Last updated: 27/04/20

 Incomprehensive summary of the Optometry Australia webinar "Myopia Management - Kids, Contacts and the Visual Environment" by Kate Gifford.

 For a full recording of the webinar and referenced studies, go to: 
https://lms.optometry.org.au/course/view.php?id=97

 For further myopia control resources such as clinical decision trees and what to advise parents, go to: https://www.myopiaprofile.com/

 Treatment options
1. Spectacle lenses - PALs, BFs, DIMS
2. Contact lenses - BF, MF
3. Specialty CL - OrthoK
4. Atropine
+ behavioural modification (outdoor time, near work & screen time)

 Spectacle lenses
Options: PALs (Progressive addition lenses), BFs (Bifocals), DIMS (defocus incorporated multiple segment) lenses
% reduction in progression per year: 
  • ~1/3 for PALs, BFs 
    • e.g. Zeiss MyoVision, Essilor MyopiLux
  • ~1/2 for DIMS
    • e.g. Hoya MyoSmart
Do single-vision modalities work?
- There is no evidence to show that single vision lenses can slow myopia progression effectively

 Contact lenses
Options: MFs (multifocals), BFs
% reduction in progression per year: 
  • ~1/2 for both MFs and BFs
    • e.g. Visioneering NaturalVue MF with single high add
    • e.g. Mark'ennovy' Mylo EDOF design
    • e.g. Coopervision MiSight dual-focus lens with +2.00 add zones
    • e.g. Coopervision D centre lens multifocal with +1.00, +1.50, +2.00 and +2.50 adds
Are toric designs available?
- Yes e.g. Coopervision Proclear MF Toric and Mard'ennovy Saphir Rx MF Toric

OrthoK
% reduction in progression per year: ~1/2

 Atropine
% reduction in progression per year: ~1/3 to 1/2
  • 12% for 0.01%
  • 29% for 0.025%
  • 51% for 0.05%

What about axial length measurements?
  • Atropine's effect depends on concentration used in treatment
    • 0.01%: 0.05mm/yr
    • 0.025%: 0.12mm/yr
    • 0.05%: 0.21mm/yr
  • DIMS lenses show evidence control of axial length progression
    • DIMS: 0.16mm/yr
  • OrthoK and SCL options (e.g. MiSight, Mylo) are control axial length to a similar extent 
    • OrthoK: 0.13mm/yr
    • SCL: 0.11mm/yr
  • BF spectacle lenses have a lesser effect, but still shows control over axial length progression
    • MyopiLux: 0.10mm/yr
  • PALs do not show significant control over axial length progression 

 What treatment option is the best?
Comparing PAL/BF spectacles, OrthoK/MF CLs, and low dose atropine (0.05% or less), they all have similar efficacy for myopia control.
The chosen treatment option depends on what is available at your practice, what suits the child (and whether they respond to treatment), presence of any binocular vision or other complexities that may affect consideration of CL wear.

 Does behaviour influence risk of myopia progression?
  • Outdoor time (>90 mins/day) shown to help prevent onset and progression of myopia
    • Related to the brightness of the environment, where even sitting in the shade outdoors gives much brighter conditions than sitting near a window indoors
    • Based on stimulating retinal dopamine or providing greater dioptric field of view to the retina for less hyperopic defocus
  • Being outdoors is more important than levels of physical activity, but >60min/day of physical activity is still recommended for children aged 5-17, and 180 mins/day for children aged 1-5
  • There is conjecture about the role of near work in myopia onset vs progression
    • Close reading distance <20cm and duration >45min increases myopia odds by 2%
    • Smartphones tend to be held closer (e.g. <30cm in one study, and half time at 15-20cm)
      • Short term viewing at 16cm increases axial length in young adults
  • Government advice for screen time:
    • Under 2 years: no screen time
    • Ages 2-5: Maximum 1 hour screen time/day, for educational purposes

 What to advise parents:
  • At least 90 mins/day of outdoor play
  • Outdoor time is key, not activity, but >60mins/day of active play
  • >20cm working distance for <45mins near work, <2 hours screen time and don't sit for too long