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Clinical Practice Guidelines: Care of the Patient with Myopia

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Clinical Practice Guidelines: Care of the Patient with Myopia OPTOMETRY: OPTOMETRIC CLINICAL THE PRIMARY EYE CARE PROFESSION PRACTICE GUIDELINE Doctors of optometry are independent primary health care providers who examine, diagnose, treat, and manage diseases and disorders of the visual system, the eye, and associated structures as well as diagnose related systemic conditions. Optometrists provide more than two-thirds of the primary eye care services in the United States. They are more widely distributed geographically than other eye care providers and are readily accessible for the delivery of eye and vision care services. There are approximately 32,000 full-time equivalent doctors of optometry currently in practice in the United States. Optometrists practice in more than 7,000 communities across the United States, serving as the sole primary eye care provider in more than 4,300 communities. Care of the Patient with The mission of the profession of optometry is to fulfill the vision and eye Myopia care needs of the public through clinical care, research, and education, all of which enhance the quality of life. OPTOMETRIC CLINICAL PRACTICE GUIDELINE CARE OF THE PATIENT WITH MYOPIA Reference Guide for Clinicians Prepared by the American Optometric Association Consensus Panel on Care of the Patient with Myopia: 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. Reviewed by the AOA Clinical Guidelines Coordinating Committee: 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. NOTE: Clinicians should not rely on the Clinical Approved by the AOA Board of Trustees August 9, 1997 Guideline alone for patient care and management. Reviewed February 2001, Reviewed 2006 Refer to the listed references and other sources for a more detailed analysis and discussion of research and patient care information. The © American Optometric Association, 1997 information in the Guideline is current as of the 243 N. Lindbergh Blvd., St. Louis, MO 63141-7881 date of publication. It will be reviewed periodically and revised as needed. Printed in U.S.A. Myopia iii iv Myopia TABLE OF CONTENTS 2. Available Treatment Options......................................... 21 a. Optical Correction................................................... 21 INTRODUCTION ...........................................................................1 b. Medical (Pharmaceutical) ....................................... 22 c. Vision Therapy........................................................ 23 I. STATEMENT OF THE PROBLEM ................................................. 3 d. Orthokeratology ...................................................... 23 A. Description and Classification of Myopia............................... 3 e. Refractive Surgery .................................................. 24 1. Simple Myopia................................................................. 6 3. Management Strategy for Myopia Correction................ 26 2. Nocturnal Myopia............................................................ 6 a. Simple Myopia........................................................ 26 3. Pseudomyopia .................................................................. 7 b. Nocturnal Myopia................................................... 28 4. Degenerative Myopia....................................................... 7 c. Pseudomyopia......................................................... 28 5. Induced Myopia ............................................................... 7 d. Degenerative Myopia.............................................. 29 B. Epidemiology of Myopia.........................................................7 e. Induced Myopia ...................................................... 29 1. Prevalence and Incidence................................................. 7 4. Management Strategy for Control of Simple Myopia.... 31 2. Risk Factors......................................................................8 a. Plus at Near............................................................. 31 C. Clinical Background of Myopia ............................................ 10 b. Rigid Contact Lenses .............................................. 36 1. Natural History............................................................... 10 c. Vision Therapy and Visual Hygiene ....................... 37 a. Simple Myopia........................................................ 10 5. Patient Education........................................................... 37 b. Nocturnal Myopia................................................... 11 a. Simple Myopia........................................................ 37 c. Pseudomyopia......................................................... 11 b. Nocturnal Myopia................................................... 38 d. Degenerative Myopia.............................................. 12 c. Pseudomyopia......................................................... 38 e. Induced Myopia ...................................................... 12 d. Degenerative Myopia.............................................. 38 2. Common Signs, Symptoms, and Complications ............ 14 e. Induced Myopia ...................................................... 39 3. Early Detection and Prevention...................................... 16 6. Prognosis and Followup................................................. 39 II. CARE PROCESS .............................................................................. 17 CONCLUSION.............................................................................................. 41 A. Diagnosis of Myopia ............................................................. 17 1. Patient History................................................................ 17 III. REFERENCES ................................................................................ 42 a. Simple Myopia........................................................ 17 b. Nocturnal Myopia................................................... 18 IV. APPENDIX ........................................................................................ 65 c. Pseudomyopia......................................................... 18 d. Degenerative Myopia.............................................. 18 Figure 1: Optometric Management of the Patient with Myopia: A e. Induced Myopia ...................................................... 18 Brief Flowchart .............................................................. 65 2. Ocular Examination ....................................................... 19 Figure 2: Frequency and Composition of Evaluation and a. Visual Acuity .......................................................... 19 Management Visits for Myopia...................................... 66 b. Refraction................................................................ 19 Figure 3: ICD-9-CM Classification of Myopia ............................. 68 c. Ocular Motility, Binocular Vision, and Abbreviations of Commonly Used Terms ........................................... 69 Accommodation...................................................... 19 Glossary ...............................................................................................70 d. Ocular Health Assessment and Systemic Health Screening................................................................. 20 3. Supplemental Testing..................................................... 20 B. Management of Myopia ........................................................ 20 1. Basis for Treatment........................................................ 21 Introduction 1 INTRODUCTION Optometrists, through their clinical education, training, experience, and broad geographic distribution, have the means to provide effective primary eye and vision care for a significant portion of the American public and are often the first health care practitioners to diagnose patients with myopia. This Optometric Clinical Practice Guideline for the Care of the Patient with Myopia describes appropriate examination and treatment procedures for myopia and contains recommendations for diagnosis and management of myopia. This Guideline will assist optometrists in achieving the following goals: • Accurately diagnose the different types of myopia • Improve the quality of care rendered to patients with myopia • Inform and educate parents, patients, and other health care practitioners about the options of correction, control, or reduction of myopia • Decrease visual morbidity related to higher degrees of myopia. Introduction 3 4 Myopia I. STATEMENT OF THE PROBLEM distance visual acuity. Degenerative myopia, also called pathological myopia, is due to the development of structural defects in the posterior Myopia is the refractive anomaly of the eye in which the conjugate focus segment of the eye. Induced myopia may be viewed as a secondary of the retina is at some finite point in front of the eye, when the eye is not myopia that is pathologic in nature, i.e., some external agent or alteration accommodating. It can also be described as the refractive condition in of normal physiological function has induced the myopia, which is often which parallel light rays from an object at optical infinity are focused by temporary. (See Appendix Figure 3 for ICD-9-CM classification codes the eye in front of the retina, with accommodation relaxed. Myopia is for myopia.) derived from the term
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