Do you remember those campaigns in the early ‘90s when becoming environmentally conscious was just starting? I recall when recycling bins were a new thing, and we all thought how crazy it would be for us to have to keep track of what went in one bin versus the other. What a pain! How is this possibly going to make a big impact? Then, we realized that our environmentally friendly actions were having a noticeable impact. Fast forward 20 years, and we look disapprovingly whenever someone throws a plastic water bottle in the garbage; I get reprimanded by my family when I don’t properly rinse a pasta sauce jar before recycling it. We have come a long way and cannot imagine going back.
A Myopia Movement
What if this trend is mirrored for myopia, and 20 years from now, we look with proper disdain upon any colleague who accepts progressive myopia as a refractive error rather than a progressive disease? A child who develops myopia around 6 to 7 years of age has a 6.6x greater risk of developing a high prescription. While warranted, these disappointed looks are not being given yet; when it comes to myopia, we still have a lack of belief, a lack of understanding, and a limited number of treatment options. However, those excuses seem to be fading.
Nearly every eyecare publication was highlighting myopia in 2019 and plans to continue this in 2020. Every major optometric meeting that I attended in 2019 (and now in 2020) has had lectures, papers, and posters talking about myopia. There is research supporting the efforts that we are making. And, while this research is not new—it dates back 20 years in many cases—it is becoming more and more mainstream. We are reaching a tipping point with myopia (Figure 1). If you are not starting to incorporate its management into your practice, and if you are not talking with parents about it, you are behind.
Options at Hand
We have good options to handle myopia, but lack of approval tends to be the major excuse. Even though only one product has been approved by the U.S. Food and Drug Administration, research supports many efforts. From low-dose atropine, multifocal lenses, and orthokeratology, we have clinically realistic off-label approaches to bring into our clinics. Other options in the works include spectacle lenses, pharmaceuticals, and other contact lenses.
If you are not performing myopia management but you see children and they are progressing, it is time to draw a line in the sand. Do you disagree with the evidence of myopia’s progressive nature that substantially leads to pathological disease? Or, are you going to do all that you can to save your patients’ vision, even if it means referring them to someone who is using these treatments?
The Time Is Now
We are not waiting for the most ideal global recycling program, nor should we wait for the ideal global myopia solution. For patients in your exam chair today, it’s time to think global and act local. CLS
READ MORE: https://www.clspectrum.com/issues/2020/april-2020/contact-lens-practice-pearls
