Myopia Management in Ontario, Canada

Abstract

Objectives: To determine how optometrists in Canada manage their pediatric myopia patients and to assess whether this has changed over time. Methods: In a retrospective chart review, records for children aged 6-10 years who had an eye exam between 2017 to 2021 were reviewed. Children were grouped by presenting refraction (myopes ≤ -0.50 D or pre-myopes ≤ +0.75 D). Up to five unique patients were selected for each age (6, 7, 8, 9, and 10) and initial visit year (2017 to 2021) for each group (myopes and pre-myopes), for a maximum of 250 files per practice. Demographic information, refraction, and recommended interventions were recorded. Logistic regression was used to model the likelihood of being prescribed a myopia control intervention based on patient and optometrist characteristics. Results: A total of 2905 patients (n = 1467 (50%) female) from 15 practices across Ontario, Canada, were included, accounting for 8546 visits. Optometrists predominantly prescribed single-vision spectacle correction as a first-line intervention for myopic children, although this declined from 98.2% in 2017 to 56.7% in 2023. The use of myopia control modalities increased from 1.8% to 43.3% over this same period. Optometrists began recommending myopia control at lower myopic refractive errors over time (-2.63 DS in 2017 vs and -1.49 DS in 2020). Myopia control spectacles were the most commonly prescribed intervention, despite the observation that optometrists are not hesitant to fit contact lenses in younger children. Optometrists who had been in practice longer were more likely to prescribe older forms of myopia control (e.g., bifocals/progressives) than more recent graduates. Conclusions: While single-vision spectacle correction remains a primary approach for initial myopia management in Ontario, Canada, optometrists increasingly recommend myopia control and are initiating interventions earlier.

Keywords: myopia; myopia control; myopia management; pre-myopia; retrospective review.

Figure 1

Distribution of myopia management modalities for each patient (n = 1160) at their initial encounter from 2017 to 2021.

Figure 2

Distribution of first-line intervention modalities across all years reviewed for all myopes (including pre-myopes who became myopic in subsequent visits), categorized by when management was altered (n = 899).

Figure 3

Box plot of patient refractive error across different modalities as first-line intervention recommended. Box boundaries denote upper and lower quartiles with the line within the box representing the median. Whiskers represent the full range of data points.

Figure 4

Patient refractive error (A) and age (B) at which SV myopia correction (n = 635) and myopia control management (n = 170) are prescribed as first-line intervention over the years. Error bars denote standard error, * denotes p < 0.05.

Figure 4

Patient refractive error (A) and age (B) at which SV myopia correction (n = 635) and myopia control management (n = 170) are prescribed as first-line intervention over the years. Error bars denote standard error, * denotes p < 0.05.