Follow-up schedules for myopia management

Once a myopia management strategy is initiated, it is important to keep to a reasonable review schedule. The frequency of reviews is dependent on the treatment modality as they bear varied risks of complications, side effects and patient compliance.

The graphic below is a panel from the free-to-download clinical resource Managing Myopia Guidelines Infographics, created by Myopia Profile to support clinical decision making and communication. There are four panels of the infographic designed to be a chairside reference for eye care professionals, and another four panels designed to guide in-room discussions between eye care professionals, patients and their parents. The panel below is the third of four panels from the chairside reference component, to support eye care professionals in prescribing decisions and long-term myopia management.

Check distance and near acuity, objective and/or subjective refraction, accommodation and binocular vision and assess ocular health. This is crucially important in the phase of establishing the treatment, as well as in long-term care. 

Additional tests relevant to the treatment type could include measuring intraocular pressure and/or pupil size and function for atropine; or corneal topography where indicated.

This helps to answer the clinical question: is the treatment suitable for the patient's vision and eye health needs?

Compliance, tolerance and safety are of utmost importance in myopia management. Along with appropriate history taking regarding vision, eye health and comfort, ask if there are any challenges in adhering to the recommended treatment, and seek to address these to support compliance and acceptance. 

• Spectacles should be worn full time (12+ hours per day, 7 days per week) to get the best myopia control outcomes.² Are they fitting well or slipping down the child’s nose? 

• Check on contact lens wearing time and how contact lenses are applied, removed and cleaned (where relevant). Full-time wear of myopia controlling contact lenses, in line with study outcomes, is 13+ hours per day, for 6 to 7 days per week.³

• Ensure atropine is being used each night,⁴ unless otherwise recommended.

This helps to answer the clinical question: does the treatment (still) suit the patient's lifestyle, needs and capacity?

Once you have established a treatment which is comfortable for the patient, encourages compliance and provides them optimum vision and eye health, you’ll want to assess how well it is working to slow myopia progression. An interim assessment of treatment efficacy could be made at six months, but since there is some seasonal variation in myopia progression (faster in winter, slower in summer),⁵ this judgement is best made after one year. 

This is perhaps the most complex step, which requires you to consider what progression could be for a child of that age if they were untreated (in single vision correction), and compare this to their measured progression. Data on refractive and axial length progression can be used Guidance on this is provided in detail on the final chairside reference panel, described in the article Gauging Success in Myopia Management.

This helps to answer the clinical question: is the treatment working to slow down myopia progression for this patient?

When communicating consultation outcomes, it is important to cover the following: is the treatment working for vision, eye health and myopia control? Is it also working for the patient and their family?

Start by communicating the positives: has the child got clear vision and is handling their treatment type  well? If myopia progression is minimal or stable, then all three areas are well managed. If there is an issue with vision, eye health or myopia progression, then it may be time for a change of strategy. Get more guidance on this in the article Why isn’t the myopia control strategy working? 

In long-term care, it is important to note that the IMI recommends cycloplegic refraction and retinal health examination through dilated pupils annually, or on indication.¹

Myopia Profile’s popular and entirely free Managing Myopia Guidelines Infographics are designed to support clinical communication and decision making in myopia management. These engaging infographics are available to download and print in several formats and numerous language translations. 

There are two four-panel infographics which can be printed in large format as poster (ANSI-C or A2), or scaled down to US Letter or A4 to be used as a handheld infographic for in-room discussions and reference. 

• The mostly blue infographic is a chairside reference guide for eye care professionals that guides you through: (1) Myopia risk factors, (2) What to prescribe, (3) Follow-up schedules and (4) Gauging success

• The multi-colored infographic is designed to help you communicate with parents and patients on the following topics : (1) Visual environment advice, (2) What are my options? (3) Kids can wear contact lenses and (4) Why myopia management is essential. 

The Infographics can also be printed as individual panels (US Letter and A4 sizes) to use each page on its own if you prefer. As above, there are four which are parent- and patient-facing (multi-coloured) and four which are your chairside reference (mostly blue coloured). The image below shows various print formats, with all panels collated (at back) and single pages (foreground).