of My-iClinic’s myopia control clinic
My-iClinic decided to open a myopia clinic in response to a lack of available services for children. It expected the clinic to last a month but has been operational since January 2019. In preparation for opening, the team started reading around the topic and connected with other myopia clinics around the world.
John Bolger, consultant ophthalmologist and director of the north London ophthalmology clinic, explains: ‘We decided that if nobody else was going to do it, we had to do it. We felt obliged to. It’s grown enormously and we have patients, not just from the local area and from London, but from all over the country and even from overseas. We’re the only clinic that’s really offering the comprehensive range of myopia treatments for children.’
The World Health Organization estimates that by 2050, 50% of the entire human race will be myopic. In addition, the number of people who will be blind from myopia is 500 million. ‘I saw a cartoon where a child was being teased in the school playground for being “specky two eyes”. As opposed to when in the old days you’d have been teased for wearing glasses by being name called “specky four eyes”. Because in 2050, if you don’t wear glasses, you’re in a very small minority,’ he says.
Patients who attend My-iClinic’s myopia services tend to be from families whose parents are already myopic and Bolger is finding that children are amenable to testing. ‘The typical situation would be when mum or dad says, “Well, I was 13 or 14 before I started wearing glasses,” and they were about minus one or two. “My child who is only six or seven is already minus four. This isn’t like the way it’s supposed to be.” That’s a very common situation so we take their full history, including refractive and family history,’ he says.
Bolger takes each child through a package of measures, including advice about contact lenses, atropine and living an emmetropic lifestyle. He explains that the evidence shows that if the hyperopic defocus in the peripheral retina is removed, the rate of elongation slows down significantly. ‘Multifocal contact lenses and ortho-k have been shown, and the studies are there, to greatly reduce the axial lengthening and therefore the progression of myopia. Additionally, atropine is even more powerful and can slow down that elongation. The exact mechanism of any of these is not quite clear yet, but it seems to be in the eyeball itself. So, the worst thing you can do for a myopic child is just give them glasses because that’s just going to make sure they’re going to get worse,’ he says, adding that it is ‘amazing’ how well children have adapted to wearing ortho-k or multifocal contact lenses.
Bolger explains that optometrists in the community are best suited to handling myopia management and the associated refractive correction. ‘At this stage, it is very important that optometry and ophthalmology work closely together. Eventually, optometry should be in a position to take it on completely,’ he says. My-iClinic is a shared care clinic for myopia and Bolger often refers patients to high street optometrists. He explains: ‘Eventually, I would like to see the whole of myopia control move into the domain of optometry. I don’t think it needs to be an ophthalmology thing. Maybe there’ll be some sort of interaction but all the steps that can control myopia are well within the domain of optometry, including the dispensing of atropine.
‘I wish that the regulators would get on and recommend atropine now. Give atropine a license for use in children for myopia so that optometrists could be dispensing it and doing the ortho-k and multifocal contact lenses too.’
Around 50 patients have been seen so far at My-iClinic’s myopic clinic, Bolger shares. ‘Our first patients have just had a year of treatment and there has definitely been a slowing down in progression while some have not. We’re talking about very small numbers here but it looks like the ones who slowed down the most are those who take on the whole package. They adopt the emmetropic lifestyle and have less time indoors, they use the atropine and they get into multifocal or ortho-k. Those who just put the drops in tend to be the ones that don’t slow down as much,’ he says.
In the next decade, Bolger expects myopia management to become very important with new research offering explanation into why myopia occurs and informing treatment plans. ‘We should never accept that being myopic is a normal thing. It’s not,’ Bolger concludes.