I'm working on a myopia protocol, which is an exciting, somewhat daunting project. Think about telling the majority of doctors that they are treating the most common diagnosis in their practice thewrong way. That should go over well, don't you think?! It is fun though and I mean that sincerely.
Research is moving fast and what many of us thought was true just isn't so. RGPs don't slow myopia significantly. Just that one fact is not believed by many contact lens fitters. A protocol that goes against their cherished belief has a high bar to overcome. Not only must the protocol lay out the science behind what suggestions are made, it needs to make a solid case for why other alternative protocols don't make sense.
I think the protocol also needs to comment on techniques that have different levels of proof. This is commonly referred to as "levels of evidence." At the top level (from another's listing) would be evidence obtained from meta-analysis of randomized controlled trials while at the lowest rung would be evidence obtained from expert committee reports or opinions and/or clinical experiences of respected authorities. That's a large span but I think it is important to both guide individual doctors and guide future research.
Here's an example: A patient who is -4.50 and progressing and not willing to go for orthok or other treatments, asks you if it would in any retard their myopia progression if they went without their glasses for part of the day. I'm sure the majority of offices say something to the effect "Just wear them - your glasses don't make your eyes better or worse, they just compensate for the blur. If you get more nearsighted, we'll change your prescription next year." Certainly there is no research out there to support either view.
You, in your enlightened state of mind however, are willing to entertain a thought process that might go like this: "Hmm - myopia seems driven by peripheral hyperopia. It is better to have peripheral myopia and animal studies have shown that short intervals daily of peripheral myopia can compensate for long intervals of negative lens blurring. If this patient takes off their glasses that are most likely creating peripheral hyperopia and looks at anything beyond their fingertips, they most likely will have significant peripheral myopia. So yeah - I think they SHOULD take their glasses off an hour or so a day and go for a walk."
Now that's a somewhat radical recommendation coming from a "traditional" optometrist. But if expert opinion agrees, maybe it needs to be mentioned in a protocol.
I don't know what the experts think yet. Imagine where you might stand.
Richard L. Anderson, O.D.
Richard L. Anderson, O.D. is a fellow of the academy and has been assigned to head a committee tasked with creating a myopia prevention protocol. He has practiced in Camarillo California for more than a few years and his passion for myopia prevention led him to most recently create a website for patients and doctors at http://www.MyopiaPrevention.org.