Fighting the myopia epidemic
Dr Scott Mundle, immediate past president of the World Council of Optometry, on the decision behind the resolution to make myopia management a standard of care and what comes next for practices
In late 2019, the World Health Organization released its first ever World Report on Vision.It recognised that myopia is increasing globally at an alarming rate, with nearly five billion people or 50% of the world’s population predicted to be affected by the condition by the year 2050, including 10% with high myopia.
While being near-sighted in itself is problematic for those of us who are so afflicted, without early identification and intervention there are associated increases in lifetime risk for further visual impairment resulting from eye diseases such as cataract, retinal detachment, myopic maculopathy, glaucoma and optic neuropathy.
Significant recent scientific research has identified a number of interventions to potentially control myopic progression so we felt it was our duty to get this message out to our members and the broader vision care sector. Simply correcting refractive error is no longer sufficient and that is why there needs to be an established standard of care that may prevent or delay the onset of myopia or slow its progression.
Historically, optometrists have simply corrected myopia and even with the recent research and treatment options now available, many have been slow to embrace this evidence and adopt the proven interventions that may halt or slow its progression.The World Council of Optometry’s (WCO) adoption of a standard of care resolution on behalf of its 38 affiliate members and 45 country members, which represent more than 114,000 optometrists, is a resounding message that the global optometry community must do more.
We call it the three Ms. Mitigation, which involves optometrists educating and counselling parents and children during early and regular eye examinations on lifestyle and other factors to prevent or delay the onset of myopia. Measurement – optometrists evaluating the status of the patient during regular comprehensive vision and eye health examinations, such as measuring refractive error and axial length whenever possible. And management, with optometrists addressing the patient’s needs by correcting myopia, while also providing evidence-based interventions, for example, contact lenses, spectacles, and or pharmaceuticals, that slow the progression of myopia for improved quality of life, and better eye health into the future.
The role optometry can play in raising the public perception of myopia starts with educating families, the broader healthcare community, public health entities, and optometric peers about the seriousness of myopia.Working with staff, optometrists should provide up-to-date materials on myopia and have conversations with parents about the importance of eye exams beginning at an early age. Early diagnosis and treatment of myopia is critical to stemming this epidemic. As for the public in general, discussions should incorporate lifestyle factors including time spent outdoors, and the long-term vision implications that may occur if a child's myopia is not properly treated. Parents, including those who are myopic themselves, may not otherwise realise how far this field has progressed since their own childhood.
This also involves educating ourselves as optometrists. We need to look at reputable studies that examine evidence-based approaches shown to prevent or delay the onset of myopia or halt or slow its progression. The optometric community must continue to pursue further education on myopia management; the data and information available are rapidly evolving, strengthening practitioners’ skills and knowledge.
The practice of optometry varies around the globe, which may limit the scope of practice of some practitioners. If there are limitations, we still have an obligation to do what is in the best interest of our patients. So look beyond your own practice, as there may be a clinician close by who could assist. Establishing a referral or shared service network can be a key component to applying myopia management as a standard of care. Regardless of where an optometrist is located, practitioners should implement myopia management approaches to the highest scope possible as allowed within their particular region.
Bringing myopia management into practice requires a fundamental change in our approach to patient care.One barrier is low awareness of myopia and myopia management among parents. Studies have shown that parents believe they know what myopia is, but few are able to correctly identify it as short sightedness or near sightedness, and that parents deem eye exams as less of a priority than visits to their primary care doctor or dentist. The lack of recognition and delay in comprehensive examinations leads to a greater risk for high myopia and its health consequences.
Another barrier is the perceived cost of myopia management treatment options. Not all families can afford the out of pocket expense. The key here is making sure we educate parents in a way that they can clearly see the value of the myopia management treatment option that it will give their child. Think of it as an insurance policy – you pay up front so that the consequences are hopefully less in the future. Historically, optometrists have often been their own worst enemy in this as they often assume patients can’t or don’t want to pay for the best treatment. My position in practice has always been; if this patient was a family member, would you recommend the best level of care? Don’t assume your patients aren’t willing to accept the cost of the best care. The last thing you would want to hear is a patient finding out there were options available that you didn’t suggest and asking why they weren’t offered.
When discussing myopia, probably the trickiest part is managing the health aspect – nobody wants to hear the bad news.
As soon as you see somebody who might be leaning towards myopia, I think you can have that dialogue – the sooner the better. What we can do is give out documentation right off the bat to say; ‘here’s where we’re at, here’s where we could be headed’. It is helpful to have parents look at this and realise, ‘If I do nothing, this is going to happen. But if we can treat it, we have some chance for success.’
Optometry is a fantastic profession. My message to optometrists is always to do what’s in your patient’s best interest and get actively involved in our profession. There’s not a lot of people on our team so I think that the more that we work together and interact with our colleagues, the better off the patients are and our profession is going forward.
- As told to Kimberley Young.