Breaking down barriers
OT hears from CooperVision professional affairs consultant, Neil Harvey and optometrist, Indie Grewal, about potential obstacles to the introduction of myopia management – and how to overcome them
09 June 2023
As momentum behind myopia management gains pace, a gap remains between the increasing evidence base behind interventions and what is happening on a daily basis in practice.
If a child is found to be myopic at their first eye examination, there is a significant chance that they will receive essentially the same optical intervention that brought their parents’ and grandparents’ world into focus.
An international survey of 3195 eye care professionals (ECPs) by Professor James Wolffsohn et al. in 2022 found that approximately 45% of respondents across Europe prescribed single vision spectacles or contact lenses as the primary mode of correction for myopic patients.
What are some of the hurdles that ECPs have overcome to bridge the divide between research and implementation? OT spoke with independent practice owner and past president of the British Contact Lens Association, Indie Grewal,† and CooperVision professional affairs consultant, Neil Harvey, about navigating barriers to success.
He added that there still remains a significant opportunity to improve this awareness today.
When he began offering myopia management, Grewal would have many conversations with parents to gain their confidence.
“The lack of CE-marked product options meant that until 2017 patients were fitted with off-label options which were sometimes met with scepticism by parents, due to this lack of understanding,” he said.
“Now we have CE-marked options backed by evidence-based clinical research, such as MiSight 1 day, a conversation about managing myopia is much easier,” Grewal emphasised.
When starting out in myopia management, Grewal made a conscientious effort to involve the whole practice team.
Many will research themselves, so it is important to ensure they get the right information from a trusted source
His staff underwent accreditation in the products his practice uses for myopia management.
“The momentum we gained as a myopia management clinic meant that the team became increasingly experienced and confident speaking to parents, with a consistent and persistent message about myopia,” Grewal shared.
While some ECPs may be hesitant to become involved in myopia management because of preconceptions about the level of equipment needed, Grewal emphasised that additional purchases were minimal.
“Whilst orthokeratology requires a topographer, the only additional piece of equipment we added was a child’s booster seat, to make it easy for them to reach the slit-lamp,” he said.
Harvey added that expensive equipment is not needed to have a conversation with a parent about myopia progression and the long-term health of their child’s eyes.
“What we do need to do is provide repeatable and objective measures,” he said.
Guidance from both the AOP and College of Optometrists recognises that axial length measurement is important but not essential.
The guidance supports cycloplegic autorefraction, in the absence of biometry, as a method of obtaining consistent assessment to review change between baseline and follow up visits.
An initial hurdle that Grewal faced was gaining the trust of parents when discussing a relatively new field of practice.
His practice developed an information leaflet summarising the latest research in a way that was accessible to the general public.
Harvey highlighted that ECPs are reporting that parental awareness of myopia and myopia management is now increasing.
Another potential obstacle in practice is the situation where a child continues progressing despite being in a myopia management intervention.
Grewal emphasised that parents are made aware that myopia management intervention can slow progression but will not always stop it.
“As their child grows we might still expect to see some changes in myopia,” Grewal said.
Harvey added that cost is an issue that occurs with any new form of technology, and not all families will be able to afford the recommendations of their ECP.
“Our standard of practice should be to allow them to make an informed choice and ensure families are aware of what myopia is, what lifestyle factors may impact myopia, the increased risks to long-term ocular health that myopia brings, and the approaches that can be used to manage myopia,” he said.
Indie’s communication tips…
“The first and last message a parent leaves with is that their child’s eyes are healthy”
“Myopia management aims to preserve the good eye health your child has today into adulthood and later life”
“When it comes to slowing the worsening of your child’s refractive error and based on the strength of the evidence, my preferred method of management is contact lenses”
“The only additional piece of equipment we added was a child’s booster seat, to make it easy for them to reach the slit lamp”
Turning to the opportunities myopia management has created for his practice, Grewal highlighted that the offering has resulted in increased practice loyalty – beyond the immediate family.
The focus of the practice has shifted from correcting myopia to managing myopia.
“This, in turn, means that seeing young patients has gone from being a transactional visit to one where we have built a long-term relationship. The halo effect of this relationship means we see other family members,” Grewal shared.
Grewal describes myopia management as “a continual growth area” when it comes to practice building.
“Possibly the biggest difference myopia management brings to our practice is professional pride. We are now able to offer a range of solutions both in contact lenses and spectacles lenses to our myopic children,” he said.
“For me, myopia management is one of the most enjoyable areas of optometry,” Grewal concluded.
† Indie Grewal is a paid consultant of CooperVision UK & Ireland.
Wolffsohn JS, et al. Global trends in myopia management attitudes and strategies in clinical practice - 2019 Update. Cont Lens Anterior Eye. 2020 Feb;43(1):9-17.
Wolffsohn J. Global trends in myopia management attitudes and strategies in clinical practice- 2022 International Myopia Institute Update, presentation at International Myopia Conference, Rotterdam, September 2022
Wolffsohn JS, et al. Global trends in myopia management attitudes and strategies in clinical practice - 2023 Update. IOVS (In press)
Chamberlain P et al. A 3-year Randomized Clinical Trial of MiSight Lenses for Myopia Control. Optom Vis Sci 2019;96:556–567
Arumugam B et al. Modelling Age Effects of Myopia Progression for the MiSight 1 day Clinical Trial. Invest. Ophthalmol Vis Sci. 2021; 62(8): 2333.
Chamberlain P et al. Myopia progression on cessation of Dual-Focus contact lens wear: MiSight 1 day 7-year findings. Optom Vis Sci. 2021; 98(E-abstract): 210049.
Hammond D et al. Myopia Control Treatment Gains are Retained after Termination of Dual-focus Contact Lens Wear with no Evidence of a Rebound Effect. Optom Vis Sci. 2021; 98(E-abstract): 215130.
https://www.aop.org.uk/advice-and-support/clinical/scope-of-practice/myopia-management-in-clinical-practice Accessed 23rd March 2023
https://www.college-optometrists.org/category-landing-pages/clinical-topics/myopia/myopia-management-%E2%80%93-guidance-for-optometrists Accessed 23rd March 2023
Gifford, Kate L., et al. "IMI–clinical management guidelines report." Investigative ophthalmology & visual science 60.3 (2019): M184-M203.
Jones, Lyndon, et al. "IMI–industry guidelines and ethical considerations for myopia control report." Investigative Ophthalmology & Visual Science 60.3 (2019): M161- M183.