Background
Several myopia management options are now available in the UK for children with progressing myopia. These include specialised soft contact lenses, spectacle lenses and orthokeratology. However, many eligible children are still being prescribed single vision correction, and it is unclear why this may be.
Until now, there has been limited peer-reviewed research into eye care professionals’ (ECPs) attitudes towards myopia and myopia management in the UK. The qualitative nature of this study allowed us to gather detailed information from ECPs directly, relating to their current experiences of prescribing myopia management and their thoughts and opinions on the area.
What was the aim of the study?
The aim of this research was to determine current barriers that may be limiting the prescribing or uptake of myopia management. From mid to late 2022, we conducted several focus groups with 41 ECPs from primary and secondary care: optometrists, pre-registration optometrists, dispensing opticians, contact lens opticians, ophthalmologists and an orthoptist.
Participants were asked about their approach to vision correction in progressing myopes, their experiences communicating myopia management with patients and parents, and any barriers they had encountered that were limiting their recommending or prescribing of myopia management. Once all focus groups had been conducted, the transcripts were analysed to extract the main themes found in ECPs’ discussions.
What do the results of the study show?
At the time we conducted the focus groups, about half of the attending practitioners were undertaking myopia management. ECPs’ knowledge about myopia management was generally good, though there was worry over possible bias in educational materials. Rather than a lack of knowledge, practitioners felt a lack of confidence and experience limited their prescribing of myopia management.
ECPs appeared to struggle with the uncertainty that comes with individualistic decision-making required in myopia management, as many expressed their desire for more prescriptive guidance, especially ECPs with less experience. Most ECPs desired greater clarity on their duty of care obligations and were concerned over possible future litigation if they had not offered, or referred onward for, myopia management when indicated.
The biggest barrier to prescribing myopia management seemed to be financial. Treatment is expensive and ECPs often queried whether there would be NHS funding available soon. ECPs expressed discomfort at mentioning cost with parents and were concerned about being perceived as profiteering.
Many barriers were indicative of systemic problems within UK eye care, such as poor public awareness of paediatric eye care, and whether myopia management care fits with current business models of many high street practices.
Why might this work be important to ECPs?
This research provides insight into some current barriers limiting the accessibility of myopia management in the UK. These may highlight some necessary adaptations practitioners can make for increased and more consistent provision of myopia across UK optical practice.
Improving communication with the patient and parent is essential, and the ECPs who were more experienced with prescribing myopia management advised on what works well in practice. The idea of ‘planting the seed’ early regarding development of myopia, and the importance of its management helps to reduce scepticism from parents later on, when myopia management is initially recommended.
Providing parents with all relevant information to aid informed decision-making is crucial, allowing enough time for digestion of information and follow-up discussion if needed. The importance of a well-trained practice team aided successful myopia management in practice – having a team member able to continue the discussion outside of the examination room is useful.
In lieu of stricter myopia management guidelines, practitioners are advised to keep themselves informed and up to date by referring to evidence reviews, and guidance from their relevant professional bodies. This should provide ECPs with more confidence in delivering a patient-dependent approach to myopia management. This research also provides an example for how ECPs can get involved in research that can inform and shape future practice.
What are the limitations of the work?
While there are many upsides to conducting qualitative research, such as the detailed insights it can provide, the information is collected from a limited number of ECPs. Most of our ECPs were centred around North-West England, and the groups included more practitioners that work in independent practices, and those also working in academia. Naturally, there may be some inherent volunteer bias, with those wanting to participate having more interest in myopia management.
What further work still needs to be undertaken in this field?
While this research provides a useful insight into ECPs’ attitudes to myopia prescribing, it would be useful to pair this with objective data on prescribing of myopia management in the UK. Similar focus groups with the public may provide more information on barriers from the point of view of patients and parents, which would also need to be addressed to improve adoption of myopia management.
Conclusion
There are currently a range of barriers limiting the wider uptake and prescribing of myopia management, from the level of the practitioner themselves, through to systemic issues within UK eye care delivery. Individual ECPs can work to address barriers within their own delivery of myopia management to ensure they are offering the best service possible.
- Sophie Coverdale is an optometrist and PhD researcher. She is currently in her third year of PhD study. Her key research topics include: myopia onset and progression in adulthood, attitudes towards myopia management, and contact lens fitting in children. Alongside her research, Coverdale supervises undergraduate students at the university and is a locum optometrist.
- Dr Neema Ghorbani-Mojarrad is an optometrist and lecturer at the University of Bradford. He is an editorial board member for the College of Optometrists Acuity magazine and an associate editor of BMJ Open Ophthalmology. He is the vice chair of the British and Irish University and College Contact Lens Educators (BUCCLE), which promotes collaboration and dissemination of evidence-based contact lens knowledge, and holds fellowships for the BCLA and IACLE. His research interests include myopia development and management, contact lenses and applied myopia genetics, for which he won the 2021 Association of German Contact Lens Specialists and Optometrists (VDCO) Peter Abel prize and the George Giles Postgraduate prize.
- Full findings were published in: Coverdale S, Rountree L, Webber K, Cufflin M, Mallen E, Alderson A, Ghorbani-Mojarrad N. Eye care practitioner perspectives and attitudes towards myopia and myopia management in the UK. BMJ Open Ophthalmology. 2024 Jan 1;9(1):e001527.