Myopia control in the community (optical interventions, biometry, protocol)
Authors: Evans Bruce J. W. 
Published: January 2025

In many countries, >50% of university students are myopic, with prevalence rising. Increasing myopia is associated with higher risks of eye disease. Myopia control is necessary because, for example, slowing myopia progression by 1D should reduce the likelihood of a patient developing myopic maculopathy by 40%. Several approaches are available that have slowed progression by ~50% in randomised control trials. In order of decreasing safety/increasing risk of complications, these are spectacle lenses that provide peripheral plus power, contrast reducing spectacle lenses, soft contact lenses providing peripheral plus power, ortho‐keratology, low dose atropine, and repeated low‐level red light therapy (RLRL). Recently, it has been argued that RLRL may not meet safety standards and this will not be considered further.

With approximately half of older children/adolescents becoming eligible for myopia control, in most countries it is not feasible for all cases to be managed in hospital ophthalmology units. Increasingly, myopia control is being undertaken in community optical practices and this talk will address best practice, and advantages and disadvantages of this myopia control being undertaken in a community setting.

Key considerations are whether community optical practices can provide the breadth of interventions required, and have appropriate skills and equipment. Concerning the breadth of interventions, most clinicians in community optical practices are optometrists and only in a few countries are optometrists able to prescribe therapeutic pharmacological agents. All the optical interventions listed above are potentially available to optometrists. Whether atropine is appropriate depends on the age, clinical characteristics (e.g., rate of progression, axial length, family history), and patient/carer preferences. Optometrists must follow appropriate referral guidelines and make patients aware of alternative approaches to those that they can provide.

Concerning the skills required, practitioners should follow recent International Myopia Institute (IMI) guidelines, referring young children with risk factors for syndromic myopia. These require a full history and eye examination, including ophthalmoscopy. Several biometers have been developed for use in myopia control and are increasingly found in optical practices. The evolving debate on the necessity of axial length measurements and/or cycloplegic refraction in myopia control will be considered, noting the 2023 IMI myopia management algorithms.

The importance of clinical presentation is emphasised. For example, a child who develops mild myopia at age 12‐14y is likely to be suitable for optical myopia control. If the optometrist has been monitoring for some years reducing hypermetropia progressing to slowly developing myopia then it is questionable whether cycloplegic refraction is required. In contrast, a 5‐7 year‐old who at the first eye examination has moderate myopia requires cycloplegic refraction to exclude pseudo‐myopia.

It is concluded that as myopia control is changing from specialist to routine eye care, it must become an essential message for dissemination by all eye care practitioners. As with other commonplace ocular conditions, straightforward cases are likely to be increasingly managed in the community and more complicated cases in secondary care. The lack of state funding, cost of interventions and therefore accessibility will be considered.