Myopia prevalence is increasing globally at a dramatic rate, with half of the world’s population predicted to be myopic by 2050 if the status quo persists. A patient with high magnitude of myopia is more susceptible to developing ocular pathologies such as myopic macular degeneration, retinal detachment and glaucoma. Controlling the progression of myopia is a part of routine optometric practice in some regions of the world and is becoming more common in the UK with the availability of CE-marked myopia control contact lenses. The College of Optometrists and the British Contact Lens Association (BCLA) have both issued guidelines on myopia management. In the first paper of this special issue, Jones and Logan offer evidence-based advice and practical tips on how to incorporate myopia management into clinical practice. They outline the myopia interventions currently available to clinicians in the UK and provide advice on how these can be implemented in a clinical scenario with a reasonable level of chair time while fitting children with contact lenses.
Orthokeratology is one of the most successful methods of myopia control and is considered to achieve this by altering the peripheral refractive error in myopes. Orthokeratology: background overview and unique case studies presents case studies of myopes corrected with orthokeratology despite having high levels of astigmatism or myopia. This paper shows the changes in peripheral refractive error that take place over the course of a day and demonstrates that sometimes orthokeratology can be successful for corrections outside the standard range.
The third paper in this issue, How effective are atropine eye drops at reducing myopia progression in children? provides a critical appraisal of the literature with regard to clinical use of atropine for myopia control. Low-dose atropine is an effective pharmacological myopia control strategy. Although not yet available commercially in the UK, clinical trials are ongoing at present and the drug could be adopted in the near future for myopia control.
Near work and outdoor activity are two of the major environmental factors influencing myopia development. In their paper, Accommodative function in myopes and the effect of myopia: management strategies on accommodative function and myopia progression, Amrizal et al. discuss the accommodative functions in myopes and how these are influenced by different myopia management options such as contact lenses and atropine. The paper concludes by suggesting that accommodation assessment is an important aspect of myopia management.
Differentiating myopic changes in the retina from other pathological changes such as glaucoma can often be complicated, as outlined in the article entitled Detecting glaucoma in myopes by Dr Sukumar, a glaucoma and IP-qualified hospital optometrist. The paper shows how OCT can be useful in differentiating glaucomatous changes from myopic degeneration and gives practical tips on what changes to look out for in the visual field when a patient has myopia and/or glaucoma.
The demand for myopia control is set to grow in the near future. I hope this special issue proves to be of interest and provides food for thought around myopia management.
