Dr Sally Dillehay, OD, EdD, FAAO
BHVI
The Myopia Meeting (TMM) was held in early December 2019 in San Francisco, with just over 100 people in attendance. TMM is headed by the Chief Medical Editor for Review of Myopia Management, Dr. Dwight Akerman, and managed by its publisher, Jobson Medical Information, LLC.
TMM was a full day of excellent information presented by Drs. Mark Bullimore, Noel Brennan, Maria Liu, Tom Aller, and S. Barry Eiden. Throughout the day, workshops and exhibits by various sponsoring companies helped to round out a full day of learning with 6 COPE approved CE hours.
Even at age 25 or older, at least 1 in 6 myopes will still progress at least 0.50D over 5 years.
Drs. Bullimore and Brennan presented a thought provoking summary of 12 evidence-based things that we all need to know about myopia. Myopia is the leading cause of irreversible vision loss, and yet its major cause of vision loss, myopic macular degeneration (MMD), is the only leading cause of blindness without an established treatment.
It may surprise you that 30% of those who develop MMD are moderate myopes in the range of -2.00 to -5.00D. Although age is the most important determinant of myopia progression, race (Asian), family history (2 parents), gender (Female), all represent additional factors in the rate of progression. The exact age when myopia progression stabilizes varies widely, but at age 15, 50% of myopes are still progressing. Even at age 25 or older, at least 1 in 6 myopes will still progress at least 0.50D over 5 years.
Likewise, many children with photophobia do not always have dilated pupils, so pupil size has limited value in predicting issues with glare, photophobia, as well as accommodation. It is common to see an anisocoria with 0.01, 0.025, and 0.050% atropine.
Dr. Liu presented her observations on atropine use, based on patients seen in the University California Berkeley School of Optometry Myopia Clinic. She has observed that low-dose atropine can create cycloplegia, mydriasis, photophobia, and allergic responses. Many children with dilated pupils have no photophobia.
Likewise, many children with photophobia do not always have dilated pupils, so pupil size has limited value in predicting issues with glare, photophobia, as well as accommodation. It is common to see an anisocoria with 0.01, 0.025, and 0.050% atropine. She has also noted a hyperopic shift in even 0.05% atropine at the 1 month visit, due to relaxation of tonic accommodation. She recommended starting with 0.025% atropine, measuring amplitude and facility of accommodation, pupil size, slit lamp exam and IOP at each follow up visit, which she completes at 1 week, then every 3-6 months.
Based on a repeatability study for myopes for one visit to the next that Dr. Eiden performed with several other practitioners on the IOLMaster (publication in progress), he recommends taking 20 measures of axial length on each eye to be able to track progression at the 0.04mm or 0.125D level.
Dr. Aller presented on his extensive clinical experience with a wide variety of soft multifocal contact lenses for treating myopia. His clinical data has shown a better effect on decreasing myopia progression by using higher add powers, based on both refractive error and axial length changes.
Dr. Eiden presented on the use of orthokeratology in his practice. He targets patients progressing 0.50D/year or greater, with increased concerns about risks for Asian eyes, onset of myopia younger than age 7, less time spent outdoors, and increased amount of time spent on reading/near work.
Dr. Eiden measures axial length on every myope, with a measure of 23 mm being the start of concern, and 26 mm having a greatly increased risk of retinal complications. Based on a repeatability study for myopes for one visit to the next that he performed with several other practitioners on the IOLMaster (publication in progress), he recommends taking 20 measures of axial length on each eye to be able to track progression at the 0.04mm or 0.125D level.
Regardless if your treatment preference is low-dose atropine, orthokeratology, soft multifocal contact lenses, or even a combination of those, all of the experts agreed on one thing: we all need to be doing everything that we can NOW to treat myopia as a disease with the potential for serious long term visual consequences.
Regardless if your treatment preference is low-dose atropine, orthokeratology, soft multifocal contact lenses, or even a combination of those, all of the experts agreed on one thing: we all need to be doing everything that we can NOW to treat myopia as a disease with the potential for serious long term visual consequences.
If you weren’t able to make it to TMM San Francisco, there will be 4 additional sessions throughout 2020: March 15 in Spokane WA, May 3 in Morristown NJ, August 30 in Cambridge MA, and October 18 in Chicago IL. Visit http://reviewofmm.com/ to sign up for the excellent content available and for more details about the future The Myopia Meeting.