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Clinical guidelines for myopia in white paper

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L-R International Myopia Institute’s committee chairs at the Texas meeting, Professor Earl Smith III, ex-pat Australian Professor Christine Wildsoet from the University of California at Berkeley, Professor David Troilo, Mr Ian Flitcroft, QUT Visiting Research Fellow Dr Kate Gifford and Professor James Wolffsohn. 

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By Helen Carter
Journalist

Brisbane optometrist Dr Kate Gifford has presented a synopsis of clinical management guidelines included in the International Myopia Institute’s inaugural white paper on myopia.

Kate, who chairs the institute’s clinical management guidelines committee, revealed details of the best practice clinical guidelines to manage myopia at the American Academy of Optometry annual meeting in San Antonio, Texas.

Seven committees comprising 86 myopia experts from around the world including Australia each authored a white paper. The papers on myopia definitions, evidence for interventions, ethical considerations, experimental models, clinical trial guidelines, genetics of myopia and clinical management guidelines will be published next January in Investigative Ophthalmology and Visual Science.

The clinical management guidelines cover patient identification, examination procedures, patient-specific considerations in selecting treatments and follow-up care. Practitioner considerations such as informed consent, prescribing off-label treatment and guides for communication to patients are detailed.

Examination and treatment

Key elements of baseline examinations for myopia control are detailed including standard procedures, binocular vision evaluation, dry eye evaluation and exploratory tests which may be incorporated into clinical practice in future.

‘All visits should include appropriate history-taking relative to treatment, distance and near visual acuity, subjective and/or objective refraction, accommodation and binocular vision assessment,’ the guidelines state.

‘Cycloplegic refraction and dilated fundus examination should be done annually or on indication, and if available, axial length measurement every six months.’

Kate said there was much discussion about the advice on axial length measurement as while it is the gold standard for a myopia control scientific study, use as a clinical diagnostic factor is problematic.

‘We have yet to fully understand ‘growth curves’ to be able to assess the difference between normal axial growth with emmetropization in childhood, compared to excessive axial elongation in progressive myopia. This is detailed in the white paper,’ she told Optometry Australia.

Guidelines for selecting a treatment strategy focus on supporting clinicians in ongoing clinical care and treatment decision making.

‘There is a white paper dedicated to the evidence on interventions for myopia management and the clinical management guidelines explain how to put this into practice. Clinical considerations such as back up corrections, review schedules, treatment duration, long-term efficacy, rebound effects and when to end treatment are also included,’ she said.

The clinical management guidelines paper also includes information on future research directions on intervention and treatment such as optimisation of orthokeratology and multifocal soft lenses, and other pharmacological, surgical and environmental modification techniques which are being researched.

Digital content includes key references, online and offline resources for practitioner education, practitioner-patient communication, software tools and an example informed consent form.

The Brien Holden Vision Institute founded the myopia institute.

Singapore myopia meeting

A regional discussion on developing myopia strategies was also held in Singapore this month, facilitated by International Agency for the Prevention of Blindness (IAPB) Chair for Western Pacific Amanda Davis.

Group photo Singapore - Myopia

Caption: Australian optometrists at the Singapore meeting were front row fourth from left, WHO Collaborating Centre for Prevention of Blindness deputy director Dr Andreas Mueller, seventh from left, Head of Myopia at the Brien Holden Vision Institute, Professor Padmaja Sankaridurg, ninth from left, Director of Academy, Brien Holden Vision Institute Foundation Dr Judith Stern, and back row standing far right, World Council of Optometry Education Committee Chair, Professor Peter Hendicott. Image, Brien Holden Vision Institute

The World Health Organization and the IAPB joined with Brien Holden Vision Institute at the collaborative meeting at the Singapore Eye Research Institute. Representatives of national health ministries from 10 countries across the Western Pacific attended.

The meeting aimed to use current evidence around myopia prevention and control to support global policy development. Participants reviewed existing and new evidence and strategies to reduce the burden of myopia, focusing on identifying public health interventions and strategies and fostering collaborations for implementation.

The prevalence of myopia is projected to increase from about two billion people worldwide in 2010 to almost five billion people in 2050.

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