Incorporating axial length data in the clinic – Q&A with Max Aricochi

Axial length data is THE most important parameter in the risk assessment of a new myopia management consultation for me. It gives me the opportunity to differentiate between axial and refractive myopia and further set the tone for the required urgency and goal setting in myopia management.

In practice I am always showing the percentile graphs as an easy-to-understand tool which allows us not only to classify the risk, but also give a forecast on where children will end up with their myopia. My goal for myopia management is to bring at-risk children back to normative eye growth with evidence-based treatments. With the comparison of axial length data, I am fully aware if the treatment is effective enough, or if it needs to be modified for better outcomes.

Based on the individual risk profile of the children we differentiate between high risk, moderate risk and low risk children. We then check these children at 3, 6 and 12 months respectively.¹ At the follow up exams, I show patients and parents the different datapoints at successive points of time. 

The primary goal is to flatten the curve as much as possible. Of course it is normal that children keep growing - that’s what I always tell parents and patients right from the beginning of myopia management. But the goal is that they grow at a normal and not an accelerated rate. Based on this, my ‘normal growth’ threshold in 7- to 10- year-olds is no more growth than 0.25mm/year, and in 10– to 13- year-olds is no more than 0.15mm/year.^2-4

The new Growth Control Module signifies an innovation in growth rate assessment, offering a quick and precise display of treatment outcomes. The module utilizes a color-coded scale – green for normal growth, orange for moderate success, and red where treatment intensification is suggested.

The simplicity of the traffic light system makes the breakdown of treatment outcomes more accessible for parents and patients. Before incorporating the Growth Control Module, explaining treatment outcomes relied solely on verbal descriptions; now, we can visually demonstrate the impact, providing a clearer understanding for all involved.

As increased axial length is the primary concern in myopic children, the ability to distinguish normal from abnormal growth rates is a game-changer, providing a precise structure for high-quality interventions and clinical communication. When it comes to adapting or intensifying treatments, the key lies in monitoring growth control rates. This evidence-based approach ensures successful, individualized interventions for optimal outcomes. 

With nearly being involved 10 years in the field of myopia management, my initial focus was based on risk tables correlating the severity of refractive (dioptric) myopia with the risk for secondary pathologies. However, a significant shift occurred when I began to see more and more low to moderate myopic children with flat corneas. In 2020, with the acquisition of the Myopia Master, insights emerged, revealing that these children often had longer eyes, indicating a higher risk compared to highly myopic children with steep corneas and shorter axial lengths.^5-6 Distinguishing between these cases has resulted in an evolution in my evidence-based approach to myopia management. Utilizing axial length changes as the primary outcome metric has proven to be the most accurate method.⁷ The recent addition of the growth rate function further facilitates the clear and comprehensive presentation of results to patients and parents.