Renowned ophthalmologist and researcher Professor Ian Flitcroft from Ireland, has visited Australia to speak to optometrists about myopia and to provide tips for its proactive management.
At events across the eastern seaboard of Australia hosted by CooperVision, Professor Flitcroft described the incidence and prevalence of myopia, stressing the importance of a multi-pronged approach to managing what has become a global epidemic.
Prof Flitcroft said despite there being two billion myopes worldwide, there is a relatively low level of awareness of the condition – analysis of online searches for myopia indicates awareness of, and interest in, myopia equates to that of table tennis and volleyball.
Early intervention is important for kids with myopia and we have very good evidence over four years that show how MiSight 1 day can manage the condition
Education is needed so that individuals change their behaviour and governments create relevant policy to help reduce myopia’s progression.
Prof Flitcroft said after age, myopia is one of the strongest risk factors for many conditions, among them glaucoma, retinal detachment, cataract and myopic maculopathy. Indeed, the risk factors of myopia are on a scale that is equivalent to those of smoking and high blood pressure, yet he said the public pays it no attention.
Importantly, the risk factor is monotonic – which means that every dioptre of myopic progression pushes a patient up the risk curve, and every dioptre of progression that can be stopped helps.
He said preventing high myopia is critical but reducing any myopia by halting or slowing abnormal elongation of the eye is just as important. Delay of myopia for as little as two years can significantly and positively impact a person’s long term ocular outcome.
Prof Flitcroft explained that acceleration of eye growth starts up to five years before onset of myopia. Growth is most rapid in the first few years then progressively declines until final stabilisation. He said research has shown that children at risk of myopia go on a different path five years before they become myopic. “That’s five years during which something can be done to slow progression,” said Prof Flitcroft.
Public Definition Should Be Promoted
With so little understanding of the long term ocular consequences of myopia outside the health and science sector, Prof Flitcroft said he had come up with a useful definition which communicates the serious nature of the condition.
He said myopia should be defined as, ‘The commonest ocular disease world wide that leads to disability without optical correction and, even when optically corrected, is a risk factor for a wide range of other eye diseases and visual loss in later life’.
“It’s not scientific but it sends a message for the general public and for politicians,” said Prof Flitcroft.
Stressing the need to take control of myopia, Prof Flitcroft said:
We need to deploy:
- Environmental / behavioural interventions (at individual and policy level – outdoor time, age of commencing school etc),
- Optical interventions, and
- Drug therapy (both optical interventions and drug therapy can be combined).
He said the aim is to treat:
- Those at risk of becoming highly myopic (“they should not be missed”),
- Any progressing myope, and
- Pre-myopes
The goals of treatment are to:
- Prevent myopia, and
- Ensure every myope ends up as low a myope as possible, so they have heathy eyes in their 50s and beyond.
Speaking of management plans and treatments for myopia, Prof Flitcroft commended the tools that have been developed by Brien Holden Vision Institute including the myopia calculator and online learning resources.
Practice Building Potential
Optometrist Oliver Woo spoke about his passion for treating children with myopia and the role myopia management has played in differentiating and building his practice. He was one of the first optometrists in Australia / New Zealand to have begun using CooperVision’s MiSight 1 day lens in 2011 when it was introduced to a small number of practices.
“99% of my myopia patients have stayed under my care and management. Most of them first came to me when they were aged between eight and ten, and I will treat them for myopia until they go to university and perhaps beyond – it is a lifetime commitment for both patient and practitioner.
“I usually end up treating the families of my young patients too, and because they talk to their friends and extended family, the referrals keep growing.”
Mr Woo said he has he has achieved good results from MiSight 1 day contact lenses in his practice.
“Early intervention is important for kids with myopia and we have very good evidence over four years that show how MiSight 1 day can manage the condition.
“You do have to be very patient when fitting children with contact lenses and when teaching them and their parents about the treatment – communication is very important because we need to make sure their contact lens wear is safe.”
He said as the only on-label product for myopia on the market, patients tend to be reassured that MiSight 1 day will actively control its progression.
Mr Woo urged practitioners to begin screening and treating appropriate patients for myopia. “Doing something (to treat myopia) is better than doing nothing – doing nothing is doing something,” he said.
The message was clear. Optometrists have a duty of care. Doing nothing for myopic children will be detrimental to the child’s learning, their future prosperity and their long term ocular health.
