myopia control strategies.

If you were reviewing a child who was already in myopia treatment but they were still progressing and crossing centiles in a way that you weren't expecting or in a way that you were hoping that they weren't going to, what sort of management would you discuss with parents?

Dr. Nicola Logan: That is a really interesting question that will indeed arise time and time again from clinical practice and we’re not yet at a stage where we have a very well-defined evidence base to enable us to really inform what we might do. Ideally, in the myopia management intervention we want them to stay on the same centile or, ideally, drop down the centiles as they grow. If they are progressing fast, the very first thing I would do, prior to taking them out of any intervention, is to have a careful discussion both with the child and parent about compliance or adherence to the myopia management strategy, because if the intervention is glasses or contact lenses are they only wearing them at school or part-time? These are the things to first consider. As time goes on, we may perhaps have more evidence about combination therapies, for example adding atropine as an adjunct or whatever else becomes available.

References

The Northern Ireland Childhood Errors of Refraction (NICER) study www.ulster.ac.uk/myopia-nicerstudy

McCullough, S. et al. Axial growth and refractive change in white European children and young adults: predictive factors for myopia. Sci Rep (2020) 10, 15189. https://pubmed.ncbi.nlm.nih.gov/32938970/

Jin, JX., Hua, WJ., Jiang, X. et al. Effect of outdoor activity on myopia onset and progression in school-aged children in northeast china: the sujiatun eye care study. BMC Ophthalmol 15, 73 (2015). https://pubmed.ncbi.nlm.nih.gov/26152123/

Interested in learning more?

Video title slide: How to identify children at risk of developing myopia
Play Video about Video title slide: How to identify children at risk of developing myopia

Presented by Sara McCullough, Nicola Logan & Carmen Abesamis-Dichoso

Learn how to recognize risks of developing myopia in children based on presenting refractive status, axial length, and family history and to implement a clinical management protocol.

Play Video

Presented by Philip Cheng, Wen Juan Chui & Ariolfo Vazquez

Hear how current leading practitioners in the field of myopia management choose a myopia management strategy for their patients.

Video title slide: how to monitor children undergoing myopia management
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Presented by Thomas Aller

Learn about tools and strategies for monitoring the myopia progression of your patients, assessing the effectiveness of their treatments and modifying their treatments to maximize their effectiveness.

Mitigation
Measurement
Management

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.