Axial length measurement – a clinical necessity?

Most eye care practitioners don’t routinely measure axial length in clinical practice, mainly due to lack of access to the instrumentation and its expense. This is not the only reason, though, that axial length (AXL) measurement is a bit of a problematic measure for gauging myopia management success in a clinical setting. When I was leading the authorship of the …

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Eight Myopia Mysteries (plus eight more!)

This open-access continuing education article I authored was published in Australian professional journal Mivision in December 2018. It describes that while there’s a lot we know about myopia control – the imperative to reduce lifelong risk of vision impairment; that numerous options are available; and that the sooner we start the better – it is imperative for the clinician to …

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Atropine – wonder or weak treatment?

Atropine has been the apparent hero of myopia management since the 2006 publication of the ATOM (atropine for the treatment of childhood myopia) study, which showed an 80% refractive and 100% axial length myopia controlling effect with 1% atropine compared to placebo.1 The significant side effects of mydriasis and cycloplegia, though, made it less than tolerable as a first line …

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Contact lenses for kids – paediatric, parent and practitioner psychology

When selecting an optical treatment for myopia management, contact lens options appear to be the most consistent, with OrthoK and multifocal soft contact lenses offering around a 50% efficacy for controlling refractive and axial change in myopia.1 And it’s not just the important benefit of modifying lifelong risk of vision impairment through successful myopia control which should be top of …

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Contact lens safety in kids

There is no doubt that the best first choice for myopia control is a contact lens option, which both corrects ametropia and shows reliable myopia control efficacy. One of the key barriers to pediatric contact lens wear is concern about safety, however, for both practitioners and parents. Mark Bullimore1 recently published a meta-analysis of pediatric soft contact lens studies (SCL) …

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Four reasons why binocular vision matters in myopia management

Binocular vision is a much neglected (and even maligned?) domain of eye care where I’ve had numerous colleagues say their professional excitement and learning opportunities have been reinvigorated through seeing the clinical imperative and application in practice. Not only does binocular vision assessment add so much more to your clinical picture, and make optometric life more interesting, it could be …

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Selecting an option – Clinical Decision Trees

There is no one-size-fits-all with myopia management, so which option should you choose for your individual patient? Here we are going to get started with some clinical decision trees, then later we will get into the detail of each of our three main myopia control treatments – atropine, OrthoK (OK) and multifocal soft contact lenses (MFSCLs: a blanket term for …

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Three clinical pillars for myopia management

Once the myopia management message has been communicated to the parent and patient – information on expectations, efficacy and safety – and the initial correction has been selected, there are three key areas of clinical focus. Firstly, advice on visual environment is useful for both the child at risk of myopia development – those with a family history of myopia …

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Myopia management message part 2 – efficacy

Let’s cut to the chase – until further notice, you can consider low dose (0.05%) atropine, soft multifocal CL’s and OrthoK as all quite similar in terms of their myopia control efficacy, being around 50% on average. A network meta-analysis of sixteen different interventions studied for myopia control showed these options to all have similar efficacy when their refractive and …

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Myopia management message part 1 – expectations

We have a convincing evidence base for several optical, one pharmacological and visual environment solutions to reduce the progression of childhood myopia, but nothing guarantees 100% efficacy. Because of this, even in when under a successful myopia management strategy, a child’s myopia may still progress. It is important to manage parental and patient expectations about myopia management – that we …

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