Myopia Management - A brighter future for our children!
Myopia Management is one of the key topics for discussion at the Nordic Contact Lens Forum (NCLF) 2019. Erik Robertstad has practised optometry in Norway since 1998 and was awarded the title “Optician of the Year” at the 2018 NCLF event. Here he looks at how myopia management is improving the lives of young patients all around the world.
Tell us a bit about your background in myopia management.
Erik Roberstad: I’ve always been interested in why near-sightedness affects so many people. It is a question that has been puzzling scientists for centuries - right back to Da Vinci and Kepler. So, academically, it is a fascinating topic.
Since I was a student, I’ve been involved with various research programmes looking at ways of influencing or changing the progression of myopia in children and young people.
My early inspiration was the research done by John Phillips and others, who, by putting a myopia control lens in one eye and a normal lens in the other during the night, found that the eye growth with the normal lens was faster. So, the myopia control lens slowed the eye growth and therefore reduced the myopia.
This was quite a small trial back in 2008, but we were heavily influenced by that and a few years later started sitting our first patients with off label products for myopia management.
Why is myopia management so important for younger patients?
ER: Myopia typically affects you when you are young and levels out when you stop growing. Studies have found that, on average, myopia increases by around 0.5 minus points each year.
So, we look at offering these specialist contact lens solutions for children, teenagers and young adults who still have years of growth ahead of them - and the amount of minus power is still increasing.
The idea behind myopia management is to slow down the progression so that the eye will not grow as fast as with spectacles or ordinary lenses.
We have shown that we can slow the progression by 50% on average - so it is certainly clinically meaningful. In some patients, we have found that myopia management can halt the progression altogether.
The contact lenses we offer to younger patients can be in the form of daily soft lenses or monthlies, but the best results come from lenses that are worn during the night - as those have been proven to actually stop the cornea growing, and therefore prevent the myopia from increasing.
How have social trends in young people - like the increased amount of screen time - affected myopia?
ER: It’s interesting, but I think there is possibly slightly less myopia in Norway and Sweden than there is in other parts of the world. There was a recent study in Nature that made the hypothesis that this was because children spent more time outdoors and less time on electronic devices. But it’s worth clarifying that there are still plenty of people in the Nordic region growing up myopic and the most important thing for practitioners like me is: What do we do about it? It doesn’t matter whether 15% of the population are affected or 30% - we still need to help the child in front of us. We need to consider the best advice for that child or parent.
What are some of the challenges and risk factors with myopia management treatments?
ER: Age is probably the biggest consideration, because the younger the patient is, the more time the myopia has to develop while they are still growing.
Younger children who present when they are around 8-12, might well have a decade or more of significant deterioration ahead of them. So, it is important we do what we can to slow that progression down.
The main challenge is around fitting young children with lenses. There is no professional argument against it, but younger patients can find the process difficult - particularly boys, interestingly. Often the key to solving that is around motivating the parents to inspire their children and explain the benefits of slowing the myopia. Sometimes, we will postpone for a year which gives us a chance to collect more data on how fast a child’s myopia is increasing - and then it is easier to motivate both children and parents.
There is a slightly higher risk in eye infections in using lenses versus wearing spectacles, but we believe that is nothing compared to the longer-term health risks associated with severe myopia - which can lead to serious issues like glaucoma, retinal disease or other conditions that are much more harmful to the eye than an infection caused by wearing lenses.
What is the most rewarding thing about the work you do?
ER: Often it is seeing the reaction of parents, particularly those who have suffered from myopia themselves. They remember when they were young - and every time they went to see the optometrist, the power of their prescription increased. So now, when they bring their children in every six months and we can tell them: “nothing has changed”, they think: “This is great!”