Myopia management in the Netherlands

Abstract

Purpose A trend that myopia is becoming gradually more common is shown in studies worldwide. Highest frequencies have been found in East Asian urban populations (96.5%) but also a study in Europe shows that nearly half of the 25‐29 year olds has myopia. With the increase in prevalence, high myopia, i.e. a spherical equivalent of ‐6 or more and an axial length of 26 mm or more is also on the rise. High myopia particularly carries a significant risk of ocular pathology related to the long axial length. This highlights the need for myopia management in children with progressive myopia, in particular progression to high myopia. Recent findings During the last decade, many intervention studies for myopia progression have emerged. Although lifestyle adjustments are effective, pharmacological and optical interventions have shown the highest efficacy on reduction of eye growth. High concentration atropine (0.5%‐1.0%) shows the most reduction in axial length progression, but has drawbacks of light sensitivity and loss of accommodation. Nevertheless, when these side effects are mitigated by multifocal photochromatic glasses, the long‐term adherence to high dose atropine is high. Lower concentrations of atropine are less effective, but have less side effects. Studies on optical interventions have reported reduction of progression for Ortho‐K and multifocal contact lenses, but are in need for replication in larger studies with longer duration. Summary The field of myopia management is rapidly evolving, and a position on the best approach for daily clinics is desirable. Over the last 10 years, our team of clinical researchers has developed a strategy which involves decision‐making based on age, axial length, position on the axial length growth chart, progression rate, risk of high myopia, risk profile based on lifestyle and familial risk, side effects, and individual preference. This personalised approach ensures the most optimal long‐term myopia control, and helps fight against visual impairment and blindness in the next generations of elderly.

A retrospective analysis of the therapeutic effects of 0.01% atropine on axial length growth in children in a real-life clinical setting

“…(1) Compliance may vary among studies. In Rotterdam, [35] 73% adherence to the treatment regimen was reported, which is impressive given the high doses of atropine and the related side effects. In the study in Beijing [32], parents were asked to mark the dates of medication in a calendar.…”

“…Other studies used much higher doses of atropine, for example, 0.5% atropine [34]. Recently, Klaver and Polling [35] confirmed that 0.5% atropine eye drops had been successfully used in The Netherlands now for one decade. They found a reduction in axial length growth with atropine by up to 0.2 mm/year in 74% of the children over 3 years.…”

Update and guidance on management of myopia. European Society of Ophthalmology in cooperation with International Myopia Institute

“…Where axial biometry measures are available, these can also be informative in identifying children at risk for myopia who should be provided behavioural advice and monitored closely for the onset of myopia in order that anti-myopia therapies can be applied. 93,337,338 Percentile growth curves for White European children are available for axial length in childhood and can be used to identify patients whose eye size puts them at increased risk for future myopia. 93,337,338 In addition to identifying risk for future myopia, these centiles can be used after the onset of myopia to monitor growth trajectories with/without anti-myopia intervention.…”

“…93,337,338 Percentile growth curves for White European children are available for axial length in childhood and can be used to identify patients whose eye size puts them at increased risk for future myopia. 93,337,338 In addition to identifying risk for future myopia, these centiles can be used after the onset of myopia to monitor growth trajectories with/without anti-myopia intervention.…”

Natuurlijk naar buiten!

“…Ook wordt geadviseerd om elke dag buiten te spelen, ook als het regent, en om het beweegadvies van de Gezondheidsraad te volgen. De myopierichtlijn geeft het advies voor kinderen de 20-20-2-regel te volgen: na 20 minuten dichtbij kijken, 20 seconden in de verte kijken, plus 2 uur per dag naar buiten [ 5 ]. Uit een peiling van het Oogfonds blijkt dat kinderen deze regel duidelijk vinden en makkelijk onthouden [ 4 ].…”