Survey says: Doctors of optometry embrace myopia management

A new AOA survey of doctors of optometry presents a snapshot on managing myopia in practices across the country and found that the majority (69%) of those who responded were providing the service.

The survey, conducted this summer, was developed by the AOA’s Research & Information Committee (RIC). Among its other findings published in the AOA Health Policy Institute brief:

• 93% of doctors who provide myopia management are in metropolitan areas; 71% of those practice independently.
• 73% believe an annual progression of 0.5 to 0.75 diopters was warranted before initiating myopia management protocols.
• Refractive error was rated the most important risk factor in warranting myopia management.
• Food and Drug Administration (FDA)-approved soft (contact) lenses was the preferred treatment method.
• 33% of myopia management candidates defer treatment; 80% of these patients defer treatment due to costs.

“Myopia management is really a hot, hot topic right now, especially post COVID-19,” says Mamie Chan, O.D., AOA RIC chair. “With the world becoming more myopic, the topic is timely and it’s also somewhat of a new area. We’re still learning about it.

“There’s also a question of how much research is out there,” Dr. Chan adds. “So, we wanted to see a wide swath of what doctors of optometry are doing. As a private practitioner, I am sometimes in a bubble. I only see myself and my friends, so it’s good to get a snapshot of what other people are doing and how many people are doing it.”

Myopia crisis

According to the 2021 Clinical Report: Myopia Management produced by the AOA’s Evidence-based Optometry Committee, the prevalence of myopia jumped in the U.S. among people aged 12-54 from 25% in 1971-1972 to 41.6% between 1999-2004.

Further, prevalence worldwide is projected to be 50% by 2050. And in a study published in January 2021 in JAMA Ophthalmology, researchers conclude that home confinement due to COVID 19 appeared to have led to a “significant myopic shift for children aged 6 to 8 years.” Children’s vision has long been a focus for the AOA.

“Younger children’s refractive status may be more sensitive to environmental changes than older ages, given the younger children are in a critical period for the development of myopia,” the researchers write.

The new AOA survey’s purpose was to obtain “real-world data” on doctors’ experiences with myopia management. The survey received 464 qualified responses from doctors of optometry in 41 states and Washington, D.C.

Eye-opening results

The survey elicited a picture of doctors’ management of myopia.

For instance, 87% of doctors in the survey report discussing myopia management techniques with parents when the child was between 5 and 8 years of age. The average age was 5.5 years.

And when presented with a list of myopia management methods, doctors of optometry ranked FDA-approved soft (contact) lenses for myopia management as their preferred treatment method. Off-label, soft multifocal contact lenses ranked second as preferred followed by atropine therapy, according to the HPI paper. Some methods were combined. The report also notes it is anticipated that interventions used for myopia management will continue to evolve as additional methods gain FDA approval.

What’s next?

In the survey, doctors of optometry were also asked about where they found their information on myopia management. The top sources of information are continuing education (43%), individual reading/research of literature (35%) and optometry school (15%).

The various treatments noted by doctors in the survey may indicate an opportunity for the AOA to provide more guidance to doctors, Dr. Chan says. Doctors replied with at least seven different treatment methods in the survey.

Another result that presents an opportunity: 63% of doctors say they would like “additional education on the science of myopia management.” Respondents also say they would like more help developing strategies to engage patients on myopia management and control, and further, wanted advocacy for insurance to cover myopia management.

What will the AOA RIC do with the results: develop potential resources and strategies to support doctors in their clinical decision-making in myopia management.

“I think there is an opportunity for the AOA—for the Contact Lens & Cornea Section and the Education Center Committee—to capitalize on educating the apparently large group that is not practicing it because they don’t feel the research is there,” Dr. Chan says. “We need to get that research out to more people.”

Resources doctors can use

To support doctors of optometry and raise public awareness, the AOA provides numerous resources:

• Access the AOA member-exclusive AOA’s Children’s Vision Toolkit.
• View the AOA Emergency Children’s Vision Summit on the AOA EyeLearn Professional Development Hub.
• Review the Evidence-based Clinical Practice Guideline: Comprehensive Pediatric Eye and Vision Examination.