How to Identify At-Risk Children: Predictive Factors

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.

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.

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.