17 - myopia control

when do you introduce myopia control?

start discussion when diagnose (regardless of age)

gauge rxn to eye drops and touching lids to determine when to start

how to manage parent expectations of myopia control (i.e. the contacts not amount of control)?

1. discuss CL fittings require multiple visits

2. kid should be able to insert and remove CL themselves in office

what is 0.1 mm of axial length elongation equivalent to?

0.25 D

what did the BLINK study find?

only +2.50 D add was significantly different from single vision lenses → cause 0.46 D less myopia progression and 0.23 mm less axial elongation

what did the FDA approve daily disposable dual focus lens for?

1. correction of ametropia

2. slowing progression of myopia

what did the 3 year study show regarding daily disposable dual focus lens for myopia control?

0.73 D less myopia progression

0.32 mm less axial elongation

what are the parameters for FDA approval of dual focus lens for myopia control?

8-12 yrs old

SE of -0.75 to -4 D at initiation

≤0.75 D of astigmatism

how does orthokeratology work?

gas permeable lenses use reverse curve geometry to reshape/flatten corneal epithelium

depending on pupil size and optic zone peripheral defocus occurs

how long do you have to wear ortho Ks?

overnight → 8 hrs or more ideally

what is an ideal ortho K candidate?

-4 D of myopia

flat Ks of 42-45 D

low or WTR astig

what is a non ideal ortho K candidate?

more than 1.50 D of ATR astig

cyl power > sph power

Ks

how do you start ortho K fitting?

determine diagnostic lens from fitting set based on refraction and keratometry/topography

OR

order first lenses empirically using HVID, refraction and keratometry

how should the ortho K lens be positioned?

well centered with tx zone that is smaller than pupil with adequate edge lift

what is ATOM1?

compared 1% atropine to placebo

1% atropine had 0.79D less progression but too many SE

what is ATOM2?

explored 0.5%, 0.1% and 0.01% atropine

all concs were effective but 0.01% had least SE and rebound → rec 0.01% atropine

what is LAMP?

evaluated 0.05%, 0.025% and 0.01% atropine

found effect of low dose atropine is concentration dependent → 0.05% showed least progression

found younger the child → less effect the tx

what is the CHAMP study?

NVK002 0.01% and 0.02% was safe and well tolerated

0.01% was effective

does combining CL and low dose atropine work?

yes

how to choose between low dose atropine vs ortho k?

low dose atropine: any age, parents can control dose, wear additional correction

ortho K: