Considering the individual in myopia management

As options for myopia management expand and the evidence basis grows, treatments can be tailored to suit the individual child, their lifestyle, their families and their myopia risk factors. Here's how to approach considering the individual in myopia management.

Lifestyle factors, personal preferences and motivations are key to understand before embarking on a prescribing strategy, especially in view of similar efficacy of several treatments.¹ Children who are highly active sporting enthusiasts or who don't enjoy wearing their spectacles may be best suited to contact lens options. Parents who are concerned about contact lens wear in children may require additional communication on Contact Lens Safety in Kids. Children with mild ocular allergies may potentially be better suited to orthokeratology (ortho-k) than soft contact lenses: 10 years of follow up in children wearing either option found no difference in adverse events between the groups, but less eyelid changes in the ortho-k group.²

Another important consideration is the home environment. Busy parents, or children who go across multiple households may not have the capacity for ortho-k wear, where consistent nightly wear and careful transport of the lenses themselves are required. In these cases, disposable myopia control soft contact lenses would be ideal, where supplies can be kept in multiple places. Alternatively, a parent who desires full supervision and control over contact lens wear may prefer ortho-k.

The first and largest risk factor for myopia progression is the child's current age. Younger children require a more proactive approach to myopia management, given that progression is fastest in younger children.³

Experts advise that all myopic children should be proactively managed for their myopia, especially children under age 12 who are at risk of faster progression and reaching high myopia.¹ Given that only half of children show axial elongation stability by age 16,⁴ myopia management should ideally continue throughout the teenage years.

Other risk factors should also be considered carefully in directing myopia management. These include the following.

• Family history of myopia. Children with myopic parents have a higher likelihood of both becoming myopic⁵ and demonstrating faster myopia progression⁶
• Prior progression. In children aged 7 to 9 years of age at baseline, those with slow progression in the first year (less than -0.50D) had slowest mean progression in the following two years (mean -0.41D/year). The children with fastest progression in the first year (more than -1.25D) had the fastest subsequent two year progression (mean -0.82D/year). This was a stronger predictor than baseline level of myopia or age of myopia onset.⁷
• Visual environment. At least 120 minutes per day of outdoor time has been shown to decrease risk of myopia onset in randomized controlled trials.⁸ While the link between outdoor time and myopia progression is mixed,⁹ there is meta-analysis support for the link between near work and myopia,¹⁰ where increased time spent and closer working distances at near are related to myopia onset^11,12 and progression.¹³

The first two of these can't be modified, while the third one can. In all three cases, understanding these risk factors can help with both parental communication on the necessity for myopia management as well as appropriately setting expectations for outcomes.

• Get to know your patients: they are more likely to stick to treatments that suit and enhance their lifestyle
• Consider risk factors: whilst some are modifiable and some aren't, all play into the decision making and communication in myopia management.

• How can we set myopia management expectations?

• Case study: Is switching the myopia control strategy necessary if there is myopia progression?

• Selecting an option - Clinical Decision Trees in Myopia Management