Selecting an option – decision trees

There is no one-size-fits-all with myopia management, so which option should you choose for your individual patient? Here we are going to get started with some clinical decision trees, then later we will get into the detail of each of our three main myopia control treatments – atropine, OrthoK (OK) and multifocal soft contact lenses (MFSCLs: a blanket term for a variety of different designs). Spectacle lens options will also feature. The overall goal here is to give you an understanding of each option, and if you’re lucky enough to have access to all of them, how to select the right treatment for your patient. Here’s our first question - knowing that contact lens options show the best efficacy of optical treatments means these should ideally be our first myopia management choice. This is because OrthoK and MFSCLs both correct ametropia and provide a research evident, consistent myopia control effect when compared to spectacles. So the initial decision tree might look like this:

Selecting an option 1

That’s the reasonable first decision, and there’s more information on selecting the spectacle lens type below in Q3. So if the answer is YES to Q1, and the child is suitable and willing to wear contact lenses, which should you select? The next decision tree looks something like this.

Selecting an option 2

The next level up in customising your treatment choice is then including binocular vision status. For Q3 we are now going to combine Q1 on contact lens suitability with information on binocular vision status. If you want to learn more about the relevance of binocular vision to myopia management, or want to expand your clinical skills in binocular vision, follow the relevant links. If you feel confident in binocular vision diagnosis and management, read on.

Selecting an option 3

Now we can see each of our options for the initial treatment choice, and how we may come to select them – OK, MFSCL, spectacles and low dose atropine. You’ll notice low dose atropine is missing from any of our first line contact lens wearer options, as it is reasonable to consider atropine, OK and MFSCLs as having similar efficacy. You may consider including atropine as a first line combination therapy with a contact lens option if we have a child at risk of faster progression, as there is early indication that combination treatment could increase efficacy.

You can read about why binocular vision matters in myopia management, and head to the Expand your Skills portal to learn more about binocular vision and myopia.

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About Kate

Dr Kate Gifford is a clinical optometrist, researcher, peer educator and professional leader from Brisbane, Australia, and a co-founder of Myopia Profile.