Myopia management College Round Table Consensus Statement

Myopia is a global problem. The rising prevalence and the risks of sight-threatening ocular pathology associated with myopia are well documented. By 2050, it is predicted that half the world’s population (five billion people) will have myopia, with nearly one billion at high risk of sight threatening ocular pathology1. Myopia is considered as a public health concern in some parts of the world and it now features on the World Health Organization’s agenda2

In the UK, the prevalence of myopia in children aged between 10-16 years has more than doubled over the last 50 years, and children are becoming myopic at a younger age3. Children with parents with myopia are more likely to be myopic than those without. 

Given this backdrop, there is a genuine and pressing need to understand how myopia develops and to find innovative solutions – including optical and pharmacological interventions – to prevent or slow the progression of myopia as much as possible. Interventions have focused on either preventing the onset of myopia, or limiting the rate at which myopia progresses. We felt it was crucial to begin to understand and tackle these issues head on as a united sector. To facilitate this, in June 2018, we held a roundtable event with researchers and clinicians in the field to consider the current evidence on childhood and adult myopia management (previously known as myopia control). The aim was to reach a consensus about what the current evidence supported with regard to practice in this area. 

Discussion highlights 

  • Evidence exists showing that progression of myopia could potentially be slowed. 
  • There is evidence that encouraging children to spend time outdoors would reduce the onset of myopia. 
  • There is very little evidence for the long-term benefits and risks of the myopia control treatments available, or the effect on myopia progression following the cessation of treatment. 
  • There is currently not enough evidence to support the widespread roll out of myopia control procedures for all patients with myopia or for those at risk of developing myopia, nor is there enough evidence to determine conclusively which interventions work for which people. 
  • At present, we do not know which children may benefit the most from myopia control interventions.  
  • We do not know whether myopia control should be best targeted to at risk groups or simply offered to all children that present with myopia and there is insufficient evidence that myopia control treatments are effective in reducing the progression of myopia. 

Consensus statement

This consensus statement represents an overview of collective analysis, evaluation, and opinion based on input from the eye health sector clinicians, researchers and lead organisations listed at the end of this statement. 

What we know 

Evidence exists showing that progression of myopia could potentially be slowed. Myopia progression and the rate of axial length growth may potentially be slowed by around 50% across different intervention strategies4.  There is evidence that encouraging children to spend time 

outdoors would reduce the onset of myopia5. There is, however, very little evidence about the longterm benefits and risks of the myopia control treatments available, or the effect on myopia progression following the cessation of treatment. 

What we do not know 

There is currently not enough evidence to support the widespread roll out of myopia control procedures for all patients with myopia or for those at risk of developing myopia, nor is there enough evidence to determine conclusively which interventions work for which people.  

At present, we do not know which children may benefit the most from myopia control interventions. 

We do not know whether myopia control should be best targeted to at risk groups or simply offered to all children that present with myopia and there is insufficient evidence that myopia control treatments are effective in reducing the progression of myopia. 

Managing myopia  

Based on current evidence

It is safe and ethical for the eye health professionals offering myopia management interventions to continue to do so, if they follow guidance to be developed by the sector. This would include giving patients and parents information and obtaining consent, establishing practices’ processes and defining practitioners’ responsibilities. 

  • All myopia control interventions need to be underpinned by explicit consent, involving clear provision of information and accurate records of the discussions leading to the consent being given.
  • If practitioners are going to recommend interventions, they need to take responsibility for ensuring that they keep up-to-date with the evidence relating to myopia management, and ensure that they understand the issues involved in obtaining consent.
  • Where practitioners offer treatments, they must discuss the option of no treatment and should record that discussion.
  • Practitioners should also discuss the mechanism they would use to measure outcomes – measurement of axial length being the best method. They should make clear that it is difficult to predict whether, and to what extent, an individual would benefit from any interventions, and that it is impossible to show what might have happened without any intervention.
  • Practices must have an adverse event reporting scheme to track safety issues and build the evidence base data set for future use.

Optical interventions 

There are contact lenses that are designed to slow the progression of myopia, however, the efficacy is variable as myopia progression has been shown to be reduced by around 40-60%, across a number of studies2

The change from a standard contact lens to a myopia control contact lens is unlikely to introduce additional risk, although there may be an impact associated with wearing lenses for longer periods. Benefits and uncertainties about efficacy, and possible risks should be clearly explained to the patient. 

The transition from spectacle wearing to contact lenses use for myopia control or any other purpose may carry some additional risks – these should be clearly explained as part of the consent process. 

At present, myopia control ophthalmic spectacle lenses are available only in countries outside the UK, although they are believed to be coming to the UK in due course. This would open up additional treatment options. 

Talking to patients and parents about myopia 

There is no obligation on a practitioner to discuss a particular treatment, as efficacy and safety are not yet adequately established by the evidence. However, practitioners do need to be well informed and familiar with the current evidence so that they are able to offer information if asked. They should be able to explain the benefits and risks of the treatments available, as well as the option of no intervention, in a clear and balanced way, even if they do not provide these treatments. They should be able to inform patients and parents about the current evidence and explain whether and why they do, or do not, offer myopia management. 

Rising numbers

By 2050, it is predicted that half the world’s population will have myopia

Myopic parents

Children with parents with myopia are more likely to be myopic than those without

Public health concern

In some parts of the world and it now features on the World Health Organization’s agenda.

What does the eye health and care sector need?

  • More research - myopia management is an area that will be changing and The College of Optometrists will continually review and update its guidance accordingly. Continuing research is welcomed to underpin any change in routine clinical practice. Because myopia prevalence varies with ethnicity, we do not know if the current evidence base would be fully relevant to children of European ancestry. As much research has been in children of East Asian origin, more research is needed in children of European and other ancestries.
  • Professional guidance - there is a need to produce guidance based on the current evidence for eye health professionals. The College of Optometrists will lead the development of guidance mainly about:
    • What eye care professionals should tell patients and their parents about what treatment is available, for whom it is suitable, how effective it might be and the probability of it being effective, and what the short-term and long-term risks and benefits are likely to be.
    • Specific points about what eye care professionals already offering myopia control/management interventions should do.

This consensus statement represents an overview of collective analysis, evaluation, and opinion based on input from the following eye health sector clinicians, researchers and lead organisations. 

  • Mr Andrew Price – Association of British Dispensing Opticians
  • Ms Debbie McGill – Association of British Dispensing Opticians
  • Dr Peter Hampson - Association of Optometrists
  • Ms Kathy Jones – Association of Optometrists
  • Dr Matthew Cufflin – Bradford University
  • Professor Anna Horwood – British and Irish Orthoptic Society
  • Mrs Laura Williams – BBR Optometry
  • Professor Jeremy Guggenheim – Cardiff University
  • Professor John Lawrenson – City, University of London
  • Professor Jennifer Evans – Cochrane Eyes and Vision
  • Professor Ed Mallen - College of Optometrists
  • Mr Paul Carroll – Federation of (Ophthalmic and Dispensing) Opticians
  • Mr Frank Norville – Federation of (Ophthalmic and Dispensing) Opticians
  • Professor Niall Strang – Glasgow Caledonian University
  • Professor Bruce Evans – Institute of Optometry
  • Professor Chris Hammond – King's College London
  • Miss Parul Desai – Moorfields Eye Hospital NHS Foundation Trust
  • Mrs Diana Haines – Optometry Wales
  • Dr Hetal Buckhurst – University of Plymouth
  • Dr Lesley Doyle – University of Ulster
  • Professor Kathryn Saunders – University of Ulster
  • Mr Matt Broom – Vision UK
  • Ms Mary Bairstow – Vision UK
  • Professor Peter Allen - Anglia Ruskin University

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