Refraction challenges in children – what to prescribe?

Children can be tricky to refract. Here is a challenging refraction case discussed by colleagues – while not a case of a myope, it describes useful clinical principles for prescribing for children, especially children under 6 who require particular consideration to ensure normal visual development.

A myope or not? Pseudomyopia, antimetropia and more

Refraction can be challenging in children, and even more so in a complex presentation as for this case. Is this patient a myope or not? When dealing with a complex case of pseudomyopia, antimetropia and latent hyperopia, all in one patient – how should we manage the patient? The answer involves balancing goals to manage ametropia correction, binocular vision function and myopia control. 

Is rubbing orthokeratology lenses necessary?

When cleaning orthokeratology contact lenses, is rubbing necessary? Would rubbing the ortho k lens cause warpage or deformation over time? Read more to find out how colleagues responded and what the research tells us.

How much orthokeratology over-correction is ideal?

Orthokeratology is designed to achieve slight over-correction so the optical treatment will last all day. How much overcorrection is ideal to achieve good vision throughout the day while achieving good visual performance?

Managing a 5-year-old pre-myope

Pre-myopes can be readily identified, and best practice dictates that we should offer some form of intervention to help delay the onset of myopia. In this case we discuss the features of a pre-myope and an example in a 5 year old patient who satisfies the refractive criteria for pre-myopia, and has a strong family history of myopia.

Do you need to treat esophoria in an emmetropic patient?

Esophoria at near is a risk factor for myopia development and progression. Does it need to be managed in an emmetropic patient without symptoms? Is this patient a pre-myope, and how should this factor into management? Read this interesting clinical case, where colleagues discuss whether to intervene or not, and how to potentially manage both myopia risk and binocular vision.

Which soft multifocal contact lens to choose for astigmatism?

Soft multifocal contact lenses for myopia control can provide a great option for children with high myopia and astigmatism. In this case study we review what options are available, including toric and sphere-plus-other options, materials and replacement schedules.

Switching from atropine to MiSight – one or both treatments?

When atropine isn’t working as a monotherapy, is it valuable to combine it with a myopia controlling contact lens? Could switching from atropine to a contact lens be the better option? In this post on the Facebook discussion group, a colleague sought opinions on combining atropine and MiSight contact lenses.

A two-year-old with low myopia – to correct or not?

Would you prescribe glasses for a young child with mild myopia? Is myopia control beneficial for a toddler? This case discussion covers whether to treat or monitor, with the research evidence for prescribing as well as clinical considerations for co-management between primary eye care and ophthalmology.

How to manage the highly myopic toddler

A two-year-old with high myopia and astigmatism – the discussion included co-management, the best optical correction, and the lifelong management ahead. Read more on managing the highly myopic toddler.