Findings from a survey conducted by Jobson Optical Research and Review of Myopia Management on myopia management sought to understand the current status of myopia management treatments provided to patients aged 18 and under in the United States.
Give me some background first.
Myopia is caused by structural changes to the eye due to elongation that can put children at a significantly higher risk of ocular pathology with every diopter of myopic refractive error.
Further, with a growing myopia epidemic, eyecare practitioners (ECPs) are in a position to intervene and initiate myopia treatments early, potentially preserving the vision of pediatric patients.
Now talk about the survey.
The survey was administered by Jobson Optical Research by emailing invitations to their in-house database of ECPs with an offered incentive for participating.
Responses were collected from December 11-18, 2023; ECPs had to meet three criteria to qualify to participate:
- Be an optometrist or ophthalmologist
- See patients 18 and under
- Practice in the United States
Findings?
In total, 461 qualified respondents completed the survey. Of that, 293 (63.6%) expressed that their practice provides myopia management therapies to control progression for patients aged 18 and under.
Note: Almost 23% of myopic patients aged 18 and younger receive some form of myopia therapy—highlighting a significant portion of pediatric patients who are potentially not receiving treatment.
Which myopia treatments do ECPs tend to prescribe the most?
For ECPs who provide myopia management treatments for myopia progression control, the most frequently prescribed interventions were (ECPs could check all responses that applied):
- Multifocal soft contact lenses: 78.8%
- More time outdoors: 68.8%
- Topical low-dose atropine: 55.8%
- Visual hygiene recommendations: 54.8%
- Single vision eyeglasses: 44.2%
- Anti-fatigue/blue-light blocker eyeglasses: 41.8%
- Progressive addition eyeglasses: 41.4%
- Orthokeratology: 32.9%
- Combination therapy: 13.4%
- Other: 6.5%
Per the survey, single-vision eyeglasses, anti-fatigue/blue-light blocker, and progressive addition eyeglasses “have been shown in randomized controlled clinical trials not to provide significant myopia control.”
When did ECPs report initiating treatments for progressive pediatric myopia?
The top two indicators for when ECPs begin myopia progression control treatments were:
- As soon as a child is diagnosed as a fast progressor (-0.75D progression or higher per year): 32.0%
- As soon as a child is diagnosed with -0.50D or more of myopia: 20.3%
Why does this matter?
These benchmarks are crucial, as progression is highly likely once a child is identified as pre-myopic or myopic.
Reducing myopia by 1.00D reduces the likelihood of a patient developing myopic macular degeneration by about 40%—highlighting how critical it is to treat progressive myopia early.
How did ECPs report monitoring myopia management interventions?
The majority of ECPs (56.4%) reported monitoring myopia treatment success with dry refraction every 6 months, followed by 32% who perform cycloplegic autorefraction once per year, and 26.1% perform dry refraction once per year.
According to the survey, “unfortunately, dry refractions are notoriously unreliable in children and adolescents due to their very active accommodative systems.”
So how can ECPs incorporate axial length into myopia management protocols?
The survey authors reported that 21.3% of respondents noted that they perform axial length measurements every 6 months and 12.7% said they perform axial length measurement once per year—which is significantly higher than previous ECP surveys.
In a similar vein, 34.4% of respondents who reported offering myopia management in their practices also noted that they currently measure axial length.
Expert opinion?
The survey authors stated, “Since juvenile-onset myopia is an axial length disease, monitoring treatment success with an optical biometer is critical.”
“This survey appears to indicate that this is a fact that ECPs who are practicing myopia management are gradually learning,” they added.
Take home.
Nearly 50% of respondents who offer therapy for myopia progression expect a significant increase (>10%) in the number of patients aged 18 and younger over the next 12 months.
As such, there is a notable untapped potential market for myopia management due to a large proportion of myopic children who are not receiving myopia management treatments.