This document provides an overview of myopia, including its definition, global epidemiology, risk factors, management options, and the importance of controlling axial length growth. It discusses that myopia prevalence is increasing globally and poses lifelong risks. Risk factors for increased myopia progression include younger age, family history, near work, ethnicity, and binocular vision issues. The document reviews behavioral, optical, and pharmacological management strategies and their effectiveness, noting that controlling axial length growth through approaches like orthokeratology and atropine is key to managing myopia progression.
Scleral contact lenses , types, uses in various ocular conditions.
An in-depth and unbiased details of these lenses as a therapeutic and also as a drug - delivery system in modern ophthalmology.
A must read for all Ophthalmologists and Optometrists.
Scleral contact lenses , types, uses in various ocular conditions.
An in-depth and unbiased details of these lenses as a therapeutic and also as a drug - delivery system in modern ophthalmology.
A must read for all Ophthalmologists and Optometrists.
Contact lens for congenital aphakia and other eye conditions for infants and toddlers. The slide presentation encompasses indications for CL fitting in paediatric, contact lens options, fitting techniques, challenges and contact lens as myopia control.
what is Duochrome Test, Why do we take Red and Green color only,
What is the Principal of Duochrome Test, Why Hyperopic Pt sees green better than red and vice versa
Accommodation/ Accommodation of Eye, Measurement of Accommodation of Eye (hea...Bikash Sapkota
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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).
Contact lens for congenital aphakia and other eye conditions for infants and toddlers. The slide presentation encompasses indications for CL fitting in paediatric, contact lens options, fitting techniques, challenges and contact lens as myopia control.
what is Duochrome Test, Why do we take Red and Green color only,
What is the Principal of Duochrome Test, Why Hyperopic Pt sees green better than red and vice versa
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).
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.
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
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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 classification and management by Tahir Shaukat Optometry Club
Nearsightedness (myopia) is a common vision condition in which you can see objects near to you clearly, but objects farther away are blurry. It occurs when the shape of your eye causes light rays to bend (refract) incorrectly, focusing images in front of your retina instead of on your retina.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
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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.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
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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.
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Stay informed, stay safe, and get your flu shot today!
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
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
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
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
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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
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
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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
2. Myopia control
Table of contents
• Introduction of myopia
• Global epidemiology of myopia
• Why myopia control is necessary?
• Risk factors of myopia
• Why axial length control is crucial for the control of myopia?
• Management options for Myopia
Introduction of myopia
It is a type of refractive error (not diseases) in which the parallel rays of light coming from infinity comes to focus in
front of the retina when accommodation is minimum or near rest. Myopia is a significant global public health and
socioeconomic problem. Myopia can be characterized as refractive or axial, although a continuum of the two types
exists. In refractive myopia the overall refractive power of the eyes as determined by cornea and crystalline lens
power is excessive in relation to an eye of normal axial length. A single mm change in curvature of cornea changes
6D of refractive power. Axial myopia is the result of an excessive elongation of the eye with respective to its
refractive components. In axial myopia, 1mm of axial length change gives 3D of refractive error change.
There are several classifications of myopia but according to Curtin (1985) classification, myopia is divided into
following groups.
1. Simple or physiological myopia (less than -3D) with usually no funduschanges.
2. Intermediate myopia (- 3 to -5D), in which temporal crescents are present.
3. High or pathological myopia (-6D or more) due to excessive axial elongation and is associated with posterior
segment anomalies
High Myopia is a condition in which the mean spherical equivalent objective refractive error is ≥ −6.00 D or axial
length is ≥ 26 mm in either eye
Global epidemiology
High myopia is one of the leading causes of low vision in the world. There is higher prevalence in Asian countries, but
it is estimated that 1% of the global population exhibits high myopia. According to published studies, the prevalence
of myopia is highest in East Asia, where China, Japan, the Republic of Korea and Singapore have a prevalence of
approximately 50%, and lower in Australia, Europe and north and South America. It is estimated myopia and high
myopia will affect 52% (4949 million) and 10.0% (925 million), respectively, of the world’s population by 2050
Why myopia control is necessary?
It is commonly understood that myopia prevalence is growing globally. By 2050, it is predicted that half of the
world’s population - five billion people - will be myopic, with nearly one billion at risk of myopia related ocular
pathology. high myopia is strongly linked to higher risk of cataract, retinal detachment and myopic maculopathy, and
increasing rates of vision impairment and blindness due to the latter are already evident in Asian countries.
The myopia control imperative is understanding that even -1.00D of myopia carries an additional lifelong risk of
posterior subcapsular cataract (PSCC), retinal detachment (RD) and myopic maculopathy (MM). A convincing case
3. has been previously made by pediatric ophthalmologist Ian Flitcroft that the delineation of physiological and
pathological myopia is not valid, as the term ‘physiological’ implies that there is a level of myopia which could be
considered ‘safe’ in comparison to emmetropia. Using odds ratios, which describe the increased risk of a condition
over a reference of 1 (this being the risk of emmetropia), the table below summarizes Flitcroft’s data which shows
that even 1D of myopia doubles the risk of MM and PSCC, and triples the risk of RD compared to the emmetrope. At
3D of myopia, the risk of PSCC triples, with the risk of RD and MM being nine times that of the emmetrope. Higher
levels of myopia bring more eye-watering risks
Risk factor of myopia
Myopia is etiologically heterogenous. Myopia development and progression is multifactorial. Assessing the risk
factor for early onset and progression is more crucial in the selection of most appropriate intervention for myopia
control.
Identifying the pre-myope
There are four key principles for assessing risk of myopia onset:
Family history – one myopic parent increases risk by three-fold, while two myopic parents doubles this risk again
Visual environment – less than 90 minutes a day spent outdoors increases risk, especially if combined with more
than 3 hours a day spent on near work activities (outside of school time)
Binocular vision – Children with higher accommodative convergence (AC/A) ratios, typically seen with esophoria,
have an increased risk of myopia development within one year of over 20 times. Accommodative lag may also be a
risk factor but there is conjecture. Intermittent exotropia has also been associated with onset of myopia.
Current refraction – the most significant risk factor of this lot for future myopia is if a child exhibits 0.50D or less
of manifest hyperopia at age 6-7. This risk is independent of family history and visual environment.
In addition to this, the fastest rate of refractive change in myopic children occurs in the year prior to onset, so the
child who is less hyperopic than age normal should be closely monitored, especially if concurrent risk factors are
evident.
Identifying the myopia progressor
Age - the younger a child becomes myopic, the faster they will progress, with children 7 years of age progressing by
at least 1D per year with this halving by age 11-12.
Family history - children with two myopic parents have been shown to be the fastest progressors in single vision
spectacle and atropine corrections, and children with one myopic parent progress less than the former but more
than the child without such family history.
4. Visual environment – near work at less than 20cm working distance and durations of longer than 45 minutes have
been linked with more myopia progression.
Ethnicity - Asian ethnicity has been linked to faster myopia progression
Binocular vision – watch for esophoria, accommodative lag and intermittent exotropia. In myopia control studies
of progressive addition spectacle lenses (PAL), children with esophoria in single vision spectacle control groups were
found to progress more quickly, and children with a larger baseline accommodative lag in the PAL groups showed
statistically greater treatment effect. Children with lower baseline accommodative amplitude have shown a greater
myopia control response to orthokeratology contact lens wear compared to normal accommodators. Finally, while
the effect of controlling IXT on controlling myopia has not yet been studied, 50% of children with intermittent
exotropia (IXT) are myopic by age 10 and 90% by age 20.
Why axial length control is crucial for the control of myopia?
Ultimately the myopia control is the control of axial length. Tiedeman and colleagues from the Netherlands
evaluated the prevalence of lifelong visual impairment (6/12 or less) with increasing axial length, using data from
over 10,000 Dutch people with an average age of 61 years – an axial length of 24-26mm was used as the referent.
Axial length of 26-28mm doubled the risk of visual impairment by age 60, while 28-30mm increased the risk by 11
times and an axial length of 30mm or more by 25 times. The prevalence of visual impairment by age 75 for the
longest eyeballs (over 30mm) was 90%. Between 26-30mm axial length, the likelihood of being visually impaired by
age 75 was around 25%, with the difference between shorter (26-28mm) and longer (28-30mm) eyes being the age
of onset – the person with longer eyeballs is likely to suffer visual impairment for a longer duration of their life.
Summarized in the table below, this is sobering data and provides the clear message to both patients and parents
that controlling axial elongation also controls lifelong risk of visual impairment.
Treatment options for the control of myopia
• Assess the risk of myopia
• Behavioral management
• Optical management
• Pharmacological management
• Asses and manage binocular vision
ASSESS THE RISK OF MYOPIA
We should always assess the risk of myopia even a 1D myopia can results in a lifelong risk of PSCC, retinal
detachment and myopic maculopathy.
There should be regular eye examination of the people who are at a greater risk of myopic complications.
The child who are less hyperopic at the age of 6-7 yrs. should undergo regular follow-up eye examination.
5. BEHAVIORAL MANAGEMENT
In this management option, it is mainly concerned with the change in behavior and attitude.
Behavioral management includes:
• Time spent outdoors
• Less near work
Time spent outdoors and less near work
Outdoor light exposure during childhood is the most critical known modifiable risk factor for myopia. Outdoor light
exposure prevents or delays the onset of myopia and may slow progression. (Ho et al., 2019) The protective effect of
being outside is currently explained by high light intensity triggering the release of retinal dopamine, an ocular
growth inhibitor that inhibits myopic development. (Ramamurthy et al, 2015) Another potential explanation is that
pupils are more constricted outdoors, causing a greater depth of field and less image blur, resulting in less myopic
stimulus. (Flitcroft 2012)
. In animal studies, higher light levels greatly retarded form- deprivation myopia a reaction which is abolished by
dopamine antagonists
The role of chromaticity (red and blue) and ultraviolet (UV) light is still uncertain, Also, vitamin D levels to degree
of myopia change is very small.
Rudnicka et al. (2016) found that children living in predominantly urban environments have 2.6 times the risk of
myopia compared to children living in rural environments.
Potential explanations include:
more congested environment,
greater emphasis on education,
- more near-vision work &
- fewer outdoor activities
The clinical culmination is that at least 90 minutes of average outdoor time per day for children is beneficial
with less near work and working distance. UV protection is important and must be balanced with the visual
and retinal stimulation provided by bright natural light
20-20-2 rule for myopia control
20-20-2 Rule, proposed by Prof. Caroline Klaver, MD, PhD, and her co-researchers at the Erasmus University Myopia
Research Group in Rotterdam, Netherlands, is more effective in reducing the incidence of myopia and possibly
slowing progression. (Klaver et al, 2020) What is the 20-20-2 Rule? After 20 minutes of close work, children should
gaze at objects in the distance for at least 20 seconds, and they should be outside intermittently for at least 2 hours
per day.
6. Optical Management
Optical management includes the use of appropriate concave lens to correct the myopia. But the management
should also control the progression of myopia and its onset. Various spectacles, contact lens design have been
studied in the control of myopia progression. All the treatment options should be individualized and must be
evidence based. For the individual patient, there could be one primary driver to myopia progression and
development I.e. genetics, environment, peripheral refraction, accommodation or it could be a combination.
• Spectacles lenses
• Contact lenses
• Orthokeratology
Spectacles lenses
Studies have shown that single vision lenses (SVL) is ineffective in the control of myopia progression. So, most
investigated spectacles lens design for the control of myopia progression are Progressive addition lenses (PAL),
Bifocal lenses, and Prismatic bifocal (bifocal lenses with BI Prism).
New spectacle lens technology for myopia control is on the horizon -the award-winning Defocus incorporated
multiple segments (DIMS) spectacle lenses, developed at the Hongkong polytechnic university, has just been
released in Asia.
PAL, Bifocal and prismatic bifocal lenses
PAL and bifocal spectacle lenses have shown reasonable research results for myopia control. Spectacles lenses are
the first line of treatment we usually prescribe for myopia contralesionally, it is also an important adjunct treatment
in soft contact lens wearers as a backup correction and also in case where atropine is being prescribed as a first line
of treatment.
PAL studies for myopia control show negligible results when single adds are applied to all children, however when
applied to children with esophoria and accommodative lag, the results become more impressive at 30-40% efficacy.
Cheng et all’s study investigated a standard bifocal with +1.50 Add, and the same add with the 3BI prism in each eye.
After three years of wear, they found a moderate myopia control effect around 35% for axial length and 50% for
refractive change. the study incorporated children with orthophoria and exophoria in their baseline SVL. They found
minimal effect in esophoric children, and when analyzed by accommodative lag, both bifocal types show similar
effect in children with high accommodative lag (over 1D), but found better results with prismatic bifocal in children
with low accommodative lag.
So, which to pick in practice?
Esophoria and high accommodative lag: PAL
Orthophoria, exophria or normal accommodation (lag<1D): bifocal or prismatic bifocal
DIMS LENSES
The DIMS lens has a 10 mm clear central optical zone with the distance correction, and then is covered with +3.50
lens lets with regions of the distance correctio in between the lenslets.the intended result is that wherever a child
looks in the lens, they’ll experience 50%of retinal focus being their distance correction, and 50% of the +3.50 Add.
These lenses look like the single vision lens but could work more like a contact lens because a newly published two-
year study with these lenses have shown 50% refractive control and 60% axial length control.
7. Contact lenses
Numerous studies have concluded that the SV soft contact lens and conventional GP (not OK) lenses didn’t show
promising results in the control of myopia progression.
Contact lens options appear to be the most consistent, with multifocal soft contact lenses and OrthoK offering
around 50% efficacy for controlling both refractive and axial length in myopia.
Multifocal soft CL
Although they come in many designs, only center-distance designs have been formally investigated in the context of
myopia control. In these designs, the peripheral region of the lens has relatively more positive (plus) power,
incorporated as a gradual increase toward the periphery (progressive design) or presented in distinct zones
(concentric ring design). The lens design is reflected in the labeling: bifocal, MF, gradient, progressive, or positive
spherical aberration–inducing lenses. In most cases, the lenses are intended to provide clear distance vision, while
imposing myopic defocus on the more peripheral retina as a putative stimulus to slow eye growth. Based on sample
size–weighted averages, the eight trials published over the 2011 to 2016 period showed a 38.0% slowing of myopia
progression and a 37.9% slowing of axial elongation with MF soft contact lens interventions. Interestingly, concentric
ring designs showed better control over axial elongation than progressive designs (44.4% versus 31.6%), whereas
their effects on myopia progression were similar (36.3% versus 36.4%).
accommodative responses to near tasks were consistent with accommodation being driven by the center-distance
zone of the MF lenses, the implication being that accommodative lags would have been minimally affected.
However, two other studies reported positive benefits on accommodative errors in the presence of MF soft contact
lenses (i.e., decreased accommodative lags and accommodative leads)
Orthokeratology (OK)
OK, also known as corneal reshaping therapy, involves reshaping of the cornea to reduce myopic refractive errors.
OK has proven to be effective in slowing myopia progression. OK also has been shown to induce relative myopic
shifts in peripheral refractive errors in all meridians, consistent with the most popular hypothesis for this myopia
control effect.
Individual studies and meta-analyses have shown a 40–60% reduction in the rate of myopia progression with ortho-k
lenses compared with controls using SVL spectacles
In a meta-analysis by Sun et al., the combined results showed
-a mean AL reduction of 0.27 mm (95% CI: 0.22, 0.32) after 2 years, corresponding to a 45% reduction in myopic
progression
Younger children (aged 7–8 years) with faster myopic progression (>1.0 D/year) might benefit more benefits were
noted even in partially corrected children with high myopia However, studies show that the efficacy may decrease
over time, especially after 4–5 years, and a potential “rebound” after discontinuation, especially in children under 14
years.
Pharmacological management
Atropine is a non-specific muscarinic acetylcholine receptor antagonist initially thought to work by blocking
accommodation. this theory has since been disproved in animal studies. Its exact mechanism is still unknown, but it
is thought to work through muscarinic or non-muscarinic pathways either in the retina or in the Bruch’s membrane.
Atropine has a strong dose-dependent inhibitory effect of myopia progression. The initial high doses of atropine (i.e.,
0.5% or 1.0%) slowed myopia progression by more than 70% over 1–2 years. However, lower doses (0.1% or less)
can also slow myopia by 30–60%, and may be associated with fewer side effects (pupil dilation, glare or blur).
8. Various studies are done on the pharmacological treatment of myopia with atropine and still there are many studies
currently underway, among them ATOM 1 and ATOM 2 study shows the most promising results.
ATOM 1 study (atropine in the treatment of myopia)
• Parallel-group, placebo-controlled, randomized, double-maskedstudy
• Conducted in Singapore
• Included 400 children aged 6-12 years (mean age 9.2years)
• With moderate myopia (-1.00 D to -6.00 D, mean -3.50D)
• For 3 yrs. (2-yrs treatment period and 1-yr washoutperiod)
• The treatment group received atropine 1% at bed time in one eye and no treatment in the othereye
RESULTS
• Over 2 yrs., there was a 77% reduction in the mean progression of myopia (progression of-1.20 D+/-0.69 in
the placebo group and -0.28D +/- 0.92 in the atropinegroup)
• There was also a strong correlation with reduction in axial length in the atropinegroup
• there were no severe adverse effects associated with atropine eyedrops
• At 3 yrs., a significant rebound was seen for both the myopia progression and axial elongation after cessation
of atropine 1% for 1 yr.
ATOM 2 study
Conducted shortly after ATOM 1 study
Aim: To compare the safety and efficacy of 3 lower doses of
atropine (0.5%, 0.1%, and 0.01%)
• Double-masked, randomized, controlled trial
• Included 400 children
• Age: 6-12 years
• Myopia worse than -2.00 D
• Children were randomized to receive either 0.5% atropine (n=161), 0.1% (n=155), or 0.01%(n=84)
• Both eyes were treated
• This was a 5-yr study that included 2 yrs. of treatment, 1 yr. of washout, and 2 yrs. where treatment was
restarted in children who continued to progress
• These children were retreated with only 1 dose of atropine
• The results showed a dose-related response with atropine and myopiaprogression
• But these differences were clinically small (-0.30 +/0.60 D for 0.5%, -3.8 +/- 0.60 D for 0.1%, and -4.9 +/- 0.63
D for 0.01%)
Conclusion from both studies
• 0.01% atropine has similar efficacy compared to the higher concn
of 0.1% and0.5%.
• Side effects with atropine 0.01% were minimal compared to the 2 higherconcn
• Negligible effect on accommodation
• No effect on near VA in the 0.01% group (mean value of 20/20,J1)
• During the washout period, children in the 0.01% atropine group had minimal rebound (-0.87 +/- 0.52 D in
the 0.5% group, -0.68 +/- 0.45 D in the 0.1% group,and -0.28 +/- 0.33 D in the 0.01% group, P<0.01)
• No rebound seen for axial length in the 0.01%group
The lower myopia progression in the 0.01% group persisted during phase 3, with overall myopia progression and
change in axial elongation being the lowest in this group at the end of 5 yrs. The low dose of atropine is clinically
palatable, appearing to have negligible side effects profile compared to higher concentration
9. Recently another study lower concentration Atropine for myopia progression (LAMP) with one-year study showing
efficacy with different concentration of atropine was published.
• LAMP study
• A randomized, double blinded, placebo-controlled trial of 0.05%,0.025% and 0.01%atropine
• Amied to evaluate the efficacy and safety of low concentration ofatropine
• Study time period was 1 year
• Enrolled 438 children aged 4to 12 years with myopia of at least -1.0D and astigmatism of -2.5 D or less
• Participants were randomly assigned in a 1:1:1:1 ratio to receive 0.05%, 0.025%, and 0.01% atropine eye
drops, or placebo eye drop, respectively, once nightly to both eyes for 1year
• Cycloplegic refraction, axial length (AL), accommodation amplitude, pupil diameter, and best-corrected
visual acuity were measured at baseline, 2 weeks, 4 months, 8 months, and 12 months. Visual Function
Questionnaire was administered at the 1-yearvisit.
Results:
• After 1 year, the mean SE change was −0.27±0.61 D, −0.46±0.45 D, −0.59±0.61 D, and −0.81±0.53 D in the
0.05%, 0.025%, and 0.01% atropine groups, and placebo groups, respectively ( P <0.001), with a respective
mean increase in AL of 0.20±0.25 mm, 0.29±0.20 mm, 0.36±0.29 mm, and 0.41±0.22 mm ( P < 0.001)
• Visual acuity and vision-related quality of life were not affected in eachgroup
• This study concluded that 0.025 % will have 30% AL control and 0.05% have around 50% controleffect.
• 0.05% atropine was most effective in controlling SE progression and AL elongation over a period of 1 year.
10. At the end there is infographics to help select the myopia control strategies from spectacle lens, multifocal contact
lens, orthokeratology and atropine options taking binocular vision under consideration and also have a chart for
gauging success
This infographic is taken from myopia profile online learning website
11. References:
1. Holden BA, Jong M, Davis S et al. Nearly 1 billion myopes at risk of myopia-related sight-threatening conditions by
2050 - time to act now. Clin Exp Optom. 2015;98:491-3.
2. Flitcroft DI. The complex interactions of retinal, optical and environmental factors in myopia aetiology. Prog Retin Eye
Res. 2012;31:622-60.
3. Rose KA et al. Outdoor activity reduces the prevalence of myopia in children. Ophthalmology. 2007;15:1279-85.
4. Cheng D, Woo GC, Schmid KL. Bifocal lens control of myopic progression in children. Clin Exp Optom 2011;94:24-32
5. Chua W-H, Balakrishnan V, Chan Y-H et al. Atropine for the treatment of childhood myopia. Ophthalmol.
2006;113:2285–91.
6. Chia A, Chua W-H, Cheung Y-B et al. Atropine for the treatment of childhood myopia: safety and efficacy of 0.5%,
0.1%, and 0.01% doses (Atropine for the Treatment of Myopia 2). Ophthalmol 2012;119:347–54.
7. Chia A, Lu Q-S, Tan D. Five-Year Clinical Trial on Atropine for the Treatment of Myopia 2: Myopia Control with
Atropine 0.01% Eyedrops. Ophthalmol 2016; 123;391-9.
8. Bullimore M, Berntsen D. Low-dose atropine for myopia control: considering all the data. JAMA Ophthalmol
2018;136:303
9. https://www.myopiaprofile.com