Rather than answering the question of how you take the first steps to introduce myopia management in practice, perhaps it’s more appropriate to start with ‘why should I?’
Over the last decade or so, there has been a growing body of evidence indicating a rapid rise in the prevalence of myopia in the UK. The link between myopia and its associated pathologies like cataract, glaucoma, retinal detachment and myopic maculopathy is clear and gives a compelling reason for practitioners to look at interventions that can help minimise myopia progression as much as possible. Carefully controlled clinical trials show great promise with myopia treatment interventions including optical management and pharmacological management.
Despite this, myopia management is largely limited to a minority of eye care practitioners (ECPs) and has yet to gain a strong foothold in general optometric practice. It’s understandable why this might be the case as commercially available myopia control products are not yet fully available. But there are options for ECPs wishing to proactively address the myopia epidemic.
What can I do to get started?
The first port of call is to get familiar with the latest research. Myopia management is a high profile topic at many optical conferences and regularly features in trade publications, so there is a wealth of easily accessible information available. Exploring the topic in this way will help you uncover key insights that can be readily adopted into everyday practice.
It’s also crucial to have experience of fitting young children with contact lenses and to have your practice environment set up appropriately. This may include adapting your approach to slit lamp exams by getting children to kneel on the chair or stand up, using the right communication during contact lens appointments to help understanding with both the parent and the child, and making sure that if you delegate the contact lens teach appointment, you have well trained staff to make sure that this is managed well. It will also convince you that contact lenses and children are a brilliant combination.
"If you are ready to take the next step into myopia management with optical management, contact lenses seem to offer the best results and ECPs are skilled this area"
Assess the risk
After addressing any practice practicalities, you can begin to build a myopia risk assessment for children in your practice. While a strong family history of myopia ought to raise suspicion that a child has an elevated risk of being myopic, genetics can’t fully explain the prevalence and earlier onset of myopia that we are facing. A child’s refraction can also identify a child at risk of myopia. A child at the age of six with +0.75D or less of hyperopia is considered high risk for developing myopia by the time they become a teenager, regardless of family history. Identifying baseline refraction in young children, coupled with an understanding of family history, can help formulate a management plan in terms of advice and recall intervals.
Lifestyle advice
Lifestyle advice can be addressed alongside the myopia risk assessment and is an approach that can be easily adopted by ECPs as a standard part of their routine advice to all young children and their parents. There is clear evidence that spending time outdoors is protective for myopia development although it’s not wholly understood why. The more time spent outside, the better the effect. However, a minimum of 10 hours a week (or roughly 90 minutes per day) appears to be an achievable recommendation.
"Myopia management is largely limited to a minority of eye care practitioners and has yet to gain a strong foothold in general optometric practice"
The first port of call is to get familiar with the latest research. Myopia management is a high profile topic at many optical conferences and regularly features in trade publications, so there is a wealth of easily accessible information available. Exploring the topic in this way will help you uncover key insights that can be readily adopted into everyday practice.
It’s also crucial to have experience of fitting young children with contact lenses and to have your practice environment set up appropriately. This may include adapting your approach to slit lamp exams by getting children to kneel on the chair or stand up, using the right communication during contact lens appointments to help understanding with both the parent and the child, and making sure that if you delegate the contact lens teach appointment, you have well trained staff to make sure that this is managed well. It will also convince you that contact lenses and children are a brilliant combination.
Optical treatment
If you are ready to take the next step into myopia management with optical management, contact lenses seem to offer the best results and ECPs are skilled in this arena.
Using contact lenses to manage myopia progression relies on adjusting the optics of the lens itself (soft multifocal or dual focus contact lenses), or by manipulating the optics of the cornea as in orthokeratology.
Current soft multifocal contact lens options primarily utilise the optics of a centre-distance multifocal contact lens using the highest Add power a child can tolerate to create the required treatment effect of myopic defocus, while simultaneously correcting refractive error. Ortho-K creates a similar effect but reshapes the cornea overnight to achieve this.
In addition to these existing options, CooperVision has recently introduced MiSight 1 day, a daily disposable soft contact lens specifically designed for myopia control, to a limited group of eye care professionals who have embraced myopia management and who will be able to use their experience to support the wider launch of MiSight 1 day in the future.
For further information, read the AOP’s statement on juvenile myopia management.
Three steps to success
1. Read up on the research
2. Adapt the practice and establish a myopia risk assessment for children
3. Combine it with lifestyle advice.
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