Myopia Management PERSPECTIVES

What is Evidence-Based Practice?

Evidence-Based Practice in Myopia Management

Paper authors: James Wolffsohn, Elizabeth Lumb, and Anna Sulley

Evidence-based practice, which arose from Evidence-based medicine, emphasizes the integration of the strongest available research evidence from peer-reviewed journals and clinical experience into clinical decision making and care. A hierarchical evidence model categorizes research evidence based on its strength, from systematic reviews and randomized controlled clinical trials to case reports and expert opinions; the strength of this evidence can be used to decide if it should (or should not) affect methods of clinical care. Overall, evidence-based practice empowers eye care professionals (ECPs) to make well-informed decisions, ensuring the best possible outcomes for their patients.

Research Findings from Wolffsohn et al.

In this second Perspective, we examine an article by Wolffsohn et al. titled ”Evidence-based practice in myopia management” (Optometry in Practice, 2021). The paper explores evidence-based strategies for preventing the development and slowing the progression of myopia. However, its insights extend beyond myopia management, and also highlight the broader significance of evidence-based practice in the field of optometry and healthcare more generally.

Combine Evidence & Experience

The authors emphasize that evidence-based practice in myopia management involves making healthcare decisions based on the strongest available research evidence from peer-reviewed journals. Well-rounded patient care is achieved by ECPs by combining this evidence with their own clinical experience and input from the patient.

Staying Updated

The paper underscores the importance of staying updated with the latest research developments. It encourages ECPs to be proactive in seeking new evidence and incorporating it into their practice, not only for myopia but also for various eye conditions.

Several Critical Strategies Available

This article also explores critical strategies for preventing myopia development and slowing its progression – for example, environmental modification (including increased time outdoors), and optical treatments (such as soft dual-focus contact lenses, orthokeratology, and soft multifocal contact lenses) have all shown promise in controlling myopia progression. Additionally, pharmaceutical treatment with atropine and combination therapy approaches have been explored to enhance the efficacy of myopia control.

Awareness Still Needed

The authors note that ECPs continue to fit standard single-vision correction to progressing myopic patients, so there is an ongoing need for greater awareness and adoption of evidence-based myopia management.

 

Ideal Study Design Features for Myopia Control Trials

Girl at eye examination

In addition to clinical recommendations, the paper highlights key design recommendations for clinical studies from the International Myopia Institute’s 2019 report:

  • Prospective Design: Follow subjects forward in time for accurate data.
  • Parallel Groups: Track interventions within separate groups for optimum comparisons.
  • Double-Masked: Eliminate bias with participants and researchers as unaware as possible of the assigned intervention.
  • Randomized Allocation: Randomly assign participants to minimize bias.
  • Study Duration: Ideally more than two years with 1-year follow-up after treatment cessation to explore any rebound.
  • Age 7-12: Enroll children during peak myopia progression ages.
  • Compliance Monitoring: Track intervention adherence closely.

These features significantly enhance the credibility and reliability of myopia management research, providing a robust foundation for the advancement of our understanding of myopia control strategies.

Key Takeaways for Practising Eye Care Professionals

ECPs play a crucial role in managing myopia and its potential complications. The research underscores the importance of timely interventions to slow axial elongation and reduce the risk of myopia-related ocular complications. Factors such as patient age, refractive error, and parental myopia history can help predict the likelihood of myopia development, aiding early management decisions. Various clinical management options with good supporting evidence are now available, and we will discuss them in upcoming Reports. Keeping up-to-date with the ever-expanding academic literature and efficacy findings is essential to offer the best care to paediatric patients.

Three Action Items for Practising Eye Care Professionals

Stay Informed: Check in each month to our Myopia Management Reports series and other resources here on the Standard of Care for Myopia Management website. Regularly review the latest research, systematic reviews, and professional guidelines to stay abreast of the latest myopia management strategies.

Proactive Intervention: Recognize high-risk children prone to myopia development and proactively address the situation using a “mitigate, measure, and manage” approach as per the WCO resolution:

  • Mitigate: Implement strategies such as advocating increased outdoor time and regular eye examinations to help mitigate myopia risk.
  • Measure: Ensure comprehensive baseline measurements of refractive error through cycloplegic refraction (where feasible) and assess axial length (when accessible).
  • Manage: Employ interventions rooted in evidence-based practices to effectively manage myopia progression and optimize patient outcomes.

Personalized Care: Tailor myopia management approaches to individual patient needs, considering factors like age, refractive error, and parental myopia history.

As we embark on this series, our goal is to equip you, our dedicated ECPs, with evidence-based insights to navigate the dynamic field of myopia management effectively. Together, we can make a significant impact in reducing the prevalence and progression of myopia, safeguarding the eye health and vision of generations to come.

For the full-length article, please visit here.

Interested in learning more?

Video title slide: How to identify children at risk of developing myopia
Play Video about Video title slide: How to identify children at risk of developing myopia

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Learn how to recognize risks of developing myopia in children based on presenting refractive status, axial length, and family history and to implement a clinical management protocol.

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Presented by Philip Cheng, Wen Juan Chui & Ariolfo Vazquez

Hear how current leading practitioners in the field of myopia management choose a myopia management strategy for their patients.

Video title slide: how to monitor children undergoing myopia management
Play Video about Video title slide: how to monitor children undergoing myopia management

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Learn about tools and strategies for monitoring the myopia progression of your patients, assessing the effectiveness of their treatments and modifying their treatments to maximize their effectiveness.

Mitigation
Measurement
Management

Prepared by the World Council of Optometry Myopia Management Resource Committee 2023.
The World Council of Optometry Myopia Management Standard of Care initiative is a collaborative partnership between World Council of Optometry and CooperVision.

Soft Dual Focus or Multifocal Contact Lenses

Spectacle Lenses for Myopia Control

Orthokeratology

Atropine

When to wear it

Children who are physically active
Ideal for very young wearers
Children disliking glasses and/or inclined to not wearing them full-time

Considerations

Shown to improve confidence and ability to participate in activities.

Typically more availability for astigmats.

No wearing time during waking hours.

Optical correction is still needed.

* Excluding children frequently engaged in water sports.