New Guide From J&J Vision For Progression of Myopia in Children
Myopia is a continuum of disease stages which should be assessed as early as possible. Myopia may continue to progress beyond the teenage years and the associated disease risk increases exponentially with severity of myopia, making early diagnosis and treatment crucial to lifetime eye health.
Early myopia onset increases risk of high myopia Myopia progresses more quickly in younger children. Because early onset implies more years of progression, myopes younger than 12 are at greater risk of developing high myopia.
This is why it’s essential to examine children at least once between the ages of 3-5 years to establish baseline measurements and examine all children at least annually until they reach 18 years old.
Myopia is sometimes called ‘nearsightedness’ but it is much more. It is a chronic and progressive disease that poses the biggest eye health threat of the 21st Century.
Additionally, half of the world’s population is projected to be myopic by 2050 with one billion people expected to have high myopia.
“As optometrists, we have been concerned for the eye health of children and the trajectory of myopia on a global level, and COVID-19 has only increased our concern,” said Noel Brennan, MScOptom, PhD, FAAO and Clinical Research Fellow, Myopia Control Platform, Johnson & Johnson Vision.
“Johnson & Johnson Vision in partnership with leaders in optometry has created this new myopia management guide as a clinical response to address the rising rates of myopia globally and solidify our collective commitment to combating myopia as a major threat to our children’s eye health.”
Myopia may be caused by both environmental and genetic factors, and it increases the risk of myopic macular degeneration (MMD), staphyloma, retinal detachment, primary open-angle glaucoma, and cataracts – all of which can lead to visual impairment and blindness.
The new recommendations bring greater awareness to the urgent need to assess, monitor and treat myopia in children.
“Doctors of optometry are on the primary eye care frontlines battling this crisis and it is imperative to deliver forward-looking clinical information, grounded in emerging data and first-hand, real-world experience,” said Robert Layman, O.D., President-Elect, American Optometric Association.
“In collaborating with Johnson & Johnson Vision and this group of leaders, we are providing doctors with information that will enable them to deliver individualized patient care that will support the patient throughout their childhood and into adulthood.”
Managing Myopia: A Clinical Response to the Growing Epidemic adds to the collective awareness, research and understanding of myopia and provides a research-based rationale for how and why we need to prioritize the eye health of children.
“The new recommendations to help slow the progression of myopia are a great step forward for our children,” said Ken Tong, BSc Optom, President, Singapore Optometric Association. “Traditional ways have taught us to simply change glasses upon prescription updates.
However, this is a dangerous act as there is bound to be a rapid progression of myopia during childhood. This situation is too common in clinic, where our practitioners see myopia in children increase over time.
An increase in myopia compromises the structure and health of the eye, meaning a greater risk of eye disease and vision loss. As such, myopia control methods must be implemented to curb preventable eye diseases from progressing.
If there is no intervention in a myopic child’s visual system, myopia will continue to worsen and present greater threats to eye health over an individual’s lifetime.”
Key points for eye care professionals and patients to consider based on the new guide include:
- Monitor for myopia in children: Based on guidelines from the American Optometric Association (AOA), children need eye examinations between the ages of 6-12 months and at least once between ages 3-5, then annually through age 17.
- Secure early treatment: The defining indication for beginning treatment is the onset of myopia. Identifying and treating myopia as early as possible is critical to slow progression.
- Find the right therapy: The right treatment for a myopic child depends on a combination of the practitioner’s advice, parents’ preference and the child’s capabilities and maturity.
- Knowing efficacy is similar across treatments, practitioners and families can choose the best option for each patient, including orthokeratology, soft multifocal contact lenses, myopia control spectacles or atropine eye drops.
- Monitoring myopia progression: Frequent monitoring, at least every six months once treatment is established, helps reduce barriers to use, identify non-compliant or risky behaviors, and address any problems as early as possible.
- Axial length and cycloplegic refractive error may be measured at frequent intervals, but should be evaluated over at least one year before considering therapeutic changes or supplemental therapy because progression can vary seasonally.
- Communicating myopia control efficacy: Myopia control treatment effect tends to be more of an absolute effect than a proportional effect. The best descriptor of myopia control efficacy is the cumulative absolute reduction in elongation or refractive error (i.e. total mm or D).