A dedicated Clinic at University of New South Wales, co-managing the vision of many progressive myopes with referring optometrists, is achieving impressive results.
In March 2016, an 11 year-old Caucasian male was referred to the University of New South Wales (UNSW) Myopia Clinic for myopia control treatment. After discussing both atropine and orthokeratology lens treatment options, the patient opted for atropine. The patient returned for numerous appointments, with the most recent in August 2017.
His myopia progression was monitored by the Clinic through axial length (IOLMaster; Zeiss) and subjective refraction measurements (Figures 1 and 2 respectively). Although there has been some variability since initiating treatment, overall, the patient’s axial length and refraction has not changed for the past 1.5 years, indicating no myopia progression.
The patient has been advised to continue with atropine eye drops for the next six months, at which time the efficacy of treatment will be reassessed. To date, the patient has been extremely compliant with atropine treatment and has not experienced adverse effects. He and parents are very pleased with results from atropine treatment and overall myopia management experience.
Atropine is currently the most popular myopia control treatment option
Several online tools are now available, which attempt to predict myopic progression with and without treatment. While there is individual variation in results, using one of these calculators (www.brienholdenvision.org /translational-research/myopia/myopia-calculator.html) predicted that without treatment, his myopia may have progressed to between -5.75D and -6.50D by the time he reached 17 years of age.
About the Clinic
The UNSW Optometry Clinic at the School of Optometry and Vision Science opened its Myopia Clinic in 2015. Its development was supported with advice from the Myopia Clinic at the Queensland University of Technology, which is coordinated by Dr. Emily Woodman-Pieterse.
The aim of the Clinic was to provide evidence-based management of progressive myopia and today, using state-of-the art instrumentation and myopia research expertise within the School, it has achieved this with a dedicated service for progressive myopes. Additionally, the Clinic delivers clinical education on myopia management to undergraduate and postgraduate Optometry and Vision Science students.
The UNSW Myopia Clinic offers optical and pharmacological myopia control treatments listed below, as well as recommendations on behavioural modifications:
- Multifocal soft contact lenses (Biofinity Multifocal and MiSight; CooperVision)
- Multifocal spectacle lenses (MyoVision and other progressive addition lenses)
- 0.01 per cent atropine eye drops
Patients who attend the UNSW Myopia Clinic are either existing patients of the UNSW Optometry Clinic or, more frequently, referred from local optometrists.
Each patient receives a comprehensive assessment of their vision, refraction, accommodation and binocular co-ordination, and biometry to help select the most appropriate treatment. The results of these assessments are also used to monitor the efficacy of myopia control treatments.
Referred patients are offered an assessment only or assessment and co-management options. The majority of referred patients are for co-management of their myopia treatment with the referring optometrist. This is an effective way to provide optometrists with further information about their patient’s biometry as well as exposure to myopia management experience, particularly with treatments they may not be familiar with.
Outcomes and Ongoing Management
Of the first 50 patients (32 F, 18 M) seen at the UNSW Myopia Clinic, most were of Caucasian or East Asian ethnicity (Figure 3). Fifteen patients were referred back to their optometrist for myopia control treatment and 35 were offered treatment and monitored at the clinic.
Atropine is currently the most popular myopia control treatment option, followed by orthokeratology (Figure 4). The mean age of children undergoing atropine treatment (11.6 years) is slightly younger than those prescribed orthokeratology (12.6 years). The popularity and slightly younger age of children undergoing atropine treatment is attributed to the ease of use of daily eye drops compared to orthokeratology, which requires development of appropriate contact lens handling skills.
Once prescribed atropine treatment, patients are advised to return for early reviews after one week and one month of commencing treatment. The Clinic’s clinical protocol also requires patients undergoing atropine treatment to return for follow-up consultations at either the UNSW Myopia Clinic or the referring optometrist every three months to monitor for any adverse reactions to atropine eye drops. Patients on all treatments are instructed to return to the clinic at least every six months to assess and monitor the efficacy of the myopia control treatment.
Although there has been some individual variability in the efficacy of atropine and orthokeratology treatments to control myopia progression, the Clinic has experienced successful cases and encourages optometrists to refer patients on for assessment and co-management strategies.
The UNSW Myopia Clinic currently runs on Wednesday mornings (9:30-11:30am) and on Fridays. For information about the UNSW Myopia Clinic or referrals, contact the UNSW Optometry Clinic on (AUS) 02 9385 4624 or email email@example.com.
Dr. Pauline Kang is a Lecturer at the School of Optometry and Vision Science, UNSW. Her research focuses on optical strategies of myopia control, with the aim of improving efficacy of current myopia control devices.
Kathleen Watt is Clinic Director of the UNSW Optometry Clinic at the University of New South Wales School of Optometry and Vision Sciences.