Myopia management guidance for practice teams

Case on managing myopic patients who attend with external prescriptions

Is it possible to offer myopia management to myopic patients who attend my practice using their external prescription for dispensing? 

Advice

Dr Paramdeep Bilkhu MCOptom, Clinical Adviser at The College of Optometrists, says: “Myopia management products are not simply an optical device or lens enhancement that can be dispensed. They are considered as a clinical intervention that should be planned as part of a longer-term course of treatment. There is insufficient information to consider offering myopia management based upon the prescription alone.

“It is important to remember that myopia management is designed to reduce myopia or prevent it from progressing. It requires professional judgement and oversight to determine suitability, appropriate informed consent to proceed, and establishing a management plan to collate relevant baseline data and monitor progression and treatment outcomes.

“Optometrists and dispensing opticians are best placed to work collaboratively when providing myopia management and ongoing monitoring.

“While the prescription provides information about the level of myopic refractive error and the patient’s age, there are other factors that influence decision making, and are not available from the prescription alone. These include ocular and family history, relevant lifestyle behaviours, age of onset and the rate of progression. The decision to recommend myopia management should be directed by an appropriately-qualified clinician who is able to utilise this information, alongside evidence-based risk stratification tools, if appropriate to determine the risk of myopia progression on a case-by-case basis.

“For this reason, when presented with an external prescription, it should not be assumed that a discussion on myopia management had not taken place. You must not make any unfounded or unnecessary claims that may make the patient doubt the knowledge or skills of your fellow optometrist colleagues or other health professionals. Patients have the right to take their prescriptions elsewhere. So, if a prescribing clinician feels myopia management is appropriate, then this should be noted on the patient record and prescription.

“Where practice staff involved in the dispensing journey believe a patient with an external prescription may benefit from myopia management, they should discuss this with a clinical colleague from the outset. Should they agree, and if the patient consents, then the clinician should make all reasonable efforts to contact the prescribing practice to discuss the relevant clinical findings to establish progression risk and make a treatment, including no treatment, recommendation. This step is particularly important where patients are currently undergoing treatment for other eye condition(s) and/or have been provided a hospital prescription. In this case, they should contact the hospital eye service for advice in the first instance to determine whether myopia management is appropriate at this stage.”

Further reading

• The College of Optometrists: Assessing and managing children with myopia
• The College of Optometrists: Childhood-onset myopia management: Guidance for optometrists
• The College of Optometrists: Consent
• The College of Optometrists: Working with colleagues  
• General Optical Council: Conduct appropriate assessments, examinations, treatments, and referrals
• General Optical Council: Work collaboratively with colleagues in the interests of patients