Kate Gifford 
Once the myopia management message has been communicated to the parent and patient – information on expectations, efficacy and safety – and the initial correction has been selected, there are three key areas of clinical focus.
Considering even emmetropic eyes elongate, what are the limits of myopia control efficacy? This novel analysis explores the absolute axial elongation of treated and untreated myopes in the MiSight 3-year clinical trial in comparison to previously published models of myopic and emmetropic eye growth. The results indicate a potential limit to the short-term percentage efficacy of myopia control treatments.
What can you expert in short-term fitting, vision, handling and comfort outcomes in children through to long term outcomes in myopia control, vision and ocular health? This article provides the scientific and clinical basis to get started and continue successfully fitting MiSight 1 day for myopic children.
When setting myopia control expectations both at outset and follow up, it is important to compare the child’s observed myopia progression to ‘average’, and to then judge the expected outcomes of treatment. Bringing their lifestyle, motivations and abilities into consideration is also important. Here we explore how to use resources in practice to set expectations and gauge success along the way.
Contact lenses offer numerous functional, psychological and myopia controlling benefits for children. What should you do if a parent or patient says no to contact lenses for their child, and you consider it an ideal option? How can you approach communication to convey the safety and benefits?
Should we change myopia control strategy when there is myopia progression? Before making the decision, it’s important to evaluate the evidence base in judging treatment success, and considering the best course of management based on both myopia correction as well as myopia control.
Previous multi-ethnicity studies have shown ‘normal’ axial elongation in emmetropic children to be around 0.1mm / year. In this study, 700 Chinese schoolchildren with stable emmetropia showed 0.2mm per year axial elongation from age 7-11, which reduced with age and ceased at age 15. This appears higher than measured in Singaporean Chinese children in the SCORM study, 20 years ago.
Total spherical-like higher-order aberrations (HOA) increased by more than double in the distance-centred +2.50 Add compared to +1.50 Add, with total coma-like HOA increasing further. Since orthokeratology studies have reported an association between more change in HOAs and better myopia control efficacy, this could indicate a mechanism of action in multifocal contact lens myopia control.
Young adults wearing the spectacle-mounted Clouclip device to measure viewing behaviour and light exposure also kept an activity diary. Mean daily near work and outdoor time were subjectively reported at about 150% of the objectively measured hours. This indicates the value of objective measures in research, as well as for clinical education and behaviour modification tools in future.
A sample of slow and fast progressors in prior 24 month orthokeratology clinical trials were found to have the same baseline refraction and axial length. The slow progressors were older, and showed 0.5mm smaller treatment zone diameters (TZDs), but no difference in induced peripheral myopic shift. There was also no direct correlation between TZD and axial elongation, indicating an intriguing but not yet defined relationship.
