Myopia Management & Control Strategies.pptx
- 1. Myopia Control Strategies Riton Deb, B.Optom, MSc, Fellow(LVPEI) Consultant Optometrist Contact: riton.optom@gmail.com +88 01822920611
- 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.
- 9. When to start myopia control ? As a rule of thumb, we should begin discussing myopia control as an optio • If 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 with overstimulation of eye growth, thus instigating myopia progression. ・5 mm central zone ・Surrounded 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- Creates 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 Diopter to – 8.00 Diopter • 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 • Irregular corneas (keratoconus, corneal scar, PMD) -Corneal Dystrophies and degenerations • Nystagmus • Glaucoma • 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
- 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. THANK YOU