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. 2023 May 1;64(6):3.
doi: 10.1167/iovs.64.6.3.

IMI-Management and Investigation of High Myopia in Infants and Young Children

Ian Flitcroft  1   2 , John Ainsworth  3 , Audrey Chia  4 , Susan Cotter  5 , Elise Harb  6   7 , Zi-Bing Jin  8 , Caroline C W Klaver  9   10   11   12 , Anthony T Moore  7 , Ken K Nischal  13 , Kyoko Ohno-Matsui  14 , Evelyn A Paysse  15 , Michael X Repka  16 , Irina Y Smirnova  17 , Martin Snead  18 , Virginie J M Verhoeven  9   19 , Pavan K Verkicharla  20
Affiliations

IMI-Management and Investigation of High Myopia in Infants and Young Children

Ian Flitcroft et al. Invest Ophthalmol Vis Sci. .

Abstract

Purpose: The purpose of this study was to evaluate the epidemiology, etiology, clinical assessment, investigation, management, and visual consequences of high myopia (≤-6 diopters [D]) in infants and young children.

Findings: High myopia is rare in pre-school children with a prevalence less than 1%. The etiology of myopia in such children is different than in older children, with a high rate of secondary myopia associated with prematurity or genetic causes. The priority following the diagnosis of high myopia in childhood is to determine whether there is an associated medical diagnosis that may be of greater overall importance to the health of the child through a clinical evaluation that targets the commonest features associated with syndromic forms of myopia. Biometric evaluation (including axial length and corneal curvature) is important to distinguishing axial myopia from refractive myopia associated with abnormal development of the anterior segment. Additional investigation includes ocular imaging, electrophysiological tests, genetic testing, and involvement of pediatricians and clinical geneticists is often warranted. Following investigation, optical correction is essential, but this may be more challenging and complex than in older children. Application of myopia control interventions in this group of children requires a case-by-case approach due to the lack of evidence of efficacy and clinical heterogeneity of high myopia in young children.

Conclusions: High myopia in infants and young children is a rare condition with a different pattern of etiology to that seen in older children. The clinical management of such children, in terms of investigation, optical correction, and use of myopia control treatments, is a complex and often multidisciplinary process.

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Conflict of interest statement

Disclosure: I. Flitcroft, CooperVision (C), EssilorLuxottica (C), Johnson & Johnson Vision (C), Vyluma (C), Thea (C), Ocumetra (O), Myopia control monitoring tools and devices (P); J. Ainsworth, None; A. Chia, None; S. Cotter, None; E. Harb, None; Z.-B. Jin, None; C.C.W. Klaver, Bayer (C), Novartis (C), Optos (C), Topcon (F), Thea (C); A.T. Moore, None; K.K. Nischal, Essilor Luxoittica (C), Ocumension (C), Graybug (C), Santen (C); K. Ohno-Matsui, Santen (C), CooperVision (C); E.A. Paysse, None; M.X. Repka, Alcon (C), Luminopia (C); I.Y. Smirnova, None; M. Snead, None; V.J.M. Verhoeven, None; P.K. Verkicharla, Essilor India (C)

Figures

Figure 1.
Figure 1.
A comprehensive guide to the assessment, investigation, diagnosis, and management of high myopia in a hospital setting.
Figure 2.
Figure 2.
Guide for identification of cases that may represent secondary or syndromic myopia in a primary eye care setting and hence merit referral.
See this image and copyright information in PMC

References

    1. Gifford KL, Richdale K, Kang P, et al. .. IMI—Clinical management guidelines report. Invest Ophthalmol Vis Sci. 2019; 60(3): M184–M203. - PubMed
    1. Németh J, Tapasztó B, Aclimandos WA, et al. .. Update and guidance on management of myopia. European Society of Ophthalmology in cooperation with International Myopia Institute. Eur J Ophthalmol. 2021; 31: 853–883. - PMC - PubMed
    1. Verkicharla PK, Kammari P, Das AV. Myopia progression varies with age and severity of myopia. PLoS One. 2020; 15: e0241759. - PMC - PubMed
    1. Flitcroft DI, He M, Jonas JB, et al. .. IMI—Defining and classifying myopia: A proposed set of standards for clinical and epidemiologic studies. Invest Ophthalmol Vis Sci. 2019; 60: M20–M30. - PMC - PubMed
    1. Tychsen L, Hoekel J. Refractive surgery for high bilateral myopia in children with neurobehavioral disorders: 2. Laser-assisted subepithelial keratectomy (LASEK) . J AAPOS. 2006; 10: 364–370. - PubMed

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