Practice patterns to decrease myopia progression differ among paediatric ophthalmologists around the world

Abstract

IntroductionMyopia is a worldwide epidemic. Plethora of treatments are offered to decrease myopia progression. In this study, we compared between different geographical areas worldwide the practice patterns used by paediatric ophthalmologists to decrease the progression of myopia.MethodsGlobal responses to a questionnaire were analysed (n=794) for demographic variations. Pharmacological, optical and behavioural categories were defined as effective or ineffective based on the current scientific peer reviewed literature.ResultsTreatment rates varied significantly between geographical regions (mean 57%, range 39%–89%, p<0.001). Nearly all participants who treat myopia used at least one form of effective treatment, regardless of location (98%, p=0.16). Among those prescribing pharmacological treatments, European physicians offered the lowest rate of effective treatment compared with other regions (85% vs mean 97%). Rates of effective optical treatment varied significantly between locations (p<0.001), from 16% (Central-South America) to 56% (Far East). Most treating respondents advocated behavioural modifications (92%), between 87% (North America) and 100% (Central Asia). Nearly all respondents used combinations of treatment modalities (95%)—mostly pharmacological, optical and behavioural combination. However, combination rates varied significantly between regions (p<0.001).DiscussionThe utility of treatment to decrease myopia progression differs significantly across the world both in type, combination and efficacy.ConclusionPaediatric ophthalmologists involvement and proficiency in myopia progression treatment varies around the world. This may entail promoting continuous medical education and other incentives to increase the number and proficiency of paediatric ophthalmologist to have a more effective impact to control the myopia epidemic in children.

Update and guidance on management of myopia. European Society of Ophthalmology in cooperation with International Myopia Institute

“…A combination of all three modalities was the most popular in most regions, apart from Central-Asia where the prevalence of optical and behavioural combinations was higher. 324 Currently, numerous publications provide the evidence that combined treatment with atropine and ortho-K lenses provides an additive benefit in myopia control. [325][326][327][328] In a preliminary study, during a 1-year follow-up, the combination of ortho-K and atropine 0.01% ophthalmic solution was more effective in slowing axial elongation than ortho-K monotherapy in 8-12 years old children.…”

Myopia Control 2020: Where are we and where are we heading?

“…Thus, the vast majority of young myopes progress. The previously described survey of paediatric ophthalmologists 73 indicates that fast progression is the primary reason to intervene, but it is becoming evident that past progression does not predict future progression. Hernandez et al .…”

Annual Myopia Progression and Subsequent 2-Year Myopia Progression in Singaporean Children

“…To date, no evidence-based clinical management guideline for myopic children has been established to tailor treatment based on expected future myopia progression. Past progression has been the most favored indicator among pediatric ophthalmologists for initiating myopia progression therapy, and the average threshold used is -1 D. 22 However, using past progression has obvious pitfalls. Children with slow progression (>-0.50 D/y) in the first year of our study had a mean (± SD) progression of -0.41 ± 0.33 D/y, indicating that about 16% of children (one in six) that progress by less than 0.50 in year 1 will progress by -0.74 D in the subsequent 2 years.…”

“…A survey of pediatric ophthalmologists reported that the most common indication for initiating myopia control treatment was prior rate of progression. 22 By association, this criterion has been used to predict faster future progression, but there is limited information available to link myopia progression during a given year with subsequent myopia progression in a longitudinal cohort study.…”