CPD MCAs – C-100263

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 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.

Which three possible risk factors for developing myopia are identified in the patient information provided for Dominic? a. Two myopic parents, being more minus than +0.75DS at age six and little time spent outdoors b. One myopic parent, having East-Asian ethnicity and being more minus than +0.75DS at age six c. One myopic parent, having East-Asian ethnicity and spending little time outdoors d. Having East-Asian ethnicity, being more minus than +0.75DS at age six and not having an eye examination previously. b is the correct answer. Dominic has one parent with myopia, he has East Asian ethnicity on his mother’s side and he is more minus that +0.75DS at age six, which has been identified as ideal in the emmetropisation process that takes place in childhood. From the information provided, we know Dominic spends some time outdoors playing football and with his Beavers troop.

The evidence that is found in the NICER study is particularly relevant to some optical practices in the UK because: a. it is the latest study to be conducted about myopia and children b. there was a broad range of ethnicities amongst the participants c. the study participants are from a UK-based population d. the study involved more participants than any other conducted about myopia and children c is the correct answer. The NICER study involved children from primary and secondary schools in Northern Ireland and was the first of its kind to monitor growth patterns of the eye from childhood to adulthood in a UKbased population. Much research about childhood myopia has been conducted in countries in the Far East, where the general ethnicity mix of the population is different from that found in the UK and many European countries. Therefore, research that has involved a population ethnicity similar to that which may be found in UK practice may be more relevant. It should be noted the NICER study participants were exclusively white and this should be considered in relation to the population base of individual practices in the UK.

Reviewing academic research supports everyday clinical practice and patient care

Myopia is a concern as it is associated, particularly later in life, with damage to which ocular structures? a. Crystalline lens, cornea and chorioretina b. Crystalline lens, optic nerve and chorioretina c. Iris, optic nerve and chorioretina d. Cornea, iris and optic nerve b is the correct answer. Myopia and an increase in axial length is associated with myopic pathologies, which although more common with higher levels of myopia, can occur with low levels of myopia. Ocular structures that can be damaged both directly and indirectly are the crystalline lens, the chorioretina and the optic nerve.

Findings from the NICER study have shown that the number of children who are short-sighted in Northern Ireland has: a. remained consistent over the last 50 years b. doubled over the last 50 years c. doubled over the last 15 years d. decreased over the last five years b is the correct answer. One of the key findings from the NICER study is that the number of children who are short-sighted in the Northern Ireland has doubled over the last 50 years. They also found children in Northern Ireland are becoming short-sighted at a younger age than was previously thought, and this is most likely to occur during the primary school years.

Eyecare professionals should be fully knowledgeable about the products they recommend