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Myopia: Spectacles the most common approach for Aussie optometrists

Australia’s first myopia management survey has revealed single‐vision distance spectacles are the mainstay of myopia correction in school‐aged children, despite awareness among practitioners of the potential effectiveness of other interventions.

The survey of 239 Australian optometrists aimed to investigate their knowledge and understanding of myopia, as well as their self‐reported clinical practices in terms of diagnosis and management of childhood myopia.

Optometry Australia members and optometrists Dr Amanda Douglass, Associate Professor Peter Keller and Dr Laura Downie, from the University of Melbourne Department of Optometry and Vision Science, and Centre for Eye Research Australia ophthalmologist Professor Mingguang He authored the survey, which was sent to Optometry Australia members in 2016.

In one of the starkest findings, it was revealed the most common approach to management were single‐vision distance (full correction) spectacles. More than 50% of respondents indicated they would ‘always’ or ‘mostly’ prescribe this modality, with it being less likely in respondents with an interest in myopia and in independent practice.

This is 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.

“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,” the study concluded.

“Clinical guidelines may be of value for assisting practitioners in making clinical decisions based upon the current, best‐available research evidence.”

Clinical equipment ‘a barrier’

In other findings, almost half of practitioners considered progressive addition spectacles to be more efficacious than single‐vision distance spectacles for reducing childhood myopia progression. This is despite the totality of the evidence suggesting that any potential clinical benefits are modest.

About 20% of respondents considered the need to purchase additional clinical equipment as an ‘important’ or ‘very important’ barrier to myopia management, although this response was less likely if the practitioner had an interest in myopia or was in independent practice.

The study also examined the criteria for ceasing treatments. Responses varied considerably, both with respect to patient age – with most respondents selecting either 21 or 25 years – and the time period of refractive stability – with 58% selecting the absence of myopia progression for at least 24 months.

“This spread of ages suggests there is uncertainty regarding the appropriate age for ceasing an intervention to assure refractive stability,” the authors said.

The survey also found that, relative to a single‐vision distance full‐correction, practitioners considered orthokeratology (85.4 per cent), low‐dose (0.01%) topical atropine (54.4 per cent) and soft defocus contact lenses (40.6 per cent) as the three most effective modalities.

The minimum absolute degree of refractive error most practitioners considered necessary to prescribe for a child was −0.50 D.

To date, the only other study on clinical trends in myopia management was a cross‐sectional survey in 2016 involving 971 eye‐care practitioners, including optometrists, dispensing opticians and ophthalmologists, across Asia, Australasia, Europe, North America and South America.

The authors acknowledged that despite the survey taking place in 2016 coupled with a conservative completed response rate, the findings are considered to be a reasonable reflection of the current interest in paediatric optometry as a subspecialty.