How consistent is compounded topical atropine from bottle-to-bottle? What clinical results could indicate variability? Read more in this clinical case where a miniscule change in concentration gave notably better clinical outcomes.
This meta-analysis of 5 studies of 1, 6 and 12 months duration found that slower axial growth is evident when using orthokeratology in conjunction with atropine as a combined therapy compared to orthokeratology alone. A slowing effect of 0.09mm was seen with the combined approach for up to a 12 month follow-up period. Longer data was not available for the meta-analysis.
This systematic review of 9 studies confirms that under-correction of myopia does not slow progression; rather, at least half of the studies have shown the myopia progression is accelerated. There was no benefit found in overcorrection, and the evidence for un-correction was equivocal. Clinically, this advocates for the full correction of myopia.
During the COVID-19 pandemic, governments imposed home confinement and school-based learning was the normal. Has this caused more myopia? In this clinical case, the unique environment of lockdown is explored in view of myopia management outcomes.
An 8-year-old child is essentially monocular, due to unilateral high myopia associated with coloboma. The normally sighted eye has low myopia. How should we best balance safety and proactive myopia control in such a case?
What amount of axial length growth be expected in myopes versus emmetropes, and how can you tell if your myopia control treatment is working? This important clinical reference provides all this information and more on axial growth in younger and older children, emmetropes and myopes, and even data on typical myopia stabilization.
In this case study of a teenager with around 15D of myopia and moderate astigmatism, discussion included ocular and systemic health, contact lens options and whether myopia control is necessary.
The Erasmus Medical Group in the Netherlands set out four steps in their myopia management protocol: providing visual environment advice, identifying high-risk myopes by axial length and treating them with atropine 0.5%, managing other myopes with optical treatments or lower-concentration atropine, and ceasing treatment in the late teens once axial length is stable. The described use of axial length percentile growth charts for diagnosis, choice of treatment, monitoring and cessation is a world-first.
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.
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.
