Identifying premyopia and encouraging preventative treatments

Leslie Scher, OD, FAAO, continues her discussion on pediatric myopia care and management. Scher’s approach to myopia has changed over the years, and she now views it less as a simple prescription change and more as a disease state. Myopia is caused by higher axial lengths, which can lead to increased long-term risk of retinal detachment, myopic macular degeneration, glaucoma, and cataracts.

After diagnosing myopia, Scher conducts lengthy discussions with her patient and their family about treatment options to control progression, often spacing the conversation across multiple visits rather than deciding same-day. She emphasized the importance of including children in the conversation, as it makes it less likely they will disregard her advice, and helps them feel engaged in their own eye health and compliant with treatment.

Scher also considers her patient's hobbies, such as reading or video games, in order to tailor her advice, since near-work habits directly affect progression. She advises parents to implement realistic lifestyle changes, such as the 20-20-20 rule, increasing outdoor time, and encouraging children not to hold books or screens too close to their face. Scher acknowledges these habits aren't always perfectly achievable, and encourages patients to adjust what they can.

Scher also works to identify premyopia in younger patients, generally ages 9 to 12, and discusses treatment options with parents sooner rather than later, since earlier onset of myopia predicts a higher risk of severe progression. She recommends low-dose atropine treatment as an effective tool in treating pre-myopia, and has had success keeping several patients from progressing into full myopia.

When treating an adult patient with advanced myopia, Scher will suggest they bring in their children to start treatment plans early. She finds this method effective, as parents with lived myopia experience are more likely to pursue treatment options for their children. She also stressed the value of annual comprehensive exams for all patients, regardless of whether their prescription seems stable, since these visits monitor broader ocular health beyond refraction alone.