With more proven treatments coming to market to slow myopia progression, DR JIM KOKKINAKIS says configured optical biometers like the OCULUS Myopia Master are becoming a must-have device for Australian primary eyecare professionals.
Prominent Sydney optometrist Dr Jim Kokkinakis has a philosophy to retire an old piece of equipment each year and install something new in its place. Without this approach, he’d struggle to provide the highest standard of care for the four key areas that differentiate his practice: myopia management, dry eye, specialty contact lenses and ocular therapeutics.
In the case of myopia management, this was a service Kokkinakis started offering almost by accident in the mid-1990s. His business – The Eye Practice located in Sydney’s CBD – began by prescribing orthokeratology (orthoK). Back then, this approach was used for vision correction purposes, with the literature in the proceeding years confirming orthoK’s myopia controlling effect. Newer contact lens and spectacle-based interventions, as well as atropine, round out his suite of treatments today.
Like many Australian optometrists, Kokkinakis had monitored progression by changes in the patient’s prescription, but as the industry moves towards the more objective, gold standard measure of axial length, it was imperative to make an optical biometer his latest investment. Recently, the practice installed the OCULUS Myopia Master, distributed by Designs For Vision, with the device having an immediate impact.
“Initially, I thought the Myopia Master would complement my myopia control but I think it’s taken over that part of my practice – it’s that impressive. It’s an old cliché that you don’t know what you don’t know, but it applies in here,” he says.
“Technology like this is what’s kept me in this profession, without it I would have been gone a long time ago.”
While the German-engineered device prides itself on accurate auto-refraction and keratometry combined with axial length measurement (using dual partial coherence interferometry) – it is the normative database collated by and in collaboration with the Sydney-based Brien Holden Vision Institute (BHVI) that sets the Myopia Master apart.
The software works in three ways, being: diagnostic, managerial and educational. Its analysis draws on a combination of measurement data, behavioural variables and genetic links to provide a holistic picture and approach to myopia control in an individual.
Being an inner-city practice, The Eye Practice doesn’t see the volume of children a suburban optometrist might. But Kokkinakis cares for a high number of adult myopes who often bring in their children for a second opinion, many whom have been prescribed a pair of single vision lenses.
“And that’s where the Myopia Master is so powerful with its ability to present visual graphs and projections into the future to show where a child might end up without treatment; it’s sobering to see, but it gets people motivated to take action,” he says.
“Previously, I had no concept of myopia progression risk going forward, other than looking at the parents and/or if the child spends a lot of time indoors reading or on an iPad. I’d only be able to go off the refraction, but now with the Myopia Master, I’m able to get ahead of the curve. We’re able to know what level of risk the child faces, all the way through to how much intervention is needed.”
Optical biometry cementing its place
Kokkinakis believes his new optical biometer has potential implications beyond myopia control. He says the longer the axial length, the stronger the likelihood of a patient developing a retinal detachment or other diseases. This helps him inform his eyecare for adult myopes, even if they have stopped progressing many years earlier.
“Refraction to measure myopia is an issue because you can have a zero prescription, but with a long eye. You are, in fact, anatomically myopic with all the associated risks, so refraction can only tell part of the story,” he says.
“But from the perspective of accurate management, if I was in the suburbs and seeing a large volume of kids, there’s no ifs or buts about the need for an optical biometer. Soon every second child that’s coming in is going to have some myopia: it’s like saying I’m going to practise without a refractor head, it’s insane.”
In fact, myopia is approaching, if not already at, epidemic proportions among youth. While more than 30% of the world’s population is currently myopic, by 2050 it is estimated that more than 50% will have myopia and 10% – or almost one billion people – will have high myopia.1
The increasing incidence is thought to be largely due to lifestyle factors with children spending less time outdoors and more time indoors doing near sighted tasks on phones, tablets and screens.2,3,4 This essentially makes it a by-product of the technological revolution, resulting in increasingly more children presenting to health practitioners, and at younger ages,5 often identified by difficulty seeing in the classroom.
It means primary eyecare professionals like Kokkinaks have been thrust into the fight to counter this rising problem.
Furthermore, research indicates that myopia is most commonly caused by increased axial length of the eye.6 The higher the degree of myopia, generally the longer the axial length, and with that comes increased future risks of serious complications like glaucoma, retinal detachment and myopic maculopathy.7
Early intervention is therefore recommended to minimise axial elongation, with various treatments now approved in Australia, including atropine drops, orthoK, distance-centre multifocal soft contact lenses, and new spectacle lens technology.8
But these interventions can’t be prescribed well without accurate diagnostics, hence why configured biometers like the Myopia Master have become an important tool for optometrists to both diagnose and manage progressing myopes.
Mr Malcolm Sketcher, from Designs For Vision in Queensland, explains that diagnostically the device takes raw data from the patient’s eye and compares that to a population of their peers, including specific BHVI data sets for Caucasian and Asian eyes.
The practitioner, patient and parent can then easily observe where the child is currently placed with relation to axial length and subsequent myopia compared to normative values.
“In managing known myopes, projected percentile growth curves provide accurate information on current status and future progression. The level of myopia in adulthood can be predicted, highlighting the consequences if intervention is not implemented and adhered to,” he says.
“Likewise, the effect of any intervention already undertaken is easily evaluated and explained to patients and their parents.”
Myopia Master also has an optional module called GRAS (Gullstrand Refractive Analysis System), which Sketcher says is proving popular among eyecare professionals.
It compares the patient’s measured data to a theoretical emmetropic eye, modified to match their age using BHVI’s extensive data.
It then identifies how much myopia is being caused by each component of the eye: axial length, keratometry and the crystalline lens/accommodation.
“When axial length is the major contributing factor, GRAS is invaluable in explaining to parents why treatment is so important,” Sketcher explains.
“This ‘educational value’ of the OCULUS Myopia Master should not be underestimated. The culmination of a complete exam is a take-home report for each patient and parent to aid in their understanding of the disease itself, whilst highlighting the importance of adherence to treatment and attendance at follow up appointments. The result is that a higher proportion of patients accept recommendations for initiating, continuing, or increasing treatment. In a world with billions of myopes, that can only be a good outcome for eye health.”
Getting patients invested in their care
Kokkinakis agrees. When weighing up which optical biometer to invest in, he says Myopia Master’s educational software and BHVI projections was the clincher.
“Once I was sold on the software, I then knew it would be easy for me to explain the benefits to parents,” he explains.
“As you’re going along, it plots new data points as the individual child is progressing. It projects from their age, when initiating treatment, all the way through to an adult, and where they will end up plus or minus some prescription. And then you can plot data points along as you capture more data and, hopefully, you’ll see the patient’s not progressing as fast as the graph is estimating.”
With around 40 years’ experience, Kokkinakis says he has learned to communicate effectively, believing patients respond better to several mediums.
“It’s not a matter of sitting down, grunting a few words and flicking them out the door with a bit of paper, saying here’s your new glasses. The way I explain it is that optometrists will differentiate themselves by appealing to the senses. The patient needs to see, hear and preferably feel something throughout their visit,” he says.
“With technology, of course, you can support that approach. The lights are flashing, the sound of the equipment, the puff of air when measuring for pressure – these all give the patient a very unique experience and hopefully get them to return and remain invested in their care.”
NOTE: References available upon request.
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