MCAs
Multiple choice answers Myopia management and research resources By Alexandra Webster MSc, PGDipE, FBDO CL, FHEA, FBCLA CPD CODE: C-100263 Published in February 2022
Six of the following questions were presented online to entrants to comply with the General Optical Council’s best practice specifications for this type of CPD. Which of the following measurements has been shown to have the strongest correlation to myopia-associated pathology? a. Age at onset of myopia b. Cycloplegic refractive error c. Axial length d. Number of myopic parents (0-2) c is the correct answer. Myopia-associated pathologies, such as myopic maculopathy and retinal detachment, are caused by the lengthening of the eye, which is associated in practice with a myopic refraction but is actually measured using axial length. It is still rare to have the ability to measure axial length in practice, therefore it is more common to discuss ‘risk’ factors associated with levels of myopic refraction. There is now thought to be consistent evidence of a causal association between higher prevalence and degree of myopia with which of the following? a. Close working distances b. Time spent on tablet devices c. Living in urban environments d. Duration of education d is the correct answer. From reviewing the evidence currently available, the IMI (International Myopia Institute) has identified education and time spent outdoors as the key factors associated with the development and progression of myopia. Greater levels of time spent outdoors is a factor in decreasing risk whereas, intensity and duration of education are found to be factors increasing risk. Which of the following refractions could qualify as premyopia, given the IMI definition of premyopia? a. +0.50D b. +1.00D c. -0.75D d. -1.00D a is the correct answer. To ensure there is no miscalculation and unless no accommodation is assured, it is advised to conduct a cycloplegic refraction
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DISPENSING OPTICS J U N E 2 0 2 2
If a child is identified as having ‘pre-myopia’ according to the IMI 2021 Reports and Digest – Reflections on the Implications for Clinical Practice paper: a. they should be provided with a refractive spectacle correction b. they should be recalled in 12 months c. their parents should be informed and provided with or signposted to resources to aid their understanding d. they should be fitted with soft contact lenses designed for myopia management c is the correct answer. Wolffsohn et al (2021) suggest the evidence-based clinical approach to managing a patient with pre-myopia or low myopia (<-0.50D), is to provide advice on the need for regular examinations and inform the patient and their parents/carers about the circumstances, but that is not appropriate to provide a refraction. This is in the absence of any other refractive or binocular issue. Considering the patient case information provided in the article, which of the following statements is true? a. Part 1 of the PreMO risk calculator can be used to determine Scarlett’s risk of future myopia b. The PreMO risk calculator can be used as a stand-alone tool to support how to manage Dominic in practice c. There is not enough information provided to be able to use the PreMo risk calculator accurately d. Scarlett should be placed on a six-month recall as, according to Part 2 of the PreMo risk calculator she is at high risk of myopia progression c is the correct answer. Part 1 of the PreMo risk calculator could be used to better understand Dominic’s risk of becoming myopic, however, a cycloplegic examination is required and an estimation of axial length using the Estimate Axial Length tool would be required. The PreMO risk calculator Part 2 is used for children over the age of six who are already myopic. However, the calculator requires the practitioner to have conducted two successive cycloplegic examinations to confirm the spherical equivalent refraction. Although we are provided with Scarlett’s spectacle refraction over two examinations, there is no confirmation that a cycloplegic refraction was performed and a spherical equivalent has not been provided.
