Children can be tricky to refract. Here is a challenging refraction case discussed by colleagues – while not a case of a myope, it describes useful clinical principles for prescribing for children, especially children under 6 who require particular consideration to ensure normal visual development.
Ensuring an accurate refraction is a hallmark of best practice myopia management. Yet refractions in children can present particular challenges. Which technique is most accurate, and when is cycloplegia necessary? Covering acuity measurement, retinoscopy, autorefraction and when and how to employ cycloplegia – here are some tips to achieve the best outcomes, especially for younger children where compliance and participation in testing can be more challenging.
There’s a common clinical belief that orthokeratology doesn’t work as well in lower myopes for myopia control. This is even sometimes included in conference presentations as prescribing advice. Is orthokeratology useful for control of low myopia? Here’s what’s fact and what’s fiction, when considering its efficacy for low vs high myopia, and orthokeratology vs multifocal contact lens myopia control.
Children are accessing screens at school, around the home and for personal entertainment at younger and younger ages. At the same time, there has been an unprecedented increase in myopia in children, with higher numbers and earlier age of onset. Read about what we do and don’t know about this link; the impact of screen time on binocular vision and dry eye in kids, and guidelines for advice to parents.
If our goal is to manage myopia, preventing its onset should be an even more valuable target. How can we consistently identify pre-myopes, explain the concern to parents, and how can we best manage them based on the evidence?
Half of children with high myopia have an underlying systemic condition: ophthalmology co-management, best optical corrections, parental education and eye health monitoring are crucial. It’s also important to offer myopia control strategies while also being aware of the limitations of the evidence base. This blog provides guidance on appropriate ocular health and optical management of children with more than 5-6D of myopia.
When atropine isn’t working as a monotherapy, is it valuable to combine it with a myopia controlling contact lens? Could switching from atropine to a contact lens be the better option? In this post on the Facebook discussion group, a colleague sought opinions on combining atropine and MiSight contact lenses.
Most myopia control intervention studies employing spectacles or atropine enrol from age 6, and most contact lens studies enrol from age 8. So how should we manage myopes younger than this? In this blog we’ll give you some guidance on managing myopes under age 6-7 with low and moderate myopia. Children in this age group with high myopia will require primary eye care as well as ophthalmology care. This important clinical reference includes information on first steps, when and how to prescribe for both myopia correction and control, when to refer or co-manage with ophthalmology, and communication with parents.
A two-year-old with high myopia and astigmatism – the discussion included co-management, the best optical correction, and the lifelong management ahead. Read more on managing the highly myopic toddler.
What do you do when your patient doesn’t respond to your orthokeratology (orthoK) treatment and things don’t add up? Here’s a case for you where an optometrist had to become a bit more investigative to determine the cause.
