Welcome to question of the day #165

Welcome to question of the day #165

One of my patients who has myopia asked me if their 6-year-old daughter had pre-myopia. What is that?

Pre-myopia is a concept I first saw in a 2019 journal article. It makes use of data from a study published in 2105.

This definition of pre-myopia that has been put forward:

A refractive state of an eye of ≤ +0.75 DS and > -0.50 DS in children where a combination of base line refraction, age, and other quantifiable risk factors provide a sufficient likelihood of the future development of myopia to merit preventative interventions.

Preventative interventions being myopia management drugs, multi-focal spectacle lenses, multi-focal soft contact lenses and orthokeratology.

In other words,a patient can be described as pre-myopic if they have a nonmyopic refraction in which a combination of risk factors and the observed pattern of eye growth indicate a high risk of progression to myopia.

The exact refractive error thresholds for pre-myopia vary with age; <+0.75 DS at age 6, ≤ +0.50 DS, at ages 7 to 8, ≤ +0.25 D at ages 9 to 10, and ≤ 0 D at age 11 years.

Children with these magnitudes of refractive error at these ages are in an emmetropic range at an age they shouldn’t be; they should be more hyperopic.

It would be useful to examine the daughter’s refractive error and if she falls into the pre-myopia refractive error range for a 6 year old then suggest myopia management to the mother.