Eyecare practitioner perspectives and attitudes towards myopia management in the UK.

Hi all, let me introduce myself, I’m Dr. Neema Ghorbani-Mojarrad a lecturer at the University of Bradfor and a locum optometrist, with a keen interest in myopia management. I recently had the pleasure and honour of being invited to join the Myopia Focus Advisory Committee, joining an esteemed list of myopia experts, who, like me, care deeply about tackling the myopia epidemic.

In my first contribution I wanted to talk about a recently published journal article I worked on with six colleagues from the University of Bradford, primarily talking about the work written and completed by my PhD student, Sophie Coverdale, who is also an Optometrist with an interest in myopia, as part of her research work. This study explores the perceptions, attitudes, and experiences of UK eyecare practitioners regarding myopia management [1]. The aim of the study was to identify barriers that may hinder the implementation and adoption of myopia management in clinical practice, especially for children with progressive myopia.

Despite the global increase in myopia management prescriptions, a gap persists in understanding the factors limiting these rates, especially considering the variances in eyecare delivery models, training, and regulatory guidance across different nations.

As you're likely aware, myopia is escalating globally, including in the United Kingdom. The incidence of myopia is rising among both children and adults. Notably, the percentage of children under 17 years in the UK requiring myopic prescriptions increased from 24% in 2009 to 32% in 2016–2017, indicating a greater proportion of myopic children, with children appearing to become myopic at younger ages [2].

To combat this trend, a variety of myopia management interventions have been introduced, offering strategies to slow the progression of myopia. These interventions encompass optical solutions like specialised contact lenses and spectacles, as well as non-optical treatments such as atropine and now low-level red light therapy, prescribed by ECPs. Despite the global increase in myopia management prescriptions, a gap persists in understanding the factors limiting these rates, especially considering the variances in eyecare delivery models, training, and regulatory guidance across different nations.

The scarcity of peer-reviewed research on UK practitioners' perspectives towards myopia management is alarming. With the rising rates of myopia and the growing demand for effective management strategies, further research is urgently needed. The distinct challenges and viewpoints within the UK eyecare community demand a more profound understanding of ECPs' adoption of myopia management interventions. This gap motivated our study, highlighting its significance in illuminating the current stance of UK eyecare professionals amid the rapidly changing myopia management landscape.

Our research chose focus groups over surveys to gain deeper insights. Although surveys are efficient and cost-effective, they come with inherent limitations [3]. Through focus groups, we aimed to provide a platform for participants to discuss their views, feelings, and experiences more thoroughly [4]. Conducted online, these focus groups included 41 eyecare practitioners from both primary and secondary eyecare sectors in the UK.

UK ECPs are increasingly aware of the growing prevalence of myopia. Although currently viewed as a lesser concern compared to East Asia, the anticipation is that it will become a significant challenge, particularly with potential implications for the National Health Service (NHS). ECPs expressed concerns about the quality and possible bias in available educational materials on myopia management, underscoring the need for practical training within degree programmes. They also highlighted the challenges in keeping abreast of advancements in the field, citing issues such as confidence in managing progressive myopia and scepticism about the effectiveness of available treatments. This points to a need for robust evidence from UK-based studies.

Communicating the risk of myopia-associated pathology with parents poses challenges for several UK ECPs, who worry about causing undue concern, especially for those unable to afford myopia management.

Time constraints in busy clinics further complicate comprehensive discussions.

Time constraints in busy clinics further complicate comprehensive discussions. Some ECPs occasionally skip myopia management discussions based on perceived parental disengagement or financial constraints. The absence of NHS funding for myopia management within the General Ophthalmic Services (GOS) system is a significant concern. Successful myopia management implementation often occurs only when all patient-facing staff can communicate effectively and create a harmonious and unified approach about myopia.

UK ECPs encounter obstacles related to clinical decision-making and duty of care in myopia management. A lack of consensus exists among ECPs on identifying suitable candidates for myopia management and determining when to cease treatment. Awareness of available guidance, such as from the International Myopia Institute (IMI) or professional bodies like the College of Optometrists and the Association of British Dispensing Opticians (ABDO), varies, with some ECPs deeming existing guidance outdated and questioning its relevance in the rapidly evolving field of myopia management.

ECPs also expressed concerns about potential negligence claims if patients are not informed about or offered myopia management, highlighting a conflict between duty of care and the risk of losing business for the practice.

UK ECPs face challenges related to public awareness and attitudes towards eyecare, particularly concerning myopia management. The perception of optometric practices primarily as retail entities diminishes the credibility of optometry as a healthcare profession in the public's eyes. ECPs emphasised the need for public education on the importance of eye health, early eye examinations, and specifically myopia.

Additionally, ECPs express concerns about the incompatibility of myopia management with current eyecare business models. The lack of relevant equipment in practices, the perceived reluctance of some practice owners to view myopia management as lucrative, and compatibility issues with the GOS system further compound these challenges.

Additionally, ECPs express concerns about the incompatibility of myopia management with current eyecare business models.

In conclusion, our study outlines the myriad barriers faced by primary and secondary eyecare practitioners in the UK in providing myopia management to their patients. There is inconsistency in the implementation of myopia management practices across the country. To improve accessibility, changes are needed at various levels, from individual eyecare practitioners to broader stakeholders in the UK's eyecare services provision.

Access the journal article here.