As we have all found out over the past year, the best way to respond to a global pandemic is with a unified global response. And eye care professionals were perhaps more familiar with the ‘p’ word than most, having heard for many years the term ‘pandemic’ used in association with myopia. And, with a rapidly increasing incidence of myopia in recent decades leading to a prevalence in some parts of the world approaching 100 percent combining with growing evidence of a strong association with visual impairment and eye disease, the term was not being used lightly. So, the recent resolution from the World Council of Optometry (WCO) is something we should all be aware of and support as best we can.
How big is the problem?
The figures do bear repeating. As WCO president Paul Folkesson reminded us all as the resolution was announced last week, myopia will affect more than five billion people by 2050. And we should no longer think of myopia as solely ametropia, though uncorrected refraction itself is a major cause of visual impairment across the world. Increasing axial length increases the risk of sight loss through retinal and macular degeneration and disease, cataract, glaucoma, vascular perfusion compromise and optic neuropathy. If the current trend continues, the socioeconomic impact on everybody’s life will be immeasurable.
What is the WCO?
Founded more than 90 years ago, first based in Berlin, then London and now St Louis in the US, the WCO has played an increasing and important role in moving towards a standard of eye care throughout the world, where optometrists ‘are the primary healthcare practitioners of the eye and visual system who provide comprehensive eye and vision care, which includes refraction and dispensing, detection/diagnosis and management of disease in the eye, and the rehabilitation of conditions of the visual system.’
That it has had a good degree of success, through the provision of high-quality education, legislative and logistical support, and funding through its World Optometry Foundation programme is plain to see. Just ask anyone how eye care has changed in recent years in countries as disparate as France, Mexico, Nigeria and Malaysia. Each region presents different challenges to a unified strategy for eye care but, having already successfully addressed many of these, the WCO is well positioned to garner all of our various skills and talents as we face our myopic future.
What can be done?
As this special issue of Optician hopefully makes clear, there is a growing bank of robust evidence to show that early, targeted and patient-focused intervention, by a variety of means, can delay the onset, slow the progression, minimise the long-term damage and, in some cases, prevent myopia. And the intervention needs to be undertaken by skilled eye health professionals, with equal levels of training, access to resource and community standing.
What does the resolution state?
The WCO wants to establish a global standard of care for myopia management by optometrists. The standard must be evidence-based and so has three components, the three ‘M’s.
- Mitigation; we must all be able to appropriately educate and counsel our patients, discuss risk factors and lifestyle influences, so to be better able to predict or detect myopia at the earliest stages.
- Measurement; regular eye examinations for all should include accurate refraction and, ideally, axial length measurement.
- Management; we should all know what to do to maximise impact upon each patient threatening myopic progression.
If these three principles were adopted everywhere, the chance of avoiding mass blindness suddenly seem less. Getting to that point, however, is going to be a long, hard slog. That is why the WCO is also advising optometrists everywhere to embrace myopia management. And not just through planned correction, but importantly through education about myopia, its risk factors, the various ways of limiting the damage and the risks that will present if nothing is done.
What can I do?
You are already doing it by reading this issue. Keep up to date. Develop myopia management skills. Embrace new techniques and devices. Contact the WCO and get involved.
- For further information, go to https://worldcouncilofoptometry.info/resolution-the-standard-of-care-for-myopia-management-by-optometrists