How Steep Is Your Myopia Management Learning Curve?

Three decades ago, we had OrthoK and 1% atropine. Today the toolbox is overflowing. So why are so many ODs still dabbling?

I am a bit envious of my younger colleagues. When my generation walked into the myopia epidemic, we had OrthoK, 1% atropine, and a long list of things we suspected but couldn't prove. They walk in with MiSight, Stellest, low-dose atropine on the horizon, and a research base that grows every quarter. The question is what they — and you — are doing with all of it.

While our learning curve with OrthoK was indeed steep, it was not so much directed by reductions in progression, while that sometimes indeed happened, but rather to the nuances of fitting the cornea to allow for a temporary reduction in myopic error to allow seamless vision during waking hours. We knew we were impacting the myopic progression at the time, but we didn’t know the exact mechanism. That would have to wait for Earl Smith’s groundbreaking work with primate eyeballs.

As for Atropine (1%), two decades of work in Taiwan with one of the fastest-progressing populations on the planet had shown it to be effective while you used it but subject to a rebound effect once treatment ended. Besides, patients needed a tinted lens for outdoors in the form of a bifocal due to the reduction of accommodation. At the end of the millennium, this was rather daunting, and few took this road. It was comforting that if you happened to be a member of the OAA/AAOMC, you had ready access to the pioneers in the field like Jeffrey Cooper and Tom Aller, who readily shared their research.

The Toolbox Has Exploded

Today we have so much more to talk about, and it’s exciting, to say the least. With MiSight and Stellest FDA approval for myopia control, we have a new awareness among our colleagues and the lay public that our field is serious about the myopia epidemic. Perhaps soon we will also have an approval for low-dose Atropine (Sydnexis) to add to the myopia control toolbox. And while it’s unlikely we’ll see OrthoK approved due to the lack of a washout measuring period in studies so far, the abundance of research and studies on this alone dwarfs the rest.

Beyond the Lens: Lifestyle, Behavior, and RLRL

Studies have shown that lifestyle modifications like increased outdoor activity and reduction in progression, especially as intervention is started early in a child’s life, are very effective. We are not far behind behavioral modifications like vision training taking their rightful place in the battle to slow myopic progression. Perhaps someday soon RLRL therapy can be considered safe enough to be utilized here in the US as well. Will some of the next frontiers for a myopia specialist also include dietary modifications and supplementation of specific minerals and vitamins? Only time will tell.

The Glaucoma Test

The possibilities are almost endless. Which brings me to the point of this piece. How steep or flat is your myopia management learning curve? Are you a colleague who is immersed in the field, plugging in new therapies and bringing patients back for timely updates, or are you still a dabbler treating a random patient a day? Are you attending conferences like VBD and GSLS often? Do you update your staff in a timely fashion about everything that is happening today in myopia management? Are your resources adequate enough to allow for the investment in new technology like biometers or newer topographers linked to advanced lens design software?

"Are you a colleague who is immersed in the field… or are you still a dabbler treating a random patient a day?"

If you are treating glaucoma in your practice, you wouldn’t hesitate to have all necessary technology and seek the best advanced education to stay on top of your field. Myopia management is no different. So again, how steep is your MM learning curve? If it’s flat or leveling off, perhaps it’s time to reassess what’s going on in your specialty, making the necessary changes to again steepen the curve.

"If you are treating glaucoma in your practice, you wouldn't hesitate to have all necessary technology… Myopia management is no different."