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Monocular Myopia Management 

How can we best manage myopia which is anisometropic, unilateral or progressing in a child who is monocular? Here, the term 'monocular myopia management' is used as a catch-all for these unusual cases and clinical situations. For the monocular patient, safety is paramount. For the unilateral or anisometropic myope, who are almost always excluded from myopia control studies, what evidence is there for interventions? The good news is, there is some evidence. Read on to learn more. 

Clinical Article

Monocular Myopia Management: Unilateral And Anisometropic Myopia
How should you best manage children with unilateral or anisometropic myopia? Learn about what drives aniso-myopic development, associations with amblyopia and ocular pathology, and the evidence base for orthokeratology to slow aniso-myopic eye growth.

Clinical Cases

Managing Unilateral Myopia
Unilateral myopia can present a challenge to both myopia correction and control choices. In this case study, learn about which interventions have evidence for myopia control and reducing anisometropia, as well as the considerations for monocular versus binocular correction and treatment.
A Monocular Myope With Coloboma
An 8-year-old child is essentially monocular, due to unilateral high myopia associated with coloboma. The normally sighted eye has low myopia. How should we best balance safety and proactive myopia control in such a case? 

Science Snippet

Is orthokeratology effective for control unilateral and anisometropic myopia? 

This quantitative meta-analysis investigated the effectiveness of orthokeratology in controlling the progression of anisomyopia in predominantly Asian children. 10 cohort studies were included, with some examining unilateral myopic children and others bilateral anisomyopic children. The unilateral myopic group showed a mean AL elongation difference between myopic and emmetropic eyes of 0.27 mm (p<0.01) at 1-year follow-up and 0.17 mm (p=0.03) at 2-year follow-up. The AL of the emmetropic eye increased more than the myopic eye at both years of follow-up, with a reduction in total anisometropia. In the bilateral anisomyopic group, mean AL elongation difference between high and low myopic eyes was 0.06 mm (p<0.01) at 1-year and 0.13 mm (p<0.01) at 2-year follow-up. Total anisomyopia decreased; however this effect was reduced at year 2 in comparison to year 1. Overall, this study demonstrates that orthokeratology can effectively retard myopia progression in aniso-myopia and reduce overall axial anisometropia.
 
Tsai HR, Wang JH, Chiu CJ. Effect of orthokeratology on anisometropia control: A meta-analysis. J Formos Med Assoc. 2021 Jun 9:S0929-6646(21)00239-4.
Can late bedtimes cause myopia in children? 

This 2-year study collated data on the sleeping patterns, behavioural habits and demographic information of over 6,000 schoolchildren aged between 6 and 10 years in Shanghai, China, in order to explore the association with myopia development and progression.

Late bedtimes and late waking for the children was found to be significantly associated with baseline myopia and incident myopia, although the duration of their sleep was not. 

Over the study period, myopic prevalence increased from 6.77% to 27.64%.  This increase was seen alongside twice as many children who went to bed at 10pm or later over the 2 years. Where other confounding factors such as time spent outdoors, family history of myopia and age were considered, children with 9.30pm or later bedtimes were shown to have 1.55-fold higher odds of having myopia at the start of the study.  For incident myopia, this figure was 1.4-fold higher.

The mean progression of myopia over 2 years was -0.92D for all children.  For those who slept later than 9.30pm, progression was -0.16D more compared to children who went to bed before 9pm. When weekend sleep patterns were compared to weekdays, bedtimes were found to be similar, but waking times were an hour later suggesting waking time was less important for predicting risk of myopia than bedtime.  This was also seen when considering the associations between sleep and incident myopia.

Increased time reading and using screens and less time spent outside were common for children who had later bedtimes, indicating that other behaviours may also contribute to the risk of myopia development and progression. These findings may also add weight to the relationship between circadian rhythm disturbance and myopia. 

Liu XN, Naduvilath TJ, Wang J, Xiong S, He X, Xu X, Sankaridurg PR. Sleeping late is a risk factor for myopia development amongst school-aged children in China. Sci Rep. 2020 Oct 14;10(1):17194.

BRAND NEW online course!

Communicating the Myopia Message will help you master effective and efficient clinical myopia management without having to become a science expert. The interactive two-hour course covers all aspects of the myopia management journey from explaining the fundamentals through to gauging long-term management success. Each lesson provides a scientific foundation with advice on communicating this knowledge to parents. You'll find interactive parent communication scenarios, downloadable support tools, quick quizzes and more in engaging formats. Check out the course here and try the first chapter for free.

Myopia Profile Academy learning platform update

Our world leading, completely free Myopia Management in Practice online course has been updated with a brand new look in our engaging, interactive new text-based format. The content has also been updated to include the latest research on efficacy and outcomes of myopia management interventions. Have you checked it out yet? 

Recently we have also launched two brand new online courses entitled Communicating the Myopia Message and also launched our newest online course Mastering Refraction for Kids. Both two hour courses, these are designed to be engaging with animations, interactive communication scenarios, downloads and more to support your clinical skills and practice. Learn more about our courses and try out the first chapter(s) of any course for free here.

Our Resources to help you manage myopia

Courses Our world first, FREE Myopia Management in Practice course will get you started on your learning journey. Check out our five additional courses on Binocular Vision Fundamentals, Orthokeratology Fundamentals, Contact Lenses for Kids, Mastering Refraction for Kids and Communicating the Myopia Message.
Managing Myopia Guidelines Infographics Designed to support your clinical communication with parents and young patients, our hugely popular infographics are free to download and available in eight languages with various options based on your region and scope of practice. 
 
MyKidsVision.org Our public awareness website supports your in-room communications with fast facts, a risk survey, a detailed blog and 18 How-To videos to explain myopia to parents. All are freely available for you to link and share to your own website and social media accounts.
Instagram Follow MyopiaProfile for more links and learning experiences for eye care practitioners. Follow MyKidsVision for bite-sized, graphically appealing info on myopia and children's vision for parents which you can share to your own platforms.
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