Mobilizing against myopia

Excerpted from page 22 of the Fall 2024 edition of AOA Focus. 

In June 2023, the AOA announced its national Pediatric Vision and Eye Health Mobilization.  

One year later, at Optometry’s Meeting® 2024, Curtis A. Ono, O.D., a member of the AOA’s Board of Trustees, reported to the House of Delegates, “Since just last year, we’ve made some real progress.” 

Today, the multifaceted mobilization, a marshalling of an array of AOA resources, is off and running. 

A longtime priority for the AOA 

Axial length of more than 24 millimeters and refractive error of greater than -0.50 diopters are characteristic of onset of myopia. Due to environmental factors, such as an increase in pandemic-related near activities, and genetic ones like parental history, myopia is being diagnosed at younger ages. Unfortunately, when the condition starts at a young age in children, there’s a higher risk for progression. Untreated myopia can eventually lead to blindness, impacting a child’s schooling and, later on in adulthood, their quality of life. 

In its landmark evidence-based clinical practice guideline, Comprehensive Pediatric Eye and Vision Examination, released in 2017, the AOA Evidence-based Optometry (EBO) Committee noted that many children do not receive needed comprehensive eye care. 

“An estimated one in five preschool children and one in four school-age children in the United States has a vision problem; however, the Centers for Disease Control and Prevention report that less than 15% of preschoolers receive an eye examination by an eye care professional and less than 22% receive some type of vision screening,” reads the guideline, which is currently being updated by the EBO Committee with a 2025 reissue date. 

In 2021, just a few years after the initial publication, the committee again underscored in its Clinical Report: Myopia Management that age matters, noting that the prevalence of myopia, the leading cause of distance vision blur that could lead to permanent visual impairment in adulthood, is seeing a dramatic rise worldwide. It soared among people 

between 12 and 54 years old from 25% in 1971-1972 to 41.6% in 1999-2004. By 2030, nearly half of North America is projected to have myopia. 

“Expanded myopia management services will be needed beyond the correction of myopic 

refractive error with current commonly prescribed spectacles or contact lenses for distance vision correction only,” the clinical report says. 

AOA President Steven T. Reed, O.D., provides five reasons for the mobilization that rallies around proactive health care. 

1. 80% of what children learn is through vision. “A good education begins with good vision,” Dr. Reed says.
2. Promoting children’s vision often leads to better care of the entire family as they come in for examinations, too.
3. Historically speaking, the AOA has promoted children’s vision from the start of our organization. It is that important.
4. A child’s vision can determine the trajectory of their life.
5. A child who learns to value their vision will often take better care of their own children’s vision once they become parents, setting up a cycle of success. 

Closing the gap 

At Optometry’s Meeting this year, Dr. Ono explained the AOA’s goal: To “ensure all children have access to the eye care they need and deserve.” It is focused on “closing the gap” created and hastened by several factors:

• Historic access disparities.
• Overuse of digital devices during the COVID-19 pandemic. 

He cited other crucial factors. “Far too many children are going without care,” said Dr. Ono, who noted that there are about 75 million children in the U.S., yet “there are currently fewer than 1,100 pediatric ophthalmologists in the country.” 

Vision screenings aren’t adequate enough, he said. “We are still grappling with how best to close the referral loop following vision screenings. Depending on the source, up to 80% of children failing a vision screening never get an eye exam.” 

On the march 

The AOA is mobilizing to close the gap in children’s eye care. Here are three key initiatives: 

1) SUPPORT OF FEDERAL LEGISLATION

A federal plan to address children’s access to eye health and vision care services received the AOA’s backing in May. 

Introduced by U.S. Reps. Marc Veasey, D-Texas, and Gus Bilirakis, R-Fla., in May, H.R. 8400, the “Early Detection of Vision Impairments in Children (EDVI) Act,” would fund initiatives by state, community and tribal authorities to establish programs promoting early identification, intervention and referral for children with vision problems. There is currently no federally funded program that specifically addresses children’s vision, unlike public health programs targeting children’s hearing or oral health. 

“The disparity in access to children’s vision care is a crisis that can only be solved by unifying the industry,” Dr. Reed said in his announcement of support. “With most learning, cognition and perception abilities mediated through vision, there is a clear and present need to activate solutions that will close the eye health and vision care gap before it adversely impacts more children’s literacy, visual efficiency and perceptual skills.” 

Reported Dr. Ono: “Recognizing we are experiencing an especially challenging time related to children getting the eye care they need, the AOA Board is committed to identifying and pursuing new state and federal policy initiatives as well as public and private partnerships that will better ensure that children get the care they need.” 

The reasons behind the AOA’s support dovetails with its mobilization on children’s eye health and vision by: 

• Advocating for federal policies and programs that ensure children’s eye care.
• Creating an evidence-based playbook for expanding advocacy efforts into children’s eye care.
• Addressing access to care, especially for underserved communities.
• Driving public awareness and education for children’s eye care and access. 

2) LAUNCH OF THE MYOPIA COLLECTIVE

Myopia generally first appears in school-age children. In April 2024, the AOA and CooperVision unveiled a groundbreaking partnership: the Myopia Collective. It strives to give doctors more advanced options to manage myopia among children. Change will be driven by the “Change Agents” who will: 

• Receive specialized training in myopia management.
• Lead legislative and community advocacy in their respective state legislatures and communities. 

An invitation to join the collective rallied doctors—within three days an impressive 757 members had joined the collective and over 250 Change Agent applications were submitted. Revealed at Optometry’s Meeting, the 68 Change Agents hail from every state. 

“Change Agents will be part of a movement to shift our nation’s approach to childhood myopia and will do this at grassroots level,” Dr. Ono reported to the House of Delegates. 

The Change Agents are motivated. 

Viola Kanevsky, O.D., of New York, has spent over 30 years providing eye care to families in her practice. “I have had the privilege of watching my young patients grow and bring me their own children for their first eye exams,” she says. “I have also watched as each generation became slightly more nearsighted than the last. Although many new developments have kept me fascinated and engaged with my career, I have found none as exciting and empowering as myopia control.” 

Dr. Kanevsky adds: “For the first time in my memory, my profession stands poised to transform the face of pediatric vision care—instead of just watching our children become ever more nearsighted, we can rein in the changes and offer them a clearer, healthier future. My hope for the collective is that we can bring standardized, evidence-based, state-of-the-art myopia control to every optometric practice, and change the trajectory of environmentally induced visual decline for future generations.” 

Shane Foster, O.D., of Ohio, is ready for change. Dr. Foster, a practice owner and president of the Ohio Optometric Foundation, has been advocating for children’s eye care for more than a decade. He hopes the collective will raise public awareness and inspire a paradigm shift among reluctant clinicians. 

“I have recognized the fundamental role that clear and comfortable vision has in learning and the development of literacy,” Dr. Foster observes. “Myopia management is now an integral part of quality, comprehensive, pediatric eye care. I have been doing myopia management ‘off label’ for years, but I recently became more engaged with myopia management by becoming an investigator for two sponsored clinical trials for myopia control devices. After seeing great results over the years, I want to help ensure that more children have the opportunity for this kind of treatment.” 

Education of the public and doctors of optometry is key, says Adam Ramsey, O.D., who practices in Florida. Dr. Ramsey recalled his days in optometry school. 

“We never learned it in school,” he says. “Now we’re having to learn this on the fly. It can take a while for the standard of care to change, even after it was declared in 2021.” 

Like Drs. Kanevsky and Foster, Dr. Ramsey is excited to be a part of the collective’s charge. He looks forward to not only educating doctors and patients about myopia management but also making the case to legislators, educators, school nurses and insurance companies. 

“I’m thinking big,” Dr. Ramsey says. “I want to say, ‘This is the standard of care, and we have to find a way to provide this access to care for children.’” 

3) JOIN INFANTSEE®

InfantSEE, a program of The AOA Foundation, will celebrate its 20th anniversary in 2025. Since its launch, the program’s doctors of optometry have diagnosed well over 19,000 cases involving visual acuity, ocular motility, binocularity, refractive status and ocular health. 

Under the program, InfantSEE doctors provide one-time, no-cost eye and vision assessments to infants between the ages of 6 and 12 months regardless of family income or access to insurance. These practitioners have provided over 170,000 assessments and identified thousands of infants with causes for concern, including retinoblastoma—a life-threatening condition. 

“If you are not already, I urge you to consider becoming an InfantSEE provider,” said Dr. Ono in concluding his report at Optometry’s Meeting. 

The AOA recommends children receive comprehensive eye exams on a regular basis beginning in infancy, including: 

• A comprehensive baseline eye assessment between the ages of 6 months and 12 months
• At least one comprehensive eye exam between the ages of 3 and 5 to check for any conditions that could have long-term effects
• An annual, comprehensive eye exam starting before first grade 

Many parents aren’t aware of these guidelines, so it’s up to doctors of optometry to spread the word about the importance of children’s vision to schooling and socialization, says Jennifer Zolman, O.D., chair of the AOA’s InfantSEE & Children’s Vision Committee. 

“I am ecstatic that the AOA is embracing children’s vision and eye health in its children’s vision initiative,” Dr. Zolman says. “Its efforts over the past year coordinating listening sessions to understand the synergy we need between other infant and children’s medical providers, community partners and others in the children’s vision arena have been intense and very much appreciated. 

“Our InfantSEE & Children’s Vision Committee is very excited to be able to join in leading the charge as we embrace the focus on our next generations of patients.”