Spring 2017

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24 CLSA EyeWitness Spring 2017 thalmology participated in a panel dis- cussion. This was the first meeting of its kind where the rise in myopia prev- alence was acknowledged. A healthy discussion followed on the possibility of a future medical device, in this case a soft contact lens, aimed specifically at slowing the progression of myopia. It was concluded that a series of trials and assessments need to be execut- ed before we see an approved device based on regulatory requirements. However, what is important is that steps in the right direction have been taken at the public health level. Regardless of the type of contact lens used to control the progression of myopia, practitioners should proceed with some level of caution. The aca- demic evidence is strong but informed consent of any treatment plan should be acquired before carrying out these types of contact lens fits on any patient. II. Kids and Sports Children today are involved in a vari- ety of extracurricular activities and organized sports. The details of these activities should be discovered in the patient history. For children who par- ring design have been shown to slow the development of myopia as well as axial elongation of the eye, and can be potentially as effectively as orthokera- tology lenses. The same ideal pediatric candidates for orthokeratology extends to those who can be fit with a soft con- tact lens option. While no specific ADD power has been reported as most effec- tive, previous studies have used ADD powers of +2.00D and +2.50D 9,10 to achieve the desired mid-peripheral defo- cus on the retina. It is reported that the higher the ADD power, the greater the effect in slowing the progression of my- opia. The conundrum here for practi- tioners is that most stock multifocal lens- es are available up to +2.50D and fitting children with higher ADD power would warrant custom contact lens design op- tions. More research is needed to not only determine what the optimal ADD power should be, but also to determine the potential long-term effects on the binocular system of a child who wears multifocal lenses on a regular basis. In September 2016, a meeting was held at the FDA headquarters in Silver Spring, MD. At this meeting, spokes- persons from both optometry and oph- presented to both parent and child to determine the child's interests in the regimen and future likelihood of com- pliance. In addition to refractive error, a thorough assessment of anterior and posterior ocular health should be per- formed and a baseline topography ob- tained. Tips to improve your chances of success during the first fitting visit include taking the time to describe the necessary steps in the process, instilling a drop of topical anesthetic in-office to the patent's cornea (if applicable based on supervision) to decrease the degree of discomfort associated with initial lens wear, and having a designated area where a child can comfortably practice insertion and removal of contact lens- es. In some instances, the responsibility will be on the parent to ensure lenses are properly handled and cared for. b. Multifocal Soft Contact Lenses These lenses are no longer reserved for your presbyopic patients only. The optics of a simultaneous design center-distance (near peripheral lens) has been shown to provide sustained myopic defocus on the retina outside the fovea 8 . Studies utilizing a center-distance concentric

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