I remember my optometrist first walking me over to the window and showing me my vision through my first prescription. I recall the shopping center and everything that I saw like it was yesterday. I was sold. I wanted to help people who had this same problem. I wanted to give glasses and contact lenses to people so that they could see. My focus has since shifted. No longer do I want to just help people see better, I want to stop their diseases as well. And the disease that I see more than anything else in practice—myopia.
When practitioners see myopia as a disease, they take it to task to find solutions for all myopic youngsters. If they have already recognized myopia as a disease, then they have already seen the incredible success that orthokeratology, soft multifocals, and atropine have revealed. Other treatment options are being researched and will continue to come out, but for now, these three dominate most practices.
I have come to realize the importance of education for both the patients and their parents. With preventative medicine, practitioners realize that outcomes need to be redefined. Practitioners should stress that myopia management is not refractive management. In its purest sense, it is the management of the disease of myopia and the quest to slow or halt its progression.
As with all other treatments, eyecare practitioners aim to do this with as little modification from normal vision as possible. However, optimal vision should never be the primary outcome. If a patient has a refractive error that is not fully corrected with myopia management, there are additional visual corrections that can be implemented to optimize their vision. Through all of this, the primary aim of myopia management should not be abandoned if it alone does not provide perfect vision.
A group that tends to fall into this category more than the others is that of myopic astigmats. With this in mind, if practitioners do partial correction with spherical soft multifocal lenses, or partial correction with orthokeratology, they are still able to correct the remainder of the prescription for their patients with spectacle lenses—and there is nothing wrong with this approach.
However, if practitioners want to target the cylinder with contact lenses, several options are available. With orthokeratology, many of the patients who have residual cylinder have a limbal astigmatism that requires a contact lens with altered peripheral curves. The majority of the orthokeratology manufacturers have a design to match this limbal astigmatism, but they need to be made aware of it either through topography or a detailed description. Work with a consultant directly using topography.
When fitting a soft multifocal contact lens, there are options available that have a distance center (my preferred) and a toric power. These can be ordered through a distributor, or they can be custom made through a specialty soft lens manufacturer.
A point of warning: once practitioners begin to focus on the refractive outcome, these patients may become hypercritical of the visual outcome and require a significant amount of time to achieve their desired outcome. As such, eyecare practitioners may want to adjust their fitting fees to match the inevitable additional time and costs.
Myopia management is a new normal. If physicians are waiting for evidence, it’s here. If they are waiting for effective treatments, those treatments are already here. Jump aboard the train and become part of the solution. Whether spherical, low cylinder, or high cylinder, there are approaches that can work for each patient. Whether spectacles are chosen as an additional treatment, or whether practitioners aim to target the whole refractive error, they must ensure that they are prepared for the conversation. Ignoring the problem is no longer an option. CLS