Myopia management (previously known as myopia control)

Background

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 will have myopia, with nearly one billion at high risk of sight threatening ocular pathology. 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 age. Given this backdrop, we felt it was crucial to begin to understand and tackle these issues head on as a united sector. To facilitate this, 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.

Source: Acuity, Focus on Myopia, August 2018

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 about 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.

How findings might affect you in practice?

All myopia control interventions need to be underpinned by patients’ explicit consent, involving clear provision of information and accurate records of the discussions leading to the consent being given.
If you are going to recommend interventions, you need to take responsibility for ensuring that you keep up-to-date with the evidence relating to myopia management, and ensure that you understand the issues involved in obtaining consent.
You must discuss the option of no treatment and should record that discussion.
You should discuss the mechanism you would use to measure outcomes – measurement of axial length being the best method.
You 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.
Your practices must have an adverse event reporting scheme to track safety issues and build the evidence base data set for future use.

The College developed myopia management guidance to help you decide what:

you 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
you should do if you are already offering myopia management interventions.

Downloads

Download the complete roundtable report, the consensus statement and the guidance for optometrists below:

Listen to our podcasts

Listen to Professor Chris Hammond, Consultant Ophthalmologist at Kings College London and St Thomas' hospital, and Professor Kathryn Saunders FCOptom, Professor of Optometry and Vision Science at Ulster University, discuss all things myopia. They talk about current evidence and how patients can be guided through their treatment options.

Genetic, or genomic testing, seems to be available for diagnosing a wide range of health conditions, but what if we could use the same method to predict myopia? We talk to Director of Research at Cardiff University, Professor Jeremy Guggenheim MCOptom who discusses the impact of genetics on myopia.

Patient leaflet consultation

Context
The College hosted a myopia management round table in 2018, where we committed to producing a leaflet to educate patients and their parents’ information on myopia management. The leaflet would be based on the College’s consensus statement and guidance for optometrists. The leaflet’s primary aim would be an authoritative and independent source of information for the public who were interested in finding out more about myopia management options. It would also act as an aid to members who practice myopia management to ensure enough information was available to potential wearers and their parents, supporting the consent process.

Member consultation
The leaflet was drafted so that it was carefully balanced and impartial to satisfy the needs of all members, both enthusiasts and those cautious to myopia management interventions. Based on our guidance and consensus statements we drafted a leaflet in our house style in collaboration with the Research and Policy teams, with revisions by our Patient and Public Reference Group (PPRG) and a Plain English editor. We put this draft to our members for a consultation.

Conclusions
In total, 49 members responded to the consultation. 87% of respondents said they would use the leaflet in practice.

We asked members to score the leaflet out of five, five being high:

There was a theme amongst the free-text responses that the proposed leaflet was too enthusiastic about myopia management. As a result, we made the following changes:

We added the word ‘slightly’ to emphasis the reduced risk of sight loss was small.
We reduced the number of times we used the term ‘sight loss’ as there was feedback that this could provoke unnecessary fear.
We added a section on the option of no treatment to aid the consent process.
We added a section to reassure parents of the legitimacy of using traditional methods of sight correction until more evidence is available.

Plain English has now approved the revised leaflet. The first edition is in publication and is available for members to order. It will next be reviewed in autumn 2020.