Using the AOP's consent form on myopia management

While the evidence at present appears to show that some interventions may be effective in slowing the progression of myopia, the difficulty is that perhaps one of the most promising treatment options, low dose atropine, isn’t currently commercially available in the UK. That leaves us with limited opportunities that are mainly focused around various contact lens options, such as modified multifocal lenses and orthokeratology.

At first glance these seem like risk-free options, and while evidence suggests that the risk of contact lens-related complications amongst children is no higher than the adult population, I think there is a need for some caution in two main areas.

If you are going to offer myopia management it is important that you are aware of the latest research and good practice. In all clinical care settings the idea of “dabbling” has been discouraged

Don’t overpromise

The main cause for concern is ensuring that we are open and honest with patients about what we know and what we don’t know. This will hopefully prevent any later accusations of overselling, or unsubstantiated promises. While myopia management may reduce myopia progression for some patients, it is highly unlikely to stop the progression completely; we cannot be certain how much the progression will be reduced by, and we do not know how much the myopia would have progressed without treatment. We also cannot be certain what will happen when treatment is stopped, or if that will truly modify the risk of myopia-related disease for all patients.

If we overpromise, there is a risk that patients may seek compensation if their expectations aren’t met. To avoid that, AOP members should make use of the information and consent leaflet that we have produced and make sure they keep good records.

Be careful about dabbling

GOC standard 5.3 says that practitioners should: “Be aware of current good practice, taking into account relevant developments in clinical research, and apply this to the care you provide."

Therefore, if you are going to offer myopia management it is important that you are aware of the latest research and good practice. In all clinical care settings the idea of “dabbling” has been discouraged, and this is particularly true in this setting.

Also, as the greatest risk for future pathology is axial length, it is important that you have some way of monitoring how axial length is changing. For soft contact lens options, the proxy measurement of refractive error can be used, but for management options, such as orthokeratology, this becomes more difficult. To be truly confident that orthokeratology is working, axial length change should be monitored; if it isn’t can we honestly tell the patient or their parents the treatment is working?

If we overpromise, there is a risk that patients may seek compensation if their expectations aren’t met

What should we be telling patients?

One of the common queries the AOP receives is: ‘If I don’t tell patients about myopia management am I negligent?’ We’ve heard various opinions on this. Strong advocates for myopia management will give you a resounding yes, but currently we don’t share that view. That isn’t to say that practitioners shouldn’t talk to patients about myopia management, but if they currently don’t feel confident, we don’t think that is a problem. However, as this is an evolving area, we might get to that stage as more evidence emerges.

• As told to Emily McCormick.