We all know that high myopia is associated with higher incidences of retinal detachment, glaucoma and myopic maculopathy1. Instigating early, evidence based myopia control in rapidly progressing myopes gives the best outcomes both pathophysiologically and refractively. However when faced with a low, slower progressing myope, or a patient whom has already progressed is there any point in persisting with myopia control?
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.
Are progressive addition lenses and bifocals created equal for myopia control? When do they work and when do spectacles have minimal efficacy? How should we pick which lens type to prescribe, and what’s on the horizon for our non-contact lens wearing young myopes?
This article provides insights into identifying the pre-myope, identifying the myopia progressor & effective management strategies.
In May 2019 the professional journal Contact Lens Spectrum published my bi-annual ‘Refractive Focus’ column, entitled ‘An Ode to my Retinoscope’.
The landmark International Myopia Institute (IMI) White paper reports were published on 28 February 2019. As lead author on the Clinical Management Guidelines paper, I was thrilled to see the work of my 13 co-authors and I shared with a keen clinician audience worldwide.
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.
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.
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.
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.
