|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.