There has been essentially zero discussion in the literature about how a doctor might put all the research on myopia development into use in clinical practice. In fact, there has been very little discussion that anything should be done at all to change the standard of care which is still to correct myopes with the least minus for maximum acuity, or some small variation of that strategy.
Historically, there have nearly always been the outliers that espouse more significant interventions, most often some calculated amount of additional plus power for near, either as an aid for efficiency, comfort, clarity, or prevention of progression. Other methods are tried at times, such as RGP wear, undercorrection, removal of glasses for reading, etc.
It's time to put the research to work and develop an actual protocol based on clinical trials reported in refereed journals. This is only one protocol. I hope it begins to generate a significant discussion within the profession as to what a "correct" protocol might be.
Lens interventions are based on the proven principle that creation of a peripheral myopia creates a stop/slow signal for further axial growth and thus myopic progression. The principle has been proven more in animal models but human studies are starting to show the effect. Some devices create peripheral myopia better than others.
The protocol does not incorporate the use of atropine, the one treatment modality that has been proven so far the most effective at stopping myopia progression. That may seem like an odd omission and I think one that may change. The most recent report by Audrey Chia (2011) found under the Research - Medications/molecular menu showed that very low dosages of atropine were very effective with essentially no side effects.
There are serious advocates. Paul E. Romano, in Optometry and Vision Science, in a letter: Much Can Be Done for Your Child's Myopia. Also, Jeffrey Cooper, O.D., Clinical Professor of Optometry at SUNY State College of Optometry advocates for the use of atropine in a Letter to the Editor in Review of Optometry. Thirty one atropine references are cited: Use Atropine for Myopia
Perhaps the most significant thing that the atropine findings have done is spur further research into more specific muscarinic receptor antagonists with the goal of finding one with few side effects. There could even be a pathway that avoids muscarinic receptors. Maybe someday we will pass out MyoPills to those determined to be at risk. For now, if atropine is elected to be part of your protocol, do not fail to give adequate informed consent.
I have not put the rationale for specific recommendations into the protocol itself. The best method to find the rationale is to find the topic under the Treatments menu item or in the summaries of the research articles. Sometimes I just used my own clinical judgment.
You must start to treat children of a younger age. The ability to control the changes is best when the level of myopia is low. Our eventual goal should be to determine when to intervene before myopia manifests with blurred distance vision.
(Commentary: I have recently (Fall 2011) been assigned the chairmanship of a committee of the Orthokeratology Academy of America tasked with creating a myopia prevention and control protocol. I have been given free rein to consider every modality, not just orthokeratology. I am assembling a world class group of researchers and clinicians to create a quality document that should guide every doctor in how to treat myopia and I look forward to replacing the rough protocol below that I created one afternoon. Richard L. Anderson, O.D.)