Delaying myopia onset with Dr. Jeffrey Walline

Jeffrey Walline, OD, PhD, FAAO, discusses the complexities of myopia control, noting that individual progression rates cannot be definitively measured, but average eye growth rates are used as a benchmark. The average eye growth for an emmetropic eye is 0.1 mm/year, while a myopic eye grows at about 0.2 mm/year. Eye growth varies seasonally and with age, making it difficult to predict individual outcomes. Treatment success is assessed by comparing growth rates to these averages. Walline also mentions the evolving knowledge base in myopia control, the importance of predicting myopia, and the potential benefits of delaying myopia onset, including reduced severity and risk of sight-threatening complications. Innovative treatments are being developed to manage myopia progression.

Video transcript

Editor's note: This transcript has been lightly edited for clarity.

Jeffrey Walline, OD, PhD, FAAO:

When it comes to myopia control, there are no numbers for any given individual that say whether or not the treatment is working, but what we think about is the average eye growth of a particular patient. So the average eye growth of an emmetropic eye or an eye without any myopia, is about a 10th of a millimeter per year. So even those eyes that don't need glasses are still growing. The growth of a myopic eye is about 2 10th of a millimeter per year, or about double what it is for intros. However, having said that, eye growth slows with age, and it also doesn't happen just linearly. It tends to go quicker and slower, even across the year. Our eyes tend to grow more during winter months and less during summer months. So given those numbers, we really can't tell anything about individuals, whether a treatments working, but on average, those are the numbers that we keep in mind. So if somebody's growing, even under myopia control treatment, more than 2 10ths of a millimeter, we get more concerned. If they're growing somewhere between a 10th and .2 millimeters, then we're less concerned. But there is still some concern. When they're a 10th of a millimeter less, there's far less concern about trying to slow the progression of myopia.

The other thing we have to keep in mind is that the previous year's growth of the eye has almost no predictability for the next year's growth of the eye. So that kind of indicates that we should provide myopia control for all myopic patients, as opposed to just those ones whose eyes grew quickly over the past year. So I think our knowledge base is evolving, and those are some of the things that we can take away, but we still got a long way to go.

I think one of the areas that we're really delving into right now is predicting myopia, which we're actually pretty good at. All we have to do is measure the refractive error of the eye, but once we predict it, then the goal is to try and delay the onset of myopia. That has a couple of potential effects. The first one is obviously that you won't have to wear glasses until you reach an older age. But the second one that we think is true is if we can delay the onset, ultimately, as an adult, you will be less myopic. And so that's where we're headed next is with just eye drops that we can give to patients before they become myopic, and we delay the onset, and ultimately make them less myopic as adults, so that their risk of sight threatening complications is therefore potentially lower as well. So I think that's where the direction of myopia control is headed that's new and different. And then, of course, we'll come up with innovative treatments that patients can can use to try and slow the progression of myopia once the onset occurs.