Panel Discussion: Myopia Management Strategies

Dr. Philip Cheng: I always take axial length and put it into a spreadsheet where it gets graphed and they can physically see the eyeball length and if it is longer than it should be. They quickly understand what the condition is actually about. I have some colour bars on the side which indicate the level of risk and so on.

Dr. Wen Juan Chui: I talk about how when the child squints and strains hers or his eyes the vision is not very efficient; it’s going to affect school performance, other hobbies such as dance or sports. I explain to parents that the window of opportunity is now, during childhood and early teenage years; by the time they are 16 or 17 it’s a little too late.

Dr. Wen Juan Chui: I will give them all four options, optometric and pharmaceutical, I will then suggest two of these options based on the patient’s needs, costs, ease of use and so on. I will also mention that this is a continuous conversation and we are not ‘done’ today.

Dr. Philip Cheng: I actually try to put the child back in the appointment book that same day for a later time so I know I will see them again.

Dr. Wen Juan Chui: I tend to say that around adolescence we can begin to relax treatment a little bit but bearing in mind that every diopter of myopia increases the risk of myopic macular degenerations. I think it’s important to emphasize that we would like to not just monitor your refraction and vision but also your eye health. I guess the short answer is probably: a lifetime!

Dr. Ariolfo Vazquez: I tend to not give a timeframe; I tell them that my focus is on keeping myopia as low as possible, ‘Every Diopter Counts’ as Doctor Bullimore says. The only time I may mention a timeframe is if the child is prescribed atropine – via an opthahlmologist – as I may mention that we may need to stop treatment after a couple of years.

Dr. Philip Cheng: Generally, my recommendation is to continue treatment until the child is unlikely to progress further, this is usually around 18 years-old or even even later no I generally do not recommend stopping any treatment until they finish all their studies, such as university studies. Why would you stop a treatment and undo the good work that we have been doing?

Dr. Philip Cheng: If I am seeing significant axial length changes which is a very precise measurement, then yes, I would. For example, if I am seeing a 0.3 or 0.4 millimeters change in six months that is a significant change and we need to do something. If they’re in Orthokeratology lenses maybe we can combine it with something, if they’re wearing myopia control glasses I will check if they are fitting properly and if the patient is actually wearing them, if he or she is not then maybe a better solution is wearing contact lenses. In summary, I have no issue changing treatment if something is not working.

Dr. Wen Juan Chui: I find it particularly important with younger children as they tend to progress faster. Changing treatment happens due to two considerations for me: is the patient not seeing well at school and in other settings? Am I seeing significant changes in axial length? Compliance is also important; a treatment may not be working because the patient is not compliant and we need to understand why. Overall, close monitoring is important, if I only see a patient every twelve months I might have missed a few good opportunities.