Caught in the Crossover: Do ophthalmologists and optometrists have different intervention strategies for myopia management?

There is significant overlap between the fields of ophthalmology and optometry, and the treatment of myopia is no exception. COOKIE Magazine caught up with one of our regular contributors, Dr. Jeffrey Walline, to get the lowdown on what’s hot in myopia management right now, and whether optometrists and ophthalmologists have different strategies when it comes to myopia control.

It’s reassuring to know that eye health professionals are well-informed about the myopia epidemic and actively collaborating to evaluate, innovate, and educate each other on the issue.

We asked Dr. Jeffrey Walline, associate dean for research at the Ohio State University College of Optometry in the US, how ophthalmologists and optometrists are working together to tackle the epidemic, what similarities and differences one might expect to find in their respective treatment approaches, and what innovative new methods are showing promise.

They got this!

“The American Academy of Ophthalmology created a task force on myopia and included representatives from the American Academy of Optometry, the American Academy of Family Physicians, and the American Academy of Pediatrics. They wrote a white paper¹ on the topic,” shared Dr. Walline.

“There is also a group of industry partners called the Global Myopia Awareness Consortium (GMAC)² that work together to improve public awareness about myopia and myopia control. They include optometry and ophthalmology association members, such as the Academy of Optometry, the World Society of Pediatric Ophthalmology and Strabismus, and the International Agency for the Prevention of Blindness,” he added.

So, what’s working?

What is currently best practice when it comes to myopia management, you ask? What tried and proven treatment methods are out there?

“In the United States, we can offer our patients soft multifocal contact lenses, orthokeratology, and low-concentration atropine eye drops,” Dr. Walline continued. 

These treatment options (or a combination of them) have proven to be equally effective in the fight against myopia.³ 

Opt or ophth: What will it be?

Do ophthalmologists and optometrists have different preferences when it comes to prescribing treatments?

“Both optometrists and ophthalmologists can offer the full variety of options available to patients for myopia control,” said Dr. Walline. “All of the treatments provide approximately the same amount of myopia control for patients, and you can’t predict which one will work best for an individual patient. So, we should provide the option that best suits the patient’s needs because they are most likely to be compliant with that modality. Having said that, optometrists are more likely to offer soft multifocal and orthokeratology contact lenses for myopia control than ophthalmologists, and ophthalmologists most frequently prescribe low-concentration atropine,” he opined. 

“Patients should also ask their eye care practitioner what options are available for myopia control because there are many optometrists and ophthalmologists who don’t offer all three modalities for myopia control,” he noted. 

Given there are varied factors leading to myopia development, a holistic approach makes sense. As does choosing a treatment regime that the patient is most likely to be compliant with. 

A myopian future, anyone?

So, we know that soft multifocals, orthokeratology, and low-dose atropine can help manage myopia. But what about emerging innovative technologies and treatments that might have potential to move forward?

“The only treatments available in the United States today are soft multifocal contact lenses, orthokeratology, and low-concentration atropine,” Dr. Walline shared. “Innovative treatments on the horizon may include spectacles produced specifically for myopia control, and red light therapy. The glasses are marketed throughout the world, but have not yet earned Food and Drug Administration (FDA) approval for myopia control.” 

“In Asia, children are provided instruments to use at home that shine red laser light at the eyes two times per day for three minutes each time, and that is reported to slow the progression of nearsightedness. However, that therapy is not available in the United States and requires much more study of the effects on eye health, vision, and progression of nearsightedness before it will be used in clinics,” he added.⁴

Dr. Walline offers an anecdotal prediction for when these treatments might become available in the US.

“I don’t think the FDA ever works on a specific timeline. Honestly, I don’t know much about the approval process for any of the three options,” he said. “Typically, the FDA requires data collected in the United States, and I think only SightGlass (CooperVision/Essilor, CA, USA/Paris, France) has collected data in the US. However, you never know for sure what they will allow, so I hate to speculate. I also haven’t seen any data presented beyond one year for SightGlass, so I don’t know how effective they are.”

He’s optimistic, however, about the effect emerging technologies and treatments could have amid the current myopic milieu.

“I do expect that an FDA-approved myopia control spectacle will change the game (in the USA) dramatically. Interestingly, the glasses don’t have to be specifically prescribed by a doctor, but they should specifically be fitted to the child by an optician or doctor. In other words, a doctor will write a prescription to correct myopia, then the parent can get regular glasses or myopia-control glasses,” Dr. Walline explained. “However, the glasses should be fit so that the patient looks directly through the center of the lens, which is the clear part to allow clear distance vision.”

Clear distance vision

This is perhaps a good mantra to help lead us onwards to a future where we have greater control over and understanding of myopia progression. There are a lot of moving parts and as yet unknowns within the myopia epidemic. What is clear, though, is that this kind of cross-industry/professional cooperation and sharing of knowledge can only be of benefit. 

Long may the crossover continue!

REFERENCES: 

1. Modjtahedi BS, Abbott RL, Fong DS, et al. Reducing the Global Burden of Myopia by Delaying the Onset of Myopia and Reducing Myopic Progression in Children: The Academy’s Task Force on Myopia. Ophthalmology. 2021;128(6):816-826.

2. Global Myopia Awareness Coalition. Available at https://www.myopiaawareness.org/. Accessed on June 3, 2023. 

3. Walline JJ, Lindsley KB, Vedula SS, et al. Interventions to slow progression of myopia in children. Cochrane Database Syst Rev. 2020;1(1):CD004916.4. Jiang Y, Zhu Z, Tan X, et al. Effect of Repeated Low-Level Red-Light Therapy for Myopia Control in Children: A Multicenter Randomized Controlled Trial. Ophthalmology. 2022 May;129(5):509-519.