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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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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Progressive vs bifocal spectacles – which is best?

Podcast summary: Are progressive addition lenses and bifocals created equal for myopia control? How should we pick which lens type to prescribe, and what’s on the horizon for our non-contact lens wearing young myopes? Progressive addition lens (PAL) studies for myopia control show negligible results when single adds are applied to all children, however when applied to children with esophoria …

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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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Clinical Myopia Management (Lecture)

This one hour lecture, delivered to final year QUT optometry students in August 2017, covers the ‘why’ of myopia control; understanding the relative risks of doing something versus doing nothing; a brief literature review of mechanisms and options; putting it into practice and clinical resources available online. Since, then, my message on efficacy has been updated and simplified, but the …

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Vision with Pediatric Bifocal Contact Lens Wear

Center-distance soft multifocal contact lenses have been shown to slow the progression of myopia,1-5 but practitioners around the world are concerned about the vision produced by soft multifocal contact lens wear in children. Many doctors place soft multifocal contact lenses with center-distance design on children’s eyes and measure the vision. If the child can only read 20/30 to 20/40, the …

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