Orthokeratology (ortho-k) and other off-label modalities for managing myopia are gaining awareness in the general eyecare community, among the general public, and even in the medical community. But, are most eyecare providers prescribing these modalities? Are parents and patients flocking to eyecare practitioners seeking ortho-k? And, are pediatricians and pediatric ophthalmologists referring their patients for management of myopia progression? Sadly, the answer to these questions is a resounding “No” (Wolffsohn et al, 2016). At least, not until their kids become progressive myopes.
The number of articles on myopia management in journals such as this one is increasing. Local, national, and international eyecare meetings have been focusing more on myopia. Each month, studies on myopia and its management fill the peer-reviewed journals. But even with all of this attention, there has been only a meager increase in ortho-k prescribing and support for its use.
But, interest and concern may peak in clinicians and in parents when progressive myopia truly hits home: in their own kids. What follows are examples of this effect that I’ve seen over the past few years.
Now It’s Personal
A pediatric ophthalmologist referred a 9-year-old girl to me who had progressed from –1.50D to –2.75D in 10 months. The persistent parents had pleaded with him, saying: “We’re concerned about our daughter’s rate of increasing myopia. There must something else that you can do other than prescribing stronger glasses.”
Next, a pediatrician brought her 8-year-old son to our office to discuss myopia management after a recent eye exam elsewhere revealed that his prescription had progressed to –4.50 –1.75 x 180, up from –3.00 –1.25 x 180 one year ago.
The final example is of a family whose friend was our retina specialist. Their son similarly had a large increase in myopia over a six-month period. The family asked their retina friend about the risks of high myopia later in life. The doctor knew me as a colleague and had heard presentations that I had given, but he had never shown much interest and had not previously referred any of his patients. On this occasion, he emailed me with questions about ortho-k and low-dose atropine, then asked how soon his friend’s son could be seen.
The common thread here is that myopia does not seem to be of too much concern until it touches closer to home. This begs the question: “Shouldn’t we treat our patients/children as if they were our own?”
In a similar vein, I truly enjoy stories from fellow ortho-k practitioners who state that they fit their kids as soon as they became myopic. They understood the efficacy and safety of ortho-k as well as the risks of myopia later in life. When weighing the risks versus the benefits of various treatment options, they chose ortho-k for their own kids.
One Big Family
Ortho-k offers benefits over other modalities for correcting myopia (Lipson et al, 2005; Lipson, 2008), it is safe (Liu and Xie, 2016; Bullimore et al, 2013), and it provides clear vision (Lipson, 2008). Increased prevalence and incidence of myopia in combination with younger age of onset strongly suggest the need to educate patients and families about the risks of high myopia and the evidence-based alternatives to manage myopia. It’s time to embrace ortho-k and treat patients as if they are family. CLS
For references, please visit www.clspectrum.com/references and click on document #289.