From Alpha to Delta, the pandemic has been a wake-up call to optometrists involved in myopia management.
We thought we had myopia under control. We thought we knew everything there was to know. But we didn’t, and we don’t.
What we do know is that we need to change our mindset. We need to constantly educate ourselves on emerging evidence surrounding myopia management; and we need to be confident in communicating with parents about products and technology with proven efficacy for myopia control.
From lockdown to freedom and back… from lockdown to lockdown, then lockdown again… How has your life changed since the arrival of Alpha? How did your practice and professional life change? What were the good things to come from COVID-19? What did you need most during the pandemic?
Was it a reserve of 100 toilet rolls? Or the plus reserve for our youngsters?
when you get everything right, your patients will take their myopia management seriously; they will appreciate your efforts and experience the results. The way you make them feel will never be forgotten
The pandemic could have been great for myopes. Restricted movement during this time presented one of the best opportunities to slow its progression by spending at least two hours a day outside and safely gaining the benefits of UV exposure. But we failed to take advantage.
Frustratingly, rather than enjoying family time outdoors, exploring the local parks, waterfalls and gardens around our homes, we sat in front of our screens.
We enjoyed being at home too much; doing lots of work, studying hard, spending plenty of time on Zoom and becoming experienced online shoppers.
Hardly a great example to set for our young kids and myopes who need to spend at least two hours a day outside to protect their long-term vision…
Like me, you have probably witnessed an increase of myopia progression during our journey through the Alpha and Delta variants of COVID-19.
I have significantly changed the management of my myopia patients. In an effort to reverse the impact of increased screen time and decreased outdoor time, I have had to review and revise my protocol and management plans.
We always knew that environmental factors played a major part in myopia progression, but few realised the additional negative impact that home schooling and online learning would have.
Consequently, we have realised the need to regularly examine our young patients at risk of myopia, as well those with myopia, to detect any signs of physiological and visual changes.
Detecting pre-myopes and identifying risk factors for individual patients has become more important than ever before as this enables early intervention and preventive work, which is the best thing we can offer.
PUT YOUR KNOWLEDGE TO USE
If there was one professional benefit of COVID-19, perhaps that was to afford us time to upskill and increase our knowledge on ocular diseases, among them myopia. In fact, the hottest optometry-related search topics in the last 12 months have been ‘myopia’, ‘myopia control’ and ‘myopia management’.
With so many webinars focussing on myopia during the lockdown, it’s hard to imagine there are any optometry practices around the country that remain unaware of the importance of managing myopia or the (limited) on-label and (many) off-label products available to do it.
I’d like to encourage you to be courageous in embracing all the technology available, from dual focus soft contact lenses and extended depth of focus contact lenses, to defocus ophthalmic lenses, orthokeratology lenses and atropine. They’re all great in managing myopia.
The trick is which technology to start using first and, armed with all the knowledge from the lockdown webinars, perhaps you’ve been left unsure. Or perhaps you don’t have all of these technologies at your disposal.
Don’t worry. If there’s one thing I am sure of, from my many years of experience, it’s that myopia management is like cooking. You’ve probably had enough great ingredients sitting right in front of you all along, and now you have the recipes too. All you need now is to add your love, commitment and patience.
Remember, this is not fast-food. To achieve the best end result, patience is essential.
Finally, you need to share your knowledge with your patients and their parents so they know why ‘following the recipe’ is so important, and they understand the dangers of not doing so.
Believe me, when you get everything right, your patients will take their myopia management seriously; they will appreciate your efforts and experience the results. The way you make them feel will never be forgotten.
YOU CAN ‘VACCINATE’ AGAINST MYOPIA
With so much discussion on myopia management, and so much demand for expertise, you may be wondering whether it’s time to transform your business into a dedicated myopia management practice.
The answer is there’s no need. Regardless of whether you are an independent practitioner or part of a corporate group, you can offer advice and solutions to protect against myopia at any time and to any extent.
Perhaps more important questions to ask are:
If you’re not currently offering patients any level of protection against myopia progression, why not?
Why are you holding them back from accessing this sight saving treatment?
We all know that axial elongation is irreversible. We need to slow the growth and flatten the curve as fast as possible.
If there is a six-year-old child sitting in your consult with -1.00D, axial length of 23.89mm OU and some binocular vision issues, what will you go to do to minimise potential risks to their retinal health in the future?
We all need to use the optimal strategies to manage myopia.
EFFICACY
What are you looking for; 60%, 70%, 80% or 90%? This is not about vaccinating the entire population against COVID-19.
When talking about measuring efficacy in myopia management, biometry is fast becoming the gold standard. Refractive error, measured in dioptres (D), is an indicator when diagnosing myopia, and axial length (mm) gives the most accurate indication of whether or not our management plan is working to slow myopia progression.
It is critical that we approach myopia management with evidence-based studies and treatment plans. These days, we have access to devices equipped with myopia software, backed by great scientific and evidence-based data, which can help us understand whether the management option/s we are using are achieving optimal results. These devices also empower us to communicate with patients and their parents about the urgency in managing myopia and the management options we are going to use for them. Unfortunately, many parents still do not understand that myopia is a disease – we need to continue to increase awareness among both parents and our profession.
Fortunately, we are now seeing a growing global commitment to awareness campaigns. Increasingly, the industry is collaborating to ensure eye care professionals and the public alike recognise that myopia is not just about Ds. It’s about controlling the mms… in axial myopia!
INTERVENTION
I am a strong advocate for preventing progression with early intervention, rather than controlling deterioration in myopia. We should be advising all pre-myopes and myopes to spend at least two hours a day outside and to safely expose their eyes to violet light (360–400nm wavelength) – these are the most effective strategies to supress myopia that are free and easy to implement. Early intervention to slow myopia progression, with any of the products we’ve discussed here, coupled with patient education, will lower the risks of serious retinal disease in later years. However, once a child is myopic, any myopia management product is better than a pair of single vision spectacles.
Let me share the story of a six-year-old girl who sat in front of me recently.
Miss L* came in for her myopia management assessment with her aunt. Her mum was unable to join them in the practice, due to her vaccination status.
During the assessment we found she was myopic; -1.50D OU and with axial length of 24.02mm OU.
After a detailed explanation using evidence-based information, and a long discussion, we decided to use orthokeratology to manage her myopia. We had great success in the trial fitting assessment session and Miss L and her aunt went on their way.
This wasn’t your usual orthokeratology session. Despite my many years’ experience managing myopia, this consult was entirely new to me.
You see, the entire 75 minute consultation was live streamed with Miss L’s mum watching on from her home to witness how we, as orthokeratologists, were about to begin reshaping her daughter’s cornea to achieve 20/20 vision.
Much like the wet labs I attended during lockdown, I was able to take my existing myopia management practice to an entirely new level by embracing the latest technology and equipment. I believe that in 12-years’ time, I will be celebrating the success of Miss L’s myopia management with her, her mother and her aunt.
THINGS CHANGE
Things changed while we were in lockdown. While we couldn’t get to the pub for drinks, we were able to increase our alcohol intake from hand sanitisers… Clean hands are back!
Most importantly, we have learnt to adapt, using new technologies to manage the ever growing incidence of myopia, regardless of the environment in which we live and work.
Can we deliver the vaccination against myopia? Let’s work towards being the Omega to myopia.
*Patient name changed for anonymity.
Dr Oliver Woo is a clinical optometrist who is passionate about paediatric vision, myopia management and practice management. He has extensive experience in orthokeratology and lens design, and is an internationally recognised lecturer, mentor and educator in myopia management, especially in Asia. Dr Woo has delivered over 100 international presentations. He delivered two lectures at the World Ophthalmology Congress 2020 (WOC) on myopia and the latest contact lens technology for dry eye. Actively involved in many international organisations, he is a board director for the International Academy of Orthokeratology and Myopia Control (IAOMC), Chairman and Lead for Orthokeratology and Myopia Management of the Asia Optometric Congress (AOC) and the AOC Academy, Vice President and Councillor of the Asia Optometric Management Academy (AOMA), and education coordinator for the AOC and Global Myopia Symposium (GMS). He is on the NSW state committee of the Cornea and Contact Lens Society of Australia, a past board member of the Oceania Society of Orthokeratology (OSO) and a key opinion leader for several industries.
