Myopia Management & Control Strategies.pptx

Myopia is becoming epidemic burden globally. Different strategies are mentioned in this presentation to combat Myopia.

1. Myopia Control Strategies Riton Deb, B.Optom, MSc, Fellow(LVPEI) Consultant Optometrist Contact: r [email protected] [phone]

2. Disclaimer No financial disclosure Company or brand names mentioned in this presentation is only for information purpose

3. Introduction Myopia, or nearsightedness is a common eye condition that causes distant objects to appear blurry while close-up objects remain clear. American Academy of Ophthalmology(AAO): Low: < 3.00 D Moderate : 3.00-6.00 Ds High: > 6.00 DS

4. PREVALENCE According to recent studies, myopia is becoming increasingly prevalent in the population, particularly among children and young adult. 5 billion people- Myopia- (50% of total population) and 1 billion people – High Myopia (10% of total population) by 2050. Holden BA, Fricke TR, Wilson DA et al. Global prevalance of myopia and high myopia and temporal trends from 2000 through 2050. Ophthalmology. 2016 ; 123 (5):1036-1042

5. Risk factor for severe eye disorders Permanent vision loss if left untreated Adopted from Flitcroft DI, The complex interactions of retinal optical and environmental factors in myopia aetiology. Prog Retin Eye Res. 2012.

6. Myopia Management

7. Myopia Management

8. Myopia Control- Concept

9. When to start myopia control ? As a rule of thumb, we should begin discussing myopia control as an optio I f the patient’s progression is >0.50 D a year Early onset- Early treatment, especially if parents highly myopic. dopted from K Zadnik , The Collaborative Longitudinal Evaluation of Ethnicity and Refractive Error  (CLEERE)  Study, 2015.

10. Clinical Examination- SOP by IMI History taking  Visual Acuity Refraction (Cycloplegic) Binocular vision assessment Pupillary examination- photopic & mesopic condition Ocular health assessment- SLE / IOP measurement Fundus evaluation Corneal topography A-scan (Axial length measurement)

11. Exclude from Myopia control strategy Congenital Myopia Pathological Myopia Degenerative Myopia Positional Myopia Index Myopia Corneal irregularity Accommodative spasm Myopia associated with any other eye diseases

12. Myopia Control with optical tech. Traditional Spectacles Next Generation Spectacles Multifocal / multifocal-like Soft Contact Lenses EDOF Contact Lenses Orthokeratology

13. Traditional Spectacles Different types available D Bifocal/ Executive Bifocal Progressive addition lenses (PALs) Addition of +2.00 D with distant correction This can help to reduce the strain on the eyes when focusing on nearby objects, thereby decreases progression of Myopia.

14. Next Generation Spectacles Also Called Peripheral defocus lenses A type of spectacle lens design to reduce the progression of Myopia in Children. These lenses work by creating myopic defocus on the retinal periphery. DIMS, HALT, CARE & DOT

15. D.I.M.S Technology Defocus Incorporated Multiple Segments •Consists of central zone (9 mm diameter) • Honey-comb like multiple segments of lenslets with + 3.50D adds • Almost 400 multiple defocus segments (33 mm diameter) • Miyosmart from Hoya. Power : Upto -10.00D, Cyl -4.00 D and 3△ Slow down the progression of myopia by on average of 60%

16. H.A.L.T Technology Highly Aspherical Lenslets Target 11 rings of 1021 contiguous(touching) aspherical lenslets (1.12 mm in dia) generate a Volume of Myopic Defocus (VoMD ) Central clear zone of 9 mm Central area of the lens without lenslets and the areas in between the rings of lenslets provides distance correction. Stellest from Essilor, Power:upto -10.00 D, Cyl-4.00D, 2 △ Myopia control efficacy 60%

17. C.A.R.E Technology Cylindrical Annular Refractive Elements A central zone small enough to establish an effective functional zone projecting myopic defocus on the near periphery close to the fovea . Zeiss Myocare and Myocare S Efficacy 86% for children aged 10-12 years and 63% for children aged 7-9 years

18. D.O.T Technology Diffusion Optics Technology CONTRAST THEORY FOR MYOPIA: Overstimulation of the retina from high contrast is associated w ith overstimulation of eye growth, thus i nstigating myopia progression. ・5 mm central zone ・ S urrounded by thousand of microdots. ・ SightGlass vision from cooper vision ・ DOT lens slightly reduces retinal contrast by scattering light- slow the myopia progression by 59%

19. Options for Myopia Control with CL Multifocal soft contact lenses (MFSCLs) Specially designed soft contact lenses for myopia control

20. MFSCLs Soft contact lenses are increasingly used as a myopia management option There is solid scientific evidence of successful myopia control with centre distance multifocal contact lenses Addition power ranging from +1.50 to + 2.50D (Majority + 2.00D) Advised for children 8 years and older A daily disposable modality is recommended Power available up to -12.00D Misight 1 day - multifocal like contact lens( –6.00D)

21. EDOF Contact Lenses Extended depth of focus multifocal lens design that has centre distance optics with add power placed immediately next to the central distance zone. This creates a blurr zone at the peripheral retina Greater stereopsis and enhanced depth perception can be achieved with the lens. Seed 1 day pure EDOF (Daily disposable) Power range: up to -12.00D Add: + 0.75D, +1.50D,+2.25D

22. Orthokeratology Ortho – straight; Kerato – cornea; logy – knowledge. AAO : Orthokeratology is the use of specially designed and fitted contact lenses to temporarily reshape the cornea to improve vision.

23. Ortho-K, OK George Jessen in 1960 first attempted to deliberately change refractive myopic error with rigid PMMA contact lens using a technique he named ‘orthofocus’. Ortho-k is FDA approved for overnight wear and indicated for the correction of myopia and astigmatism in patients of all ages. Corneal Refracive Therapy (CRT) Vision Shaping Treatment (VST) Breath-o-correct -All are made from high DK materials

24. Ortho-K Design Reverse geometry gas permeable lens Flatten central cornea to correct for Myopia Mid-peripheral steepening- C reates peripheral myopic defocus Alignment curve- stability of lens Peripheral curve-Edge lift

25. How it works 1 D reduction= 4-6 micron flattening

26. Indications Eyes with a clear cornea that have no history of surgery (No irregular cornea) Myopia from -1.00 D iopter to – 8.00 D iopter With-the-rule astigmatisms of up to -1.75 D and against-the-rule astigmatisms of up to- 0.75D Age from 6 years and above. Highly motivatted patients Can afford cost Anyone who wants to be free of spectacles and contact lenses during the day and falls on the specified correction power. Multifocal Soft contact lens failures Occupational Applications:         • Airline Pilots         • Military         • Firemen/Police         • Bus /Truck Drivers

27. Contraindications Irregul ar corneas ( keratoconus, corneal scar, PMD) -Corneal Dystrophies and degenerations N ystagmus G laucoma Ocular inflammation and infection High Myopia > – 8.00D, Astigmatism > 1.75 D Large Pupils > 6.00 mm Severe allergic conjunctivitis Severe dry eye disease Sleep deprived patients Any previous ocular refractive surgery

28. Baseline Data Patient’s history Visual acuity and Refraction (Cycloplegic) Binocular vision evaluation Slit lamp examination Measurement of corneal HVID Pupil size measurement Baseline corneal topography Baseline A-scan Discussion of patient motivation and expectation

29. Fitting Philosophy Trial lens selection: FT- Fitting Curve (alignment curve) T.P- Target Power B.C- Base Curve P- Power S- Size/ Diameter FT =Average K reading TP= Spectacle power (Spherical+Cylinder) BC= TP- Jessen factor/compression factor (+0.75) (42.50-4.25)=38.25 → 337.5/38.25= 8.82

30. IDEAL FIT To achieve Bull’s eye pattern

31. FLAT FIT Smiley face Superior decentration

32. STEEP FIT Frowney face Inferior decentratiom

33. Fitting Philosophy

34. Myopia Control Studies Summary (reduction in axial elongation)

35. Online software for prediction Brien Holden Vision Institute (BHVI) Myopia Calculator https:// bhvi.org /myopia-calculator-resources/

36. T H A N K Y O U