CLM - Non-Surgical Management of Myopia I - Week 7

Question 1

Define myopia control.

Answer 1

Various methods aimed at slowing or arrestng the progression of myopia

Question 2

List two categories for optical strategies for myopia control and for each, list 4 items.

Answer 2

Spectacles
-under-correction
-bifocals
-progressive addition lenses
-monovision, peripheral aberration control
Contact lenses
-SCLs
-RGPs
-Dual-focus/bifocals
-orthokeratology

Question 3

Aside from optical and pharmacological strategies, list two other means of myopia control.

Answer 3

Refractive surgery

Outdoor activity

Question 4

List two pharmacological strategies for myopia control.

Answer 4

Atropine

Selective muscarinic antagonists

Question 5

What is meant by under-correction and detail the proposed mechanism by which it is a myopia control strategy.

Answer 5

Under-correction of the full distance refraction
Proposed mechanism
-induction of myopic defocus at distance
-reduction in accommodative response for near vision

Question 6

Is there any therapeutic benefit to spectacle under-correction for myopia control? Consider that under-correction would be mainly for children, what impact might this have?

Answer 6

No therapeutic benefit of under-correction, with the possibility of enhanced myopic progression
Under-correction produces blur, impacting learning of children
Under-correction for myopic control is therefore not indicated

Question 7

What is the rationale of using near addition spectacles for myopia control?

Answer 7

Reducing the accommodative demand at near to reduce myopic progression

Question 8

What do myopic children tend to show regarding their accommodative response to near objects what what may this be associated with (2)?

Answer 8

Reduced accommodative response to near objects, which may be associated with retinal blur and aberrant ocular growth

Question 9

List 4 benefits of near addition spectacles.

Answer 9

Decreases accommodative demand at near
Reduces accommodative lag
Reduces near blur
Increased benefit depending on phoria

Question 10

Children with what kind of accommodative dysfunction and phoria may benefit most from PALs for myopia control? What do these findings support a role for increased retinal blur?

Answer 10

Near esophores (>2^D) with significant accommodative lag (>0.4D)
These findings partially support a role for increased retinal blur causing myopic progression

Question 11

Do PALs/BFs have any clinically significant effect in slowing down myopic progression compared with SVLs?

Answer 11

Possibly a small effect, but unknown if this is clinically significant

Question 12

What is the reasoning behind using monovision for myopia control? What does it compromise?

Answer 12

Reduces accommodative effort during near work, potentially slowing myopic progression
Does compromise binocular vision however

Question 13

Consider children fitted with monovision correction for myopic control. How does each eye accommodate to read? What effect does this have on each eye (2)? How does this affect myopic progression? Can any change be noted on axial length?

Answer 13

All children accommodated to read with the distance corrected eye
The near corrected eye experienced myopic defocus at all levels of accommodation
Myopic progression in the near corrected eye was significantly less
Corresponding degree of reduced axial length was found

Question 14

How does monovision correction compare with under-correction in both eyes?

Answer 14

Under-correction in one eye has a different effect (myopia control) to under-correction in both eyes (no effect to possible enhanced myopic progression)

Question 15

Do SVD soft contact lenses significantly alter myopic progression when compared with SVD spectacles?

Answer 15

No, neither enhanced nor inhibited progression

Question 16

Do SVD RGP contact lenses significantly alter myopic progression when compared with SVD spectacles?

Answer 16

No, neither enhanced nor inhibited progression