Lecture: Managing Myopia in Resource-Limited Settings: Insights & Innovations | Cybersight

Brief Summary

This webinar, led by Dr. Pavan K. Verkicharla, addresses myopia management in resource-limited settings, particularly in India. It covers current practices, research findings, and innovations for myopia diagnosis, community screenings, and treatment, emphasizing preventative measures. The lecture defines myopia correction, control, and management, highlighting the importance of axial length measurement and lifestyle modifications. It introduces the IMPACT myopia management guidelines and discusses the challenges and strategies specific to resource-limited environments.

• Myopia management is more than just correcting vision; it involves controlling progression and managing complications.
• Axial length measurement is crucial for understanding and managing myopia effectively.
• Lifestyle modifications and early intervention are key to preventing and controlling myopia.

Introduction

Dr. Pavan K. Verkicharla welcomes the audience to a Cybersight webinar on managing myopia in resource-limited settings. He outlines the topics to be covered, including myopia management strategies, the importance of axial length, and preventative measures. He clarifies that the lecture is not intended to endorse any specific product.

Audience Polls

Dr. Verkicharla conducts polls to understand the audience's professional backgrounds and current practices in myopia management. The results show a mix of optometrists, ophthalmologists, and ophthalmic assistants, with a significant portion already practicing myopia management or interested in starting.

Defining Myopia Management

The lecture emphasizes that myopia management is more than just correcting refractive errors; it's about treating myopia as a disease due to the complications associated with axial elongation. Key points include:

• Myopia is a growing pandemic, with approximately 50% of the population expected to have it by 2050.
• The costs of myopia are both direct (e.g., consultations, spectacles) and indirect (e.g., psychological stress, occupational limitations).
• Myopia is multifactorial, and while the exact cause is unknown, it can be prevented and its progression controlled with various available solutions.

Myopia Correction vs. Control vs. Management

Dr. Verkicharla explains the distinctions between myopia correction, control, and management based on a recent publication in IOVS:

• Correction: Correcting refractive errors without affecting myopia progression or axial length.
• Control: Clinical interventions to slow myopia progression and axial elongation, requiring regular monitoring.
• Management: A comprehensive approach including early detection, correction, control, monitoring, and management of complications.

Managing Myopia

Multiple solutions exist to control myopia progression, including lifestyle modifications, bifocal spectacles, multifocal contact lenses, orthokeratology, specialized spectacles, and low-dose atropine eye drops. Research indicates that these treatments can effectively control axial elongation. Under correction is not effective, and while high-dose atropine is potent, it comes with potential complications.

Resource-Limited Settings

A resource-limited setting is defined by inadequate infrastructure, a shortage of skilled personnel, limited access to technology, low awareness, and geographic challenges, leading to suboptimal services. This definition applies to myopia management due to limitations in skilled practitioners, infrastructure, technology, and awareness. Many practitioners and parents lack awareness about myopia management, and there is often a lack of monitoring equipment.

Importance of Axial Length

Axial length measurement is crucial in myopia practice. Dr. Verkicharla presents five reasons why axial length is important:

1. It is directly related to the risk of complications associated with myopia.
2. Not all myopes are axial myopes; axial length helps differentiate between different types of myopia (refractive, corneal, lenticular, or axial).
3. Control in refractive error does not always mean control in axial length.
4. Modern instruments offer high resolution, allowing for the detection of small changes in axial length.
5. It provides confidence in assessing the effectiveness of treatment.

Axial Length Measurement Techniques

Traditionally, ultrasound systems were used for axial length measurement, but they are contact-based, relatively invasive, and require skilled personnel. Non-contact biometers are now available and provide comparable measurements. Emerging devices, like the OBM-2L, offer rapid and comprehensive measurements.

When to Start Treatment

Dr. Verkicharla discusses when to initiate myopia control treatment, emphasizing that it is not necessary for all myopic children. He introduces the IMPACT myopia management guidelines, a six-step approach developed by scientists, optometrists, and ophthalmologists:

1. Identify true axial myopes.
2. Map risk factors (genetics, environment).
3. Pick a progressive myope.
4. Advise appropriate treatment.
5. Consult regularly (every 4-6 months).
6. Combine treatment if necessary.
7. Tapering treatment in late teenage.

Myopia in India

In India, myopia prevalence is similar to global trends, with significant differences between rural (less than 5%) and urban populations (up to 25% in children aged 5-15 years). Approximately 20% of myopic children in India experience rapid progression.

Preventative Strategies

Time spent outdoors is a key preventative measure for myopia due to factors like relaxed accommodation, different spectral composition of light, UV exposure, and dopamine release. However, lifestyle modifications should also address near work. Light exposure levels vary significantly depending on the outdoor environment (open area vs. shade).

Light Exposure and Near Work

Research indicates that near work, whether indoors or outdoors, can trigger changes in axial length. Therefore, simply being outdoors while engaging in near work may not provide the same benefits as being outdoors without near work.

Risk Assessment Tool

Dr. Verkicharla introduces a scientifically validated tool that assesses the risk of myopia progression based on age, current spectacle power, previous spectacle power, and time spent outdoors.

Summary and Conclusion

Dr. Verkicharla summarizes the key points of the lecture, including the definitions of myopia correction, control, and management, the importance of axial length measurement, the IMPACT guidelines, and the need for more nuanced lifestyle recommendations. He emphasizes that myopia management is beyond single vision correction and that each case should be treated individually.