How I Became a Believer

I began my optometric career as a student at the Southern California College of Optometry (SCCO) in 2000. My knowledge of myopia and myopia progression, however, began much earlier, when I was prescribed my first pair of glasses at the age of 7 and my prescription continued to increase through my childhood, teen years, and into my academic career. Little did I know that myopia, and the slowing of its progression, would become a focus of my education and clinical practice.

THE BEGINNING OF MY JOURNEY

While at SCCO, I was fortunate to learn from two of the giants in our profession, Harue Marsden, OD, MS, and Timothy B. Edrington, OD, MS, both of whom were influential in the development of the design and fitting of specialty contact lenses, including gas permeable (GP) and reverse geometry orthokeratology (ortho-k) lenses. Dr. Edrington taught me the fundamentals of specialty lenses and guided me in my decision to pursue a residency. Dr. Marsden taught me so much about lens fitting and taught me by example to want to push the profession forward through leadership, research, and thinking outside the box. She was an extraordinary role model. During my studies and into my residency, my focus was on learning how to fit these specialty lenses.

In 2004, Pauline Cho, PhD, published a case report suggesting that regular use of ortho-k lenses could slow the progression of myopia.¹ Prior to this study, the retardation of myopia progression was studied with spectacle wear, but no evidence of effective treatment control was found. At this time, I was in my residency, still learning to fit GP and ortho-k lenses, read fluorescein patterns, and just enjoy (and survive) the year. The concept of myopia management was nowhere on my radar.

REALIZING THE EFFECT

Upon returning to Canada, I bought a specialty lens practice, where existing patients claimed to have halted the progression of their myopia with their ortho-k lenses. I was originally confused by the lens designs and lack of topography. I eventually figured out that an old method of ortho-k fitting was done by fitting daytime GP lenses flatter than normal in order to flatten the cornea and achieve a reduction in myopia of about 1.00 D. The lenses were molding the cornea to create this effect. To my understanding, ortho-k referred to overnight contact lens wear. The 3-year CLAMP study showed that the fit of GP lenses can slow the progression of myopia in the original manor in which they were being used.²

It wasn’t until I joined the American Optometric Association’s Contact Lens and Cornea Section, where I met Jeffrey J. Walline, OD, PhD, that I really started to learn about the effect that I was having by fitting patients in ortho-k lenses all these years. Dr. Walline has done so much research on myopia management over the past 2 decades, and I have learned a great deal about the affect of myopia from my time with him. Dr. Walline ignited my passion for learning about myopia management and wanting to do more for the profession and our patients. He is not only my mentor, but also a friend.

In 2016, the Brien Holden Vision Institute (BHVI) published a landmark paper in Ophthalmology on the global prevalence of myopia, high myopia, and future trend estimates.³ The prevalence of myopia was shown to have grown 66% in the past 3 decades. The BHVI predicted that myopia would affect one-third of the world’s population by 2020 (2.6 billion people) and was estimated to affect half of the world’s population by 2050. This estimation made myopia a public health issue.

THE MYOPIA CRUSADE BEGINS

It is estimated that close to 5 billion people will be myopic by 2050.³ Approximately 1 billion of these myopes will be highly myopic, having a refractive error of ≥ -5.00 D and a significantly increased risk of permanent visual impairment.³

A patient who is older than 75 years of age and has a highly myopic eye with an axial length of > 30 mm has a 90% chance of significant visual impairment.⁴ Even higher myopes with a refractive error of ≥ -6.00 D have an 846x higher risk of macular degeneration compared with an emmetrope.⁵

These numbers took my simple desire to learn about myopia to a level of concern. I wanted and needed to educate as many people as I could. These data changed my viewpoint from myopia being a simple condition that we treat in-office to one of it being of epidemic proportions. I was on a mission to tell every myope, every parent, every doctor, and every student what was going on in our world and what our profession could do about it.

MOVING FORWARD

I gave my first lecture on myopia management soon after. The room was packed, and I realized that I was not alone. Others were just as concerned as I was and wanted to learn more about this growing epidemic. The energy in the room made me realize that together, we were going to change the future of our planet. I knew from the BHVI paper that the progression of myopia was a global concern,³ but I didn’t truly understand the extent to which eye care providers were united until the first Global Myopia Symposium, which took place September 25-26, 2020.

Eye care providers from more than 80 countries were online watching and learning about myopia, risk factors, and how we can slow its progression. If I ever had any doubts, this meeting opened my eyes to the global problem we are all trying to solve together.

MAKING PROGRESS

In all four treatment areas—soft multifocal lenses, ortho-k, atropine, and spectacles—there have been new products launched and others soon to be approved for use. Soon, the method for treating myopia in teens and children will be done only with myopia-reducing options.