VIEWPOINT - Clinical Spotlight - New Myopia Management Clinic

As seen in the Fall 2018/Winter 2019 edition of Viewpoint:

Clinical Spotlight:

New Myopia Management Clinic Takes Aim at Major Cause of Eye Disease

 

 

 

 

 

 

 

 

 

 

 

 

 

    
Pictured: Y. Shira Kresch, OD, MS, FAAO consulting a patient.

 

If you use glasses or contact lenses, or had LASIK or other corrective surgery for myopia (nearsightedness), you are far from alone. Almost half the U.S. population is now estimated to be myopic, a figure that has almost doubled over the past four decades. Myopia is also on the rise worldwide: in many East and South Asian countries, myopia rates have reached 80% to 90%.

“Why are myopia rates increasing so dramatically? Genetic factors play a major role in the development of myopia. Children are more likely to be nearsighted if one or both parents also have the condition, and a large number of myopia-related genes have been identified. But environmental factors such as close-up work, reading or working on a computer play a very important role in the development of myopia. For example, research published in the 1990s found that teenage boys in Israel who attended yeshivas where they spent long days studying religious texts had significantly higher rates of myopia than students who did not attend such schools.”

“Over the past four decades, the level of near work has significantly increased in most of the world, because of computers, mobile devices and smartphones,” says Andrei V. Tkatchenko, MD, PhD, Associate Professor of Ophthalmic Sciences (in Ophthalmology and Pathology and Cell Biology). “Myopia rates have increased as a result.” While glasses, contact lenses and surgery can correct the effects of myopia and allow clear distance vision, they treat the symptoms of the condition, not the cause. The underlying defect in myopia is an excessively elongated eyeball, which means that the lens focuses light in front of the retina, rather than directly on it. And this abnormality is more than just an inconvenience: it poses long-term hazards to a person’s vision.

“When the eye becomes longer, the tissue of the retina and the structures supporting the optic nerve in the back of the eye stretch and become thinner,” says Y. Shira Kresch, OD, MS, FAAO, Instructor in Optometric Science. “This elongation increases the risk of eye diseases that can cause visual impairment or even blindness, including cataracts, myopic maculopathy, retinal detachment and glaucoma. Earlier onset of myopia is linked with faster and more significant progression, which greatly increases the risk of these myopia-associated diseases. In fact, myopia is one of the five ocular conditions identified as an immediate priority by the World Health Organization’s Global Health Initiative for the Elimination of Preventable Blindness. What was once considered as a mostly benign condition is becoming a serious concern.”

Putting the Brakes on Myopia Progression

In spite of the high rate of myopia, there may be a window of time in children and young adults when proper intervention can substantially slow its progression. “There is a clearly defined treatable period between ages eight and 25 during which there is the greatest progression of myopia,” says Dr. Tkatchenko. “Myopia control is most effective during those years.”

The Department of Ophthalmology will be taking a leading role in tackling this major threat to ocular health by launching one of the first myopia control clinics in the greater New York City area. The clinic will officially open in early 2019, under the directorship of Dr. Kresch.

“Any child or young adult with myopia, especially if accompanied with signs of progression, should be considered for referral to our clinic,” Dr. Kresch says. "We can now predict with a fair amount of accuracy which individuals are most likely to progress and recommend specific interventions that may slow down the progression rate. By slowing the rate at which myopia advances, we hope to prevent more serious complications later on. As an academic medical center we maintain a critical approach to carefully evaluating the scientific evidence underlying any treatment we recommend, and we will also be involved in the investigation of new treatment strategies.”

After a comprehensive baseline eye examination with one of the Department’s pediatric optometrists or ophthalmologists, children and their parents will meet with the clinic’s faculty to discuss whether or not the child is eligible for myopia control and, if so, which available treatment option is best.

There are three main modalities that show evidence of slowing the progression of myopia, although none have yet received approval from the Food and Drug Administration (FDA). These include ophthalmic atropine eye drops, soft multifocal contact lenses with a center distance design, and orthokeratology (gas-permeable contact lenses that temporarily reshape the cornea). Adjunctive treatments include progressive or bifocal spectacles. Recommendation for a specific treatment plan will be determined on an individual basis with the agreement of the child, parents and treating physician. Orthokeratology will not be offered at this time due its slightly increased risk of infection compared to the other options. There may be opportunities in the near future for enrollment in myopia-related studies. Although these modalities seem promising, there is still no guarantee about the effectiveness of myopia control.

The Great Outdoors

Parents, teachers, and other caregivers can also help slow down the progression of a child’s myopia with one simple prescription that has no detrimental side effects and many other health benefits: spending time outside.

“A number of studies over the last several years have shown that outside activities suppress the development of myopia,” says Dr. Tkatchenko. For example, an Australian study called ROAM (Role of Outdoor Activity in Myopia) followed 101 children aged 10-15. The children wore wristwatch light sensors to record their light exposure and physical activity. The children who habitually spent less than 60 minutes a day outdoors had significantly faster eye growth compared with those who spent more time outside. And it appears to be time spent outside, not exercise, that protects against myopia. This and other studies found no relationship between physical activity level and myopia progression. “Go outside and play,” says Dr. Tkatchenko. “That’s the best thing parents can tell their children to help prevent myopia.”

“The emerging research, both clinical and scientific, gives us optimism that halting the progression of myopia may now be within reach,” says Steven Brooks, MD, the Anne S. Cohen Professor of Pediatric Ophthalmology and Chief of Pediatric Ophthalmology at the Harkness Eye Institute. “We are excited to offer patients the latest treatment options, and to continue exploring new and better ways to deal with this worldwide problem affecting vision.” More information about scheduling an appointment with the Myopia Management Clinic will be available after it opens in early 2019.

 

To learn more, schedule a consult, or speak with a specialist contact Ms. Jacqueline Maldonado by phone at (212)342-5632, or via email at jm4836@cumc.columbia.edu.


Viewpoint is a publication of the Edward S. Harkness Eye Institute and the Department of Ophthalmology in the Vagelos College of Physicians and Surgeons at CUIMC. Copyright © 2019. All rights reserved. For more information about the publication, our programs, or to discuss a gift, please contact Jane Heffner at (212) 305-7827, or jh2236@cumc.columbia.edu. To make a tax-deductible gift in support of the Department's vision research, education, or patient care, visit Ophthalmology Philanthropy.