Clinical management of progressive myopia

Abstract

Myopia has been increasing in prevalence throughout the world, reaching over 90% in some East Asian populations. There is increasing evidence that whereas genetics clearly have an important role, the type of visual environment to which one is exposed to likely influences the onset, progression, and cessation of myopia. Consequently, attempts to either modify the environment or to reduce the exposure of the eye to various environmental stimuli to eye growth through the use of various optical devices are well under way at research centers around the globe. The most promising of current treatments include low-percentage atropine, bifocal soft contact lenses, orthokeratology, and multifocal spectacles. These methods are discussed briefly and are then categorized in terms of their expected degree of myopia progression control. A clinical strategy is presented for selecting the most effective treatment for the appropriate type of patient at the optimal stage of refractive development to achieve the maximum control of myopia progression.

Figure 1

Shows the mean of five measures of the power profiles through the optical zone for some single vision soft contact lenses. Power measurements in the central 1 mm are less precise and are not shown. Data are re-plotted from Wagner.

Figure 2

Shows the power profiles for a single vision soft contact lens with additional minus power in the periphery, a lens with a flat optical profile and a lens with additional peripheral plus power. Also shown are the myopia progression rates associated with such lenses from several studies. Data are re-plotted from Holden.

Figure 3

Illustrates possible final refractive outcomes for five mythical sisters with identical initial refractive errors treated with five different treatment strategies over 18 years of refractive management.