Understanding Myopia Control for Optometrists

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Myopia, or nearsightedness, is a growing concern with increasing prevalence, especially among younger populations in Asia. Genetics, environmental factors like prolonged digital device use, and lack of outdoor activities contribute to its development. Controlling myopia is crucial to prevent risks like myopic maculopathy, retinal detachments, and cataracts. Various treatment options such as orthokeratology and low-dose atropine are available. Optometrists play a key role in managing myopia through proper diagnosis, monitoring, and treatment.

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Myopia Control for the Primary Care Optometrist Dr. Nidhi Rana MS, OD, FAAO Wills Eye Hospital/ University Children Eye Center

No financial disclosures Email: drnidhirana@yahoo.com Cell: 856-981-0778

7yo F 2019: -1.00sph 2020: -2.50sph

Myopia Distance images are focus in front of the retina Mismatch happens increased axial length of the eye Normal process of emmetropization Match length of the eye with the power of its optical contents When lengthening of the eye occurs beyond emmetropization myopia

Myopia Classification based on degree of myopia Low myopia: < 3D Moderate myopia: 3-6D High myopia: > 6D

Myopia Myopia is becoming epidemic Prevalence: increasing Younger population (80 -90%): south/ south east asia

Myopia Causes Genetics (10%) Environmental Schooling/ ipad/ TV time Decreased time outdoors Increased near work Ethnicity Asians

Myopia Control Why control myopia ? Higher myopia risks Myopic maculopathy Retinal detachments Increased risk for POAG (50%) Increased risk for early onset cataracts (17%)

Myopia Currently 1/3rdworld s population has myopia Heading to world s population by 2050

Myopia Control Treatment Options Bifocals/ progressive lenses Orthokeratology ATOM Low dose atropine Misight contact lenses

Clinical Pearl Aim to NOT overmius or underminus myopia Cycloplegic exams in younger children

Myopia Control Orthokeratology Reshaping the cornea Mehcanism Decreasing peripheral hyperopic defocus Changes aberration profiles Accommodation/ convergence dynamics Axial length monitored for success rate

Orthokeratology Pros Cons Expensive $$$ RGP lens motivation Risks Infectious keratitis Endothelial changes Microvascular complications Done at night No glasses in daytime Works on high myopia

MiSight Contact Lens Peripheral hyperopic blur increases myopia Paracentral add power Changes peripheral defocus to myopia

MiSight Contact Lenses Pros Cons Expensive $$ Risks Infectious keratitis Soft contact lens Worn in daytime Can slow down progression Relatively new

Orthokeratology vs Misight lenses Orthokeratology RGP lens Overnight wear Expensive $$$ Risk Infectious keratitis MiSight lenses Soft contact lens Daytime wear Expensive $$ Risk Infectious keratitis

ATOM Low dose Atropine for the treatment of myopia Pharmacological agent Non selective muscarinic antagonist Doses 0.01%, 0.02%, 0.05%

Low Dose Atropine Pros Cons Once per night easy dosage Can slow down progression Pt prefer over CL Not much side effects Pharmacological agent Expensive $$

Myopia Control How to determine progression Axial length changes Dioptric changes Progression of myopia 6-9yo 0.75D/ yr Axial length 0.32mm/ yr 10-13yo 0.50D / yr Axial length 0.19mm/ yr