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A fundamental commitment

Andrew McClean finds out what myopia resources are available to practitioners in order to help deliver the best care to patients

There is currently no obligation for an optometrist to recommend a particular treatment for myopia management, according to guidance published by the College of Optometrists.

It reasons that efficacy and safety data is not yet fully established with current evidence. However, Dr Paramdeep Bilkhu, clinical adviser at the College of Optometrists, says: ‘Optometrists should make sure that they can hold a discussion with patients and parents about the evidence, the benefits and the risks, if asked about myopia management interventions.’

There is a wealth of myopia-related resources and tools available at the disposal of practitioners from various sources in the industry, including the College’s patient leaflet, podcast and CET.

Bilkhu adds that patients should keep up to date with evidence, explain this to patients, discuss how they will measure outcomes of any treatment, as well as obtain explicit consent and keep accurate patient records.

Myopia can no longer be considered a benign refractive error correctable by optical means, according to Debbie Jones, clinical scientist at the Centre for Ocular Research and Education (Core).

‘It is imperative that optometrists are educated on the risk factors for myopia in order to be able to discuss preventative measures, and also educated on management options available for their myopic patients. All patients should be introduced to the options available to slow down myopia progression to reduce the risks of long term myopia induced ocular pathology. Myopia management needs to be standard of care for our patients,’ she says.

Jones adds that optometrists need to equip themselves with the knowledge and understanding of myopia management in order to be able to discuss this with their patients. ‘Fundamentally, myopia management is a commitment that has to be made in order to provide contemporary, evidence-based care for patients.’

Conversational confidence

Indie Grewal, president of the British Contact Lens Association (BCLA), says it is important for optometrists to undertake education on myopia as understanding around its impact on ocular health has increased.

‘We know more about the clinical significance of myopia and its pathological impact on the eye. As a result, there is an increasing interest in slowing the progression of myopia in young children,’ Grewal explains.

He adds that it is important eye care professionals (ECPs) understand how each available modality works so myopia management can be tailored to each patient.

Practitioners may look to upskill in order to meet the needs of myopic patients and the BCLA offers the opportunity to gain a certificate specific to myopia management.

It provides an overview of myopia in six online lectures, including why to consider myopia management, behavioural management of the pre-myope, methods of intervention and how to start providing the service in practice.

‘After completing the online lectures participants are required to attend an interactive myopia management session and then a 30-minute viva oral examination, which leads to the Certificate of Myopia Management,’ Grewal explains.

It was designed to translate the latest global research findings to clinical practice while simultaneously improving awareness of the issue among patients.

Development of the certificate was led by past-president of the BCLA Keith Tempany and it is aimed at any practitioner who wants to gain confidence in having conversations with patients on the topic.

Almost 100 ECPs have now registered for the BCLA’s Certificate of Myopia Management, with some of those now reaching the end of the course and assessments scheduled in the coming weeks.

Research into practice

Australian-based Myopia Profile provides access to a multi-platform digital suite for myopia management, which includes a Facebook group where over 9,000 practitioners share cases and discuss research findings.

Founded in 2016 by optometrist husband and wife duo, doctors Kate and Paul Gifford, the website has grown from a self-developed clinical paper to a comprehensive learning academy.

Kate Gifford says: ‘Its three pillars of activity are in educating the ECP, providing actionable clinical resources to support ECP clinical communication in translating research into practice, and educating parents and the public on childhood myopia.’

Its public awareness website, mykidsvision.org, includes a survey on myopia risk factors, how-to video guides for practitioners to share and social media platforms for parents to learn about myopia and what options are available to their children.

Myopia Profile also works on the development of educational and research projects in collaboration with Core in Waterloo, Canada.

Core provides ECPs with information to help inform their myopia management practice from a number of sources, including independent resources, such as Myopia Profile, and via a number of contact lens and spectacle lens manufacturers.

Its own educational online magazine, contactlensupdate.com, is designed to translate recent science into practical and applicable information. Recent issues have included a review of dose-dependent response in various interventions and contact lens wear in children.

Appropriate treatment

A range of free to download resources to help patients understand their eye health are available from the Association of Optometrists’ (AOP) website and includes myopia in its Your Prescription Explained leaflet.

Dr Peter Hampson, AOP clinical director, says: ‘Firstly, it is crucial that your patient, or the parental guardian of your patient, understands the outcome of their sight test and prognosis in language that makes sense to them. This will enable you to determine the appropriate treatment options for them.’

He adds that myopia management is a rapidly changing area of practice. ‘It is therefore of the utmost importance that practitioners who want to be involved in myopia management keep up to date with the latest research and CET in this area to ensure they can have the most useful and informed discussions with their patients,’ Hampson explains.

The AOP will shortly update its myopia management consent form, which is designed to help practitioners explain myopia and possible treatment options.

Ongoing education

Ensuring a strong understanding of myopia management and how best to present that to parents is essential for successful outcomes in practice. CooperVision provides an interactive, online education programme to support ECPs who are new to myopia management.

Krupa Patel, head of professional services for the UK & Ireland at CooperVision, says: ‘This programme is around two hours long and broken down into eight short modules covering everything from the theory of myopia management through to suggestions on how to manage discussions with parents. We’d also suggest having materials to support your conversations. There are various materials available for you to use in practice including the CooperVision Your Child and Short-sightedness guide.’

She adds that CooperVision offers one-to-one sessions with optometrists who are experienced in myopia management and ongoing education events and content to support ECPs in this rapidly progressing area of optometry.

Communication tools

Launching later this year is Menicon’s Bloom Myopia Control Management System, which includes its night and day lens products, treatment plans to support practitioners and a two-part monitoring system that features software for ECPs and an app to enhance communication between practitioners and patients.

Gill Narramore, UK sales manager at Menicon’s speciality lens division, says: ‘Contact lens innovations continue to drive welcome progress in this regard, but this is not the whole story when it comes to effective management of myopia in children.

‘We believe ongoing communication between the children, their parents or guardians, and the eye care practitioner is paramount. The Bloom app will deliver this with ease, improving compliance and safety throughout the myopia treatment programme.’

Identifying interventions

Menicon has also partnered with Johnson & Johnson Vision in order to ‘help reshape the future of myopia’ and introduce products and services to manage progression.

Menicon will develop and manufacture therapeutic contact lenses to help manage the progression of myopia in children while Johnson & Johnson Vision will focus on expanding availability of these lenses around the world.

As part of its efforts to raise awareness of myopia and provide tools for optometrists, Johnson & Johnson Vision has also developed guidelines and formed a research partnership with the Singapore National Eye Centre and the Singapore Eye Research Institute.

The guidance includes recommendations on frequency of eye examinations, identifying interventions to slow progression and monitoring efficacy.

Kamlesh Chauhan, director of professional affairs at Johnson & Johnson Vision, says practitioners can best support patients by keeping up to date with the latest literature on myopia in order to inform clinical judgements.

‘The concept of myopia management and its importance as a serious eye health issue is poorly understood by parents. Although clinical knowledge and skills are critical, the same can be said of communication skills around an area not frequently practised and will be of high concern to parents. Ensuring that practitioners have considered and reviewed how they have the discussion with parents on this sensitive topic is very important,’ he says.

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