Welcome to question of the day #168

Welcome to question of the day #168

I would like to offer a myopia management service in my practice but don’t know where to start? What should I do?

I’ve watched a very enlightening video on myopia management by Professor Flitcroft several times over the last few days. It is full of very clear and useful information on the epidemiology of myopia, the research underpinning theories on myopia development and progression and on introducing myopia management into practice. Unfortunately, the video is behind a firewall and only available to members of one of the UK professional bodies so there’s no point in providing the link.

Professor Flitcroft explained the following steps to starting a myopia management service in practice. He assumed that eye specialists will provide single vision lenses for people with myopia but suggested that when the patient is between seven and 11 years old, that the eye specialist has a conversation about myopic progression, the possible ocular complications associated with myopia and treatments available for myopia management.

Professor Flitcroft suggested that providing single vision lenses and having a conversation is now the minimum standard of care. He was concerned that not having this conversation could lead to problems if patients and/or parents discover myopia management themselves later on when the child is too old for successful management. This would lead to a different and more difficult conversation. For parents with myopia and children who are emmetropic and seven to 11 years old part of the conversation should be about spending more time outdoors. Some parents would decline the offer of myopia management others would accept it.

Interestingly, the UK’s College of Optometrists has taken the following position (2019):

'If you are not already offering myopia management intervention, you do not have to do so. However, you should make sure that you can hold a discussion with patients and their parents about the evidence, the benefits and the risks.'

Professor Flitcroft mentioned that the next step would be choosing and starting a myopia management intervention-dual focus contact lenses, dual focus spectacle lenses or orthokeratology.

And, the last step, a comprehensive monitoring and management plan, including time period between patient reviews, patient information and fees.

Excellent training in myopia management is available at https://bhvi.org/myopia-education-program/

Every dioptre counts.