OPPORTUNITY TO INFLUENCE.
Yes, I've seen my fair share of progressing myopes in practice over the past couple of decades or so. And, let's be honest, the arrival of a young myope in the late afternoon of a pressed clinic is often a welcome respite against the backdrop of more complex cases; a chance to gulp a few mouthfuls of my tepid Yorkshire brew at the very least.
As a high myope myself, and having reached the dizzy heights of qualifying for an NHS sight test on refractive error alone, the potential perils of comorbidity that lie ahead certainly play on my mind. Nevertheless, in the past I will confess to taking an almost blase approach to managing these patients; particularly low myopes where the majority are faced with nothing more than a refractive burden that will translate into a gift when presbyopia arrives. Outside of optical correction, what else could we do anyway? But then the rules of the game changed.
Cracking the concept
I first dipped my toe into the water with myopia control (or myopia management to give it a more palatable term) about four years ago, mostly through off-label use of centre-distance multifocal soft contact lenses. It was a liberating experience. No longer simply a corrector of refractive error, it was an opportunity to influence outcome.
The prescribing part of the management process is straightforward enough, but the challenging aspect was (and still is) communicating the concept to often bewildered parents and their disengaged teenage offspring: 'So, by using a special type of contact lens we may be able to slow down the growth of the eye, which should limit the progression of your short-sightedness. But it might not. And, we won't really know for sure if it worked.' Not the most compelling argument.
Added to this: 'And you should try to spend a couple of hours outdoors each day and restrict time on your gadgets where possible.'
You can sense the tension rising in the consulting room at this point as the parents picture themselves trying to wrestle a grubby games console off a grunting adolescent while thrusting them out of the house to face the brutal elements of the British weather for their 'outside time.' My delivery style has become smoother, but I am always mindful that it is safest to under-promise and over-deliver in this regard.
As the evidence base continues to build, and more options for myopia management trickle through to the High Street, the profession will undoubtedly join the fray en masse. At the forefront of the commercial supplier's minds must be to ensure that practitioners are equipped to deliver messages to an expectant public using a balanced approach.
With this edition of OT dedicated to myopia,
I think we should devote a mention to our often-neglected hyperopes--for my own self-indulgence if nothing else. Should we consider the possibility of being able to encourage axial growth in this cohort? While the 'rest of the world' has been trying to slam the brakes on axial growth in myopes, the lab at Aston University has been beavering away to do the opposite with their refractive counterparts. The hypothesis is if we can slow down axial growth in myopes using centre-distance multifocal contact lenses, can we accelerate it in hyperopes using centre-near designs? Could there be a positive side to axial growth? Time will tell.
Dr Ian Beasley is an optometrist, OT clinical editor and AOP head of education
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|Title Annotation:||PERSPECTIVES; dialogue with Association of Optometrists' Ian Beasley|
|Date:||Feb 1, 2018|
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