Dr. Ankit S. Varshney is an accomplished optometrist with a Ph.D., FIACLE, FASCO, M.Optom, and B.Optom. He is currently serving as an Associate Professor at Shree Bharatimaiya College of Optometry in Surat and also as a Consultant at the Shree K.P. Sanghvi Eye Institute. As myopia is becoming a global epidemic, with the projection that by 2050, half of the world’s population will be affected by it, it is crucial to raise awareness about evidence-based approaches to its management and mitigation. The Indian Optician recently spoke to Dr. Varshney about his professional opinions on the standard of care for myopia management and how he integrates it into his practice.
The Indian Optician (TIO): How do you identify children who are at risk of developing myopia in your clinic? Do you have any special considerations for preschool-aged children?
Dr. Ankit S. Varshney (Dr. Ankit): Myopia risk factors among children include having myopic parents, spending less than 90 minutes daily outside, spending more than 2-3 hours on close work outside of school, and certain binocular vision conditions like esophoria, accommodative lag, high AC/A ratios and intermittent exotropia. The most significant risk factor for myopia development is being +0.75D or less at six years old, which indicates pre-myopia.
Early detection and an accurate refraction are crucial for pre-school and early-school-aged children. Other factors, such as binocular vision, the visual environment, and a family history of myopia, also increase the risk.
TIO: When do you believe the concept of myopia management should be introduced?
Dr. Ankit: To prevent myopia, it is important to educate patients and parents on healthy lifestyle practices such as spending time outside and taking breaks from close work. Discussing the risks of myopia and management options with families is also crucial. Treatment for children depends on whether they reach ocular developmental milestones, with a follow-up recommended every six months if there is a risk of future myopia. In summary, educating patients, identifying risk factors, and conducting regular follow-ups are essential to managing myopia.
TIO: What variables affect your expectations for a myopia management intervention’s degree of success? What elements can cause you to change your mind about the chosen intervention?
Dr. Ankit: Age, motivation, and compliance are key factors in predicting the success of myopia interventions. Predicted eye growth curves can be used as a guide. Lifestyle changes, such as reducing work hours and increasing outdoor time, can also be helpful. Axial length is a more accurate measure of myopia progression than refraction. Additional interventions may be necessary if growth is not within age-related norms after 12 months.
TIO: What areas of concern do you pay special attention to during follow-up examinations of a child receiving myopia management?
Dr. Ankit: During follow-up exams, my main concern depends on the type of myopia treatment, and patient adherence is crucial for its effectiveness. Non-compliance can lead to severe consequences, therefore, assessing the patient’s history of tolerance and adherence is important. For assessing clinical results, subjective and cycloplegic refraction and axial length measurements are used. Finally, effective communication with patients and parents is necessary for encouraging intervention compliance and explaining outcomes.
TIO: Do you include spherical equivalent as well as axial elongation when evaluating myopia management success?
Dr. Ankit: The most important part of the eye exam for young myopic patients is giving them the right refraction to correct, maintain, and preserve their eyesight. Although parents and patients understand refraction well, it is less precise in detecting small changes in myopia than axial length assessment. For example, I’ve found that parents are frustrated when their 8-year-old child progresses by -0.50 in a year or their axial length grows by 0.15mm, despite the fact that both of these measures indicate a good outcome at that age. Both measurements are crucial indicators of higher eye disease risk and require context and explanation to properly understand.
TIO: What does management as a component of the standard of care for myopia management suggest to you? How do you put that into practice?
Dr. Ankit: Myopia management involves more than refractive error correction. It begins with educating parents on myopia’s developmental growth and its short- and long-term impact, followed by advice on the visual environment, such as increasing outdoor time and limiting screen time, and finally, choosing the best optical intervention for the child to correct and slow myopia growth.
TIO: At what age do you suggest initiating a myopia management intervention with a child? What factors influence your decision-making?
Dr. Ankit: Starting myopia management as soon as a child develops myopia, regardless of age, is recommended because myopia increases more quickly around the time of onset and progresses faster in younger children, leading to higher levels of myopia in adulthood. It’s important to have a variety of interventions available that match the child’s circumstances and lifestyle at different life stages. Traditional myopia correction methods such as single-vision spectacles or contact lenses are not recommended for children under 15 who are at risk of developing myopia.
TIO: How do you determine which myopia management intervention is most appropriate for each patient?
Dr. Ankit: Interviewing parents about their children’s lifestyle is crucial to evaluating the most effective myopia management strategy. This helps determine if the child will comply with the recommended approach. Myopia control glasses are used when single-vision contact lenses are ineffective, and 0.01% atropine is prescribed by an ophthalmologist to slow the progression of myopia. However, this treatment is generally only available to affluent families in India.
TIO: What circumstances can cause you to reconsider your myopia management intervention choice?
Dr. Ankit: To control myopia growth, a switch or combination of management options may be necessary. Combining atropine with other methods has shown positive results. Non-compliance may require me to change to a more suitable option or stop intervention altogether. If a poor response or side effects occur, it’s advisable to change or terminate the intervention.
TIO: When do you normally consider discontinuing your myopia management method, and how do you follow patients once the intervention has ended?
Dr. Ankit: Most myopes stabilise by age 18, but some may continue to progress into their twenties. Effective management techniques are important, and the consequences of stopping should be considered, including the need for continued vision correction. After stopping, the patient’s vision and comfort should be assessed, and continuous monitoring of eye health should be emphasised.
TIO: Finally, what does early prevention mean to you as part of the standard care for myopia management? How do you put it into action in your practice?
Dr. Ankit: Coming from a family of eye care professionals (ECPs), I had “traditionally” practiced myopia correction, so making the transition to myopia management as a standard of treatment was difficult. As the saying goes, everything unique needs time to be accepted. In my efforts to make this shift, I’ve encountered a lot of “wait and watch” mindsets.
In 2020, my practice became focused on myopia management, and the greatest challenge now is getting children to come in for eye exams. To encourage more visits, I urge adult patients to bring their children for exams and use social media and articles in local media to promote paediatric eye care.
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