Management workflow
The number that matters is not today’s refraction.
It is the rate of change, and what you do about it. OptoGuide™ structures the myopia consultation so the options, their uncertainty, and what each asks of the family are in front of you while the child is still in the chair.
Structured for Australian optometry practice. Source-cited clinical reference; not individually clinician-reviewed.
Clinical decision support only
Red flags: assess urgently before anything else
Myopia management is squarely optometrist-led; these are the features that make a routine progression review something else first. Retinal symptoms in a myope are assessed as retinal symptoms.
- New flashes, a shower of floaters, or a shadow in the field — a myopic eye carries a higher retinal detachment risk, and this is a same-day retinal assessment.
- A sudden myopic shift in an adult — raises concern for cataract, hyperglycaemia, or a medication effect rather than a change in axial length.
- Unilateral or markedly asymmetric myopia in a child — assess for amblyopia and for a structural cause.
- Best-corrected acuity that the refraction does not explain.
- Myopia in a very young child, or progression continuing despite an adequate plan — the earlier the onset, the longer the eye has to grow.
One connected workflow, not separate lookups
Recognition, management, prescribing, and referral usually live in different tools. In OptoGuide™ they are one path, and each step hands off to the next so the decision keeps moving.
Step 1
Establish the trajectory, not just the refraction
Myopia management is a decision about rate of change, so the previous refraction does more work than today’s. The consultation starts by assembling what the eye has already done.
- Age at onset, earlier refractions and parental myopia shape the risk more than the current prescription does.
- Cycloplegic refraction in children: a manifest result can overstate myopia and send the plan in the wrong direction.
- Axial length, where the practice has it, is a measure that does not fluctuate with accommodation.
- Ask about time outdoors and near-work habits, and record what was actually asked rather than letting an unasked question read as a normal answer.
Step 2
Build the plan against what is actually available here
The module ranks the interventions available in Australia by the strength of their evidence and shows each one’s uncertainty rather than a single headline figure. Effect sits beside what the option asks of the family.
- Options are compared on wear time, handling, review burden and cost as well as on effect — the plan a family will follow beats the one that models best.
- The ranking is brand-neutral by construction: products are examples, and inclusion cannot be bought or reordered by sponsorship.
- Lifestyle advice stays scope-honest, separating what the evidence supports for onset from what it does not establish for progression.
- Prescribing detail for atropine lives in Therapeutics and is opened from the plan rather than restated inside it.
Step 3
Set the expectation before the next visit
A projection the parents can see changes the conversation more than a number written into the record. The workflow puts the expected course, with its uncertainty, on the screen between you.
- Agree what a working plan looks like before the next review, so an ordinary amount of progression is not read as failure.
- The projection is illustrative: a model of the likely course, not a prediction for this child.
- Escalate on a red flag, or where progression continues despite an adequate plan and adequate wear.
Clinical basis
This guidance reflects standard optometric clinical reasoning based on:
- Australian optometry clinical practice patterns
- Australian medicines regulation and PBS prescribing context
- Common ophthalmology referral standards
- Evidence-based clinical training and practice
Put the myopia plan in front of the family at the point of care.
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