Selecting a contact lens for astigmatic myopia

A clinical case of high astigmatism with myopia was discussed, where the author STW faced a myopia managing dilemma for a patient whose myopia and astigmatism exceeded the parameters of the more common forms of myopia control with contact lenses.

Prescribing for the Progressing Myope with Astigmatism

Whilst each individual child has their own circumstances and situation to consider when prescribing myopia control, children with astigmatism present a unique set of challenges when selecting the best option for not only slowing down the progression of their axial growth, but also providing them with good vision.

Spectacle lenses for myopia control Part 2: Back ups and dispensing

There’s a little more to think about in the important role spectacle lenses play in myopia management. Even if we prescribe contact lenses, our young myopes are most likely to need a back up spectacle lens option. Children prescribed atropine will need the best spectacle lens prescribed for them to minimise the impact of any side effects.

Kids, contact lenses, dry eye and binocular vision

Only a minimal percentage of children are likely to suffer dry eye symptoms (4%) compared to 56% in adult contact lens wearers.(1) Teens may be more likely to report contact lens related dry eye than younger children,(2) and consideration should be given to any systemic medications which could exacerbate dry eye symptoms, such as acne medications and those taken for anxiety and depression.

What about the exophores?

While esophoria and myopia have a long-associated link,(1-3) exophoria must also be on our myopia management agenda. The punchline, up front – research has shown that of kids with intermittent exotropia, 50% are myopic by age 10 and 90% are myopic by age 20,(4) and we need to be extra wary if considering fitting a myopic child like this into contact lenses.

The esophoric myope and contact lenses

When it comes to contact lens corrections for young myopes, the impact of orthokeratology (OK) and multifocal soft contact lenses (MFSCL) on binocular vision is pertinent to visual comfort and understanding mechanisms of myopia progression and control.

Specs to contacts – what happens to BV?

Changing a myope from spectacle to contact lens wear can alter their binocular vision (BV) function. The myope reading through their spectacles experiences base-in prism at near, as demonstrated in the image above, which moves the image further away and decreases vergence demand.