Managing expectations in myopia management

OT asked manufacturers in contact lenses and spectacle lenses to share the key considerations to cover when managing expectations of an intervention for myopia.

Clear communication

Nicky Latham, professional affairs lead for myopia management at CooperVision, emphasised the need for clear communication: “Parents, including those without myopia, must grasp the condition’s implications and how it can worsen over time.”

The value of early intervention is an important conversation to have in the consulting room.

“It’s essential to realise that while interventions can slow down the worsening of myopia, they cannot reverse it,” she said, highlighting the need to emphasise prompt action.

Latham pointed out that evidence demonstrates that some myopia management interventions, such as the MiSight 1 day, work for as long as the eyes are growing.

“Parents should therefore be counselled to anticipate keeping their child in myopia management for as long as the eyes are changing,” she said.

In discussing this, Latham recommended eye care professionals educate patients and parents that, even during a myopia management treatment, a change in prescription can occur, adding: “Myopia management slows the worsening of myopia, rather than stopping it or reversing it.”

Abiding by the recommended wear times is also a necessary conversation.

“Treatment is dose-dependant, so adherence with the recommended wear times for the selected product is highly correlated with increased myopia control efficacy,” Latham said. “Eye care professionals and families need to consider the required minimum wear time for myopia management spectacles or contact lenses, and how achievable this will be with the child’s weekly routine of activities,” she added.

“Often parents will not realise that myopia is a disease that causes excessive eye growth,” Latham said, sharing data from the MiSight 1 day study which showed that changes in refractive error “highly correlated with changes in eyes’ axial lengths in both MiSight 1 day and single vision one-day contact lens groups.”

CooperVision has created a myopia management tear pad which can be a useful way to plot the patient’s prescription.

Latham explained: “This indicates whether the child is at risk of myopia and its associated ocular health problems later in life. Other resources and online tools also exist to support with conversations about healthy eye growth, such as the Predicting Myopia Onset and Progression Risk Indicator tool, which is open access.”

Risk levels of myopia

Fabio Carta, global professional services manager for the myopia management business division at Menicon, also emphasised the importance of sharing with parents. “The earlier that myopia emerges, the greater the risk of progression to a higher prescription,” he said.

Within this consultation, he suggested explaining the factors influencing a child’s risk of developing myopia.

This could include explaining how the level of refractive error deemed as normal for a patient would be influenced by ethnicity, or parental levels of myopia.

“The presence of myopia in one parent increases the risk of myopia in the child. That risk further increases if both parents are myopic. Even if both parents are non-myopic, their child may still develop myopia,” Carta said.

When it comes to discussing the healthy growth of the eye within myopia management, Carta suggested a number of different steps for children of different ages and at different stages of myopia.

This begins with encouraging pre-school age children to attend an eye exam, and emphasising the importance of follow-ups, particularly for children at an increased risk.

Advice for parents and families should include lifestyle factors, such as explaining the 20–20 principle or spending time outdoors, with Carta suggesting: “A minimum of two hours per day of outdoor activity at any point during the day, including school time.”

Ocular health and consent

Andy Sanders, professional services director at Hoya UK, commented on the different levels of awareness an eye care professional might encounter when talking to patients and their parents: “When you talk about myopia, some people know what it is, whereas others don’t know what short sightedness is. So, it is really important to use both terms and ensure understanding.”

Providing a demonstration of what a child’s prescription is like can be helpful to show the impact of myopia on vision, while utilising visual tools to illustrate how the child’s vision is predicted to change with and without an intervention can also aid understanding.

Discussing myopia management in terms of ocular health can be a helpful approach, he suggested, particularly for younger children who might be high myopes.

“Long-term, we need to start talking to them about the potential pathology,” Sanders suggested, adding: “You might say to the parents, ‘Your child’s vision is healthy now and we want to keep it that way. By slowing the worsening or progression of myopia we want to reduce the end point prescription which, in turn, can improve quality of life and reduce the risk of eye health problems. In a nutshell, we want them to have the best possible future life and keep their vision healthy.’”

“When we talk about myopia management, we are supporting natural eye growth,” Sanders added.

A necessary component of any myopia management consultation is consent, and Sanders shared: “If they decide they are going to opt for myopia management, then absolutely you need consent.”

He also emphasised the role of compliance to wearing times in myopia management.

“You need to have the discussion with both the child and the parent, putting the child at the heart of the decision of what they would really like. This may be different to what the parent thinks the child wants or needs, but there is no point giving the child an intervention if they are not going to wear it,” he said, adding: “Compliance is key to any of these interventions, and that’s why I think we sometimes get more progression than we would expect.”