Research Review

From Down Under, Clinician Perspectives on Myopia Management

By Dwight Akerman, OD, MBA, FAAO
Chief Medical Editor, Review of Myopia Management

Dec. 3, 2019

Much of our knowledge about myopia has been generated by Australian researchers at BHVI and other leading academic institutions. Also, several contact lenses have regulatory approval for slowing childhood progressive myopia from Australia’s Therapeutic Goods Administration (TGA), the Australian equivalent to the U.S. Food and Drug Administration.

A recent article was published that investigated the understanding of practicing Australian optometrists in relation to myopia, its natural history and associations with vision-threatening ocular disease, self-reported clinical diagnosis and management approaches for childhood myopia, engagement with adult caregivers, and utilization of information to guide practice. An online survey was distributed to 4,124 Australian optometrists, and completed questionnaires were returned by 239 optometrists.

Most respondents demonstrated knowledge of the association between high myopia and retinal breaks, retinal detachment and primary open-angle glaucoma. Optometrists used a range of techniques to diagnose childhood myopia, with a preference for non-cycloplegic refractive measures. The most common approaches to management were single-vision distance and progressive addition spectacle lenses, despite most optometrists identifying orthokeratology, low-dose (0.01%) topical atropine and soft peripheral defocus contact lenses as three potentially more effective therapeutic interventions for modifying childhood myopia progression. Almost 90 percent of respondents considered increasing time spent outdoors to be beneficial for reducing the rate of myopia progression. The main sources of information used to guide clinical practice were continuing education conferences and events, systematic reviews, and personal experience. Respondents perceived adult caregivers to generally be involved in myopia management decisions and considered all aspects of myopia education as important.

The authors concluded from the survey results that Australian optometrists appear aware of emerging evidence but are not routinely adopting measures that have not yet received regulatory approval for modulating childhood myopia progression. Clinical guidelines may be of value for assisting practitioners in making clinical decisions based upon the current, best-available research evidence.

To date, most US eye care professionals have not incorporated myopia management into their practices to any significant extent. Although no intervention has an FDA labeling indication for myopia control currently, I expect this situation to change shortly. With several off-label treatment options available that have demonstrated efficacy in well-controlled clinical trials, eye care professionals have a professional responsibility to discuss myopia management options with all parents of children at risk for progressive myopia.

Knowledge, perspectives and clinical practices of Australian optometrists in relation to childhood myopia.

Douglass A, Keller PR, He M, Downie LE

ABSTRACT

BACKGROUND: The aim was to investigate the understanding of Australian optometrists in relation to myopia, its natural history and associations with vision-threatening ocular disease, self-reported clinical diagnosis and management approaches for childhood myopia, engagement with adult caregivers, and utilization of information to guide practice.

METHODS: An online survey was distributed to Australian optometrists (n = 4,124). Respondents provided information about their demographics (for example, gender, age, practice location and modality), myopia knowledge, self-reported practice behaviors relating to childhood myopia, the information and evidence base used to guide their practice, and perceived extent of adult caregiver engagement in making management decisions for myopic children.

RESULTS: Completed surveys were returned by 239 optometrists (six per cent completed response rate). Most respondents demonstrated knowledge of the association between high myopia and retinal breaks, retinal detachment and primary open-angle glaucoma. Optometrists used a range of techniques to diagnose childhood myopia, with a preference for non-cycloplegic refractive measures. The most common approaches to management were single-vision distance and progressive addition spectacle lenses, despite most optometrists identifying orthokeratology, low-dose (0.01%) topical atropine and soft peripheral defocus contact lenses as three potentially more effective therapeutic interventions for modifying childhood myopia progression. Almost 90 percent of respondents considered increasing time spent outdoors to be beneficial for reducing the rate of myopia progression. The main sources of information used to guide clinical practice were continuing education conferences and events, systematic reviews, and personal experience. Respondents perceived adult caregivers to generally be involved in myopia management decisions and considered all aspects of myopia education as important.

CONCLUSION: Current optometric practices reflect the inconclusive nature of several key aspects of the evidence for childhood myopia management. Australian optometrists appear aware of emerging evidence but are not routinely adopting measures that have not yet received regulatory approval for modulating childhood myopia progression. Clinical guidelines may be of value for assisting practitioners in making clinical decisions based upon the current, best-available research evidence.

 

Douglass, A., Keller, P. R., He, M., & Downie, L. E. (2019). Knowledge, perspectives and clinical practices of Australian optometrists in relation to childhood myopia. Clinical and Experimental Optometry.

DOI: 10.1111/cxo.12936

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