Sydney optometrist DR OLIVER WOO explains why colleagues need to be on the look out for pre-myopes and how prescribing plano defocus spectacle lenses has become a preventative tool in his practice.
Myopia management has been a core part of my clinic and professional life for the last 18 years. From early adoption of biometry, through to orthokeratology, specially designed soft contact lenses and low-dose atropine – we’ve remained at the pointy end of best-practice myopia care.
But the advent of defocus myopia control spectacles circa 2018 have completely changed the game for two key reasons.
The first is that during the first six months of COVID-19 in 2020, there was a surge in progression for many young patients. And along with lifestyle changes and increased screentime, the issue isn’t going away; many of them are young, under seven, and considered low myopes. Myopic defocus glasses have been an excellent option to intervene early.
The second is that these lenses have spurred a mindset shift towards prevention in those who aren’t myopic – yet.
One of the crucial steps has been an installation of the latest biometry machine with myopia software. It proved that – along with other treatments at my disposal – myopic defocused glasses effectively slowed progression.
Many parents are concerned about their children’s “hyperopic reserve” – a safety threshold of +1.50 D until age eight – and their axial length. They visit regularly for monitoring. We used both the myopia software and the growth charts for reference, with visualisation playing a crucial role in getting parents on board and refining my treatment strategy.
Communication and explanation about myopia management are vital to the execution. One of the great resources is the ANZ Myopia Guidelines (2022). It helped us to explain the risks of untreated myopia and high myopia.
I love using these lines with parents:
• “These lenses act like a brake, slowing eye growth.”
• “They’re not a cure but reduce risks by over 60%.”
• “We don’t want your eyeball to keep blowing up like a balloon, it might burst when it’s too large!”
• “Let’s flatten the curve” – an instantly-recognisable slogan from COVID.
After flatten the curve in my patients for the last decade, I then pondered: what about the pre-myope? Is myopia ‘prevention’ possible?
I started using plano Stellest lenses to prevent and delay the onset of myopia for my patients in late 2021.
Essilor launched these lenses in Australia in 2022, which incorporate Highly Aspherical Lenslet Target (H.A.L.T.) technology. The latest data shows they slowed myopia progression by 1.75 D and axial elongation by 0.72mm on average over five years for all subjects, compared to the extrapolated control group.
But in pre-myopes, I’ve witnessed and documented many successful cases. I also presented a poster on it at the 2024 International Myopia Conference in China (Figure 1), and have over 100 pre-myope patients using plano Stellest in practice – most who are incredibly happy and satisfied.
My plano Stellest prescribing criteria:
• ≥3 consultations over six to nine months with biometry measured each visit.
• Cycloplegic refraction in the first visit is a must.
• Axial elongation >0.20mm and or refractive shift ≥0.50D in six months.
• Low hyperopic reserve relative to age norms.
• Family history of early-onset myopia.
Case: Hyperopic reserve and axial length changed significantly in six months
• Six-year-old Asian male
• Baseline (2022): Axial length: 23.40 mm (OD – right eye), 23.46 mm (OS – left eyeº. Rx: +0.75 -0.25 X 3, +0.75 -0.25 X 176, unaided 6/6 visual acuity.
• Six months post-COVID: Axial growth surged (+0.27 mm OD, +0.29 mm OS).
• Discussed the progression and lowering hyperopic reserve with parents. Plano Stellest was prescribed with a myopia management specific frame.
• 30 months post-intervention: Growth slowed to 0.18 mm (OD) and 0.19 mm (OS) with plano Stellest. Rx: Plano -0.75 X3 (OD) and Plano -0.75 X 176 (OS)
We witnessed a significant axial slowdown of 0.27mm/six months vs. 0.18mm/30 months* OD and 0.29mm/six months vs. 0.19mm/30 months* OS, and the refractive changes for both eyes were much slower than before plano Stellest. With this approach, it’s great to demonstrate to parents the line has flattened with only a 0.12 mm change in their son’s eyeball length in the last 12 months. And he still has a plus reserve.
Myopia management is not only about slowing progression in axial length and refractive error in confirmed myopes. We can even do it before it comes.
By delaying each 1.00 D of progression, we reduce myopia maculopathy risk by 67%* and a 0.25 D reduction in myopia (equivalent to about 0.1 mm) yields close to a 10% reduction in risk.* We need to strive to detect and identify potential pre-myopes earlier from regular and comprehensive exams, communicate with parents about the risks to retinal health, and offer and execute the treatment plans and regular aftercare.
In my clinic, plano Stellest lenses have helped combat myopia in pre-myopes whose parents are resistant to the pharmacological approach. Reassurance and regular examination will ensure compliance in wearing the glasses more regularly during the day. I hope there will be fewer myopes in 2050.
More reading
Essilor Stellest lenses demonstrate continued long-term efficacy
Survey exposes how little parents know about their child’s myopia
Playing it safe: integrating UV safety with myopia control
