I haven't posted in a while.  But, we are still here, still seeing our "myopia management" young people, and making a positive difference in their lives!  Please consider joining the effort to beat myopia!

I recently returned from my second annual meeting of the American Academy of Orthokeratology and Myopia Control, which was held outside of Chicago in Schaumberg, Illinois September 6-9.

Myopia Management is all about slowing the progression of nearsightedness (myopia) in children, roughly between age 6 years and 16 years, but often into the early 20’s for higher risk patients including those going off to college and graduate school.  This process reduces the risk of eye disease for the children later in life, while frequently having the young patients go through processes that make them less dependent on eyeglasses to see well, and in that process, improving their current self-image, self-esteem, and ability to perform.

I failed to capture a picture of myself in the limelight this year, but have a few photo memories of my time there.  Pictured above are a photo of our lecture hall while an orthokeratology lecture was in progress.  Also above is a photo of several presenters (faculty, if you will) who were at the meeting for whom I have gained a lot of respect, including Dr.Ken Maller, Dr. Cheryl Chapman, Dr. Matthew Martin, and Dr. Bill Tullo.
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I am actively doing Myopia Management here at Davis Hawley Eyecare in Enola.  The prime prospects are children 6-16 years old who are showing signs of trouble seeing things far away.  Those between 17 and 24 can also be helped, but the opportunity to make as big of a difference in outcomes is not as great.

It has taken some time to get our message out to our parents of young children, but Myopia Management has taken root here at Davis Hawley Eyecare!  We now have multiple patients in all 3 (you might say 4) methods of myopia management - MiSight daily soft disposable contact lenses, Orthokeratology (Ortho-K) overnight lenses, and low dose atropine.  (And, wide-lined bifocals for those on a more limited budget).  Axial length measurement is showing that these methods are working to help beat myopia and its long term consequences!

Washington State, that is!  Dr. Hawley attended the meeting of the American Academy of Orthokeratology and Myopia Control in Bellevue, Washington in late September/early October 2022.  The focus of these sessions was education in regard to orthokeratology lens designs, and myopia control with orthokeratology, peripheral defocus soft contact lenses, and low-dose atropine.  Even after many years in practice, there is SO much to learn!  This was a great meeting with rich educational content and doctors attending from the US, Canada, Italy, and other places around the world who are genuinely interested in helping patients fight the myopic menace!

2022 saw an update to a brand new corneal topographer (instrument that measures corneal curvature, corneal size, and tear film quality) in our office.  We now have the new Medmont Meridia Pro in our office, and we are so happy to be able to take our patient care to the next level with this instrument!

The short answer is that at this time, NO, myopia progression cannot be stopped completely!  

However, to borrow a phrase from recent popular culture, we can "flatten the curve" of myopia progression so that today's children are less likely to become tomorrow's victims of retinal detachment, glaucoma, and myopic macular degeneration!  These eye problems are more likely to present themselves after 40 years of age - but the seeds of these problems go back to their elementary school days in many cases.  We can alter the course of history for the kids for when they become adults - but they will have their hands tied when they are faced with these problems as older adults because at that point it's "water over the dam".

On a practical level, myopia management is the doctor prescribing, and the patient USING the prescribed modality to decrease the progression (not completely stop the progression) of myopia that would occur to the child if left to conventional means of correction (regular eyeglasses or regular contact lenses).

The main means of intervention in myopia management are 1) bifocal eyeglasses (there are specifics about this that will be the topic of a later post), 2) special contact lenses that cause peripheral myopic defocus such as the Cooper MiSight, 3) special contact lenses that are worn overnight that gently reshape the cornea such as the Paragon CRT lens, and 4) low dose topical atropine eyedrop treatment.  These are the workhorses of myopia management.
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Who gets myopia and why?  This is a very old question, and although research continues into this question - some things appear to be reasonably clear at this point.  There is an involvement of both genetics and environment in the development of myopia.  Ethnicity does play a role in a child's risk of developing myopia.  Highest risk is generally for those of East Asian heritage, particularly those with roots in the area of China or Korea.  The next largest risk group appears to be with those of European heritage.  Finally, those with African heritage are somewhat less at risk for the development of myopia.  The next risk factor usually considered is the number of parents who have myopia.  The risk of a child becoming myopic is greater if one parent is myopic than if neither parent is myopic.  Likewise, if both parents are myopic, there is a greater risk of myopia development than if only one parent is myopic.  In terms of the environment, children who spend several hours outdoors each day are less likely to become myopic than those who are always indoors.  Finally, those children who do a great deal of detailed near work (reading, computer, tablets, phones) are more at risk than those who do not participate as much in these activities.  If you have young children - getting them outside for 2-3 hours per day when possible is good advice that may have preventive value in the development of myopia.  Likewise, minimizing near work may be of value - yet this could present a parental dilemma in terms of deciding between the educational / learning value of near work versus risk of myopia.

Another common word for myopia is nearsightedness, or difficulty being able to focus on objects that are far away from us.  But that's NOT the whole story with myopia, and that's a huge part of the problem!

A big part of the PATHOLOGICAL process involved in myopia is elongation of the eyeball and the resultant increased risk of eye disease, especially as we get older.  The most common and potentially devastating disease processes associated with myopia are retinal detachment, glaucoma, and myopic macular degeneration.  These disease processes can cause significant loss of vision or even blindness.

So - this is the key concept that we need to understand - myopia is MORE than just a focusing problem!  It is in fact associated with very significant disease processes of the eye over our lifetime that can cause loss of vision or blindness.

Now - I don't mean to create hysteria over patients being or becoming myopic.  Not every patient who is myopic will develop an eye pathology!  However, just as in any scenario in life, an ounce of prevention can be worth a pound of cure - especially because for some of these pathologies relating to myopia - although there are treatments, there are no complete cures.  So ... reducing risk is the best we can do, just like when we wear seatbelts in our cars, or when we use safety glasses while operating power tools.

I'm starting this blog on July 5, 2021.  Our practice will be taking a new direction in the coming months regarding our care for our patients with myopia, most especially our young patients with myopia from ages 6 to 12, but also for some of our older patients with myopia.

Stay tuned ... more to come soon!