February 2022 Virtual event PANEL DISCUSSION

Panel Discussion: Myopia Management Strategies

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Image of WCO Myopia management event 2022 panel speakers

By Wen Juan Chui BOptom (Hons), MOptom, Singapore, Philip Cheng BOptom, Australia, Ariolfo Vazquez OD, Colombia & Justin Kwan OD, United States

About the panel discussion

Hear how current leading practitioners in the field of myopia management choose a myopia management strategy for their patients. Wen Juan Chui, former Vice-President of Singapore Optometric Association, has a special interest in managing myopia in young persons, knowing well that risks need to be mitigated for her patients’ future eye health and vision. Philip Cheng from Australia is an experienced orthokeratology practitioner and a Fellow of the International Academy of Orthokeratology and Myopia Control. Ariolfo Vazquez from Colombia is a co-founder of the LATAM Myopia Management Group; International Myopia Institute ambassador for Latin America and specializes in contact lenses and myopia management. The panel’s moderator, Justin Kwan from the US, is a senior manager at CooperVision and the current president of the Chicago North Side Optometric Society and immediate past chair of the Fellows Doing Research SIG of the Academy.

FAQ from the event

What techniques do you use to demonstrate to parents how their uncorrected myopic child sees?

Dr. Ariolfo Vazquez: I use the plus four diopters lens on the parents to show them how the child sees.

Dr. Philip Cheng: Yes, physically showing parents what their child is actually seeing is quite powerful; they can be quite shocked.

Not many medical conditions or diseases progress or worsen at a similar rapid pace in young people as myopia, so bringing us back to the exam room: how do you show parents that you're very concerned about their child's myopia and that you want to start treatment as soon as possible without scaring them?

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.

How do you explain the different myopia management treatment options? I imagine it can take a lot of time to explain each one and it can probably also be overwhelming to parents who didn't know there were more than one or two options available. How do you strike that balance in other words?

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.

Do you have an automated system in place to put patients and parents on the schedule again in six months if they say 'No' initially to myopia management?

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?

How often do you feel the need to change myopia management treatment, for example, due to the severity of progression?

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.

References

International Myopia Institute White Papers & Clinical Summaries https://myopiainstitute.org/imi-white-papers/

MyopiaProfile Myopia Risk Assessment Worksheet https://www.myopiaprofile.com/product/myopia-risk-assessment/

Interested in learning more?

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

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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.