The document outlines various strategies for myopia control, a corrective approach for nearsightedness that is increasingly prevalent, especially among children. It discusses clinical guidelines for initiating myopia management, including optical technologies like traditional spectacles, next-generation spectacles, multifocal soft contact lenses, and orthokeratology. The document emphasizes the importance of early intervention and tailored solutions based on individual patient needs to slow down the progression of myopia.

1. Myopia Control Strategies
Riton Deb, B.Optom, MSc, Fellow(LVPEI)
Consultant Optometrist
Contact: riton.optom@gmail.com
+88 01822920611

2. Disclaimer
• No financial disclosure
• Company or brand names mentioned in this
presentation is only for information purpose

3. Introduction
Myopia, or nearsightedness is a common eye
condition that causes distant objects to appear
blurry while close-up objects remain clear.
American Academy of Ophthalmology(AAO):
• Low: < 3.00 D
• Moderate : 3.00-6.00 Ds
• High: > 6.00 DS

4. PREVALENCE
According to recent studies, myopia is becoming increasingly
prevalent in the population, particularly among children and young
adult.
5 billion people- Myopia- (50% of total population) and
1 billion people – High Myopia (10% of total population) by 2050.
Holden BA, Fricke TR, Wilson DA et al. Global prevalance of myopia and high myopia and temporal trends from 2000 through 2050. Ophthalmology. 2016 ; 123 (5):1036-1042

5. Risk factor for severe eye disorders
• Permanent vision loss if left untreated
Adopted from Flitcroft DI, The complex interactions of retinal optical and environmental factors in myopia aetiology. Prog Retin Eye Res. 2012.

6. Myopia Management

7. Myopia Management

8. Myopia Control- Concept

9. When to start myopia control ?
As a rule of thumb, we should begin discussing myopia control
as an optio
• If the patient’s progression is >0.50 D a year
• Early onset- Early treatment, especially if parents highly
myopic.
dopted from K Zadnik, The Collaborative Longitudinal Evaluation of Ethnicity and Refractive Error (CLEERE) Study, 2015.

10. Clinical Examination- SOP by IMI
• History taking
• Visual Acuity
• Refraction (Cycloplegic)
• Binocular vision assessment
• Pupillary examination- photopic & mesopic
condition
• Ocular health assessment- SLE / IOP measurement
• Fundus evaluation
• Corneal topography
• A-scan (Axial length measurement)

11. Exclude from Myopia control strategy
• Congenital Myopia
• Pathological Myopia
• Degenerative Myopia
• Positional Myopia
• Index Myopia
• Corneal irregularity
• Accommodative spasm
• Myopia associated with any other eye diseases

12. Myopia Control with optical tech.
• Traditional Spectacles
• Next Generation Spectacles
• Multifocal / multifocal-like Soft Contact Lenses
• EDOF Contact Lenses
• Orthokeratology

13. Traditional Spectacles
• Different types available
• D Bifocal/ Executive Bifocal
• Progressive addition lenses (PALs)
• Addition of +2.00 D with distant correction
• This can help to reduce the strain on the eyes when
focusing on nearby objects, thereby decreases
progression of Myopia.

14. Next Generation Spectacles
• Also Called Peripheral defocus lenses
• A type of spectacle lens design to reduce the
progression of Myopia in Children.
• These lenses work by creating myopic defocus on
the retinal periphery.
• DIMS, HALT, CARE & DOT

15. D.I.M.S Technology
Defocus Incorporated Multiple Segments
•Consists of central zone (9 mm diameter)
• Honey-comb like multiple segments of lenslets with + 3.50D adds
• Almost 400 multiple defocus segments (33 mm diameter)
• Miyosmart from Hoya. Power : Upto -10.00D, Cyl -4.00 D and 3△
• Slow down the progression of myopia by on average of 60%

16. H.A.L.T Technology
Highly Aspherical Lenslets Target
• 11 rings of 1021 contiguous(touching) aspherical lenslets
(1.12 mm in dia) generate a Volume of Myopic Defocus (VoMD)
• Central clear zone of 9 mm
• Central area of the lens without lenslets and the areas in
between the rings of lenslets provides distance correction.
• Stellest from Essilor, Power:upto -10.00 D, Cyl-4.00D, 2 △
• Myopia control efficacy 60%

17. C.A.R.E Technology
Cylindrical Annular Refractive Elements
• A central zone small enough to establish an effective
functional zone projecting myopic defocus on the near
periphery close to the fovea.
• Zeiss Myocare and Myocare S
• Efficacy 86% for children aged 10-12 years and 63% for
children aged 7-9 years

18. D.O.T Technology
Diffusion Optics Technology
CONTRAST THEORY FOR MYOPIA:
• Overstimulation of the retina from
high contrast is associated with
overstimulation of eye growth, thus
instigating myopia progression.
・5 mm central zone
・Surrounded by thousand of microdots.
・ SightGlass vision from cooper vision
・DOT lens slightly reduces retinal contrast by scattering light- slow the
myopia progression by 59%

19. Options for Myopia Control with CL
• Multifocal soft contact lenses (MFSCLs)
• Specially designed soft contact lenses for myopia control
•
•

20. MFSCLs
• Soft contact lenses are increasingly used as a
myopia management option
• There is solid scientific evidence of successful
myopia control with centre distance multifocal
contact lenses
• Addition power ranging from +1.50 to + 2.50D
(Majority + 2.00D)
• Advised for children 8 years and older
• A daily disposable modality is recommended
• Power available up to -12.00D
• Misight 1 day - multifocal like contact lens( –6.00D)

21. EDOF Contact Lenses
• Extended depth of focus multifocal lens design that
has centre distance optics with add power placed
immediately next to the central distance zone.
• This creates a blurr zone at the peripheral retina
• Greater stereopsis and enhanced depth perception
can be achieved with the lens.
• Seed 1 day pure EDOF
(Daily disposable)
Power range: up to -12.00D
Add: + 0.75D, +1.50D,+2.25D

22. Orthokeratology
Ortho – straight; Kerato – cornea; logy – knowledge.
AAO : Orthokeratology is the use of specially designed
and fitted contact lenses to temporarily reshape the
cornea to improve vision.

23. Ortho-K, OK
• George Jessen in 1960 first attempted to
deliberately change refractive myopic error with
rigid PMMA contact lens using a technique he
named ‘orthofocus’.
• Ortho-k is FDA approved for overnight wear and
indicated for the correction of myopia and
astigmatism in patients of all ages.
• Corneal Refracive Therapy (CRT)
• Vision Shaping Treatment (VST)
• Breath-o-correct
-All are made from high DK materials

24. Ortho-K Design
• Reverse geometry gas permeable lens
• Flatten central cornea to correct for Myopia
• Mid-peripheral steepening-
Creates peripheral myopic defocus
• Alignment curve- stability of lens
• Peripheral curve-Edge lift

25. How it works
1 D reduction= 4-6 micron flattening

26. Indications
• Eyes with a clear cornea that have no history of surgery (No
irregular cornea)
• Myopia from -1.00 Diopter to – 8.00 Diopter
• With-the-rule astigmatisms of up to -1.75 D and against-
the-rule astigmatisms of up to- 0.75D
• Age from 6 years and above.
• Highly motivatted patients
• Can afford cost
• Anyone who wants to be free of spectacles and contact
lenses during the day and falls on the specified correction
power.
• Multifocal Soft contact lens failures
Occupational Applications:
• Airline Pilots
• Military
• Firemen/Police
• Bus /Truck Drivers

27. Contraindications
• Irregular corneas (keratoconus, corneal scar, PMD)
-Corneal Dystrophies and degenerations
• Nystagmus
• Glaucoma
• Ocular inflammation and infection
• High Myopia > – 8.00D, Astigmatism > 1.75 D
• Large Pupils > 6.00 mm
• Severe allergic conjunctivitis
• Severe dry eye disease
• Sleep deprived patients
• Any previous ocular refractive surgery

28. Baseline Data
• Patient’s history
• Visual acuity and Refraction (Cycloplegic)
• Binocular vision evaluation
• Slit lamp examination
• Measurement of corneal HVID
• Pupil size measurement
• Baseline corneal topography
• Baseline A-scan
• Discussion of patient motivation and expectation

29. Fitting Philosophy
Trial lens selection:
• FT- Fitting Curve (alignment curve)
• T.P- Target Power
• B.C- Base Curve
• P- Power
• S- Size/ Diameter
• FT =Average K reading
• TP= Spectacle power (Spherical+Cylinder)
• BC= TP- Jessen factor/compression factor (+0.75)
(42.50-4.25)=38.25 → 337.5/38.25= 8.82

30. IDEAL FIT
To achieve Bull’s eye pattern

31. FLAT FIT
• Smiley face
• Superior decentration

32. STEEP FIT
• Frowney face
• Inferior decentratiom

33. Fitting Philosophy

34. Myopia Control Studies Summary
(reduction in axial elongation)

35. Online software for prediction
Brien Holden Vision Institute (BHVI) Myopia Calculator
https://bhvi.org/myopia-calculator-resources/

36. THANK YOU