By Thomas Aller OD, FBCLA
On my now 30-year odyssey to find ways to better manage myopia progression in children, I have had the opportunity to meet many like-minded and not so like-minded clinicians and scientists from all around the world. Science cannot exist without robust discussions and indeed disagreements, and it is in these discussions and disagreements, science continually advances, and friendships are forged but also occasionally broken. I’ve had the good fortune to know the authors of this new book for quite a few years, in the way that you know people that you meet at conferences, occasionally enhanced with various libations known to loosen tongues. While they are all serious academics with all of the appropriate titles, degrees, fellowships, faculty appointments, publications, and awards, I always sensed the soul of a clinician in each one of them.
As a clinician for my whole professional life but with an intense interest in science and research and development, I suspected they were not stuck in the ivory tower. So when I accepted the honor bestowed upon me to write the foreword for this important book, I wrote Langis Michaud to see if my impression that he had the “soul of a clinician” was correct, and indeed, I was pleased to hear that in his professional odyssey much of his early years were spent as a clinician. This proved true for most of the co-authors, and I think this is the basis for why they are uniquely suited to provide the perfect blend of academic science and the type of clinical knowledge that comes from treating patients so that they could write a book appropriately subtitled, “One child at a time.” Only a clinician would think of such a subtitle, which is why clinicians should find this book a valuable resource for their clinical management of their patients with progressive myopia, one child at a time.
As befitting a book written by academics but with a deep understanding of what matters to clinicians and ultimately to their patients, “Managing Myopia” starts with a thorough summary and discussion of the various white papers published by the International Myopia Institute as the influential CLEAR papers. Everywhere throughout this section and the entire book, these scientists with the souls of clinicians will always translate the scientific findings back to the clinic. Doctors interested in myopia management may undoubtedly want to read the original articles or their published summaries. Still, readers of this new book will be able to discover the main points of these white papers in a concise and easily understood manner, translate them to their clinical practice, and quickly get to the meat of this new book.
Before any eye care practitioner can be convinced to care about myopia as a condition that deserves proper and effective management, they must understand why it is essential to do what can be done to slow its progression. I’ve always felt that it’s as simple as “excessive stretching is bad, because tissues get damaged when stretched, so we should do what we can to limit excessive stretching.” Rest assured that these authors will go into greater detail about the likely consequences of unrestrained axial elongation, and the readers will be suitably convinced that their professional obligation to their patients is to do something about that stretching.
Now that their readers are convinced that more must be done to help preserve the future sight of their young patients, the authors provide in-depth, evidence-based discussions about how the eyes emmetropize or fail to emmetropize to their environment. This leads to pretty much everything you would ever want to know about what is known about current treatments, along with some hints of treatments to come. The beauty of this book is that it then describes the “Montreal Experience” wherein every reader of the book is invited to the finest restaurants in Montreal, and Langis is treating! Well, perhaps the more relevant “Montreal Experience” is the clinical approach developed over many years at the University of Montreal to most effectively manage progressive myopia in their young patients, “one child at a time.” I mention the subtitle one more time, not just to hype the book and imprint the title and subtitle in your mind but to point out what I took as the key message of this book. The readers may include scientists, clinician-scientists, or (I cannot use the term “just”) clinicians, but anyone taking the responsibility to care for myopic children and endeavoring to preserve and protect their future sight and ocular health really must treat these little patients, “one child at a time.” The authors thoroughly describe their clinical approach and the scientific basis for their approach, and their actual results for hundreds of their patients, and in the final chapter, they go through an extensive series of case reports that will help the reader really understand how to manage myopia effectively.
I mentioned earlier that science and medicine can only advance if there are free discussions of ideas, and Langis and I have had our share of conversations about what we think. For example, I remember when we were assigned to take different sides of a debate at one of the International Myopia Conferences. It was all in good fun, but he argued that myopia-controlling contact lenses had to correct for distance vision in the center with plus power in the periphery. My argument was that, in my experience as a clinician, for I had no published studies to cite, I found that you could put “any damn plus any damn place” and it could control myopia. Now Langis was too much of a scientist to buy my argument forged in the clinic and not properly documented and published in peer-reviewed journals, but he was enough of a gentleman to invite me to write this foreword to this fabulous new book, and I was happy to do so, and I heartily recommend it to my colleagues and friends around the world.
Thomas Aller, OD, FBCLA
Visiting Scholar, University of California, Berkeley
All About Vision Medical Review Panel
Contributor, Brien Holden Vision Institute
Holds Multiple US and International Patents in Myopia Progression Control
Garland Clay Award – The CONTROL Study
GSLS Award of Excellence -Myopia
Consultant, Haag-Streit Lenstar Myopia
All About Vision Medical Review Panel
Scientific and Clinical Advisor, TreeHouse Eyes
Scientific Advisor, Reopia Optics, Inc.
Clinician Scientist San Bruno, CA