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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 might the findings 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:

 

Other resources of interest

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