When is an eye care professional (ECP) intervention described as a treatment or therapy? Surely, this is the case when an intervention results in anatomical changes in a target tissue or structure. If so, then occlusion therapy resulting in visual cortex changes, surgical excision of rogue tissue, or reduction in cellular activity after a drug is introduced might all be classed as medical treatments. And is it, therefore, unreasonable to describe the use of orthokeratology, atropine or dual focus lenses to reduce axial length growth as medical treatments too?
In a recent comment, I mentioned the excellent online Virtual Perspectives conference hosted by CooperVision, which offered a snapshot of current ECP practice in myopia management and likely future trends in this area. This got me thinking.
Historically, the most identified risk of high myopia has usually been retinal detachment. Less so, age-related macular degeneration (AMD). Indeed, I suspect that myopic maculopathy has been thought of as a more niche concern and distinct from AMD. Anecdotal evidence warning: a quick trawl through my records reveals a significant amount of late-stage AMD to be found in myopes, many of whom are pseudophakes so do not appear to have a myopic refraction. This does make me wonder just how many of the large number of people with visual impairment due to AMD have an underlying and contributory myopia.
Professor Mark Bullimore has stated that every increase of -1.00DS myopia increases the prevalence of myopic maculopathy by 58%. Also, every reduction of myopia by 1.00DS is associated with around 40% reduction in the risk of myopic maculopathy.
Given our current level of knowledge about treatment, surely many of the myopes we are seeing at the moment will be the visually impaired of the future. And how many of them will have access to a good lawyer in 20 years?
- Do you have an idea for a clinical feature? Email the clinical editor bill.harvey@markallengroup.com.
- For details of how to submit a case study and earn an interactive CPD point for each of the domains, go to the CPD area of opticianonline.net.
