Follow-up schedules for myopia management
In this article:
Understand how the free-to-download, multi-language Managing Myopia Guidelines Infographics can be used as a chairside reference for follow-up schedules in myopia management. Factors involved in best-practice clinical care are described, for both the initiation of a myopia control treatment and for longer term care. The following key clinical questions are explored.
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.
This image highlights the minimum recommended follow-up intervals schedule for the various modalities when establishing treatment suitability, based on the International Myopia Institute (IMI) Clinical Management Guidelines.Once treatment is established, the IMI recommends six-monthly ongoing reviews thereafter.1
Aftercare visits for soft contact lenses and orthokeratology may be more frequent than indicated in the above image depending on response to treatment and any changes necessary to optimize fit or vision especially in the initial stages.
What are the clinical considerations at each of these review examinations? As the treatment is being established, and in moving into long-term management, it is important to ask the following questions.
How are vision and eye health outcomes?
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?
Is the treatment working for the patient?
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?
Is the treatment slowing down myopia progression?
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?
Learn more about how to compare treatments for efficacy and other clinical considerations in Which myopia control treatment works best?
Communicating consultation outcomes and the next steps
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
The Managing Myopia Guidelines Infographics
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).
Freshly updated in late 2023 and built from the ground up from continued feedback with eye care practitioners and industry advisers, these Managing Myopia Guidelines Infographics are designed to be used by eye care professionals, in discussion with patients and their carers, and as a clinical reference.
For an overview of how to use the Infographics in practice, read our article Using the Managing Myopia Guidelines Infographics
For guidance on the guided clinical communication process provided the Infographics, read our article Keys to Communication in Myopia Management.
Once you have used the Infographics to explain myopia to patients and their parents or carers in your exam room, these messages can be further enhanced by providing the take-home, free-to-download Managing Myopia patient brochure.
Meet the Authors:
About Kate Gifford
Dr Kate Gifford is a clinical optometrist, researcher, peer educator and professional leader from Brisbane, Australia, and a co-founder of Myopia Profile.
About Kimberley Ngu
Kimberley is a clinical optometrist from Perth, Australia, with experience in patient education programs, having practiced in both Australia and Singapore.
Gifford KL, Richdale K, Kang P, Aller TA, Lam CS, Liu YM, Michaud L, Mulder J, Orr JB, Rose KA, Saunders KJ, Seidel D, Tideman JWL, Sankaridurg P. IMI - Clinical Management Guidelines Report. Invest Ophthalmol Vis Sci. 2019 Feb 28;60(3):M184-M203.
Bao J, Huang Y, Li X, Yang A, Zhou F, Wu J, Wang C, Li Y, Lim EW, Spiegel DP, Drobe B, Chen H. Spectacle Lenses With Aspherical Lenslets for Myopia Control vs Single-Vision Spectacle Lenses: A Randomized Clinical Trial. JAMA Ophthalmol. 2022 May 1;140(5):472-478.
Chamberlain P, Peixoto-de-Matos SC, Logan NS et al. A 3-Year Randomized Clinical Trial of Misight Lenses for Myopia Control. Optom Vis Sci 2019;96:556-67.
Yam JC, Jiang Y, Tang SM, Law AKP, Chan JJ, Wong E, Ko ST, Young AL, Tham CC, Chen LJ, Pang CP. Low-Concentration Atropine for Myopia Progression (LAMP) Study: A Randomized, Double-Blinded, Placebo-Controlled Trial of 0.05%, 0.025%, and 0.01% Atropine Eye Drops in Myopia Control. Ophthalmology. 2019 Jan;126(1):113-124.
Brennan NA, Toubouti YM, Cheng X, Bullimore MA. Efficacy in myopia control. Prog Retin Eye Res. 2021 Jul;83:100923.
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