Visual acuity testing, retinoscopy, autorefraction, or photorefraction during vision screening or clinical examination can all help detect Myopia. One of the most common vision screening batteries, the Modified Clinical Technique, includes visual acuity, ophthalmoscopy, retinoscopy and a cover test. Some screening programs include autorefraction or photorefraction rather than retinoscopy 1.
A correct evaluation of a patient with Myopia involves comprehensive eye and vision examination that should include several elements outlined below1–
Patient history
A thorough patient history includes a review of the nature of presenting problem and chief complaint, visual, ocular and general health history, developmental and family history, use of medication, allergies and vocational and avocational vision requirements. The patient history could reveal the following types of Myopia
Simple Myopia
Nocturnal Myopia
Pseudo Myopia
Degenerative Myopia
Induced Myopia
Ocular examination
Could provide important information such as on
Visual acuity
Refraction
Ocular Motility, Binocular Vision, and Accommodation
Ocular Health Assessment and Systemic Health Screening
Supplemental testing
May be indicated for identifying associated conditions and documenting and monitoring retinal changes in patients with degenerative Myopia. Some of these supplemental testing include
Fundus photography
A- and B-scan ultrasonography
Visual fields
Tests such as fasting blood sugar (e.g., to identify causes of induced Myopia)
Management
The purpose of Myopia management is to slow the elongation of the eye, minimize the spectacle prescription, and reduce the risk of complications later in life. At a younger age, disease progression is faster with Myopia. Lowering Myopia by 1.00 D can have a clinically meaningful effect on the risk of eye disease (myopic macular degeneration by 40%, open-angle glaucoma by 20%, and visual impairment by 20%). Increase in Myopia by 1.00 D is associated with a 67% increase in the prevalence of myopic macular degeneration (MMD)2 .
The myopia management can be summarized by;3
Identify risk factors for Myopia
Providing information, advice and recommendations to children, parents and other stakeholders
Prescribing appropriate interventions to slow Myopia progression
Being proactive
Current treatment options
The corrections for nearsightedness mainly include corrective lenses or surgery. Eyeglasses and refractive surgery can correct the refractive error or refocus the image onto the retina4
More time outside
By balancing screen time with outdoor times when possible, may helps to limit child’s Myopia and protect their vision as they grow
Corrective lenses
These devices make up for the curve of cornea or the elongation of eye by shifting the focus of light as it enters an eye
Eye drops
Use of low-dose atropine helps to slow down the progression of Myopia
Corneal reshaping therapy
Corneal reshaping therapy, also known as orthokeratology, involves using specific lenses to temporarily change the shape of the cornea. This therapy may help correct Myopia and prevent it from progression
Surgery
Refractive surgery is a permanent form of correction for nearsightedness. Also called laser eye surgery, the procedure reshapes the cornea to focus light onto retina. This procedure is currently not approved in children.
Prevention
Myopia prevention in first place is utmost important. It is certainly difficult to convince people, especially children to act before a problem appears. Prophylactic actions are essential for those who have a history of Myopia in their family. Some epidemiological studies suggest that children who spend more time outdoors are less likely to be or become myopic, irrespective of how much near work they do. Probably, the light-stimulated release of dopamine from retina that inhibits increased axial-elongation could account for protective effect of outdoor time spent by these children5Some of the factors that could help in preventing progression of Myopia are as follows:5
Reduction of accommodative and other stress: This could be achieved for example through reading with appropriate distance only or appropriate under-correction for reading
Image quality optimization: For instance, through good illumination
Strengthening of the connective tissue: The degradation caused due to local effects such as poor image quality or systemic processes could be prevented with the help of optimized nutrition
References
American Optometric Association.Optometric Clinical Practice Guideline. Care Of The Patient With Myopia. Available At Http://Www.Aoa.Org/Documents/Optometrists/CPG-15.Pdf. Last Assessed On 25th August 2022.
Guidelines For Managing Myopia: A Review. Available At: Https://Modernod.Com/Articles/2022-Mar/Guidelines-For-Managing-Myopia-A-Review?C4src=Article:Infinite-Scroll. Last Assessed On 25th August 2022.
What Is Myopia Management? Available At: Https://Reviewofmm.Com/What-Is-Myopia-Management/. Last Assessed On 25th August 2022.
Nearsightedness (Myopia). Available At: Https://Www.Healthline.Com/Health/Nearsightedness. Last Assessed On 11th August 2022.
