Research Review

Have Practitioners Changed Their Myopia Management Attitudes and Clinical Strategies?

Jan. 2, 2020

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

A global survey in 2015 identified a high level of eye care practitioner (ECP) concern about myopia with a moderately high level of activity. However, the vast majority of ECPs still prescribed single vision spectacles and contact lenses to juvenile-onset myopes. Researchers aimed to determine if myopia management attitudes and clinical strategies changed over the past four years.

A self-administrated, internet-based questionnaire was distributed in eight languages, through professional bodies to ECPs globally. The questions examined: awareness of increasing myopia prevalence, perceived efficacy of available strategies and adoption levels of such strategies, and reasons for not adopting specific strategies.

Of the 1336 respondents, concern was highest in Asia and lowest in Australasia. ECPs from Asia also considered their clinical practice of myopia control to be the most active, despite lack of regulatory approval of contact lenses or topical pharmaceutical agents for myopia control in China, Taiwan, or Japan. Sadly, North American practitioners were the least active. Orthokeratology was perceived to be the most effective method of myopia control, followed by pharmaceutical approaches and approved myopia control soft contact lenses. Most practitioners did not consider single-vision distance under-correction to be an effective strategy for attenuating myopia progression but prescribed single vision spectacles or contact lenses as the primary mode of correction for juvenile-onset myopes. The main justifications for their reluctance to prescribe alternatives to single vision refractive corrections were increased cost and inadequate information.

While practitioner concern about myopia and the reported level of activity have increased since 2015, the vast majority of ECPs still prescribe single vision interventions to young myopes. Myopia control techniques are not being applied early enough in a child’s ocular development to elicit their optimum effect. With recent International Myopia Institute evidence-based guidelines having been published (www.myopiainstitute.org), it is time to address the myopia epidemic proactively… especially in North America.

Global trends in myopia management attitudes and strategies in clinical practice – 2019 Update

Wolffsohn JS, Calossi A, Cho P, Gifford K, Jones L, Jones D, Guthrie S, Li M, Lipener C, Logan NS, Malet F, Peixoto-de-Matos SC, González-Méijome JM, Nichols JJ, Orr JB, Santodomingo-Rubido J, Schaefer T, Thite N, van der Worp E, Tarutta E, Iomdina E, Ali BM, Villa-Collar C, Abesamis-Dichoso C, Chen C, Pult H, Blaser P, Parra Sandra Johanna G, Iqbal F, Ramos R, Carrillo Orihuela G, Boychev N.

ABSTRACT

PURPOSE: A survey in 2015 identified a high level of eye care practitioner concern about myopia with a reported moderately high level of activity, but the vast majority still prescribed single vision interventions to young myopes. This research aimed to update these findings 4 years later.

METHODS: A self-administrated, internet-based questionnaire was distributed in eight languages, through professional bodies to eye care practitioners globally. The questions examined: awareness of increasing myopia prevalence, perceived efficacy of available strategies and adoption levels of such strategies, and reasons for not adopting specific strategies.

RESULTS: Of the 1336 respondents, concern was highest (9.0 ± 1.6; p < 0.001) in Asia and lowest (7.6 ± 2.2; p < 0.001) in Australasia. Practitioners from Asia also considered their clinical practice of myopia control to be the most active (7.7 ± 2.3; p < 0.001), the North American practitioners being the least active (6.3 ± 2.9; p < 0.001). Orthokeratology was perceived to be the most effective method of myopia control, followed by pharmaceutical approaches and approved myopia control soft contact lenses (p < 0.001). Although significant intra-regional differences existed, overall, most practitioners did not consider single-vision distance under-correction to be an effective strategy for attenuating myopia progression (79.6 %) but prescribed single vision spectacles or contact lenses as the primary mode of correction for myopic patients (63.6 ± 21.8%). The main justifications for their reluctance to prescribe alternatives to single vision refractive corrections were increased cost (20.6%) and inadequate information (17.6%).

CONCLUSIONS: While practitioner concern about myopia and the reported level of activity have increased over the last 4 years, the vast majority of eye care clinicians still prescribe single vision interventions to young myopes. With recent global consensus evidence-based guidelines having been published, it is hoped that this will inform the practice of myopia management in future.

Wolffsohn, J. S., Calossi, A., Cho, P., Gifford, K., Jones, L., Jones, D., … & Malet, F. (2019). Global trends in myopia management attitudes and strategies in clinical practice–2019 Update. Contact Lens and Anterior Eye.

DOI: 10.1016/j.clae.2019.11.002

 

 

 

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