Spring 2017

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I t is important to discuss myopia management with your patient's parents as soon as the child is diagnosed as myopic. Ideally, these children should be beginning whichever treatment option you choose by or before age 12. Methods of treatment Currently, we have a number of methods that are being utilized to slow the progression of myopia with varying rates of success. None of these treatment options are approved by the FDA for a myopia control indication. Lifestyle changes in children who had increased participation in outside activities exhibited a reduction in myopia progression. Studies have shown the more near work children perform, the more likely they are to become nearsighted. Atropine has been shown to slow progression of myopia to the highest level in several studies. Low doses of 0.01% Atropine can reduce the side effects yet slow axial length to a reasonable level. However, side effects associated with its use, such as photophobia, glare, and overall discomfort may limit its clinical use on younger myopic patients as a form of treatment. Bifocal spectacles have been a staple for managing myopia in the past. However, recent studies have shown them to be less than 20% effective in preventing myopia progression. Gas permeable lenses, like spectacles, were thought to be an effective option, but have been found to increase the progression of myopia when compared to bifocal spectacles. Soft multifocal lenses for daily wear have been shown to slow the progression of myopia by offering peripheral defocus on the retina. Soft lens researchers are seeking new designs that allow for higher rates of efficacy. Orthokeratology (Ortho-K) has been the most effective non-pharmacological method to allow peripheral defocus to retard the eye growth. Recent studies have shown that the long term use of the lenses can reduce the myopic change by as much as 50%. Careful instruction of both parents and children about what is to be expected with lens wear, including comfort Consultant's Perspective Paragon Vision Sciences manufactures Paragon CRT lenses and GP materials. Susan, Terry and Barbara provide consultation assistance for fitters in need of assistance with their patients. Together they have a combined contact lens fitting experience of over 60 years. Ortho-K Fitting Pearls By Terry James, NCLE, Susan Faul COA, NCLE, Barbara Ehlers COA upon application, signs and symptoms of problems, and after-hours contact information is vital to minimize the chances of a lens causing serious problems. Written directions and instructions, as well as informed consent, are highly recommended for all orthokeratology lens wearers. Offering Ortho-K The designs offered today have slight variations but all will work nicely if certain criteria for patient selection are adhered. Candidates that will have the most success are patients with an Rx under -4.00D and flat-K readings between 42.00D and 45.00D. Patients with higher levels of myopia will require a longer treatment period to reach the goal of correcting the refractive error, and there is a higher chance of inducing central corneal staining. When trying to troubleshoot a potential problem, fitting consultants are an excellent resource. When contacting consultation, have as much patient information as possible, including: • Refraction and K's (with pre-treatment maps, both axial and elevation) • Patient's HVID (especially important for your very young patients) • Pupil size in normal illumination • Topography history (tangential and difference maps) • Refraction over the lenses • Post wear refraction • Photos/video of the lenses on eye The more pre- and post-treatment information that can be offered, the easier it is for the consultant to offer the advice to correct the problem. From a consultant's perspective, it is very difficult to troubleshoot a fitting with only partial data. EW 8 CLSA EyeWitness Spring 2017

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