CooperVision, Inc. has published a new white paper calling for a greater recognition of pediatric myopia as disease as well as emphasizing the need for earlier treatment.
Who wrote it?
The paper was written by nine pediatric ophthalmology experts in both clinical practice and academia. They include:
- Robert A. Clark, MD
- Laura B. Enyedi, MD
- K. David Epley, MD
- Li Lian Foo, MD
- Francisco Javier Hurtado, MD
- Imran Jawaid, MD
- Benjamin R. LaHood, MD
- Christie L. Morse, MD
- Rupa K. Wong MD
Let’s start with the bigger picture.
The experts stressed the need for treating and controlling myopia progression, emphasizing the global prevalence and potential for the disease to reach 50% of the population by 2050 if there is no intervention.
They explored the evolving perspective on myopia management (MM), including how more pediatric ophthalmologists are shifting their viewings of myopia from an inconvenient symptom to a manageable disease.
What are the challenges?
Ophthalmologists are noted to be slow in prescribing MM treatments; further, many have not received training to classify myopia as a disease with treatment options aside from correcting refractive error.
The authors stated that MM, including low myopia, can be difficult to accept and requires a mindset shift.
Other factors include the inaccurate MM goal of avoiding high myopia and notion of costliness that will deter a patient; outdated beliefs associating contact lenses and pediatrics; limitations within the current healthcare system for both ophthalmologists and optometrists across the globe, and a lack of publicly available MM guidelines.
Speaking of optometrists...
Collaboration between optometry and ophthalmologists—comanagement—decreases the amount of chair time required for a MM contact lens fitting and overall in-office time for both doctors, the authors wrote.
What about current interventions?
The use of topical atropine in higher doses (0.5-0.1%) is noted for treating progression, but also comes with adverse events (photophobia, blurred near vision, etc).
See here for details on the LAMP2 study, which assessed low-concentration atropine (0.01% and 0.05%) for reducing pediatric myopia.
Spectacle lenses and contact lenses—including orthokeratology (ortho-k) and soft lenses like the FDA-approved MiSight 1 day lenses—options also offer MM for varying lengths of time.
The authors noted the use of MiSight 1 day contact lenses as a potentially successful treatment as well as reducing the onset of myopia in children in order to reduce the risk for higher myopia.
Further, behavioral modifications such as increasing time spent outdoors and limiting digital device usage may delay or prevent onset.
Limitations?
Such limitations include a lack of evidence supporting low atropine (although a recent study may help make the case); ortho-k lenses generally only correcting myopia to –6.00D and astigmatism up to –2.50D.; and a reduction in spectacle lens effectiveness if not worn full time.
How about best practices?
Of interest, the use of low-dose atropine in pediatric patients (ages 5 to 7) may increase their later acceptance of MM contact lenses (ages 8 to 9).
And from an advocacy standpoint?
Advocacy and support at the state level, as proposed by the American Academy of Pediatric Ophthalmology and Strabismus (AAPOS) is a major goal to promoting MM and educating on myopia risks.
The greatest hurdle, the authors note, is achieving this in all 50 states across the U.S., including state-by-state level coverage for MM treatments.
Conclusion.
The authors stressed the need for early myopia treatment as close to its onset during childhood.
Further, “the safety and efficacy of today’s evidence-based optical treatments for children with myopia brings confidence to ophthalmologists and families alike” for successfully slowing progression,” they wrote.