The standard of care for myopia management

Professor Ian Flitcroft discussed updated guidance from the College of Optometrists on managing myopia during his presentation at 100% Optical (25-27February).

As well as UK standards, the paediatric ophthalmologist outlined how international guidance on myopia management is also changing.

Flitcroft shared that there has been a shift from an era of correction to viewing myopia as a modifiable risk factor.

However, he added that there has been limited change to what is happening on the ground in optometry practices, with single vision lenses still the most common way of addressing myopia.

Turning to what is the minimum standard of care for a myopic child, Flitcroft presented an analogy of a staircase – with the bottom step representing not correcting myopia, while the top step involves implementing a comprehensive monitoring and management plan.

Flitcroft shared that some early adopters have “raced to the top step,” but this should not discourage those who are new to myopia management.

“Wherever you are, you must move forward – step by step – and you will get there,” he said.

Flitcroft outlined how the College of Optometrists guidelines on myopia changed between 2019 and 2021. He touched on the 2021 World Council of Optometry’s resolution on myopia and the 2023 World Society of Paediatric Ophthalmology & Strabismus Myopia Consensus Statement on interventions to slow the progress of myopia.

Flitcroft shared that the 2021 College of Optometrists guidance on myopia defines a new minimum standard of care.

The guidance requires practitioners to be able to hold a conversation with patients and their parents about the evidence regarding myopia management, as well as its risks and benefits.

If the practice does not offer myopia management, then practitioners should be aware of local practices that do off

er this service if the patient requires more information or requests a referral.

Flitcroft shared that optometrists are permitted to offer myopia management as long as it is within their scope of practice – meaning that they have the relevant skills and knowledge, through appropriate training and experience.

As with any form of therapeutic intervention, Flitcroft highlighted that the optometrist must obtain explicit consent, with the patient and parents making an informed decision to proceed.

The preferred method for assessing the stabilisation or progression of myopia is axial length monitoring, Flitcroft shared.

If this method is not available to practitioners, they should undertake cycloplegic autorefraction and keratometry to provide an estimate of axial length.

Flitcroft emphasised that, evaluated in isolation, refractive error without axial length measures would not provide as sensitive a measure of the intervention’s success.