ABDO welcomed 174 delegates for its inaugural clinical conference on myopia management at the National Resource Centre (NRC) in Birmingham on November 29 and 30, 2023.
The ABDO team, made up of Dr Alicia Thompson, director of education, research and professional development; Alex Webster, head of CPD; Cheryl Hill, CPD officer; Sue Bennett, CPD operations manager; Miranda Richardson, head of professional qualifications and education; Max Halford, clinical lead; Dean Dunning, deputy head of professional qualifications and education, and chief contact lens examiner; and current ABDO president Daryl Newsome, gave delegates a warm welcome on arrival.
Registration was early at 8.15am as there was a packed programme of CPD lectures, workshops and a visual recognition test offering a total of 14 CPD points.
Keynote speaker Professor James Wolffsohn (pictured right), professor of optometry at Aston University, provided the first of three lectures on myopia prevalence, risks and aetiology. Seeing the figures up on screen does bring the message home that myopia will affect 50% of the world’s population by 2050.
Prof Wolffsohn discussed the importance of consistent definitions for myopia and that biometric data measurements are useful but not having the equipment to measure axial length should not preclude practitioners from prescribing myopia management.
The International Myopia Institute (IMI) white papers were highlighted as a source of reference to help keep up to date but with the caveat that all evidence should be carefully considered, and limitations of research explained to patients so that informed decisions can be made. The high myopia ‘red flags’ were highlighted as well as risk factors like age of onset, ethnicity, education and near work, parental myopia and pre-myopia.
Increased time spent outdoors was strongly advocated for all children. A concerning point that stood out was that one in six eye care professionals (ECPs) still use under-correction for myopia management at least sometimes, despite evidence showing this can, in fact, increase myopic progression. This is concerning particularly as there are now many safe and effective licenced products available.
A useful communication tool was presented, the ‘PreMo’ (Predicting myopia Onset and Progression) app based on research from Ulster University that produces individualised patient-friendly reports. The overall theme of the lecture was on the importance of eye care for children and to be proactive in myopia management.
The second lecture, ‘But why has my child become myopic’, by Dr Neema Ghorbani Mojarrad (pictured below), assistant professor, University of Bradford, picked up from where Prof Wolffsohn finished and looked in detail at the evidence breaking down the accurate from the inaccurate or misunderstood results of research for each risk factor.
The detail was excellent and will be invaluable for communicating with patients and parents. A key point was made that research results are based on averages and while there is no cure for myopic progression for most it can be slowed.
Interestingly, there are over 500 genes associated with myopia. Lots of common gene variants having small effects, emphasising myopia is a complex trait due to a mixture of genetic and environmental effects. At a time when children seem to be spending an ever-increasing amount of time on digital devices WHO recommendations were given, children under one should have no screen time and those under five years should be limited to one hour a day.
Interestingly, there is no evidence that reading books is better or worse than using a screen but for each additional hour spent working up close could increase the risk of myopia by 2%. Encouraging outdoor time was again advocated with the reminder it is safe and promotes wellbeing. The results of a review of systematic reviews was presented, which showed strong proof that time outdoors was associated with reduced myopia onset, although there is limited evidence that it reduces myopic progression.
The mechanism is likely due to light, which causes an increase in dopamine release, and it is this same dopamine release that is believed to be the mechanism involved with atropine. It is likely atropine will become available in the UK in 2024 to ophthalmologists and independent prescriber optometrists but rebound effects are still a concern.
Something we are all just hearing about is Repeated Low-Level Red Light (RLRL) therapy, which is now licensed in the UK and involves a three-minute dose twice a day (four-hour gap between treatments), five days a week. The theory for this mechanism is that the light stimulates blood flow to the choroid and retina and reduces scleral hypoxia promoting a thicker choroid with this remodelling reducing myopia progression. Average efficacy in the first 12 months of 75% and new projects of combination treatments with orthokeratology are under way.
These first two lectures were excellently choreographed to disseminate current and emerging research, communicating myopia to our patients is much easier when we ourselves understand the facts and the information from these lectures will be an invaluable resource when discussing myopia with patients and parents.
The third lecture by Dr Alicia Thompson (pictured right), ABDO director of education, research and professional development, ‘Spectacles and paediatric fit – are they fit for purpose?’ The feedback from the audience was very clear on the question in the title of this presentation, many current children’s frames are not fit for purpose.
Dr Thompson demonstrated that most children’s frames are scaled down versions of adult’s frames then, using data from her own research of typically developed white British children, Chinese children, and children with Down’s syndrome showed why this approach results in designs that are inappropriate and do not fit most children.
How children’s facial anthropometry changes as the child grows provides valuable data on how children’s frames ‘should’ be designed. Delegates were reminded that spectacles are a medical device not just a fashion accessory and as such need to accurately fit the face, and hold the lenses in the correct position to ensure the visual system achieves its full potential, particularly relevant as plasticity in the visual system (critical period) is up to seven to eight years.
The impact of poorly fitting spectacles on educational achievement, social development, and behaviour was highlighted also, damage to developing facial structures and reduced lens performance due to inaccurate centration. Dr Thompson said children’s frames should not be on display but only available after assessment with five or six suitable frames selected and shown to the patient to avoid disappointment when a child is told they cannot have a chosen frame as the fit is not acceptable.
Spectacle lenses designed for myopia management have strict fitting criteria and often require a frame with a minimum B measurement, zero pantoscopic angle and vertex distance of 10mm. These lens designs have a smaller central clear zone so when a frame is not accurately fitted the child will not be looking through the correct position and the efficacy will be reduced. When fitting children’s frames, they should:
- Fit the child’s anatomical features
- Be safe, comfortable and durable
- Hold the lenses at the correct position
- Not damage the child’s developing structures
Dispensing opticians are trained and assessed in their ability to take accurate facial measurements although, sadly many facial rulers are confined to a drawer after exams. Experience and a keen eye for estimating facial characteristics is something all dispensing opticians develop as for very young children using a ruler is often not a safe option. There was great emphasis placed on understanding how facial measurements relate to frame measurements, and the effect upon frame fit when a measurement is changed.
This lecture comes at an ideal time and demonstrates the core skills required for accurate paediatric spectacle dispensing. Two frame manufacturers Millmead Optical and Stepper eyewear have worked with Dr Thompson to create a range of paediatric frames that considers her research with eye sizes, bridges and sides that actually fit children. The patient journey, communication and consent were also covered, having a specific area for dispensing to children away from distractions was advocated. The presentation ended with a very plain message, ‘Every child matters’.
It is great to see a fellow dispensing optician present their own research and will hopefully inspire others onto further study. It is very clear dispensing opticians are ideally placed and have the necessary skillset to support patients and parents in myopia management as it is an increasingly important part of optical practice.
Before breaking for lunch there was a question and answer session where Dr Thompson and Dr Neema Ghorbani Mojarrad, which addressed issues of myopia and astigmatism, whether cycloplegic refraction should always be used in assessment of myopic progression, how do we know if treatment is working? As well as the very key issue patient compliance.
Exhibition hall
During lunch delegates made their way around the exhibition where there were a wide variety of products related to myopia management including both paediatric frames and spectacle and contact lens myopia management lenses. Sarah Gillingham, managing director of Tomato Glasses UK, explained the unique but easy modifications that can be made to Tomato frames to alter crest height to suit individual patient needs or convert to curl sides.
Sophie Lifton, senior marketing manager Milmead Optical Group, showed the Star Fit Lazer Junior range ‘evidence-driven’ paediatric frame designs developed in collaboration with Dr Alicia Thompson using eco-biodegradable acetate and recycled metal ergonomically designed oval and round eye shapes to fit ages two to six years old, eight different models, each in two bright colours.
Peter Reeve, managing director Steeper (UK) with Steeper Kids new generation frames, Alpha Fit range in TX5 advanced injection moulded plastic with four age related fit variants, zero to four, four to six, six to eight, and eight to 10-years, developed again working with Dr Thompson, which are expected to go on sale in January 2024, was generating a lot of interest.
We are now seeing more new additions to the spectacle lens myopia management options joining the more familiar Hoya MiyoSmart and Essilor Stellast lenses Rayna Greenfield, sales manager for Optimum, appeared very busy discussing the new Optimyope lens with delegate Jayshree Vasani.
Vicky Knight-Smith, business development manager for CooperVision, commented it had been a busy morning.
Menicon which offers both an orthokeratology lens design, Menicon Bloom Night, as well as a soft daily disposable lens, Menicon Bloom Day, accompanied by a monitoring app to simplify communication between the patient/parent and ECP and for those interested in this feature Phillip McGriele business development manager was happy to answer questions.
Dave Smithwick, regional sales manager with Mark’ennovy, highlighted the extensive prescription ranges for their Mylo silicone hydrogel lens spheres -0.25D to -15.00D and cylinder -0.75DC to -8.00DC, which means more patients can now access these lens designs
Paul Humphries, business development consultant from Positive-Impact, was happy to talk about NaturalVue 1 day multifocal extended depth of focus lens and their online ‘Dry Eye Zone’, which aims to support independent practices who have seen many of their patients purchasing dry eye products from non-optical channels, details can be found at dyeeyezone.co.uk.
Afternoon workshops
After lunch, there were three discussion workshops. One was on spectacle lens options for myopia management led by Cheryl Hill, ABDO CPD officer, and Miranda Richardson, head of professional qualifications and education, which included lens manufacturers explaining the research behind their lens designs. Delegates were encouraged to discuss their understanding of critically appraising research – engagement in all the workshops was excellent with everyone contributing.
The contact lens options for myopia management discussion workshop was led by Dean Dunning, deputy head of professional qualifications and education and chief contact lens examiner, with tables being expertly facilitated by the contact lens suppliers who discussed the research supporting their contact lenses and managed to keep us all focused on the discussion questions.
The final workshop was on technology and myopia management led by Max Halford, clinical lead, which gave delegates the opportunity to see and try different equipment for taking biometric measurements and the available software to demonstrate potential myopic progression with myopia management and without. This is an area where I would have loved to spend more time.
As the event came to an end it was clear to see there was a lot of hard work involved in planning and executing this very successful day, well done to all the ABDO team, all I can say is: when is the next one?