New Infographic developed for Optometry Australia
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.
1: Every dioptre increases risk
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.
2: Explaining efficacy
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: What to prescribe
We felt this was a very important addition to the translation to practice - not just a list of the available options, but some guidance in which to select. This flowchart is a summary taken from our Clinical Decision Trees, and are explained in more detail in the Which Option to Slow Myopia? Infographic, also available on this website.
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?