A Q&A With Review of Myopia Management’s Chief Medical Editor


VMAIL Weekend recently sat down with (remotely of course) Dwight Akerman, OD, Review of Myopia Management’s chief medical editor, for an update on what’s happening in the world of myopia. Akerman spoke about the effects of the pandemic on myopia management, the dangers of too much screen time for kids and what’s on the horizon for treating the disease. He also offered some sound advice to ECPs who are interested in incorporating myopia management into their primary care practices.

Question 1: In light of the pandemic, what kind of adjustments did ODs have to make in their treatment of myopia patients? How big a role did telemedicine play, and has remote treatment continued even after ODs reopened their practices?
A: Over the past several months, eyecare professionals have significantly adjusted their appointment schedules to accommodate COVID-19 CDC guidelines. Comprehensive eye exams and emergency appointments, which were often scheduled every 15 minutes, are now scheduled every 30 minutes to allow for social distancing and proper disinfection of equipment and other patient touch points. Many eyecare professionals have incorporated telemedicine follow-up appointments for children undergoing treatment for progressive myopia. Children wearing myopia control contact lenses or instilling topical low-dose atropine require follow-up visits every three to six months to ensure that they are compliant with prescribed treatments and lifestyle recommendations.

Question 2: Due to the pandemic, we know that kids are spending more time on electronic devices. What are the dangers of too much screen time?

A: The current myopia prevalence in 5-to 19-years old American children is an alarming 42 percent...and increasing. Since the COVID-19 pandemic took hold in March, many U.S. children spend 10 or more hours per day looking at a digital device. Furthermore, the risk of myopia development and progression is significantly associated with reading at very close distances (<30 cm) and for continuous periods (>30 minutes) rather than being associated with total time spent on all near activities.

Worse yet, during the pandemic, many children rarely go outdoors and play with their friends. Low outdoor time (less than 90 to 120 minutes per day) has been associated with 2 to 3X increased risk for the onset of myopia as well as childhood obesity.

Question 3: What kinds of new products and treatments are out there for myopia? And what is on the horizon for the near future?

A: The CooperVision MiSight 1 day is a daily wear, single-use contact lens that has been clinically proven and FDA-approved to slow the progression of myopia when initially prescribed for children 8-12 years old. This is the only medical device or pharmaceutical agent currently approved by the FDA.

However, eyecare professionals specializing in myopia management routinely prescribe off-label a wide variety of products, depending on the needs of an individual child. The FDA does not regulate the practice of medicine. Therefore, the practitioner-patient relationship allows off-label prescribing of medical devices and drugs for any condition or disease within a legitimate health care practitioner-patient relationship.

Within the next several years, we can expect FDA approvals for topical low-dose atropine, innovative myopia control contact lenses, novel spectacle designs, and combination products, i.e., drug-eluting soft contact lenses. The future of myopia management is very bright.

Question 4: What advice can you offer ODs who are interested in incorporating myopia management into their primary care practice?

A: If an eyecare professional has decided to incorporate a myopia management program into their office, do not dabble. Do it properly by training your staff, purchasing the correct equipment, i.e., optical biometer to measure axial length, and creating a fee schedule that fairly compensates you for your time and expertise.

Proper scheduling for children undergoing myopia management is critical. Indeed, initial consultation for myopia management takes significantly longer than a child receiving a primary care eye exam and a pair of single vision glasses. After a child is fit with myopia control contact lenses or prescribed topical low-dose-atropine, they will require three to five follow-up visits throughout the first year of treatment.

This additional time must be reflected in the appointment expectations and fee schedule. Otherwise, you will soon say that myopia management “takes too long.” This attitude often causes myopia management dabblers to sputter and eventually stop providing this critical service.

Incremental revenue aside, as myopia management grows in awareness, you have three simple choices. Do nothing about it, practice it yourself, or refer children to a competent eyecare practitioner. The first choice is dangerous. Which one will you choose?

Question 5: In early 2019, when you helped launch the ROMM website, there were serious concerns about how widespread and untreated myopia was. How are things looking today?

A: Many experts have written that the global myopia crisis is an epidemic, while others have called it a pandemic. According to the U.S. Centers for Disease Control and Prevention, “epidemic refers to an increase, often sudden, in the number of cases of a disease above what is normally expected in that population in that area.” Pandemic “refers to an epidemic that has spread over several countries or continents, usually affecting a large number of people.” The textbook example of a pandemic is COVID-19, currently sweeping throughout the world.

Every region of the world is showing alarming increases in myopia prevalence. These growths are associated with significantly increased risks for vision impairment from pathologic conditions related to myopia, including retinal detachment, myopic macular degeneration, cataract, and glaucoma. In 2020, it is estimated that 34 percent (2.620 billion) of the global population is myopic. By 2030, it is predicted that 40 percent (3.361 billion) of the worldwide population will be myopic.

Based on these data and the CDC definition, myopia should be considered a pandemic. Moving forward, I recommend using this terminology when describing myopia trends.