Short-sighted approach to myopia a problem

One of the largest threats to eye health worldwide is myopia, and we’re not doing enough to stop it.

There are a myriad of reasons for this, but the fact is in three years time 2.6 billion people – or one-third of the world’s estimated population – will be short-sighted. Worryingly, its frequency is only heading one way – up.

Even more concerning, are the multiple serious retinal conditions associated with myopia. Glaucoma, cataracts, retinal detachment and myopic maculopathy are all far more common amongst myopic patients compared with those who enjoy perfect vision.

Thankfully, there are tools already available that we can use to halt its progression. Unfortunately, too few of us are utilising them.

A 2016 global practitioner survey found that while the vast majority were concerned with the increasing incidence of childhood myopia, approximately two-thirds prescribed single vision spectacles or contact lenses as the primary mode of correction for myopic patients. This is despite the fact single vision lenses were perceived to be the least effective option available.

The main justifications for this reluctance to prescribe alternative treatments were increased costs (35.6%), inadequate information (33.3%) and the unpredictability of outcomes (28.2%).

However, having studied them almost exclusively for the past 10 years, I can tell you the evidence is in, and they work.

Multiple studies that have investigated multifocal contact lens designs have reported a 30–50% reduction in myopia progression. Most recently, researchers that tried to individualise selection of near addition in multifocal soft contact lenses reported reduction of myopia progression by 72% compared to single vision correction. Additionally, orthokeratology – an underutilised weapon in the optometry arsenal in Australia – consistently donstrates an approximate 45% myopia controlling effect.

Meanwhile, for the growing number among us who are able to prescribe pharmaceuticals, atropine has in some cases achieved up to 72% reduction in myopia progression. All myopia control treatments are ‘off label’ and not without their pros and cons, however, don’t you owe it to your patients (and your practice) to investigate any and every possible means of preventing the seemingly relentless march of vision impairment?

Furthermore, I believe concerns over the increased costs of these treatments are, for the most part, unfounded. Instead, I see these new treatment options as an opportunity, especially for independent practices.

The vertical integration of supply and massive marketing budgets of corporate giants makes it impossible for independent optometrists to match them in terms of volume sales. So why try?

Instead, I consider the extra chair time spent with patients explaining different treatment options and their potential outcomes for what they are – an investment.From my own anecdotal experience working at the dedicated myopia control clinic at UNSW, I have found that patients are loyal. They are willing to go ahead with treatment – even if it is more expensive than a pair of single vision lenses – if it means it will slow down their myopia progression.

These patients won’t just come in for a pair of glasses and then suddenly disappear. They’re people who will come to you year after year to receive treatment, monitor progress and possibly start another treatment. Or even another one.

Generally, they will do whatever it takes to best manage their, or their child’s, myopia progression.

I’m not here to try and dictate to people what to prescribe or how they should run their clinic. I’m simply asking you to explore the other options and come to your own conclusions about what’s best for you, your patients and your practice.

After all, if we continue down the same path of short-sighted treatments, the solution will only get further away and – as is the case with myopia – less clear.

Name: Pauline Kang, Qualifications: PhD, B.Optom (hons), GradCertOctTherOrganisation: School of Optometry and Vision Science, University of New South WalesPosition: LecturerLocation: SydneyYears in the profession: 10


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