I notice that the Brien Holden Institute has just made available some clinical guidelines which should prove useful for anyone looking to start practising myopia therapies. They are free to download, after a one-off registration, at brienholdenvision.org/translational-research/myopia/myopia-guidelines.html. They are clear and, importantly, simple to follow.
As has been reflected in the pages of this magazine, myopia management is a hot topic at present. The use of higher dose atropine (IP optometrists only in the UK), and orthokeratology, appear to make the greatest impact among the currently available interventions, but the body of evidence from various trials continues to rise and access to a range of options is likely to grow too.
CooperVision, for example, is currently training more UK clinicians in the use of their peripheral defocus MiSight lens. Successful therapy highlights the need for excellent communication skills, both in identifying suitable patients and also in managing expectations – good news for those worried about the rise of AI.
Slowing down progression is less dramatic than total ‘cure’ and this needs a very clear understanding by patient and parent. I recommend the online calculators, such as the Holden Institute’s, to explain the predicted course of myopia for a patient based on published evidence.
Some have raised questions about who might be qualified to offer such treatment. In recent correspondence, a GOC representative stated: ‘Sections 25(1), 25(1A) and 25(5) do not directly prohibit a CLO from fitting lenses for the purpose of therapeutic intervention,’ then added, ‘only a court can issue a definitive legal interpretation.’
One other consideration relates to monitoring – is 0.25DS step refractive error measurement sensitive enough at detecting changes during therapy? Expect to see axial length measurement (light or sound A scanning) becoming a more familiar additional test in practices of the future.