Myopia Management Guideline Infographic

Updated versions and eight language translations launched November 2020

Our hugely popular infographics, parent brochures and personalized inserts have all been updated to be language based rather than country based. Each download includes three versions to reflect different regions utilizing the same language: A4 size, A4 with atropine removed, and Letter size.

Our current translations of English, Spanish, French and Romanian are freshly updated to reflect the latest scientific research and clinical messaging on myopia control efficacy. We've added the DIMS technology spectacle lens, being commercialized by Hoya as MiyoSmart; and delineated centre-distance multifocal contact lens efficacy from the CooperVision MiSight lens, based on the recently published BLINK Study.

We've also changed the imagery to children on bicycles, with the 'single vision wearing' bicycle child without a helmet to protect him from rushing towards high myopia. You'll notice the helmets become more robust as the 'protection' offered by myopia control options increases in efficacy.

We added four new translations - Hebrew, Arabic, Simplified Chinese and Traditional Chinese.

To put these into practice, you can:

Download them HERE
Watch our explanatory YouTube video HERE
Link and share our explanatory video for parents, to reinforce your explanations, from our MyKidsVision.org How-To Video Guides HERE.

Further reading and references are provided below. You can also read the history of the Managing Myopia Guidelines Infographics from their first launch in late 2019.

Four versions released in January 2020

To celebrate the launch of the brand new Global Myopia Symposium, we provided hundreds of free copies of this infographic at the Global Specialty Lens Symposium in Las Vegas. These were co-branded again with the Centre for Ocular Research and Education (CORE), University of Waterloo, Canada. This North American version is the same as that provided at AAO as noted below.

In January 2020 we launched four versions for different regions to account for variance in available treatment options, myopia management strategies, and default printing page size across the world. They were Australia/NZ, North America, UK and UK-atropine removed. In November 2020 we updated these with newer scientific data and to reflect language-use rather than country-use, as described above.

First version released in October 2019

We developed this world first, clinically focused infographic for the American Academy of Optometry (AAO) meeting in Orlando, Florida in late October 2019. In collaboration with the Centre for Ocular Research and Education (CORE), University of Waterloo, Canada - who printed them, big thanks! - and the AAO Fellows Doing Research Special Interest Group (FDR SIG), we distributed these in the Exhibit Hall. If you've got one of these myopia management infographics in your hand, hot off the press, and are looking for the scientific basis of the information in front of you, you'll find this below. It is designed to support your clinical communication with parents (Side 1) as well as provide a reference for practitioner knowledge in clinical myopia management (Side 2).

Side 1 - Protecting Children from Myopia, is the parent-facing side to help you with clinical communication:
1️⃣ Visual Environment Advice - important for all pre-myopic and myopic kids (and any kids really!)
2️⃣ What Are My Options? A racing car analogy to explain myopia control efficacy
3️⃣ Kids Can Wear Contacts - the benefits of CL wear for kids and the simple message about safety
4️⃣ Why Management is Important - understanding the risks of myopia and benefits of myopia control for lifelong eye health.

1. Visual Environment Advice 2. What are my options? 3. Kids Can Wear Contacts 4. Why Management is Important

1. Visual Environment Advice

There are three key, evidence based messages here.

Firstly that at least 90 minutes a day spent outdoors appears to delay onset, and while there is conjecture, may also help slow progression of myopia. To read more about this, check out our blog Why Outdoor Time Matters in Myopia Development.

Secondly, closer working distance (less than 20cm) and longer near work duration (continuously for more than 45 minutes) have been linked to myopia; read the research here. The 20/20 rule is a simple way to explain that regular breaks can benefit both visual stamina and refractive development - every 20 minutes take a break for 20 seconds and look across the room.

Finally, the recommendation for no more than 2 hours of screen time per day, at least 60 minutes of physical activity per day and not sitting for too long come from the recommendations of the American Academy of Pediatrics and Australian Government Department of Health.

2. What are my options?

This section uses an appealing racing car analogy to describe how childhood myopia tends to 'race away' towards higher levels if left unchecked. It also helps to demonstrate that we cannot stop the car once it's started - we can't halt myopia progression - but we can aim to slow it down. Efficacy is described by how much we're slowing down the speedometer on the 'myopia racing car'.

Our understanding of myopia control efficacy over the longer term, and whether it is relative or absolute, is evolving. There's no doubt, though, that trying to communicate percentage (%) efficacy from various studies to parents is complicated - it's even difficult for us to understand as clinicians, as a % efficacy reported in a study is not often comparable to other studies - different study duration, age of control groups and other parameters can influence the final % result.

This summary aims to keep things simple for parents and patients, and further reading is available at each of these links. Spectacle lens options for myopia control have around a one-third (33%) efficacy on average, as does 0.025% atropine in the recent LAMP study. Multifocal soft contact lenses and OrthoK have around a one-half efficacy - explained to parents as "they will slow progression by about half, on average", as does 0.05% atropine in the recent LAMP study. This makes your message easy - only two numbers to remember, either one-third or one-half, as well as a clear message to parents that nothing offers 100% efficacy, or a halt to myopia progression.

3. Kids Can Wear Contacts

4. Why Management is Important

This section is a clear picture of the 'why' of myopia control. The odds ratios of increasing risk of pathology with increasing myopia - where '1' is the risk for an emmetrope - are presented, to help you have this conversation with parents and patients. To read more on this, check out our blog on The 'Why' of Myopia Control.

Every dioptre matters - right across the range of myopia, a new data analysis published recently by Mark Bullimore and Noel Brennan has shown that from 1D to 2D; from 2D to 3D; even from 6D to 7D there is an equally escalating risk of myopic maculopathy of 67%. This is serious stuff! So when we control myopia, reducing progression by 1D in total reduces risk of myopic macuopathy by 40%. This is another clear and important message for our patients and their parents.

Side 2 - Myopia Management in Practice, features practitioner-facing info for our clinical reference:
1️⃣ The Myopia Journey - risk factors for faster progression
2️⃣ What to Prescribe - a simplified flow chart based on our Clinical Decision Trees and available infographic on the website
3️⃣ Follow-up Schedules - a reference from the IMI Clinical Management Guidelines
4️⃣ Gauging Success - how to tell if your treatment is working in the long term, based on refraction and axial length.

1. The Myopia Journey 2. What to Prescribe 3. Follow-up Schedules 4. Gauging success

1. The Myopia Journey

This tile explains factors which lead to faster progression of childhood myopia. Firstly, earlier onset (before age 9) is likely to lead to faster progression and risk of high myopia. Additional factors which then 'fuel' the 'myopia car', in no particular order of effect, include a family history of myopia; less than 60-90 minutes a day spent outdoors; more than 2-3 hours a day, after school time, spent on nearwork; and specific binocular vision disorders. You can read more about these and review the scientific references in our blog Assessing Risk of Myopia Onset and Progression.

A full literature review article written by Kate Gifford in professional journal Contact Lens Spectrum also provides all of these references and more, entitled Preparing your Practice for the Myopia Stampede.

2. What to Prescribe

3. Follow-up Schedules

4. Gauging success

Once you've prescribed a treatment, how do you know it's working? How can you determine success based on refraction, and do you need to measure axial length? We can gauge success in comparison to the expected, average amount of progression seen in single vision corrected (ie. untreated) children in meta-analysis studies. You can read more in our blogs Gauging Success in Myopia Management; and Axial Length Measurement - a Clinical Necessity?

One sided version in Optometry Australia Pharma magazine, September 2019

Optometry Australia's quarterly professional journal Pharma has published a special Myopia feature issue for September 2019 - link to the full PDF is available HERE. In conjunction with OA, we have developed this infographic to sit alongside and complement the BHVI Myopia Management Guidelines. The infographic is available to all members of Optometry Australia - a hard copy has been posted to you with your copy of Pharma.

The BHVI Guidelines feature the standard eye exam for myopia, risk factors for onset and progression, a list of available treatments, and follow up schedules. We aimed to fill in the gaps in translation to clinical practice with our Myopia Management in Practice infographic, with the following four key principles. Descriptions of each section of our infographic, and references to further reading, are below.