Guideline:
Care of the patient with myopia
Bibliographic Source(s)
- American Optometric Association. Care of the patient with myopia. St. Louis (MO): American Optometric Association; 1997. 75 p. (Optometric clinical practice guideline; no. 15). [231 references]
Guideline Status
This is the current release of the guideline.
According to the guideline developer this guideline has been reviewed on a biannual basis and is considered to be current. This review process involves updated literature searches of electronic databases and expert panel review of new evidence that has emerged since the original publication date.
Guideline Category
Diagnosis
Evaluation
Management
Intended Users
Health Plans
Optometrists
Guideline Objective(s)
- To accurately diagnose the different types of myopia
- To improve the quality of care rendered to patients with myopia
- To inform and educate parents patients and other health care practitioners about the options of correction control or reduction of myopia
- To decrease visual morbidity related to high degrees of myopia
Target Population
Patients of all ages with myopia
Interventions and Practices Considered
Diagnosis of Myopia
- Patient History
- Simple Myopia
- Nocturnal Myopia
- Pseudomyopia
- Degenerative Myopia
- Induced Myopia
- Ocular Examination
- Visual Acuity
- Refraction
- Ocular Motility Binocular Vision and Accommodation
- Ocular Health Assessment and Systemic Health Screening
- Supplemental Testing
Treatment
- Optical Correction
- Medical (Pharmaceutical)
- Vision Therapy
- Orthokeratology
- Refractive Surgery
Major Outcomes Considered
Not stated
Methods Used to Collect/Select Evidence
Hand-searches of Published Literature (Primary Sources)
Searches of Electronic Databases
Description of Methods used to Collect/Select the Evidence
The guideline developer performed literature searches using the National Library of Medicine's Medline database and the VisionNet database.
Number of Source Documents
Not stated
Methods Used to Assess the Quality and Strength of the Evidence
Expert Consensus (Committee)
Rating Scheme for the Strength of the Evidence
Not applicable
Methods Used to Analyze the Evidence
Review
Description of the Methods Used to Analyze the Evidence
Not applicable
Methods Used to Formulate the Recommendations
Not stated
Rating Scheme for the Strength of the Recommendations
Not applicable
Cost Analysis
A formal cost analysis was not performed and published cost analyses were not reviewed.
Method of Guideline Validation
Internal Peer Review
Description of Method of Guideline Validation
The Reference Guide for Clinicians was reviewed by the American Optometric Association (AOA) Clinical Guidelines Coordinating Committee and approved by the AOA Board of Trustees.
Major Recommendations
The major symptom of myopia (blurred distance vision) and the major sign (reduced unaided distance visual acuity) can generally be improved with appropriate minus power lenses.
The examination of patients who have any of the forms of myopia should include a comprehensive patient history measurement of refraction investigation of accommodation and vergence function and evaluation of ocular health. The patient should be advised about available treatment options and counseled regarding the need for follow-up care.
The frequency and composition of evaluation and management visits for myopia are summarized in the table below.
Frequency and Composition of Evaluation and Management Visits for Myopia
| Type of Patient | Number of Evaluation Visits | Treatment Options | Frequency of Follow-Up Visits | Composition of Follow-Up Evaluations | Management Plan | |||
| VA | REF | A/V | OH | |||||
| Simple myopia | 1 | Myopia correction: optical correction vision therapy | Children: annually Adults: every 2 yr or p.r.n. | Each visit
| Each visit | Each visit | Each visit | Prescribe refractive correction; provide or refer patient for vision therapy; patient education. |
| Possible myopia control: optical correction vision therapy | Every 6 mos | Each visit | Each visit | Each visit | Contact lenses: anterior segment each visit posterior segment annually Bifocals: annually | Prescribe refractive correction; provide or refer patient for vision therapy; recommend vision hygiene improvement; patient education | ||
| Myopia reduction: orthokeratology refractive surgery | Variable depending on method of myopia reduction | Each visit | Each visit | Annually | Anterior segment: each visit Posterior segment: annually | Provide or refer patient for orthokeratology; refer patient for refractive surgery; patient education. | ||
| Nocturnal myopia | 1 to 2 | Optical correction | 3 to 4 wk after dispensing of prescription then annually | Each visit | Annually or p.r.n. | Annually | Annually | Prescribe refractive correction for nighttime seeing; patient education. |
| Pseudo-myopia | 1 to 2 | Optical correction pharmaceutical vision therapy | Every 1 to 4 wk until accommodative excess is eliminated then annually | Each visit | Each visit | Annually or p.r.n. | Annually | Prescribe refractive correction; reduce accommodative response with vision therapy; prescribe cycloplegic agents to eliminate accommodative spasm; prevent pseudomyopia with plus lenses; patient education |
| Degenerative Myopia | 1 to 2 | Optical correction | Annually or more frequently depending on retinal an ocular changes | Each visit | Annually or p.r.n. | Annually or p.r.n. | Each visit | Prescribe refractive correction; provide or refer for appropriate treatment for retinal complications; patient education |
| Induced myopia | 1 to 2 | Variable depending on inducing agent or condition | Variable depending on inducing agent or condition | Each visit | Each visit | Variable depending on inducing agent or condition | Variable depending on inducing agent or condition | Identify inducing agent; prevent further exposure to causative agent; refer to appropriate practitioner for additional testing and treatment; patient education . |
VA = visual acuity testing
REF = refraction
A/V = accommodative vergence testing
OH = ocular health assessment
p.r.n. = as necessary
Clinical Algorithm(s)
An algorithm is provided for Optometric Management of the Patient with Myopia.
Type of Evidence supporting the Recommendations
The type of supporting evidence is not specifically stated for each recommendation.
Potential Benefits
Accurate optometric diagnosis and improved visual acuity for myopic patients
Potential Harms
Not stated
Qualifying Statements
Clinicians should not rely on this Clinical Guideline alone for patient care and management. Please refer to the references and other sources listed in the original guideline for a more detailed analysis and discussion of research and patient care information.
Description of Implementation Strategy
An implementation strategy was not provided.
Implementation Tools
Clinical Algorithm
Patient Resources
For information about availability see the "Availability of Companion Documents" and "Patient Resources" fields below.
IOM Care Need
Getting Better
IOM Domain
Effectiveness
Patient-centeredness
Bibliographic Source(s)
- American Optometric Association. Care of the patient with myopia. St. Louis (MO): American Optometric Association; 1997. 75 p. (Optometric clinical practice guideline; no. 15). [231 references]
Adaptation
Not applicable: The guideline was not adapted from another source.
Source(s) of Funding
Funding was provided by the Vision Service Plan (Rancho Cordova California) and its subsidiary Altair Eyewear (Rancho Cordova California)
Guideline Committee
American Optometric Association Consensus Panel on Care of the Patient with Myopia
Composition of Group that Authored the Guideline
Members: David A. Goss O.D. Ph.D. (Principal Author); Theodore P. Grosvenor O.D. Ph.D.; Jeffrey T. Keller O.D. M.P.H.; Wendy Marsh-Tootle O.D. M.S.; Thomas T. Norton Ph.D.; Karla Zadnik O.D. Ph.D.
AOA Clinical Guidelines Coordinating Committee Members: John F. Amos O.D. M.S. (Chair); Kerry L. Beebe O.D.; Jerry Cavallerano O.D. Ph.D.; John Lahr O.D.; Richard L. Wallingford Jr. O.D.
Financial Disclosures/Conflicts of Interest
Not stated
Guideline Status
This is the current release of the guideline.
According to the guideline developer this guideline has been reviewed on a biannual basis and is considered to be current. This review process involves updated literature searches of electronic databases and expert panel review of new evidence that has emerged since the original publication date.
Guideline Availability
Electronic copies: Available in Portable Document Format (PDF) from the American Optometric Association Web site.
Print copies: Available from the American Optometric Association 243 N. Lindbergh Blvd. St. Louis MO 63141-7881
Availability of Companion Documents
None available
Patient Resources
The following is available:
- Answers to your questions about nearsightedness. St. Louis MO: American Optometric Association. (Patient information pamphet).
Print copies: Available from the American Optometric Association 243 N. Lindbergh Blvd. St. Louis MO 63141-7881; Web site www.aoanet.org.
Please note: This patient information is intended to provide health professionals with information to share with their patients to help them better understand their health and their diagnosed disorders. By providing access to this patient information it is not the intention of NGC to provide specific medical advice for particular patients. Rather we urge patients and their representatives to review this material and then to consult with a licensed health professional for evaluation of treatment options suitable for them as well as for diagnosis and answers to their personal medical questions. This patient information has been derived and prepared from a guideline for health care professionals included on NGC by the authors or publishers of that original guideline. The patient information is not reviewed by NGC to establish whether or not it accurately reflects the original guideline's content.
NGC STATUS
This summary was completed by ECRI on December 1 1999. The information was verified by the guideline developer on January 31 2000.
COPYRIGHT STATEMENT
This NGC summary is based on the original guideline which is subject to the guideline developer's copyright restrictions as follows:
Copyright to the original guideline is owned by the American Optometric Association (AOA). NGC users are free to download a single copy for personal use. Reproduction without permission of the AOA is prohibited. Permissions requests should be directed to Jeffrey L. Weaver O.D. Director Clinical Care Group American Optometric Association 243 N. Lindbergh Blvd. St. Louis MO 63141; (314) 991-4100 ext. 244; fax (314) 991-4101; e-mail JLWeaver@AOA.org.
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