Monitoring Myopia Progression With the Myopia Master®

Eye care’s understanding of myopia has increased drastically over the past 15 years. As a result, the way we see myopia has changed. Traditionally, myopia was considered a nuisance that causes a decrease in visual quality. Now, we define myopia as a progressive disease that causes eyeball growth, resulting in higher disease risks, blurry vision, and changing prescriptions. We now know that, with each 1.00 D of progression, the risk of retinal pathology, macular disease, and glaucoma increases significantly, especially because of eyeball elongation.¹ The role of myopia management in our practice has therefore evolved. We were looking for a streamlined way that we could track progression on every patient, young and old. We found our solution with the Myopia Master® (OCULUS). It has become a key component of how we monitor myopia progression. In addition to auto refraction, the Myopia Master® also can be used for axial length measurements and keratometry.

MONITORING PROGRESSION

In our practice, we put more emphasis on monitoring myopia progression than ever before. We’ve been doing myopia management for 15 years, but our process, education, and effectiveness have improved, especially in the past 5 years. Historically, eye care providers would balance the severity of myopia based on the prescription number that patients had (eg, a patient with -1.00 D of myopia would have less problems than a patient with -4.00 D of myopia). We would gauge how intensely to educate patients based on how bad their eyesight was because it impacted their quality of life.

For patients with any degree of myopia, however, the effects of the disease go far beyond their current quality of life. For this reason, I changed my definition of myopia and its impact, which is worth reiterating: Myopia is a progressive disease causing eyeball growth and resulting in higher disease risks, blurry vision, and changing prescription. The stretching of the retina continues to be pathological with age and as myopia progresses. As I started to think about my patients with myopia who are at least 50 years old and have concomitant pathologies such as glaucoma and retinal disease, I asked myself how their condition might’ve been different today had I monitored their progression and conducted more aggressive therapy when they were younger. This shift in perspective happened about 5 or 6 years ago, and it triggered a significant change to the way I approach myopia management. No longer was the emphasis just on quality of life and patients' achieving a lower prescription, but on lifelong ocular health. Although I was working to slow the prescription number from increasing, I was not truly managing the disease risk. Now, I think it’s crucial for all clinicians to monitor myopia progression related to eye elongation and either refer treatment out or learn to treat it in their own practice.

THE SIGNIFICANCE OF AXIAL LENGTH

A study by Tideman and colleagues showed that eyes smaller than 26 mm have a 3.8% risk of developing a visual impairment described as worse than 20/40 BCVA compared to 25% and 90% for eyes larger than 26 and 30 mm, respectively.² Now, I no longer just worry about the patient’s prescription. More importantly, I also worry about their axial length. In the past, measuring axial length was cumbersome. It required devices that were designed for adults and focused on cataract patients. Having a device like the Myopia Master® that can measure axial length really changed the game for our practice, and we use it on every patient regardless of age. The Myopia Master® helps us identify not only children but also adults who are at a higher risk for visual impairment (Figure 1).

Other devices such as the Pentacam® AXL Wave (OCULUS) can be great tools for axial length measurements, but I prefer the Myopia Master® because in addition to axial length, we can quickly perform auto refraction and keratometry, which are two measurements that I require at all exams and myopia follow-ups. Being able to capture all three measurements in moments on the same instrument helps to streamline the management of myopia on all patients.

The Myopia Master® provides a reliable way to measure the eye in front of me and compare it to average measurements for patients of the same age. We then can look at the growth curves for where the axial length of a child’s eyes should be at a certain age. If their eyeball is longer than the average for their age (Figure 1), we know they are at risk for developing myopia, even if they currently have a hyperopic prescription.

The technology also allows us to record how effective a myopia treatment has been and anticipate its impact over time. It’s nice to provide patients’ parents with a handout of their child’s growth curve (Figure 2) and say, “Look how we’ve changed the trajectory of the line. We’ve flattened this curve. Your child doesn’t seem to be progressing nearly at the rate that they used to.” Myopia management is an out-of-pocket expense for most people, so having measurable results that you can show a parent is important. It aids in patient education and drives home the importance of managing their child’s myopia.

DECISIONS AND LOGISTICS

We typically see myopia patients about every 3 months, especially in the first 2 years of their treatment. At every visit, we use the Myopia Master® to update the patient’s trajectory. Are they becoming myopic faster than they were before? Is progression slowing down? Is treatment working? The results from the Myopia Master® dictate how we might alter our treatment if progression is detected. A small amount of progression that is in alignment with emmetropia is acceptable, but any faster and we may want to alter the treatment. The more measurements we have, the more accurate our data is and the better our treatment choices. Clinicians do not have to encounter the patient at each of these visits; the technician can capture the data, share them with the patient, and then let patients know that the doctor will connect with them if there is a need.

Most eye exams include auto refraction, so we have the Myopia Master® in our pretesting room. At our practice, patients start their exam with it. The Myopia Master® is one of the first devices our technicians learn to use when they start at our practice. Capturing the measurements is no more complicated than with a standard auto refractor, and therefore anybody in the office can do it. We then pull the images up in the exam room to show the patient or have a printout for the parent to see where their child is at. We do not charge patients a fee every time they come in for a myopia check. Rather, for myopia management we use a subscription fee and a global fee model so that patients can come in as many times as they want throughout the year. They pay the same fee, but it spreads out the cost. We tell parents, “If you’re concerned, come on into the office and we’ll do a Myopia Master® and check to see how much the eye is stretching.”

CONCLUSION

The myopia pandemic is impossible to ignore. Estimates indicate that, by 2050, about 50% of the world’s population could be myopic.³ The burden is higher in other parts of the world, including Asia, but myopia can have devastating effects for individuals worldwide who progress to high myopia. The ramifications of the disease are typically not visible in the early days of diagnosis, but long-term effects are deleterious. A tool such as the Myopia Master® is a crucial component of detecting and monitoring disease progression.

1. Bullimore MA, Brennan NA. Myopia control–why every diopter matters. Optom Vis Sci. 2019;96:463-465.

2. Tideman JWL, Snabel MCC, Tedja MS, et al. Assocation of axial length with risk of uncorrectable visual impairment for Europeans with myopia. JAMA Ophthalmol.2016;1:134(12):1355-1363

3. World Health Organization. The High Impact of Myopia and High Myopia. WHO; 2017. Accessed March 24, 2023. myopiainstitute.org/wp-content/uploads/2020/10/Myopia_report_020517.pdf