Myopia

Control
Overview
Myopia
Control
• Myopia Control or Myopia
Management is the area of
children’s eye care dedicated to
slowing down childhood Myopia
Progression
• Myopia control is more and more
popular worldwide.
• Research across globe increases in
this topic and more money is
invested in treatment options for
children with progressive Myopia
Myopia
Control
• Myopia is fast becoming a
Global Epidermic
• Myopia in Children needs
to be treated as early as
possible(ASAP) to reduce
the progression of Short-
Sightedness in these
Children.
• Myopia was Considered to
be a refractive error.
Myopia
Control
• Myopia was Considered to be a refractive
error.
• Myopia may cause functional blindness if
severe.
• Its is important to Screen Children’s Vision
before they go to school.
• Children often didn’t realize what they are
experiencing is abnormal
• We need to be very cognizant of myopia in
children and pay attention to them in all
activities –In classroom or task require them
for good distance vision such as Watching TV
or playing Computer game at distance
• Now Myopia is defined as a disease or a risk
factor for disease .
Myopia Control
Types of Myopia
• Pathologic Myopia:
- < 6 years
- Associated with abnormal and extreme Elongation of
the Axial Length of the eye
- This Extreme elongation of the eye outside normal
Limits which increases Higher risk for cataracts by
3times, Myopic Macular Degeneration, Retinal holes
and tears by 8 times and Glaucoma by Humongous 18
times
Types of Myopia
• School-Age Myopia:
- Between 6-18 years and only stabilizes in age -
Eighteens or early Twenties
- Commonly Associated with Higher IQ scores, Extra time
reading and reduced exposure to sunlight compared to
Non-Myopic patients
- Common in Urban and Industrialized Countries
Types of Myopia
• Adult-Onset Myopia:
- 20-40 years
- Associated with Accommodation Anomalies and near-
vision-dominated Occupation. Eg- Charted Accountant,
Program coders
Myopia Control Measures
• Myopia Control measures typically are prescribed by Eye care professional (an
Optometrist or an Ophthalmologist).
• The allowed practice scope of Optometrist is may vary across the world and in different
region.
• However often this condition(Myopia Control measures ) In most of the world, Primarily
is managed by Optometrist
• Across variety of studies and some years of research on this topic Four primary
categories of Myopia control treatments have been defined and Identified .
Myopia Control Treatment
• Myopia Control Treatment Options:

- Pharmacological Eye drops (i.e., Atropine eye drops)

- Multifocal Soft Contact Lenses
- Multifocal Eye-glasses
- Orthokeratology (Ortho-K)
Myopia Control Treatment
• Why is Myopia control Important?

-May Help reduce the risk of Vision-threatening

Complications associated with high myopia later in life
Prevalence of Myopia
Risk Factors for
Developing High Myopia
• Race, Gender and Genetics- Study's
have shown that the Prevalence of
Myopia in children are Higher in Urban
area
• – > Chinese ethnicity (especially East
and Southeast Asia).
• – > Girls- No Basic difference related
to gender as been found however
more recent study’s reports more
Myopia in girls
Risk Factors for
Developing High Myopia
• Parents with Myopia-Parents with
Myopia may increase child risk of
developing Myopia. Possible reasons
for this may be Myopic parents passing
on Myopic genic Life style, in addition
to share genes. Some cohort studies
also found that their may be
association between Myopia and birth
order with first born children tending
to be more myopic.
–Increased Myopia genic Lifestyle .
–More first born children tend to be
myopia
Risk Factors for
Developing High Myopia
• Environment- The children from urban
environment possibly 2 times more likely
to develop myopia as compared to
develop in rural environment, Highly
population density with constriction
living space and Housing type living in
Apartments seem to be associated with
increased likelihood of myopia in
children.
• > 2X more in urban environments
compared to Rural environments
• > High Population density, small living
spaces- In Apartments.
Risk Factors for
Developing High Myopia
• Time Performing Near Work- It shown
as risk factor for developing myopia
numerous study have accessed the
relevance of this risk factor as well as
relationship between near work and
Myopia and 27 such studies found
• >2% increased chance of developing
myopia with every hour of near work
time per week.
Risk Factors for
Developing High Myopia
• Time Spent Outdoors- Research shown
greater time outdoors is associated
with reduce risk of Myopia from age of
3 onward furthermore if additional
time spent in outdoors from ages 3 to
9 are reduced incidence of Myopia
noted between ages 10 to 15 years.
• Greater Time Outdoors = Reduce Risk
of Myopia
Time Spent Outdoors
• Time Spent Outdoors may Reduce the Risk of Myopia- This specific mechanism of why time outdoors
reduces the Risk of developing Myopia is not 100% certain however few theories are formulated .
• Theories Formulated by Different Researchers:
• Actual Light Exposure decreases the incidence of Myopia .
• Exercise may be protective to Increasing Myopia.
• Direct Light exposure releases Vitamin D- that may play role inhibiting eye growth and onset of Myopia
• Light is Brighter outdoors and slows abnormal eye growth-because bright outdoor lights stimulates the
release of Dopamine from Specialized cells in the retina and dopamine then initiates molecular
signalling in cascade that concludes with normal eye growth without development of myopia.
• Pupil Constriction in brighter light may result in a greater depth of focus.
However combination all these factors may play a role in assisting in the reduction Myopia progression
Causes of Myopia
1. Eye is too along (Axial Length):
-Average roughly 23mm
-High Myopia is 26mm or Longer

2. Eye with a high refractive Power

Spectacles or Contact Lenses for these patients is a -
3.00Ds
Association of Axial Length Risk
of Uncorrectable Visual
Impairment
• A study was conducted on 15693 Axial Eye Odds Ratio of Visual Prevalence of
Individuals in the Netherland Length Impairment by Age Visual
60 Impairment
• The Longer the axial length of the eye, By Age 75
the higher the odds and prevalence of 24-26mm 1 4%
Visual Impairment at a higher age.
26-28mm 2 25%
• Myopia will become the most
28-30mm 11 27%
important cause of Blindness
>30mm 25 90%
 Myopia Control Measures

Four Primary Categories of Myopia Control

Treatment:

Myopia 1.Pharmacological Eye Drops . Eg- Atropine eye

drops.

Treatment 2.Multifocal Soft Contact Lenses

Options 3.Multifocal Eye Glasses

4.Orthokeratology (Ortho-K)
Uncorrected Myopia and
Myopia Correction Methods

• Uncorrected Myopia:
1.In uncorrected myopia, light comes to
a focus in front of the retina, causing
blurry distance vision
2.Relative Hyperopic defocus-less
myopia in the periphery than in the
central retina
3. Relative Hyperopic defocus is linked to
an increased risk of Progressive Myopia
4.Not wearing distance correction can
accelerate sight deterioration
Uncorrected Myopia and
Myopia Correction Methods

• Traditional Myopia Correction

1.Uses traditional spectacle lenses or
contact lenses
2.Worsen the Hyperopic defocus in the
peripheral retina
3.Causes Focus of rays behind the retina
(Peripheral hyperopic defocus)
- Increase the risk factor for progressive
myopia Contact Lenses
- Stimulates the eye to grow causing
elongation of the eye
 Uncorrected Myopia and Myopia Correction Methods

• Optimal Myopic Correction

The Goal is to focus light rays in
front of the retina-Peripheral
Myopic Defocus

-Encourages retina to stabilize and not

elongate
-Allows to control axial elongation
Uncorrected Myopia and Myopia Correction
Methods
Peripheral Myopia, also known Peripheral Myopic Defocus refers to peripheral light rays
that is focused in front of the retina. Optimal Myopia correction uses Ortho-K overnight
corneal reshaping technology and special ”dual-focus“ contact lenses that fully correct
central myopia to give clear vision as well as move the peripheral focal point of the eye
forward.
Optimal myopia correction is when extra plus in the prescription of the lens causes the
peripheral light rays beyond the macular region, to focus in front of the retinal plane, thus
causing myopia defocus. This extra plus power in the correction and myopic blur
encourages the retina to stabilize and not elongate, and therefore the axial elongation can
be controlled, and the growth is halted. The latest myopia research indicates that the
modification of peripheral light rays reduces the progression of myopia
Treatment Regimens
for Myopia Control
• Three Most common Treatment
Regimens

- Atropine Eye Drops

- Multifocal Soft Contact Lenses
- Orthokeratology
Atropine Eye Drops
• Atropine Eye Drops:
Uses:
-Reduce the pain associated with certain types of eye inflammation
-Causes dilation of the pupil
-Temporarily limits the eye’s ability to accommodate
- Causes up to a 50% reduction in myopia regression

Mechanism:
-The mechanism is not clearly understood
-Might be a chemical reaction at the retinal level or the effect atropine
has on accommodation
Atropine Eye Drops
• Atropine Eye Drops
Concentrations:
-Duff et al. found that higher concentrations(1%) may have
similar effect to that of lower concentrations
-0.1% showed to have up to 90% efficacy
-0.01% has less side effects and less myopia control, however
results were statistically insignificant.
-Lamp et al shows 0.05% compound might be the drug of
choice
Atropine Eye Drops
• Uses
• Reduces the pain associated with certain types of eye inflammation
• Causes dilation of the pupil
• Temporarily limits the eye’s ability to accommodate
• Causes up to a 50% reduction in myopia progression

• Mechanism
• The mechanism is not clearly understood
• Might be a chemical reaction at the retinal level or the effect atropine
has on accommodation
Soft Center
Distance
Multifocal
Contact
Lenses
Soft Center
Distance
Multifocal
Contact
Lenses
Soft Center
Distance
Multifocal
Contact
Lenses
Fitting a Multifocal Contact Lens
for Myopia Management

• Maximum +2.50 D of add power in

astigmatism.
• In case of central blur, add strain, or
discomfort, eye more minus to
spherical power of the lens (IF THE
REFRACTION ALLOWS).
• Too much power, may also cause
headache and that these lenses will
take a few weeks to adapt.
• Pupil Size are important- Bigger pupils
will improve results for distance vision.
Myopia Control Contact Lenses-Misight 1 Day
Myopia Control Contact
Lenses-Misight 1 Day
• MiSight 1 Day: Messaging and Specs
• Easy to fit and use
• Corrects refractive error and slows the
progression of myopia
• Suitable for children as young as 8
• Over three years, MiSight reduced
myopia progression by 59%
“59% reduction in myopia progression
over three years and a -0.73D change in
spherical equivalent”.
Myopia Control Contact Lenses-Misight 1 Day
Orthokeratology

• Why is Ortho-K not more popular as a treatment

regime for myopia?
• Complex fitting and time consuming
• Expensive
• Initial comfort is not problematic
• Benefits:
• Highly successful for individuals with <5.00 DS and <-
2.00 DC (With the Rule (WTR) corneal astigmatism, and
medium progression size
• Slows down the progression of myopia
• Lens design with a reverse peripheral curve
• Retain parental/midperipheral curve as a treatment
that creates a myopic defocus
• Reduction of myopia may be up to 45%
Orthokeratology
Myopia Control
Overview
• Two main causes of Myopia are long
axial length and High refractive power
of the eye.
• The longer the axial length of the eye,
the higher the odds ratio and
prevalence of visual impairment at a
higher age
Myopia Treatment
Options
• Atropine eye drops reduce the pain associated with
certain types of eye inflammation for example uveitis.
Atropine may cause up to a 50% reduction in myopia
progression.
• The Axial Length Soft Multifocal lenses may reduce up
to 55% of center distance elongation.
• In Center Distance Soft Multifocal lenses, the distance
script is perfectly focused on the macular portion of the
retinal plane.
• The MiSight® 1 Day with ActivControl™ Technology
helps fully correct the elongation and myopia
progression, while slow the MiSight® 1 Day contact
lenses reduce the risk of myopia-related vision loss.
• Orthokeratology lens design with a reverse curve or a
related paracentral/midperipheral steepening changes
a myopic defocus.
THANK YOU