This document discusses myopia control strategies. It summarizes research showing that increased time spent outdoors is protective against myopia while near work promotes progression. Optical interventions like atropine drops, multifocal lenses, and orthokeratology have been shown to slow axial elongation by up to 50%, but have side effects. The ATOM studies found that low-dose atropine 0.01% effectively reduced myopia progression with minimal side effects and rebound. Controlling environmental factors and further developing interventions may help manage the growing public health challenge of myopia.
Accommodation/ Accommodation of Eye, Measurement of Accommodation of Eye (hea...Bikash Sapkota
CLICK HERE TO DOWNLOAD FULL PPT ❤❤ https://healthkura.com/measurement-of-accommodation-of-eye/ ❤❤
Dear viewers Check Out my other piece of works at ❤❤❤ https://healthkura.com ❤❤❤
Measurement of Accommodation of eye:
Amplitude, Facility,
Relative Accommodation, Fatigue, Lag,
Dynamic Retinoscopy
Presentation Layout:
-Introduction to accommodation of eye
-Mechanism
-Components
-Measurement of accommodation of eye
- Amplitude
- Facility
- Relative accommodation
- Lag
-Dynamic Retinoscopy
Accommodation
-dioptric adjustment of the crystalline lens of the eye
- to obtain clear vision for a given target of regard
-process by which the refractive power of eye is altered
- to ensure a clear retinal image
For further reading
-Clinical Procedures in Optometry by J.D. Bartlett, J.B. Eskridge, J.F. Amos
-Primary Care Optometry by Theodere Grosvenor
-Borish’s Clinical Refraction by W.J. Benjamin
-Clinical Procedures for Ocular examination by Carlson et al
-American Academy of Ophthalmology
-Optometric Clinical Practice Guideline by American Optometric Association
-Internet
Follow me to get in touch with optometric and ophthalmic updates
Accommodation/ Accommodation of Eye, Measurement of Accommodation of Eye (hea...Bikash Sapkota
CLICK HERE TO DOWNLOAD FULL PPT ❤❤ https://healthkura.com/measurement-of-accommodation-of-eye/ ❤❤
Dear viewers Check Out my other piece of works at ❤❤❤ https://healthkura.com ❤❤❤
Measurement of Accommodation of eye:
Amplitude, Facility,
Relative Accommodation, Fatigue, Lag,
Dynamic Retinoscopy
Presentation Layout:
-Introduction to accommodation of eye
-Mechanism
-Components
-Measurement of accommodation of eye
- Amplitude
- Facility
- Relative accommodation
- Lag
-Dynamic Retinoscopy
Accommodation
-dioptric adjustment of the crystalline lens of the eye
- to obtain clear vision for a given target of regard
-process by which the refractive power of eye is altered
- to ensure a clear retinal image
For further reading
-Clinical Procedures in Optometry by J.D. Bartlett, J.B. Eskridge, J.F. Amos
-Primary Care Optometry by Theodere Grosvenor
-Borish’s Clinical Refraction by W.J. Benjamin
-Clinical Procedures for Ocular examination by Carlson et al
-American Academy of Ophthalmology
-Optometric Clinical Practice Guideline by American Optometric Association
-Internet
Follow me to get in touch with optometric and ophthalmic updates
It contains Examination Protocol for Contact Lenses along with information about pre-requisites for fitting a Contact Lens. A helpful guide for all Students, Eye Care Practitioners (Optometrist, Ophthalmologist).
Presbyopia/ Methods of Presbyopic Addition Determination (healthkura.com)Bikash Sapkota
DIRECT DOWNLOAD LINK ❤❤https://healthkura.com/presbyopia-near-addition/❤❤
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Presbyopia and techniques of measurement
A fantastic presentation in the topic "Presbyopia and techniques of measurement"
A detailed information about presbyopia, techniques of presbyopic add determination and different correction methods.
Informative slide presentation on presbyopia for ophthalmology residents, ophthalmologists, optometrists, ophthalmic assistants, ophthalmic technicians, ophthalmic nurses, medical students, medical professors, teaching guides.
Presentation Contents:
--Introduction to presbyopia
-Types of presbyopia
-Risk factors
-Symptoms and signs
-Refractive error and presbyopia
-Methods of determining near add.
-Management of presbyopia
In a nutshell..
- The evaluation and management of presbyopia are important because significant functional deficits can occur when the condition is left untreated
- Undercorrected or uncorrected presbyopia can cause significant visual disability and have a negative impact on the pt.'s quality of life
- Finally, every tentative addition should be adjusted according to the particular needs of the patient
For Further Reading:
-Clinical Procedures in Optometry by J.D. Bartlett, J.B. Eskridge, J.F. Amos
-Primary Care Optometry by Theodere Grosvenor
-Borish’s Clinical Refraction by W.J. Benjamin
-Clinical Procedures for Ocular examination by Carlson et al
-American Academy of Ophthalmology
-Optometric Clinical Practice Guideline by American Optometric Association
-Internet
Follow me to get in touch with optometric and ophthalmic updates.
http://igolenses.co.uk
This short US paper reviews the evidence of clinical trials conducted to date where short-sighted children have undergone Overnight Vision Correction (OVC) treatment and tries to draw conclusions on the effectiveness of the treatment in slowing down or halting the further development of short-sightedness as well as in terms of the safety risks - if any - associated with OVC.
It contains Examination Protocol for Contact Lenses along with information about pre-requisites for fitting a Contact Lens. A helpful guide for all Students, Eye Care Practitioners (Optometrist, Ophthalmologist).
Presbyopia/ Methods of Presbyopic Addition Determination (healthkura.com)Bikash Sapkota
DIRECT DOWNLOAD LINK ❤❤https://healthkura.com/presbyopia-near-addition/❤❤
Dear viewers Check Out my other piece of works at ❤❤❤ https://healthkura.com ❤❤❤
Presbyopia and techniques of measurement
A fantastic presentation in the topic "Presbyopia and techniques of measurement"
A detailed information about presbyopia, techniques of presbyopic add determination and different correction methods.
Informative slide presentation on presbyopia for ophthalmology residents, ophthalmologists, optometrists, ophthalmic assistants, ophthalmic technicians, ophthalmic nurses, medical students, medical professors, teaching guides.
Presentation Contents:
--Introduction to presbyopia
-Types of presbyopia
-Risk factors
-Symptoms and signs
-Refractive error and presbyopia
-Methods of determining near add.
-Management of presbyopia
In a nutshell..
- The evaluation and management of presbyopia are important because significant functional deficits can occur when the condition is left untreated
- Undercorrected or uncorrected presbyopia can cause significant visual disability and have a negative impact on the pt.'s quality of life
- Finally, every tentative addition should be adjusted according to the particular needs of the patient
For Further Reading:
-Clinical Procedures in Optometry by J.D. Bartlett, J.B. Eskridge, J.F. Amos
-Primary Care Optometry by Theodere Grosvenor
-Borish’s Clinical Refraction by W.J. Benjamin
-Clinical Procedures for Ocular examination by Carlson et al
-American Academy of Ophthalmology
-Optometric Clinical Practice Guideline by American Optometric Association
-Internet
Follow me to get in touch with optometric and ophthalmic updates.
http://igolenses.co.uk
This short US paper reviews the evidence of clinical trials conducted to date where short-sighted children have undergone Overnight Vision Correction (OVC) treatment and tries to draw conclusions on the effectiveness of the treatment in slowing down or halting the further development of short-sightedness as well as in terms of the safety risks - if any - associated with OVC.
Myopia is considered to be a leading cause of visual impairment. Furthermore, the prevalence of myopia young adolescents has increased substantially over the
past few decades. Although myopia was identified more than two thousands years ago, a consistently effective approach to myopia control for all patients still eludes
clinicians
http://igolenses.co.uk
After reading the outcomes of the LORIC, CRAYON and SMART studies, two US opticians then undertook their own investigation into whether Overnight Vision Correction (OVC) can slow down or halt the further development of short-sightedness once patients are fitted with overnight ortho-k corrective contact lenses. T
Interventions to Reduce Myopia Progression in Children (Journal Club) (health...Bikash Sapkota
DIRECT DOWNLOAD LINK ❤❤https://healthkura.com/reduce-myopia/❤❤
Dear viewers Check Out my other piece of works at___ https://healthkura.com
Interventions to Reduce Myopia Progression in Children (Journal Club)
Objectives:
- To discuss about the different interventions to reduce myopia progression in children
- To determine the effectiveness of different interventions to slow down the progression of myopia in children
Interventions to Reduce Myopia Progression:
Environmental Considerations
- Time Spent Outdoors
- Near-Vision Activities
Spectacles & Contact Lenses
- Gas-Permeable Contact Lens Wear
- Bifocal & Multifocal Spectacles
- Soft Bifocal Contact Lenses
- Orthokeratology
Pharmacological Therapies
- Antimuscarinic Agents: Atropine & Pirenzepine
Under Correction of Myopia
Clinical study of fundal changes in high myopiaiosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
A lay forum lecture about digital eye strain, dry eye disease in children, myopia and stopping myopia, other refractive errors, common causes of eye consults, some eye myths, the truth about blue light filter in glasses, and a little bit about presbyopia and cataract for parents of Xavier School Nuvali, July 31, 2022
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...
Myopia control
1. Myopia control
1
Myopia Control
Submitted by: Submitted to:
Bipin Koirala Sanjeev Kumar Mishra
Bachelor of Optometry Programme Coordinator
Student ID no: 122
Maharajgunj Medical Campus
Institute of Medicine
2. Myopia control
2
Myopia Control
Myopia results from an eye having excessive refractive power for
its axial length. This may be due to the eye having a relatively
long axial length or to increased dioptric power of one or more
of the refractive elements.
In the review of the etiology of refractive error, 3 major theories of myopic development has
been suggested:
1. The biological-Statistical theory
2. The use-abuse theory
3. The theory of emmetropization.
Myopia is a significant global public health & socioeconomic problem. Pathologic myopia has
become a major cause of blindness or visual impairment in both Asian & western populations.
According to a summary of 145 studies regarding the global prevalence of myopia & high
myopia, there are approximately 28.3% of the global population & 4.0% of the global population
cases & are predicted to increase to 49.8% & 9.8% respectively by 2050.
Prevalence of myopia in children
Many population based studies on children have proved that the prevalence of myopia is higher
in urbanized East Asian countries with prevalence of 16.5% in Nepal (2008).
In 4282 Nepalese secondary school children aged 10-15 years the myopia prevalence was
ranged from 10.0% in 10year old to 27.3% in 15year old .
3. Myopia control
3
A recent meta-analysis found a 2.6times
higher risk of developing myopia in children of
urban residence compared with those who
lived in rural areas. These differences in the
myopia prevalence among children may be
caused by a rigorous education system which
children especially living in urbanized are
exposed to. Esp.in Eastern Asian countries,
academic success is important, and most
children are enrolled in competitive,
academically oriented schooling at very early age. It is influenced by enduring patterns of
behavior & cultural attitudes that may result in the myopic environmental factors such as higher
level of more intense near work & lower level of outdoor activity. Myopes, especially high
myopes, tend to have reduced quality of life due to adverse influences from psychological,
cosmetic, practical & financial factors. Hence, affecting productivity, mobility & activities of daily
living.
Ocular biometric changes in human myopia
Cornea: Longitudinal studies indicate that changes in corneal curvature during childhood and
early adulthood are minimal & not associated with the magnitude of myopia progression.
However since the correlation between spherical equivalent refraction and axial length to
corneal radius ratio is typically stronger than that of axial length alone by 15-20%, corneal
curvature does appear to make a modest contribution to the magnitude of myopia.
Crystalline lens & Anterior chamber depth: Mutti et al observed that within 1 year of
myopia onset, compensatory crystalline lens thickening & flattening abruptly halted compared
to children who remained emmetropic, suggesting that childhood myopia is not purely axial in
nature, but involves a decoupling of highly correlated anterior & posterior segment eye growth.
4. Myopia control
4
Vitreous chamber & Axial length : Axial length or more precisely , the vitreous chamber
depth is the primary individual biometric , contributor to refractive error in children , young
adults & elderly with VCD accounting for over 50% of the observed variation in SER , followed
by cornea & crystalline lens .
Choroid: The choroid is typically thinner in myopic compared to non-myopic eyes & thins with
increasing myopia & AL in both adults & children.
Sclera: Scleral thinning A/W axial myopia is primarily restricted to the posterior pole due to
scleral tissue redistribution, scleral thinning may alter the tissue strength surrounding the ONH,
rendering myopic eyes more susceptible to glaucomatous damage.
Effects of key environmental factors on myopia:
1. Near work and education
Numerous studies conducted across a range of different population have consistently found
that higher levels of education are Associated with higher prevalence of myopia.
Population studies examining the link between near work activities and myopia have been
conflicting, with some studies suggesting an Association between near work and myopia and
others indicating no significant effects
2. Urbanisation
Higher prevalence of myopia in children living in urban regions, Compared to children living in
rural regions.
A number of recent studies indicate that a higher population density is significantly associated
with increased myopia prevalence in children, independent of near work and outdoor activities.
Studies shows children living in smaller homes to have significantly higher prevalence of myopia;
it has been hypothesized that a constricted living space may result in an increased exposure to
hyperopic blur, thus promoting myopia.
5. Myopia control
5
3. Light exposure
A number of recent studies a report that the time children spend engaged in outdoor activities
is negatively associated with risk of myopia.
Both cross sectional and longitudinal studies indicate that greater time spent outdoor is
associated with significantly lower myopia Prevalence and reduced risk of myopia onset in
childhood.
A recent meta-analysis of studies examining the relationship between outdoor time and myopia
indicated that there was 2% reduction in the odds of having myopia for each additional hour
what week spent outdoor.
Animal studies indicate that the intensity of daily light exposure can influence refractive
development.
A recent RCT in Taiwan suggest that increased light exposure is associated with slower axial eye
growth in the human eye.
A recent study compare the habitual Ambient light exposure (Captured with wearable light
sensors) of children living in Singapore with children living in Australia and found substantially
lower level of outdoor light exposure in children living in Singapore.
Findings From human studies suggest that children who are exposed to less than 60 minute a
day of bright outdoor light are at increased risk of more rapid eye growth and myopia
development and that approximately 2 hour or more of outdoor exposure each day is required
to provide protection against myopia development in human eye.
The main risk factors for school myopia is Education and time spent outdoor.
Other possible risk factors for Myopia:
Digital screen time
Sex
Ethnicity
Parental myopia
Intelligence
Urban/rural Differences
Pollution
6. Myopia control
6
Housing
Height
Diet
Sleep
Smoking
birth order
season of birth
Allergic conjunctivitis
Clinical management and control of myopia in children
A.Optical interventions
I. Spectacles
Single vision under correction
Bifocal and progressive Addition lenses
II. Contact lens
Multi focal contact lens
Orthokeratology
Pharmacological intervention
I. Atropine (low dose)
C. Lifestyle factor (Time spent outdoor)
7. Myopia control
7
1. Single vision under correction
Under correction of myopia reduces the accommodative demand for near work and the
accommodative lag associated with development of myopia. Evidence from animal studies
supports under correction as a means of arresting myopia progression, however on human the
results are equivocal.
Other studies have reported that under correction of myopia in children can exaggerate myopia
in children.
Data from monocular under correction of myopia has yielded promising results with under
corrected eyes showing an average of 0.36 D per year less progression in myopia compared to
the fellow fully corrected eye.
2. Bifocal and progressive addition lenses
RCT showed that executive bifocal lenses slowed myopia progression by 39% and up to 51%
with base in prism Incorporated. It is possible that the large near segment made it more likely
for children to use the near add during near work and may also induce more peripheral myopic
defocus.
The largest RCT reported that children wearing multi focal spectacles progressed 0.20+/-0.08D
Less than children wearing single vision spectacles (p=0.004). But a difference of less than 0.25
D over three years is not clinically meaningful.
3. Soft bifocal contact lens
It is thought to work on the similar notion that myopic progression can be slowed by inducing a
peripheral myopic defocus which slows the rate of axial elongation.
Only center distance contact lens have been investigated for myopia control.
On average, this contact lens slow myopia progression by 46%.
8. Myopia control
8
4. Orthokeratology
These contact lens work by temporarily reshaping the corneal surface when worn at night
mainly through central epithelial thinning.
They have also been shown to be effective in reducing axial elongation and are thought to work
similarly to bifocal soft contact lens in achieving a relative peripheral myopia which is thought
to reduce myopia progression.
A recent meta-analysis done in 2015 of seven studies by sun et al , the combined results showed
that the mean AL Of 218 subjects in ortho-K Group was 0.27mm Less than that of 217 subjects
in the control group after two years corresponding to nearly 45% decrease in myopic
progression.
But the risk of infective keratitis in children using ortho K lenses overnight is 13.9 for 10,000
wearers
5. Antimuscarinic agents (Atropine and pirenzepine)
Although the specific mechanism of treatment effect of antimuscarinics agent is unknown, it is
known that their effective myopia control is not a result of required accommodation.
From animal model it is thought to work either via on neuro chemical cascade which begins with
M1/4 Receptors at retina level or directly on scleral fibroblast by inhibiting the synthesis of
glycosaminoglycan via non muscarinic mechanism.
Schwann et al (2000) Also found that at atropine stimulated an Increasing the amount of
dopamine released from RPE Cells, which in turn might cancel out Retinal signal that control eye
growth.
The atropine for the treatment of childhood myopia (ATOM) study
1. ATOM 1
2. ATOM 2
9. Myopia control
9
1. ATOM 1 STUDY
Parallel group, placebo-controlled, Randomised, double masked study conducted in
Singapore
Included 400 children 6-12 year (9.2yr)
With moderate myopia (-1.00 to - 6.00) (3.50D)
For 3 years (Two year treatment and one year washout)
The treatment group received atropine 1% at bedtime in one eye and no treatment in
the other eye.
Result: Over 2 year, there was 77% reduction in the mean progression of
myopia(progression of -1.20+/- 0.69 in placebo group & -0.28+/-0.92 in atropine
group)
There was also a strong correlation with reduction in axial length in the atropine
group.
At three year, A significant rebound was seen for both myopia progression and
axial length elongation after cessation of atropine 1% for 1 year
2. ATOM 2 STUDY
Aim was to compare the safety and efficacy of three lower doses of atropine (0.5%, 0.1%,
and 0.01%)
Double masked, randomised control trial
Included 400 children(6-12year)
Myopia > -2.00D
Children were randomised to receive either 0.5% atropine (n=161) 0.1%(n=155) or
0.01%(n=84)
Both eyes were treated
Five year study that included two years of treatment, one year of washout and Two year
where treatment was restarted in children who continued to progress.
10. Myopia control
10
Consolidating data from ATOM 1 & 2
0.01% atropine Had similar efficacy compared to higher concentration of 0.1% and 0.5%
Side effects were minimal with 0.01%
Negligible amount of accommodation( mean Residual accommodation was 11.8 Din
0.01% group, compared to 6.8 D and 4D In 0.1% and 0.5% group respectively
Pupil size(0.8mm & 1.2mm ) Difference from baseline in Mesopic and photophic
conditions respectively in 0.01% group compared to 2.8mm in 0.1% group & 3.1mm &
3.6mm in 0.5% group (p<0.01)
No effect on near visual acuity in 0.01% group
During washout period , Children in 0.01% group had minimal rebound
No rebound seen for axial length in 0.01% group
Summary
Environmental factors such as reduced time is spent outdoor and increased near work
activities have been shown to play a role in myopia progression.
Of approaches that have been discussed all have shown to slow myopia progression; in
particular, Atropine, ortho-K, Soft bifocal contact lens have been shown to be most
effective.
Each of these therapies is limited in variable extent by: Treatment compliance, potential
side effect and lack of long term data. They are likely to improve with further validation
and longer term studies. In addition, it would be interesting to evaluate the potential
additive effect of combination of therapies on the progression of myopia in further
studies.
References:
1. ATOM 1 AND 2 study
2. Previous presentation and online classes