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contact lens > MYOPIA > Flashcards

MYOPIA Flashcards

1
Q

They are estimating that by 2050, Myopia will affect ____of the population.

A

50%

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2
Q

axial, benign, component, correlational, curvature, index, lenticular,
physiologic, physiological, refractive, school, simple, syndromic

A

Presumed Etiology

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3
Q

childhood, congenital, acquired, juvenile onset, youth-onset, school, adult,
early adult onset, late adult onset

A

Age of Onset

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4
Q

Progression Pattern
(pattern wherein the amount of myopia progresses)

A

permanently progressive, progressive, progressive high, progressive high
degenerative, stationary, temporarily progressive

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5
Q

Amount of Myopia

A

low, medium, intermediate, moderate, high, pathologic, pathological, physiologic, physiological, severe, simple

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6
Q

Structural Complications

A

degenerative, degenerative high, malignant, pathologic, pathological,
pernicious, progressive, progressive high, progressive high degenerative

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7
Q
  • Myopia: S.E. refraction S -0.50 D when ocular accommodation is relaxed.
  • High Myopia: S.E. refraction $-6.00 D when ocular accommodation is relaxed.
A

IMI (International Myopia institute) Recommended definitions:
Consensus and evidence-based thresholds for low myopia and high myopia

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8
Q

Excessive axial elongation associatedwith myopia leads to structural changes in the posterior segment of the eye (including posterior staphyloma, myopic maculopathy and high myopia-associated optic neuropathy) and that can lead to loss of best correct visual acuity

A

Pathologic myopia

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9
Q

Excessive axial elongation associated with progressive myopia that can cause structural changes in the posterior segment of the eye.

A

Pathologic

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10
Q

A refractive error in which rays of light
entering the eye parallel to the optic axis are brought to a focus in front of the retina when ocular accommodation is relaxed. This usually results from the
eyeball being too long from front to back, but can be caused by an overly curved cornea and/or a lens with increased optical power. It also is called nearsightedness.

A

Myopia

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11
Q

A myopic refractive state
iv estate primarily resulting
from a greater than normal axial length.

A

axial myopia

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12
Q

A myopic refractive state that can be
attributed to changes in the structure or location of the image forming structures of the eye, i.e. the cornea and lens.

A

Refractive Myopia

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13
Q

A myopic refractive state for which a single, specific cause (e.g., drug, corneal disease or systemic clinical syndrome) can be identified that is not a recognized population risk factor for myopia development.

A

Secondary Myopia

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14
Q

“A refractive state of an eye of $ +0.75 D and > -0.50 D in children where a combination of baseline refraction, age, and other quantifiable risk factors provide a sufficient likelihood of the future development of myopia to merit preventative interventions.”

A

Pre-myopia

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15
Q

in _______ definition, hyperopia amount is included because it is the stage where children goes thru “premyopia” period. Eventually, they will lose that hyperopia refracrtion and gain myopia as they grow older.

A

Pre-myopia

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16
Q

Excessive axial elongation associated with myopia that leads to structural changes in the posterior segment of the eye (including posterior staphyloma, myopic maculopathy, and high myopia associated optic neuropathy) and that can lead to loss of best-corrected visual acuity.

A

Pathologic Myopia

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17
Q

A vision-threatening condition occurring in people with myopia, usually high myopia that comprises diffuse or patchy macular atrophy with or without lacquer cracks, macular
Bruch’s membrane defects, CNV and Fuchs spot.

A

Myopic Macular Degeneration (MMD)

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18
Q

Diagnosis subdivisions of MMD

Myopic Maculopathy

A

Category 0: no myopic retinal degenerative lesion.
Category I: tessellated fundus.
Category 2: diffuse chorioretinal atrophy.
Category 3: patchy chorioretinal atrophy.
Category 4: macular atrophy.
“Plus” features (can be applied to any category): lacquer cracks, myopic choroidal neovascularization, and Fuchs spot.

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19
Q

A person who has vision impairment and vision acuity that is not improved by pinhole which cannot be attributed to other causes, and:
* The direct ophthalmoscopy records a supplementary lens < -5.00 D and shows
changes such as “patchy atrophy” in the retina or,
* The direct ophthalmoscopy records a supplementary lens < -10.00 D.

A

Presumed myopic macular degeneration

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20
Q

A combination of macular retinoschisis, lamellar macular hole and/or foveal retinal detachment (FRD) in eyes with high myopic attributable to traction forces arising from
adherent vitreous cortex, epiretinal membrane, internal limiting membrane, retinal vessels, and posterior staphyloma.

A

Specific Clinical conditions characteristic of pathologic myopia

Myopic Traction Maculopathy

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21
Q

Optic neuropathy characterized by a loss of neuroretinal rim and enlargement of the optic cup, occurring in eyes with high myopia eyes with a secondary macrodise or peripapillary delta zone at a normal IOP.

A

Myopia-associated glaucoma- like optic neuropathy

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22
Q

Category 0: no myopic retinal degenerative lesion.
Category 1: tessellated fundus.
Category 2: diffuse chorioretinal atrophy.
Category 3: patchy chorioretinal atrophy.
Category 4: macular atrophy.
“Plus” features (can be applied to any category): lacquer cracks, myopic choroidal neovascularization, and Fuchs spot.

A

Diagnostic Subdivisions of MMD

Myopic Maculopathy

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23
Q

The fundus has some stretchings/stretches. The fundus fiels is becoming very rough already. There are also patches seen.

A

Category 2: Diffuse Atrophy

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24
Q

Patchy atrophy in the fundus.

A

Category 3: Patchy Atrophy

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25
Q

The atrophy now reaches and invades the macular lutea.

A

Category 4: Macular Atrophy

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26
Q

Lacquer cracks are like crack paints on the wall that are slowly peeling off.

A

Plus Lesions: Lacquer cracks

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27
Q
  • _____is a major cause of permanent blindness in China, Japan, Denmark and Netherlands!
  • By 2050, it is estimated that 56 million VI & 20 million blind will be associated with _____.
A

Myopic Macular Degeneration

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28
Q

Myopia and high myopia ranges in prevalence across the world
* 80 to 90% of young adults in parts of urban East Asia (myopia)
* 20% of young adults in parts of urban East Asia (high myopia)
* Lower prevalence in Western countries and lowest in Africa - but all are reporting a rise.

A

<3

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29
Q

Myopia and high myopia ranges in prevalence across the world
* 80 to 90% of young adults in parts of ______ (myopia)
* 20% of young adults in parts of _____ (high myopia)
* Lower prevalence in _____countries and lowest in _____- but all are reporting a rise.

A

1/2. urban East Asia
3. Western
4. Africa

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30
Q

Highest incident of Myopia can be found in: (2)

A

Korea
Singapore

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31
Q

Increased uncorrected refractive error Increased burden on society

A
  1. Cost of care - surgery, rehabilitation, low vision aids
  2. indirect costs
32
Q

In Philippines: there are preventable programs for Myopia. (4)

A
  • Myopia control
  • The project aims for students and young kids
  • Focus on:
     Non-myopia kids
     Progressive myopia students
     High myopia and potential pathologic myopia
  • Research outcomes are working for myopia control.
33
Q

Clinical Myopia Management (4 Methods)

A

history and risk evaluation
examination
follow up
treatment initiation

34
Q
  • Standard ocular and medical history + myopia risk evaluation
  • Guides selection of treatment
  • In history taking, we qualify the patient on where they belong.
A

History

35
Q

Fixed risk factors (factors you cannot modify)
* Family history
* Age
The younger you are, the more candidate you are for myopia.
* Ethnicity
* Axial length
* Refraction
Modifiable risk factors (factors you can change)
 Time outdoors
 Near work/education
 Electronic device use

A

Risk Evaluation

36
Q
  • VA (aided and unaided)
  • Refraction (subjective and objective)
  • BV assessment
  • Ocular health
  • Ocular biometry and other tests
A

Examination

37
Q

examination under Ocular biometry and other tests

A

 Corneal topography
 Axial length
 Pupil function
 Tonometry

38
Q

examination under BV assessment

A

 Accommodative accuracy (lag/lead)
 Amplitude of accommodation
 Accommodative facility
 Heterophorias
 Fixation disparity
 AC/Ratio

39
Q

examination under Ocular health

A

 Dilated fundus exam

40
Q

examination under Refraction (subjective and objective)

A

 1.0% cyclopentolate or 1.0% tropicamide; two drops per eye 5 minutes apart
 Cyclopentolate is not being practiced in the Philippines.

41
Q

 Stable emmetropia
 Reduces with age

A

‘Normal’ Axial Elongation

42
Q
  • N = 605 (374 emmetropic), 6 - 14 years of age
  • These are African American, Asian and Hispanic children
  • Study conducted at 1995-2003
  • They measured that the axial elongation increases at about 0.1mm/year.
A

CLEERE Study

43
Q
  • N = 793 population (490 emmetropic), 6– 9 years of age
  • Singaporean children
  • 1999 to 2001
  • 8 years old: 0.12 ± 0.24 mm
A

SCORM Study (Rozema et al 2019)

44
Q
  • N = 12,386, 6 to 9 years of age
  • Born in Netherlands
  • 0.19mm per year
A

Tideman et al 2018

45
Q

“Normal” Axial Elongation’ (per year)

A

7-10 yo:
male: emme .1-.2mm/year
female: myope .3mm+/ yrs

11-16 yo
male: myope .2mm/year reducing in teens
female: .1mm/yr ceasing by teens
Males has around 0.5mm longer axial length than females, in both emmetropia and myopia.

46
Q

Around 11-16 years, more boys become myopic according to this study.

A

true

47
Q

Novel myopia control spectacle lenses
* Induce myopic defocus onto the retina
* Different fitting procedures

A

spectacle

48
Q

Contact Lenses

A
  1. CooperVision MiSight
    The best Cl but not yet available in the Philippines.
  2. Seed 1dayPure EDOF
  3. Mylo Mark’ennovy
  4. VTI NaturalVue
  5. Off label brands using other designs for presbyopia
49
Q

Orthokeratology

A
  • Rigid contact lenses worn
  • overnight
  • Myopia correction and control
  • Additional instruments required
  • for fitting
  • Induce myopic defocus onto peripheral retina
50
Q

_______ allows the pressing of central cornea that contributes to flattening. During the flattening while sleeping, the corneal epithelium travels towards the side/corners of the lens.

A

Orthokeratology

51
Q

type of CL where the Px wears the CL at night time and takes it off during daytime.

The Px must wear this all through out their life. When you stop, the corneal epithelium goes back to the center.

A

ortho-k
(orthokeratology)

52
Q
  • Dose dependent myopia control response
  • Higher concentrations = greater symptoms of visual halos
  • Different countries have different various prescribing rights
A

Atropine

53
Q

In Australia, esp. for kids in pre-myopic stages, they already give atropine before dispensing lenses. They call it ________: drop atropine on the better eye so that it will blur forcing the bad eye to work.

A

atropine penalization

54
Q

atropine

Comparison of Treatments
* MFSCLs (Multi-focal soft contact lenses) vs OK (Ortho K) vs SV spex (Single vision spectacles)
 2 years treatment
 -0.56 D vs -0.32 D vs -0.98 D

A
55
Q

atropine

  • MFSCLs vs OK vs SV spex
     1 year treatment
     0.30 mm vs 0.31 mm vs 0.41 mm
A
56
Q

To sum it up, ______ are better because the elongation only limits to ______

But this is just to aid the selection of method on which one we should select.
No 2 patients have the same treatments because everyone is different.

A

MFSCLs
0.30mm

57
Q

SCLs, OK and spex comparative outcomes
* Adding 0.01% atropine to orthokeratology improves treatment outcomes
* Adding 0.01% atropine to multifocal soft contact lenses have limited effects

A

–

58
Q

The only downside to this multifocal soft cl is:

A

due to its softness, it absorbs the atropine.

59
Q

Selection of Treatments

A
  • Treatment eligibility
  • Contraindications to treatment
  • Availability of equipment
  • Contact lens handling skills
  • Financial costs (upfront vs ongoing)
  • Risk factor consideration
60
Q

Risk factor consideration in selection of treatments

A

 ‘‘Invasive’ vs ‘non-invasive’ optical
 Mono vs dual therapy
 Atropine concentrations (you proceed to atropine penalization and find out what concentration is the best)

61
Q

Behavioral Modifications (3)

A

near work
digital screen
outdoor time

62
Q

behavioral modification in near work

A

 Working greater than 20cm
 Duration less than 45 mins (and then take a break after)

63
Q

behavioral modification in digital screen

A

 American Academy of Pediatrics and Australian Department of Health
 Under 2 years old - no screen time
 2-5 years old- max 1 hour/day
 No more than 1 hour of inactivity (encourage the child to play outdoor or indoor games)

64
Q

behavioral modification in outdoor time

A

 At least 2 hours per day
(more would be better. Sun plays an important role in growth)
 Cumulative effect
(good relationship with all the members in the family. Also, good social relationship will be built. Enhances the child’s social growth)

65
Q

Review of Treatment
Myopia progression

A
  • Refraction
  • Axial Length
66
Q

review of schedule in atropine

A

4-7 days
1month
3mo
6 monthly

67
Q

review of schedule in keratology

A

1 day
4-7 days
1month
3mo
6 monthly

68
Q

review of schedule in multifocal SCLs

A

4-7 days
1month
6 monthly

69
Q

PAL/BIFOCAL SPECS

A

1mo
6monhtly

70
Q

in ____ You must see the Px the day because you are assessing the initial fit of the CL for 24hrs (the first night the Px slept with the CL)

A

OrthoK

71
Q
  • Spectacle options (If you give eyeglasses)
    Check for the ff:
A

 Check VA
 Spectacle lens/frame fitting

72
Q
  • Soft contact lens options (If soft CL was given)
    Check for the ff:
A

 VA
 Over-refraction
 Lens fitting
 Lens handling
 Anterior eye health

73
Q

Clinical Considerations

A
  • Other ‘myopias’
     Pseudomyopia
     Pre-myopia (100% of the time would lead to myopia)
     Underlying conditions
  • Communication
     Compliance
     Expectation
74
Q

“A refractive state of an eye of 5+0.75 D and >-0.50 D in children where a combination of baseline refraction, age, and other quantifiable risk factors provide a sufficient likelihood of the future development of myopia to merit preventative interventions”

A

Pre-myopia

75
Q

Management of Pre-Myopia
In other countries, this is how they do:

A
  • Behavioral modification
  • Give 0.01% atropine treatment
  • Regular review

Because they want that as early as pre-myopia, they want to control it already to avoid progression.

76
Q

Compliance

A
  • No standard treatment duration
     Highly variable between studies
     Reason for discrepancy in reported treatment efficacies
  • Evidence of improved efficacy with increased treatment time
    Esp. if the Px is compliant, there’s improvement.

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