Myopia in practice (MIP) study

Abstract

Purpose : To determine how optometrists in Ontario, Canada are managing myopic and pre-myopic pediatric patients over time.

Methods : This ongoing retrospective chart review included patients aged 6-10 with presenting refraction of ≤-0.50D (myopes) or ≤ +0.75D (pre-myopes) who had eye exams between 2017-2021 at optometry practices in Ontario. Up to five unique charts were selected for each age (6, 7, 8, 9, 10) and visit year (2017, 2018, 2019, 2020, 2021) for each group (myopes, pre-myopes), for up to 250 files per practice. Demographics, refraction and prescribed interventions including: no prescription recommended, single vision (SV) correction (SV glasses or contact lenses (CLs)), spectacle bifocals/progressives, myopia control (MC) treatment (ortho-K, atropine, MC glasses, MC CLs), and lifestyle change discussions were recorded. Two-tailed independent t-tests and one-way ANOVA were used to compare treatment rates across years.

Results : To date, 1,340 patient charts across 7 practices were analyzed. For myopes (n=516, 51% female), the most common initial management was SV correction in 2017 (73%) which persisted through 2021 (62%). Nevertheless, the prescribing of MC as an initial management increased from 2% to 20% over this time period. (Figure 1) Over the years, optometrists more frequently counsel patients about MC options for low-to-moderate myopia (mean±SD -2.69±1.41D in 2017 vs -1.97±1.12D in 2021, t₈₇=2.1, p=.037). However, the refractive error at which MC is implemented remains unchanged over time (-2.61±2.02 in 2018 vs -3.12±1.68 in 2022; t₃₀=0.71, p>0.05). Optometrists are most likely to implement MC between -2.00D to -2.99D (19%), and least likely for high myopia (0% at ≤-5.00D). For pre-myopes (n=824, 48% female), optometrists are more proactive at recommending lifestyle changes (2% in 2017 to 18% in 2021) (Figure 3) The refractive error at which lifestyle changes are recommended remains unchanged over the years (+0.20±0.15D; F_4,41=1.38, p>.05).

Conclusions : Although prescribing SV correction remains the predominant choice for initial management of myopia, optometrists are increasingly recommending MC and intervening earlier at lower levels of myopia. Dispite these discussions, MC is implemented only for low-to-moderate myopia during this study. Clinical evidence of MC efficacy for high myopia is necessary to promote MC awareness among optometrists. Optometrists are more proactive in recommending lifestyle changes to delay myopia onset for pre-myopes.

This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.