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January 26, 2022 |
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On the Road Again
I’m writing to you from the Global Specialty Lens Symposium (GSLS) in Las Vegas. By the time this hits your inbox I hope to have made it home safely, and whatever virus I was exposed to in Vegas, stays in Vegas.
Like last November’s American Academy of Optometry Annual Meeting, GSLS attendance by international participants was limited, but the numbers at both meetings were very strong. This demonstrates that our community values face-to-face meetings. As an industry executive opined to me last year, it’s easy to be efficient in online interactions, but it’s difficult to be effective. Of course, the two virtual, international participants in our session on Safety and Compliance were their usual effective selves.
The Global Myopia Symposium (GMS) will be online again this September, in part because of its extraordinary international flavor. The Education Committee is soliciting new and innovative courses and workshops on all aspects of myopia and its management. The deadline for submissions is February 15, 2022.
Mark Bullimore, MCOptom, PhD
mark.bullimore@pentavisionmedia.com
MYOPIA MANAGEMENT
By: Cheryl Chapman, OD
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Axial Length in Myopia Management: Like a Game of Chess
The biggest obstacle that many practitioners face when considering incorporating axial length instrumentation into their practices is the cost. Optical biometry is not a billable code for our purposes. So, it’s difficult to crunch the numbers and see the benefit. I challenge practitioners to think of it more like a game of chess. You must see the long game and see many moves into the future.
I set the stage early and often. I measure axial length on all kids at their eye exams; hyperopes and myopes alike. In doing so, I can identify very early on which hyperopes are at risk for transitioning to myopia (and when they will transition) and which myopes are progressing (spoiler alert: they almost always are). Once you have quantifiable and objective data that you have measured over time, the conversation with the parents is the next logical step. They know that you have been monitoring it and they trust you to tell them when it is time for intervention.
One of my favorite things ever is catching a kid right before he transitions from hyperopia to myopia and starting atropine when they are about +0.50D. Studies have shown us that axial length growth will accelerate up to 3 years prior to onset of myopia and even more so for the 12 months prior to onset of myopia.1 If you establish baselines early and identify these children before they transition, you can potentially keep them from ever needing glasses or at least keep their prescription extremely low. I think it is essential to have a documented rate of fast progression in axial length to provide that level of customized myopia management.
Worried about taking measurements on small children? You shouldn’t be. I would argue that it is about the same level of difficulty (perhaps even easier) than obtaining autorefraction on small children. You won’t get them all, but you will get many of them by the time they are 4 or 5 years old. We have been able to obtain measurements on kids as young as 2 years old.
Is it 100% Essential?
Can you practice myopia management if you don’t measure axial length? The short answer is YES. Practicing myopia management without axial length is better than not practicing myopia management at all. The long answer is, be prepared to move in the direction of adoption of axial length measurements in your protocols. I firmly believe that it will become the standard of care in the not-too-distant future.
References:
- Mutti DO, Hayes JR, Mitchell GL, et al. Refractive error, axial length, and relative peripheral refractive error before and after the onset of myopia. Invest Ophthalmol Vis Sci 2007;48:2510-9.
RESEARCH REVIEW
By: Mark A. Bullimore, MCOptom, PhD
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Roxanne….
Fans of 1970’s music or Eddie Murphy movies will be able to sing the line that follows the eponymous first word of the song. I was transported to this musical memory by two papers in respected journals hitting my desk this month, demonstrating the effectiveness of low-level red light therapy in slowing myopia progression. One paper was a retrospective case series,1 and the other a randomized clinical trial.2 In our world of evidence-based medicine, the latter carries more weight.
The use of light to improve vision has something of a checkered past. “Sunning”, or staring at the sun, is a component of the Bates Method, but let’s put any prejudices aside and look at the conduct and findings of the clinical trial. The authors randomly assigned 264 eligible myopic children, aged 8 to 13 years, to single vision spectacles with or without red light treatment for a year. The desktop light therapy device emits 650 nm red light with an illuminance of around 1600 lux and was administered at home for just 3 minutes per session, twice per day. Axial elongation was significantly lower in the treated myopes (0.13mm vs. 0.38mm), as was myopia progression (–0.20D vs. –0.79D).
So the results are impressive, and the 11 authors include a couple well-respected myopia researchers, but what is the mechanism by which tickling the retina with red light for a few minutes each day has such a dramatic effect on myopia eye growth? The light level used is higher than typical indoor and close to that for an overcast day. Also, how do we reconcile these data with the evidence that outdoor time has little or no effect on myopia progression? Other light therapies based on blue light and ultraviolet also show some promise, so why red light? We can probably eliminate the possibility of long-term genetic reprogramming based on years of our race associating red lights with slowing and stopping.
These studies are intriguing and exciting and I have provided more questions than answers. I will leave you with one more. Will red light therapy become part of our myopia control armamentarium? Only time will tell “if it's wrong or if it's right.”
References:
- Zhou L, Xing C, Qiang W, et al. Low-intensity, long-wavelength red light slows the progression of myopia in children: an Eastern China-based cohort [published online ahead of print, 2022 Jan 3]. Ophthalmic Physiol Opt. 2022;10.1111/opo.12939. doi:10.1111/opo.12939
- Jiang Y, Zhu Z, Tan X, et al. Effect of Repeated Low-Level Red-Light Therapy in Myopia Control in Children: A Multicenter Randomized Controlled Trial [published online ahead of print, 2021 Dec 1]. Ophthalmology. 2021;S0161-6420(21)00916-7. doi:10.1016/j.ophtha.2021.11.023
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GMS 2022: Submit Your Course for Consideration
The Global Myopia Symposium (GMS) is coming back this year, September 9-11. As the premier meeting focused solely on myopia and its management, the GMS provides cutting-edge, clinical information based on the most current research, for you to implement directly into your practice. Jason J. Nichols, OD, MPH, PhD, will continue to chair this premier event with help from the rest of the program committee: Mark Bullimore, MCOptom, PhD; Kate Gifford, PhD, BAppSc(Optom)Hons; Shalu Pal, OD; Jeff Walline, OD, PhD; and Oliver Woo, optometrist UNSW, Australia.
The Education Committee is seeking the submission of new and innovative courses and workshops on all aspects of myopia and its management in addition to related topics such as epidemiology, controversies, risks-benefits, diagnosis and treatment approaches, and practice management.
Courses may be submitted here. Submissions are being accepted until Tuesday, February 15, 2022.
WCO Releases Professional Guidance on Childhood Myopia Management
The World Council of Optometry (WCO) and CooperVision have partnered to release “A Practical Guide to Managing Children with Myopia.” The professional article is authored by four experienced ocular health and science professionals from around the world. It complements the WCO Standard of Care for Myopia Management by Optometrists Resolution, which embraces evidence-based approaches focused on the three pillars of mitigation, measurement, and management. The work is available at myopia.worldcouncilofoptometry.info/professional-article-english.
The authors include Dr. Carmen Abesamis-Dichoso of the Philippines, an Asia Pacific Council of Optometry representative for the WCO who operates her private practice, Abesamis Eye Care; Dr. Rufina Chan, a visiting lecturer at the Hong Kong Polytechnic University School of Optometry and who is in private practice; Dr. Kate Gifford of Australia, who works in clinical practice and is co-founder of MyopiaProfile.com; and Dr. Fuensanta Vera-Diaz of Boston, who serves as a reviewer for multiple journals and leads the New England College of Optometry’s Myopia Control Clinic.
CAO Releases Position Statement
The Canadian Association of Optometrists (CAO) has released a position statement on myopia management. The statement addresses risks associated with myopia, risk factors for development of myopia, impact of myopic eye disease, and myopia management options. It can be found here. The CAO supports the position of the World Council of Optometry and endorses evidence-based myopia management as a standard of care for all at-risk patients.
Campaign Launched to Create UK Myopia Strategy
A campaign called #MyopiaChat has been launched in the United Kingdom (UK) to facilitate a target of one million parent-practitioner conversations about myopia in 2022. The campaign has been set up by Tom Griffiths, director of Scotlens, with five questions about the delivery of myopia management for eye care practitioners (ECPs) to engage with from January to May. The questions and other information can be found at the group’s website.
Practitioner feedback will be collated and presented to the UK government with the hope of forming a myopia strategy that supports ECPs to better provide services to children and educate parents.
China Increasing Monitoring and Intervention for Myopia
The National Health Commission of China says monitoring and intervention for myopia among children and teenagers will be “stepped up”, in a bid to help improve eyesight among Chinese youngsters. The commission has formulated a five-year plan on vision care promotion, which listed youngsters and senior citizens as key populations susceptible to eye problems, and said the mechanism for tracking myopia rate among youngsters and detecting relevant influencing factors shall cover all counties and districts across China by the end of 2025. The commission also plans to expand the coverage rate of eye care and vision tests to more than 90 percent for children aged six and below by the end of 2025.
Clinical App Adds New Features for Myopia Management
Eyeli, a clinical app with complete online test cards and additional features for myopia management, has released a new version for 2022. The tablet-based app includes digitized tests for color vision, suppression, stereo acuity, accommodation flexibility, phoria, fixation disparity and fusional reserves. The myopia management module includes a myopia risk assessment and axial length estimator. Smart analytics automatically calculate, interpret, and compare test results to normative data. Results are interpreted and presented in a user-friendly report that can be tracked over time and instantly sent to patients from the app. Eyeli further assists with selecting treatment suggestions, based on the latest peer reviewed efficacy studies.
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Annual Incidences and Progressions of Myopia and High Myopia in Chinese Schoolchildren Based on a 5-Year Cohort Study
The purpose of this study was to determine the annual incidences and rates of progression of myopia and high myopia in Chinese schoolchildren from grade 1 to grade 6 and explore the possible cause-specific risk factors for myopia.
From 11 randomly selected primary schools in Anyang city, central China, 2835 grade 1 students were examined, with annual follow ups for 5 years. Students were invited to undergo a comprehensive examination, including cycloplegic autorefraction, ocular biometry, and standardized questionnaires.
The mean spherical equivalent refraction decreased substantially from +0.94 +/- 1.03 diopter (D) in grade 1 to -1.37 +/- 2.08D in grade 6, with rapid annual myopic shifts, especially for students in grades 3 through 6 (-0.51D to -0.59D). The prevalence of myopia increased substantially, with the yearly incidence of myopia increasing from 7.8% in grade 1 and 2 to 25.3% in grades 5 and 6, and the incidence of high myopia increased from 0.1% to 1.0%. The 5-year incidence of myopia was lowest among children who had a baseline spherical equivalent refraction of greater than +2.00D (4.4%), and increased to nearly 92.0% among children whose baseline spherical equivalent refraction was 0.00D to -0.50D. The incidence of myopia was higher in children who had less hyperopic baseline refraction, two myopic parents, longer axial length, deeper anterior chamber, higher axial length-corneal radius of curvature ratio, and thinner lenses.
The authors concluded that both the annual incidence and progression rates of myopia and high myopia were high in Chinese schoolchildren, especially after grade 3. They say hyperopic refraction of children should be monitored before primary school as hyperopia reserve to prevent the onset of myopia and high myopia.
References:
- Li SM, Wei S, Atchison DA, et al. Annual Incidences and Progressions of Myopia and High Myopia in Chinese Schoolchildren Based on a 5-Year Cohort Study. Invest Ophthalmol Vis Sci 2022;63:8. https://doi.org/10.1167/iovs.63.1.8
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