Myopia Management in Clinical Practice
AAO 2013 Seattle Course Submission
Kate Johnson BAppSc(Optom)Hons, GCOT (QUT), FBCLA, FIACLE, FCCLSA, FAAO.
Gerry & Johnson Optometrists, Brisbane, AUSTRALIA
Corresponding Author: kate@gjo.com.au
The growing incidence of paediatric myopia worldwide necessitates the practitioner to hold
a thorough understanding of the scientific literature and its translation to clinical practice.
There is strong scientific interest in understanding factors leading to myopia development
and progression, and options for myopia control. In this lecture, scientific evidence will be
combined with clinical experience and communication tools to outline best practice myopia
management.
There is much recent scientific interest in reducing the progression of myopia in children.
Many methods have been researched and variable results achieved. Standard soft and rigid
contact lenses, undercorrection of myopia and multifocal spectacles have been shown to
have minimal or no effect for myopia control. Modest results for bifocal and novel design
spectacles have been achieved in specific populations. Atropine has shown the strongest
scientific results for myopia control, but has significant side effects of photophobia and
blurred vision at near, and the effect is not permanent on discontinuation, making it an
unattractive prospect in practicality. Other pharmacological agents showing promise –
pirenzipine and atropine 0.01% - are not yet commercially available.
Overall, orthokeratology and soft bifocal / dual focus contact lens correction options have
shown the most consistent performance for myopia control with the least side effects. Best
practice myopia management involves the practitioner making a full evaluation of a child’s
risk factors for myopia development and/or progression, in view of the latest scientific
literature. A child’s binocular vision status, age and refraction, family history, visual tasks,
home and leisure environment, and capabilities with modality options must all be
considered. The usual indications for paediatric contact lens fitting must be incorporated
along with clinical considerations of limitations of the intended modality. For example
anatomical limitations for paediatric Ortho-K fitting, or application of scientific knowledge to
success with soft lens myopia control options, will influence the practitioner’s evidence
based management plan.
The concept of a ‘myopia profile’ for myopic and myopic-risk children will be introduced,
along with a description of how practitioners can put the vast scientific basis of myopia
control into practice. Case studies from a large patient base of paediatric Ortho-K and soft
contact lens wearers with a binocular vision perspective will be combined with the latest
research to demonstrate how practitioners interested in managing this growing population
can incorporate best practice myopia management into their practice. Communication tools
will be provided to ensure that the astute practitioner can successfully translate the
importance of myopia control to both parents of myopic children and myopic parents keen
to actively manage their child’s visual development.
Learning objectives:
1. A thorough understanding of the scientific literature on factors leading to myopia
development and progression
2. Understanding the scientific evidence and proposed mechanisms behind options for
myopia control
3. Consideration of factors influencing myopia control options and choices for the
individual paediatric myope
4. Application of clinical and scientific knowledge to patient selection for specific
management pathways
5. Determination of an evidence based management plan for paediatric myopia in
practice, including communication tools.