By Aamena M. Kazmi, Therapeutic Optometrist, Diplomate, ABO
Feb. 1, 2023
Parents have many decisions to make today when children are diagnosed with myopia. In the old days, it was just a matter of which frames the child would pick for their new single-vision glasses. Now, parents have the chance to slow the progression of myopia with orthokeratology (Ortho-K) or myopia management via soft multifocal lenses.
Here is how I educate parents about the myopia treatment options available for their children.
Explain What Is At Risk If No Treatment Option is Taken
It is vital for parents to understand the eye health risks of myopia and the importance of myopia control to stimulate their action, but we do not want to leave them with overwhelming anxiety about their child’s ocular and vision health.
I begin my discussion by sharing that while their child is nearsighted, and that nearsightedness increases in magnitude until the eye matures, there are now treatment programs that can slow the rate of progression, thereby keeping the level of myopia as low as possible and reducing their child’s risk of developing serious, sight-threatening eye diseases.
I focus my education on introducing the options of control and what each method will require of them to achieve positive results and less on jargon-heavy explanations of the science behind how each method implements control.
Maintain Open Discussion of Options If Possible
I only strongly recommend one option over another if the child’s prescription is a limiting factor or if I have a strong sense of the child’s personality and likelihood for success with one option over the other.
Otherwise, I like to maintain an open discussion with both the child and parent when deciding on a treatment method. I discuss each option individually and then discuss the differences between the options. Through our conversation, we create a list of pros and cons for each method specific to the individual patient’s unique perspective and needs.
Some families have friends who have been successful with either Ortho-K, soft multifocal contact lenses, or atropine, and are partial to utilizing the same method. Some families find the concept of Ortho-K foreign and are, therefore, uncomfortable pursuing it over the standard soft lenses they are more familiar with, while others love that it is a contact lens method that is completely under the control of the home (the child does not leave for school wearing the lenses) and something they can readily be involved in.
Often, patients find it appealing that they do not have to wear vision correction during waking hours with Ortho-K. On the other hand, some high-sensory patients are apprehensive about adapting to rigid lenses and decide to pursue soft lenses or atropine drops instead.
Explain How Ortho-K Works
I explain to parents that Ortho-K utilizes a specialized rigid gas permeable contact lens as a retainer to reshape the cornea temporarily, the outer front surface of the eye. The contact lenses are applied before bedtime and only worn while the patient is sleeping.
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The reshaping of the cornea accomplished overnight accounts for the patient’s prescription, thereby eliminating the need to wear vision correction (glasses or contact lenses) during regular waking hours. Because this corneal shape changes the way light is focused on the retina, it also slows the rate of myopia progression in habitual wearers.
Keep Costs Between Options Similar & Guide Patients Through Impact on Cost of Decision
At our practice, we strive to keep the cost of our contact lens programs for myopia control (soft multifocal lenses and Ortho-K) similar to deter parents from choosing one option over another due to a cost differential.
Atropine treatment programs are more cost-effective; however, it is our least chosen option despite the lower cost. Both the parent and patient are heavily involved when deciding on a treatment method. Therefore, we choose based on what truly is the best option for the child as an individual, taking into consideration their maturity, comfort level, lifestyle, personality and other deciding factors.
Provide Educational Materials for Further Reference
We have an informational packet we send home that explains each option and includes a list of FAQs.
Find More on Myopia Management
We include manufacturer brochures and a journal review article in this packet as well. Our practice website has a myopia control section that covers some of the same material.
Address Safety Concerns About Treatment Options
I am often questioned on the safety of young children and contact lens wear in general (daytime or nighttime). Furthermore, because Ortho-K utilizes contact lenses worn overnight when sleeping, I am frequently asked about its safety compared to daytime wear of soft contact lenses.
To address the former, I reference research investigating the safety of contact lens wear in children, which concluded that the “incidence of corneal infiltrative events in children is no higher than in adults, and in the youngest age range of 8 to 11 years, it may be markedly lower.”
To address the latter, I share that the FDA has declared that Ortho-K lenses are safe for use by people of many ages, including young children and adults – as long as the specialized contact lenses are made from certain highly gas-permeable materials. The risks of Ortho-K are similar to the risks of wearing any type of contact lens.
I also share that a systematic review of the safety of Ortho-K lenses found that “there is sufficient evidence to suggest that OrthoK is a safe option for myopia correction and retardation. Long-term success of Ortho-K treatment requires a combination of proper lens fitting, rigorous compliance to lens care regimen, good adherence to routine follow-ups, and timely treatment of complications.”
Aamena M. Kazmi, Therapeutic Optometrist, Diplomate, ABO, practices at Bellaire Family Eye Care (BFE), including its Contact Lens Institute of Houston (CLIH), in Houston, Texas. To contact her: Kazmi@bfeye.com
