EVALUATING PRE-MYOPIA AND MYOPIA

REFRACTIVE ERROR

  • Primary method for diagnosing myopia and a routine measurement in every comprehensive eye examination1
  • Accuracy and repeatability improve with use of cycloplegia and objective measurements (autorefraction)2
  • Strongly correlated with axial length,3 but substantially less repeatable than optical biometry even with cycloplegia4,5
  • Misleading interpretation can occur with orthokeratology and/or atropine

AXIAL LENGTH (Optical Biometry)

  • Primary metric for monitoring eye elongation
  • Highly repeatable measurement
  • Relates directly to the pathological processes in myopia
  • Doesn’t require cycloplegia
  • Less susceptible to changes in the anterior optics of the eye which may occur over the course of treatment such as orthokeratology or atropine therapy

EVALUATING PRE-MYOPIA AND MYOPIA image

MONITORING PRE-MYOPIA AND MYOPIA

KEY POINTS FOR MONITORING image

KEY POINTS FOR MONITORING

  • Young myopes will progress, so set this as the expectation6
  • Average treatment efficacy can be referenced from randomized clinical trials
  • Monitor myopia management therapy use, acceptance, and maintenance every six months
  • Evaluate progression using at least one (1) year of data to avoid seasonal changes and reduce measurement noise (even with optical biometry)
  • Treatment efficacy cannot be determined for an individual patient because there is no way to know how that individual would have progressed if left untreated
  • Refer to population-based normative data to assess progression (see Table 5)
Myopia management therapy use, acceptance, and maintenance should be frequently monitored following treatment initiation or modification and at least every six (6) months once treatment is established. Frequent monitoring helps reduce barriers to use, identify non-compliant or risky behaviors, and address any problems as early as possible, supporting safe and consistent use of the myopia management therapy.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.7 Knowing efficacy is similar across treatments, it is most critical that the treatment regimen fits the patient’s lifestyle, expectations, motivation, and their abilities.
KEY POINTS FOR MONITORING

KEY POINTS FOR MONITORING image

KEY POINTS FOR MONITORING

  • Young myopes will progress, so set this as the expectation6
  • Average treatment efficacy can be referenced from randomized clinical trials
  • Monitor myopia management therapy use, acceptance, and maintenance every six months
  • Evaluate progression using at least one (1) year of data to avoid seasonal changes and reduce measurement noise (even with optical biometry)
  • Treatment efficacy cannot be determined for an individual patient because there is no way to know how that individual would have progressed if left untreated
  • Refer to population-based normative data to assess progression (see Table 5)
Myopia management therapy use, acceptance, and maintenance should be frequently monitored following treatment initiation or modification and at least every six (6) months once treatment is established. Frequent monitoring helps reduce barriers to use, identify non-compliant or risky behaviors, and address any problems as early as possible, supporting safe and consistent use of the myopia management therapy.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.7 Knowing efficacy is similar across treatments, it is most critical that the treatment regimen fits the patient’s lifestyle, expectations, motivation, and their abilities.

EXPECTED PROGRESSION WITHOUT MYOPIA management

Eye growth should be expected in all young patients, with even stable emmetropic eyes growing around 0.1 mm per year from age 6 to 14.8 Younger myopes will progress faster on average, with average rate of progression in 7-year-old children nearly double that of 11-year-old children.6 Individual progression near the mean values by age in Table 5 should not be considered normal or healthy, since any myopia progression will exponentially increase associated disease risk. Individual progression rates vary considerably across the population.9

EXPECTED PROGRESSION WITHOUT MYOPIA CONTROL image

EXPECTED PROGRESSION WITHOUT MYOPIA management

EXPECTED PROGRESSION WITHOUT MYOPIA management

Eye growth should be expected in all young patients, with even stable emmetropic eyes growing around 0.1 mm per year from age 6 to 14.8 Younger myopes will progress faster on average, with average rate of progression in 7-year-old children nearly double that of 11-year-old children.6 Individual progression near the mean values by age in Table 5 should not be considered normal or healthy, since any myopia progression will exponentially increase associated disease risk. Individual progression rates vary considerably across the population.9

EXPECTED PROGRESSION WITHOUT MYOPIA CONTROL image

CAUTION WITH MYOPIA MANAGEMENT CALCULATORS

Myopia management calculators offer reasonable estimates of normal progression without myopia management therapy. The calculated myopia management effect, however, extrapolates a few years treatment effect for up to 11 years, omitting that treatment effect decreases over time and misleading users with overly optimistic treatment expectations.10

Review progression and compare to personalized goals

SAMPLE MYOPIA MONITORING SCHEDULE