The Myopia Exchange

Professor Karla Zadnik, Dean of the Ohio State University College of Optometry in the USA, guides us through a variety of fascinating topics. In her capacity as Principal Investigator of the Childhood Atropine for Myopia Progression (CHAMP) study, Karla explains this multi-site, four year clinical trial which is investigating two proprietary formulations manufactured by US-based specialty pharmaceutical company Nevakar. I learnt that Nevakar is derived from Sanskrit, meaning ‘new form’, which is an ideal encapsulation of what we still need to learn about atropine. 

Karla advocates for you to engage directly with the volume of primary literature sources on myopia factors and interventions, to help you best translate that to management of the child in your chair. As Study Chair for the 11-year-long the Collaborative Longitudinal Evaluation of Ethnicity and Refractive Error (CLEERE) Study which generated a notable volume of research on myopia factors, I ask Karla to choose her favourite CLEERE papers. Finally, Karla’s view on myopia management in practice takes into account the potential race- and socioeconomic-based health disparities which could be created when myopia control is declared a standard of care. Karla provides us with important food for thought and a call to life-long learning.

Dr Monica Jong, Executive Director of the International Myopia Institute, founded by the Brien Holden Vision Institute, tells us all about the IMI’s big plans for 2020. With the landmark publication of the seven IMI White Paper reports almost a year ago now, we discuss the impact of these reports so far and all of the resources available on the IMI website www.myopiainstitute.org including summaries and translations to multiple languages. 

The biggest news, though, is the seven new taskforce committees which have been formed, set to publish additional White Paper reports in around a year’s time. Monica explains how these new taskforces will cover the public health impact of myopia, paediatric and adult high myopia, environmental interventions, preferred practice patterns, accommodation and binocular vision and updates of the current papers. Monica says we each have a role to play in combating the worldwide impact of myopia, and concludes with some fascinating and insightful reflection on what her mentor Professor Brien Holden might have been researching and advocating for in 2020 and how he influences her work today.

Philip Cheng, well-known clinical optometrist from Melbourne, Australia and prolific contributor to the Myopia Profile Facebook group, takes us through the twists and turns of myopia management in practice. Philip founded his greenfield independent practice over three years ago with a near-exclusive focus on myopia management, and in this podcast we discuss how he made the leap to establishing and now running his successful practice, where a majority of his new patients come from word-of-mouth or colleague referral. 

From marketing to in-room communications; from equipment to chair time, Philip encourages you to self-educate, project your expertise, promote your brand, start discussions early and be proactive about fitting and celebrating children wearing contact lenses. We discuss the hot topic of axial length measurement in practice, of which Philip is a strong advocate – how it helps to assess risk and determine success – but also if you don’t have access, how to still offer your own expert myopia management service. Philip and I examine what makes Australia the apparent world leader in practitioner myopia management engagement. Finally we discuss setting treatment expectations; to set up the child, parent and your practice for ongoing success.

Professor Mark Bullimore of the University of Houston, Texas USA, tells us more on the complex topic of 0.01% atropine, including its stability as a compound, and takes us on a short journey through chemistry explaining how current studies are using novel formulations to address this issue. Have you heard of ‘heavy water’? I hadn’t, until now! Mark advocates for you to ‘be the doctor’, using the side effects as a gauge of drug efficacy, and even suggests a novel clinical approach in practice to determine the individual patient’s response and tolerance. We also discuss the mismatch (or otherwise) of refractive and axial length control results in atropine studies which don’t appear to be the case in studies of optical interventions, along with communicating the ‘why’ of myopia management through the dioptric effect of control.

Lyndon and Debbie Jones from the Centre for Ocular Research and Education and University of Waterloo, Canada, highlight the impact that FDA approval for CooperVision MiSight myopia control contact lens has for eye care practice in the US, and across the world. How does MiSight and the FDA approval fit within the whole ecosystem of myopia control? We cover aspects from contact lens fitting and safety in children through to the strong practice building opportunity of myopia management, and considering what is evidence-based versus on- or off-label. This podcast will give you the tools to take the next steps in your learning journey in childhood myopia control and management. 

Professor James Loughman from Technological University Dublin, and the Centre for Eye Research Ireland, challenges us to think differently about low dose atropine. What are we actually getting in the bottle? How should we approach atropine usage in practice? What will future research tell us? The message on 0.01% atropine is complex and perhaps not what you expect.

Kate Gifford chats to Professor Ian Flitcroft about the International Myopia Institute (IMI) paper on Defining and Classifying Myopia, of which he was the lead author. Topics include why we need to define myopia for clinical, epidemiological and research reasons; grading systems for structural complications of myopia; why the refractive definition doesn't specifically require cycloplegia and the definition of pre-myopia.

Are progressive addition lenses and bifocals created equal for myopia control? How should we pick which lens type to prescribe, and what's on the horizon for our non-contact lens wearing young myopes?