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.

1.89 billion people

are currently affected by myopia

3 in 10 people

are short-sighted in the UK, and the numbers are growing

Nearly 5 billion people

will be myopic by 2050

Source: Acuity, Focus on Myopia, August 2018

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.

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.