Annual Risk of Microbial Keratitis
10 Year Period of lens wear to effect Myopia Control
Non-contact lens wearer |
0.014 % |
0.14 % |
Daily disposable soft CL |
0.02 % |
0.2 % |
Daily wear silicone hydrogel |
0.12 % |
1.2 % |
Ortho-k in children |
0.14 % |
1.4 % |
Table 1 : Comparative risk of Microbial Keratitis based on Contact Lens Wear . |
The effectivity of treatment has the mantra ‘ the younger the better ’. Most clinicians advocate close monitoring and fitting upon the first signs of myopia because under-correction has been shown to encourage progression . It is also possible to predict emerging myopia based on parental myopia , sibling myopia , lifestyle and other factors before the patient actually becomes myopic 5 .
The decision to commence contact lens fitting needs to be offset by the maturity of the child , their ability to handle lenses and the level of parent support to manage the risk of infection . Handling lenses is rarely a barrier to most children and as we are see more and more children becoming myopic at a younger age it is not uncommon to fit children as young as 8 with contact lenses .
The most effective time for starting myopia control has been shown to be for children under 12 years of age . Treatment should continue until the risk of progression has stopped . We are now seeing myopia progression through into young adulthood , especially when studying or near task demands are high . This means that more myopes are reaching greater levels of myopia than was seen just a few decades ago as the progression continues for a longer period . The clinical judgment to discontinue treatment is very individual and needs to be considered with regard to educational demands , the risks of progression and the visual quality with a multifocal lens , especially when driving . Many presbyopes experience good vision with multifocal lenses and are not restricted from driving . So treatment with multifocal lenses can continue well into the late teenage and early 20s age group if necessary .
Communication and compliance . Communication is always key to compliance . It is also important to understand the motivation of the patient and their parents and for them to understand the current clinical and practical limitations of practices in myopia control . The use of online predictive tools such as www . myopiacare . com can assist in demonstrating and offering a
Figure 8 Treatment should continue until the risk of progression has stopped
comparison to parents of any effect based on where the child was likely to be without intervention . Parents must have realistic expectations at the outset and throughout the treatment period . Each patient will respond to intervention differently and it is important to manage expectations as myopia development and progression cannot be prevented . It is important to present the limitations and the benefits of different treatment to patients or parents . Some children will develop high myopia irrespective of any intervention , and the extent to which progression is reduced may be unpredictable . When undertaking myopia control therapy , it is important to ensure that appropriate and valid informed consent is obtained 4 .
None of the options for the management of myopia is currently directly or indirectly funded through the NHS or recommended by NICE
Customised and holistic approaches
The aetiology of myopia progression is multifactorial , so it is the opinion of this author that an evidence-based holistic approach is adopted . This should include advice on lifestyle , outdoor activities and optical correction . These should not be considered in isolation but rather as a combined therapy based on an individual patient presentation . Myopia control is a very active area of current research and product development . Although there is still
16 etCETera | January 2017