This Guidance does not change what you must do under the law.

You should keep up to date with the evidence on myopia management.³⁶

You should be able to discuss what myopia is and the lifestyle factors that may impact myopia, the increased risks to long-term ocular health that myopia brings and the approaches that can be used to manage myopia when it is diagnosed.^{37, 38}. This includes standard refractive correction and available treatment options to slow its progression.

Risk factors for becoming highly myopic: 

1. Having parents with myopia
2. East Asian ethnic origin
3. Myopia before the age of nine
4. Spending limited time outside and being heavily engaged in activities using near vision³⁹. 

You should consider using risk stratification tools based on age and level of refraction, which may be used to identify those at risk of developing myopia. (For example, the PreMO tool.)

You should advise patients at risk of myopia, and their parents or carers, that there is evidence that spending more time outdoors may delay the onset of myopia, and may prevent it in others^{40, 41, 42}.

You should recommend myopia management treatment options when, in your professional opinion, it is clinically indicated and when it is in the patient’s best interests⁴³.

When discussing myopia management, you should: 

1. explain the short- and long-term benefits and risks of all available interventions in a way that is readily understandable. This should include the possible outcomes of using traditional single vision optical corrections in comparison to the use of myopia management options, and the risks of no optical correction. 

2. ensure patients understand the anticipated treatment outcomes and manage their expectations. This should be based on the available level of evidence and, where possible, using relative and absolute risk examples, presented in a clear and impartial way. 

3. you should ensure your patients understand the likely length of treatment and required aftercare. 

When a decision to manage myopia is made, you must obtain explicit consent. This means providing sufficient information about all material risks which a reasonable person in the patient's or a child’s parents/carers’ position would attach significance to and giving them the time they need to make a decision. A written consent form is a robust record of the consent decision and information provided. The clinical record should include a summary of the discussion including, decisions made, summary of the anticipated management outcomes and actions taken. See section on Consent.

A management plan should be set out at the start of treatment. You should use a repeatable, objective method for measuring baseline data, monitor progression and treatment outcomes which are appropriate to the child’s age. This may include undertaking direct (eg using biometry) or derived axial length measurement (calculated from keratometry and a cycloplegic refraction) at appropriate intervals. Cycloplegic autorefraction provides an objective and repeatable measure of refractive status at baseline, and follow-up visits. Practitioners should use their professional judgment to determine when this is clinically indicated.