How it began
I have been practising myopia management for about 14 years and first started after a dad who was -16.00 dioptres myopic, brought his son to see me. The boy had developed myopia at age eight, with a -1.00 prescription.
The father had done his research and wanted to try orthokeratology lenses, which had been shown to slow down the development of myopia, so I trained up and he was my very first ortho-k patient.
That patient is now at college and still wearing the contact lenses. He has a very healthy axial length and is approximately -3.00 myopic, but this would have been a very different story had his dad not acted. The odds were stacked against his son at eight and he would have been on a rollercoaster ride to poor vision.
This spurred me on and sparked my interest in myopia management but I have found that the challenge with contact lenses has always been that some children are not motivated to wear them.
A new solution
Essilor Stellest lenses have been a wonderful addition to my armoury in the battle against myopia. As soon as Essilor released the lens last year, we jumped at the chance to do a soft launch in practice and it took off. I am now able to give parents more options to help slow myopia progression in their children.
Stellest offers myopia management to younger patients, who no longer need to wait until they are suitable for contact lenses or mature enough to wear them. I can give a Stellest lens to school-aged children and have zero adaptation issues. No parent has come back and said their child cannot wear them.
Parents are given all the information from the onset and I show them an axial length chart to measure and plot the risk, which helps educate the parent.
I think it is very important to manage expectations and explain that it might not work for every child. However, on average it has been shown to slow down myopia progression by 67% in children who wore the lenses every day for 12 hours,1 so the odds are with us.
If they are happy to pay a bit more upfront for Stellest lenses, the child will be changing lenses less often in the long run. I had a dad who could not believe that his daughter with a -2.00 prescription had kept the same Stellest lenses for more than a year when he was changing lenses every four months at her age.
If a child’s prescription goes up every six months, they will have to keep changing their lenses and eventually pay out more money, so it makes sense to invest initially in something that will hopefully slow down progression. I tend to encourage patients to wait for 24 hours before making a decision. Some decide there and then, but those who are sceptical will read up on it and, invariably, I get a 95% uptake.
If patients can afford the lenses, then it is a no-brainer and they also have the guarantee that if there is a change of over -0.50 and above in 12 months, Essilor will replace them free of charge. That said, I have had very few sent back.
Addressing a child’s environment
Once a child is fitted with Stellest lenses, I assess them every six months, including re-checking their prescription and, most importantly, re-checking their axial length. I explain to parents that there is going to be some growth, but that it is the accelerated unhealthy growth we are trying to control.
I make clear to parents that, as well as the lenses fighting myopia, the child’s environment must be addressed too. If a child is spending seven hours on a screen and playing no sports, then this needs to be considered as well.
The younger the child is with short sight, the more risks there are. If I had a 15-year-old with short-sightedness, I would compare it to a ‘slow coach’, but a seven-year-old developing myopia is more like a fast train with Boeing 747 engines. I try to demonstrate to parents that my role is to stand in front of that train to try to slow it down, but if a child spends too long looking at screens it is going to make it very difficult.
Parents trust me and they are happy we can finally do something to help slow myopia. In the past, all we could do was sit and watch the eye progressing, change the lens every six months and do nothing about it. During the past 14 years, I have been offering patients ortho-k, but now we have spectacle lenses that are backed by research. It is unbelievable and parents are ecstatic.
The importance of education
By 2050, it is believed that half the world’s population could be living with myopia2 with stretched, long eyeballs, and this is very worrying. The problem is, if an eyeball is stretching and growing at the age of eight, it has got another 10 years of growth ahead of it, so it is eventually going to be very elongated and unhealthy.
So, it is all about patient and parent education. I use a biometer in practice to help assess myopia progression based on a few current measurements and that can tell me how myopic a child is likely to be when they are 20. This information spurs the parents on to make an investment in myopia management through lenses and lifestyle changes.
A lot of patients see myopia as an inconvenience to their child and they do not understand the health aspect. In my experience, about 75% of parents do not realise the health risk associated with myopia. They do not understand the importance of trying to slow it down or the effects screens are having on their children’s eyes, and this is of great concern.
I have seen children recently who had good vision last year, but 12 months on they have progressed and become myopic because they are spending so long on screens. The parents do not realise this is irreversible and they are not going to get that vision back. Lockdown massively escalated this problem.
Patient education is a must. I have posters and point of sale displays everywhere and the optical team educate parents as they come into the practice. We have a weekly staff meeting where we talk about myopia control options and we all complete CPD on myopia management via Essilor’s e-Academy.
I am also in the habit of asking every myopic patient if they have children so I can try to identify the high risk pre-myope early, get them in for an eye examination and educate the parent about delaying the onset of myopia.
Practices that are not suggesting myopia management in some form may have a problem further down the line when parents question why it was not offered. I see a lot of children who are advanced and, thankfully, Stellest lenses have such a high range of prescription, we can always offer it to them as an option, unlike other myopia treatments such as ortho-k which are for lower myopia.
My aim for the next 20 years is to try to keep retinas short and healthy and I hope other eye care professionals join me in that mission.
Patient case study
Elaine, mother of patient: ‘Our previous optician suggested we bring our nine-year-old to Andrea as her short-sightedness kept getting worse. Andrea introduced us to the world of myopia and fitted Clara’s glasses with special Stellest lenses. We’ve just had our next check-up and not only has the prescription stayed the same but the important measurements from the front to the back of her eye have reduced.’
Jamie, patient aged 10: ‘My dad took me to see the same person who gives him his glasses. Her name is Andrea and she said I have the same eyes as my dad. He has really thick glasses. My dad says I’m lucky because Andrea gave me special glasses that will stop my eyes from getting as bad as his.’
References
- Compared to single vision lenses, when worn 12 hours a day. Two-year prospective, controlled, randomised, double-masked clinical trial results on 54 myopic children wearing Stellest lenses compared to 50 myopic children wearing single vision lenses. Efficacy results based on 32 children who declared wearing Stellest lenses at least 12 hours per day every day. Bao J. et al (2021). Myopia control with spectacle lenses with aspherical lenslets: a two-year randomised clinical trial. Invest. Ophthalmol. Vis. Sci.; 62(8):2888.
- Brien A. Holden, et al, (2016). Global Prevalence of Myopia and High Myopia and Temporal Trends from 2000 through 2050. Ophthalmology, 123 (5), 1036-1042
