When It Comes To Myopia Progression, Earlier Intervention Is Better

DON’T ASSUME PATIENTS WILL ASK

Dr. Agarwal is the independent optometrist and owner of two practices in Ontario, Canada, that are adjacent to LensCrafters locations. She knows firsthand how important it is to have early education and detection of vision problems; at age 11, she was diagnosed with glaucoma and was taking a variety of drops a day. She was also a -12.00D myope. Her parents didn’t know myopia was a risk at her age, she says, or that there was anything they could do to slow progression. She says the “critical development period” to correct vision is before the age of seven.

“I think of myopia management as a part of a routine eye exam, especially a pediatric one, the same way you’d ask a senior patient about cataracts,” she says.

DR. CHANG
Dr. Chang, the optometrist and owner of Iris Bright Optometry, also located beside a LensCrafters retail location in Irvine, California, had a similar experience. She didn’t get her first eye exam until her she was almost 10 and was diagnosed with meridional amblyopia.

“If I had seen an eye doctor earlier, maybe it wouldn’t have progressed so severely,” Dr. Chang says. “Patient—and parent—education is huge. If they don’t bring it up, I do.” Parents don’t know what they don’t know, so Dr. Chang says it’s important that primary care optometrists advise them that myopia progression can be managed.

Both Dr. Agarwal and Dr. Chang make questions about lifestyle and visual demands a part of every exam. “As screen time continues to become a larger part of everyday life, I am only seeing more pediatric patients with myopia and myopia that is progressing more quickly,” Dr. Chang says.

Today, even young patients are affected by increased screen time. “If the patient works or studies from home or likes to play video games, then I’ll know to discuss the myopia and strategies for visual comfort with them,” Dr. Agarwal agrees. She’ll review taking breaks from screens and spending time outdoors.

Dr. Chang says she also makes it a point to ask myopic patients if they have kids—and if they do, encouraging them to bring the children in for an eye exam.

“Myopia cannot be cured, but the earlier we catch it, the better we can help the patient manage it,” Dr. Agarwal says. “I stress to the parents that their myopic children should be seen more regularly. Without follow-ups, we don’t know if the therapy is effective.” Dr. Chang agrees, routinely scheduling myopia patients for visits every six months.

LEVERAGE STAFF SKILLS
To make myopia management work in their settings, these doctors rely on their teams. This is particularly helpful during the busy back-to-school season. Staff can help identify prospective patients and carry out the doctor’s instructions. Dr. Agarwal includes specific written policies on myopia management discussion in her staff training, including asking the patient about their myopia risk factors before the OD ever sees the patient. Dr. Chang’s staff reinforces with parents ways to recognize vision issues, including changes in the child’s attention span or behavior.

KEEP UP WITH THE SCIENCE AND TECHNOLOGY
Dr. Agarwal says a part of the reason she became an optometrist was to help other children manage their vision problems. “I was bullied for my thick spectacle lenses,” she says. “But there have been so many advancements in myopia research and management. Kids don’t have to suffer with it anymore.” Myopia progression also comes with an increased risk of retinal tears and macular degeneration, Dr. Chang says, so the earlier it’s caught and managed, the better off the patient will be.

“To me, myopia management is like orthodontic braces,” Dr. Chang says. “The longer you wait, the worse it usually gets,” Dr. Chang says. She also notes that there is “more we can do for a patient than eyeglasses,” including orthokeratology, soft contact lenses, atropine and spectacles. She bases her management recommendations on the patient’s lifestyle. If a patient is active or plays sports, she may advise using orthokeratology; if the child is too young to handle wearing hard lenses, she may steer toward soft contact lenses indicated for slowing myopia progression.

Dr. Agarwal says her “hands down favorite” management option are myopia control spectacles. She’ll consider adding low-dose atropine if necessary but prefers those two options. The conversation changes with the parents and child and what their expectations are.

To these doctors, myopia management is an important part of the primary eye care that they offer.