2 March 2020

Myopia management: Cochrane review updates the evidence

Our Director of Research, Michael Bowen, looks at how the Cochrane review will affect our guidance on myopia management.

In order for future studies and trials to produce findings that will improve the overall quality of research in this area for a future review, guidelines are needed to promote consistency, continuity and quality. 

The new International Myopia Institute’s Clinical Myopia Control Trials and Instrumentation Report provides clear guidance on this, which will be helpful in ensuring that future trials have the greatest chance of producing results that will inform our understanding in this field, and ultimately enable data from more studies to be included in future reviews.

This review is an important update to the evidence base and practice in this area, as it incorporates data from 41 studies published up to February 2018, with a total of 6772 participants. As well as exploring the evidence that these studies provide on the efficacy of the interventions, the review provides an analysis of the certainty of the evidence available for each intervention. The key findings from the review can be found on the here.

When the College established a group of experts across the eye health sector to develop the Consensus Statement on Myopia Management, and produce guidance for optometrists and patients, we were aware that the Cochrane review was due for update, but wanted to provide members with some information and advice on this emerging area of practice in the interim. When we released the College’s resulting Consensus Statement and guidance in 2019, we indicated that we would review them regularly, and would take the updated Cochrane review into account when it became available.

What does the review tell optometrists about the different interventions? It sets out clearly that, despite the rapid increase in research in this area since the last Cochrane Review in 2011, there is still not enough high certainty evidence in relation to the main interventions. More research is needed before we can determine the long term efficacy and impact of interventions to slow myopia progression in children. For example, one of the trials cited in the review, the IMI’s “Clinical Myopia Control Trials and Instrumentation Report” led by Professor James Wolffsohn, will be very helpful in supporting future trials to produce evidence of the quality needed.

The review also indirectly raises other key questions for UK optometry. Current (moderate certainty) evidence indicates that atropine is likely to be the most effective intervention, but this is not currently available to UK optometrists. While we wait for longer-term data to become available and European studies to report, we need to agree the level of evidence required to determine if optometrists can use atropine in myopia management. What evidence do we need to be satisfied that the benefits outweigh the risks? How should the profession discuss the long term risks and benefits with patients and parents? We also need to consider whether there is a role for multifocal spectacle lenses (Bifocal or progressive) which the review found (moderate certainly) yielded a small effect in slowing myopic progression. And, at what point should we explore making an effective myopia management intervention available through the national health services?

The College will continue to interpret the evidence as it emerges so that optometrists in the UK can apply the findings in practice. In the meantime, we will review our guidance on myopia management in light of the Cochrane review and will be asking members to feedback to us on the existing guidance and updates. While we don’t believe that this systematic review significantly changes our position, we want to ensure we support members with their evidence-based practice and robust research.

Related further reading

Here we summarise three research papers from a recent issue of Optometry in Practice.

A framework for delivering eye care to children in special schools aims to help those who often seek treatment the least, writes Anna Scott.

Adrian O’Dowd asks if the growing use of topography in community optometry will lead to wavefront analysis gaining traction as a complementary tool.