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CONTACT LENS PRACTICE PEARLS

BILLIONS OF PEOPLE CAN’T BE WRONG—OR CAN THEY?

You’ve probably heard that just because everyone jumps off a bridge, that doesn’t mean that it’s a smart idea. Following the crowd is something that our parents always warned us about. While the majority is a safe place to be, it doesn’t mean that those in the majority are right.

I have traditionally thought of myopia as an inconvenience. You need to wear glasses? Not a big deal, so do billions of other people. Contact lenses are certainly an option if you want to be free of glasses. We have all come to accept this fact and are comfortable with it.

Low amounts of myopia may even be a good thing, right? A prescription of –1.00D or –2.50D can offer freedom from wearing glasses for near work when we become presbyopic. Patients who have higher prescriptions do not have this luxury, but at least there are glasses and contact lenses for them.

The Truth About Myopia

These have been my sentiments for the last 15 years, but now that has all changed. Now I realize that no amount of myopia is acceptable. Patients who have even small amounts of nearsightedness are at substantial risk for glaucoma, maculopathy, and retinal detachments. As the prescription goes up, those risk factors skyrocket.

Think about your own practice. How many pre-cataract surgery patients in your practice have high amounts of myopia and healthy retinas?

I started reflecting on this, and time and again, high myopes who have pathology started crossing my mind. Again, and again, I could see these patients’ faces in my mind: real people who were emmetropes 50 years ago, but now they are progressive myopes. They are taking medication for their glaucoma, getting injections for their maculopathy, and returning to the clinic every time that they think there is a floater because they’ve had a detached retina and are worried that something else has happened.

One of my patients is not elderly. She is a 28-year-old myope who has such severe maculopathy that she is getting regular injections to maintain what little vision she has left. She has recently needed to come to terms with the reality that if she was to get pregnant and stop her injections, she would lose her vision. As such, she recently made the difficult decision to not have children of her own.

If you were to ask these high myopes whether they would have wanted a technology that could have slowed down their myopia progression had it been available when they were younger, what do you think that their answer would be? I think that we all know the answer to that question.

It’s Time to Manage Myopia

Are you following the crowd and using regular eyeglasses or contact lenses to correct just the refractive error from myopia? Or are you doing what you can to stop the progression of myopia? Myopia management should not be a “specialty.” It should be mainstream.

Any eyecare practitioner who sees myopic children under the age of 18 has the choice to either manage this condition or to accept the consequences of billions of myopic patients on our hands. It’s time to take our heads out of the sand and make myopia management mainstream. CLS