How much axial eye growth is normal?

Axial eye growth is the primary outcome in myopia control studies and is increasingly important in clinical management. We know we should measure it, but what does normal look like?

In this edition powered by OCULUS, we explain the typical axial growth patterns in emmetropes and untreated progressing myopes, how they vary by age, and how you can determine treatment success. Our two clinical case studies take ocular measurement further by examining how measuring the cornea and axial length can help to solve clinical puzzles in myopia and support best-practice management.

Clinical Article

How Much Axial Length Growth Is Normal?
What amount of axial length growth be expected in myopes versus emmetropes, and how can you tell if your myopia control treatment is working? This important clinical reference provides all this information and more on axial growth in younger and older children, emmetropes and myopes, and even data on typical myopia stabilization.

Clinical Cases

Is It Myopia Progression Or Early Keratoconus?
How would you manage a progressing myope with early keratoconus? In this case, refractive progression of myopia was not just due to axial elongation, and astute repeated measurement of both the corneal curvature and axial length helped with accurate diagnosis.
Are You Measuring The Cornea In Myopia Management?
Measuring the cornea in myopes is crucial to understanding their clinical picture and even their profile of myopia risk. Flat corneas can mask an axial length which is longer than expected for the patient's refraction. Learn more in this clinical case study.

Science Snippet

Myopia management in the Netherlands - advice and outcomes from a new protocol 

This study from the Erasmus Myopia Research Group explored factors to consider when managing children’s myopia, and described their own myopia management protocol based on axial length centile growth charts.

Part 1: Lifestyle advice. The Erasmus protocol includes providing lifestyle advice to all myopic children as follows.
  • limiting close work/screen time to 2 hours maximum in children 5-12yrs
  • holding close work no closer than 30cm
  • using the 20-20-2 rule of looking afar for 20 seconds every 20 mins and spending 2 hours outside daily
Part 2: Proactively treat children at risk of high myopia with 0.5% atropine. Children with axial lengths on or above the 75th centile are at risk of high myopia (6D or 26mm) and hence should receive the most effective treatments. Atropine 0.5% is prescribed for these children and the concentration adjusted six-monthly according to progress, which is plotted on axial length growth curves where success is indicated by reduction in percentile. Side-effects of photophobia and near vision blur are managed by prescribing all of these children photochromic multifocal spectacles with a +3.00 Add. In a real-world study of almost 80 children prescribed this protocol, 74% had less than 0.2mm per year axial growth compared to an average of 0.34mm per year in a non-treated historical comparison group. Around 17% of children still progressed by more than 0.3mm per year.

Part 3: Manage remaining myopic children with other treatments. For children under the 75th centile, treatments with less side effects are offered: atropine 0.05%, orthokeratology and dual-focus or multifocal soft contact lenses. Atropine is considered for children over 6 and contact lenses for children over 8 years. Follow up occurs every six months, using the growth charts to plot progress. For all myopic children, the authors report that visualization of treatment progress using the growth charts is “an enormous stimulus for parents to adhere to treatment.”

Part 4: Ceasing treatment in the late teens. The authors state that treatment generally occurs until age 15, or beyond if required for children in the highest percentiles. When axial length growth has stabilized to less than 0.1mm per year for more than a year, atropine concentration is tapered. Treatment is ceased when the rate of eye growth is less than 0.05mm per year.

Klaver C, Polling JR; Erasmus Myopia Research Group. Myopia management in the Netherlands. Ophthalmic Physiol Opt. 2020 Mar;40(2):230-240.

Helpful links from Oculus

Video Lecture: How to dance with the Myopia Master
In this one hour seminar, learn from Optometrist Dr Oliver Woo how to utilize all the capabilities of the OCULUS Myopia Master® in everyday myopia management, combining knowledge, equipment and treatment options for clinical success.
Case Report: Myopia Case Report – New standard of care in children
Max Aricochi, Optometrist, explains a case of myopia management in an 8-year-old exophoric patient, and how measuring axial length fits into this picture.

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 also launched our newest online course Mastering Refraction for Kids. This two hour course will increase your knowledge, clinical skills and confidence in refraction techniques and prescribing decisions for children. 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 additional courses on Binocular Vision Fundamentals, Orthokeratology Fundamentals, Contact Lenses for Kids and Mastering Refraction for Kids.
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. 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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