Knowledge, perspectives and clinical practices of Australian optometrists in relation to childhood myopia

Abstract

Background The aim was to investigate the understanding of Australian optometrists in relation to myopia, its natural history and associations with vision‐threatening ocular disease, self‐reported clinical diagnosis and management approaches for childhood myopia, engagement with adult caregivers, and utilisation of information to guide practice. Methods An online survey was distributed to Australian optometrists (n = 4,124). Respondents provided information about their demographics (for example, gender, age, practice location and modality), myopia knowledge, self‐reported practice behaviours relating to childhood myopia, the information and evidence base used to guide their practice, and perceived extent of adult caregiver engagement in making management decisions for myopic children. Results Completed surveys were returned by 239 optometrists (six per cent completed response rate). Most respondents demonstrated knowledge of the association between high myopia and retinal breaks, retinal detachment and primary open‐angle glaucoma. Optometrists used a range of techniques to diagnose childhood myopia, with a preference for non‐cycloplegic refractive measures. The most common approaches to management were single‐vision distance and progressive addition spectacle lenses, despite most optometrists identifying orthokeratology, low‐dose (0.01%) topical atropine and soft peripheral defocus contact lenses as three potentially more effective therapeutic interventions for modifying childhood myopia progression. Almost 90 per cent of respondents considered increasing time spent outdoors to be beneficial for reducing the rate of myopia progression. The main sources of information used to guide clinical practice were continuing education conferences and events, systematic reviews, and personal experience. Respondents perceived adult caregivers to generally be involved in myopia management decisions, and considered all aspects of myopia education as important. Conclusion Current optometric practices reflect the inconclusive nature of several key aspects of the evidence for childhood myopia management. Australian optometrists appear aware of emerging evidence, but are not routinely adopting measures that have not yet received regulatory approval for modulating childhood myopia progression. Clinical guidelines may be of value for assisting practitioners in making clinical decisions based upon the current, best‐available research evidence.

BCLA CLEAR - Orthokeratology

“…In an early retrospective analysis published in 1957, Morrison [3] reported no refractive progression in seven to 19-year-old children with previously steadily progressing myopia who wore flat-fitting rigid corneal lenses (~2.00 D flatter than the flattest corneal meridian) for at least 18 h a day. Since the late 1990's, ortho-k has been perceived by ECPs to be one of the most effective methods of myopia control [15][16][17][18] (see Section 8). In 2005, half a century after Morrison's clinical observations [3], a prospective single-arm intervention study suggested that ortho-k had the capacity to modulate myopia progression in children, relative to a historical control group of single-vision distance spectacle lens wearers [19].…”

Is optometry ready for myopia control? Education and other barriers to the treatment of myopia

“…Despite these advances, the majority of progressive myopes are still prescribed single vision spectacles, especially in countries outside of Asia 23 – 26 . There is a scarcity of published literature that examines the possible reasons for the very limited uptake of active myopia management.…”

BCLA CLEAR – Contact lens technologies of the future

“…The lens designs that have been assessed incorporate either concentric rings of plus power, peripheral optical zone(s) with add power and lens designs that incorporate non-monotonic variations in power, varying in both myopic and hyperopic directions. However, in spite of these significant advances, contact lens fittings for myopia control are limited to only about 2-5 % of the total contact lens fittings, with single vision spectacles remaining the most popular myopia management modality [451,452].…”

“…One of the reasons for low uptake of soft contact lenses for myopia management relate to perceptions on efficacy, with soft lenses ranking behind orthokeratology and pharmaceutical options in terms of perceived efficacy by ECPs worldwide [451,452]. Despite this, the myopia control field is growing and research considering innovative and improved approaches to slow myopia is of great interest.…”