Myopia

Question 1

Juvenile Onset Myopia

Answer 1

Onset around school age until Puberty (15)

progression due to axial elongation

0.50D per year

females have more myopia and progress faster

Question 2

pathological consequences of myopia

Answer 2

Glaucoma, Retinal Detachment, and Cataracts

Myopic Macular Degeneration / Myopic Retinopathy: diffuse, patchy macular atrophy with or without Fuch’s Spots , CNVM, lacquer cracks

Question 3

gene associated with high myopia (more than 6D)

Answer 3

PAX6 gene

Question 4

etiologies for myopia development

Answer 4

genetics
environment
peripheral hyperopic defocus
bino vision abnormality (accommodative dysfunction)

Question 5

AAP Guidelines on Electronic Use

Answer 5

under 18 mos: video chat only

18-24 mos: high quality program

2-5 years: 2 hrs a day

6+: place limits to ensure sleep and physical activity and media-free zones

Question 6

Treatment Options for Myopia

Answer 6

Time Outdoors 
Under Correction 
BF Lens 
Soft Contact 
Orthokeratology
MF Lens 
Atropine 
Spectacle Lens

Question 7

Undercorrection

Answer 7

associated with myopia progression compared to full correction

Question 8

BF Lens

Answer 8

theory is that myopes have poor accommodation and control the accommodative response

Executive BF and BI Prism: only helps eso and high lag patients

Question 9

COMET Study 2003

Answer 9

RCT, progressive, double blinded

PAL vs SV lens in 469 children

Rx: -1.25 to -4.50D

3 year study that showed decrease in myopia by 0.20D and 0.64D with eso and high lag patients

Question 10

soft contact lens

Answer 10

no diff in myopia progression

Question 11

orthokeratology

Answer 11

temporary decrease in myopia due to corneal reshaping overnight by steepening the peripheral retina and flattening the central cornea (redistribution of epithelial cells)
+ improves accommodation

decreases axial length + myopia progression !!

Question 12

Multifocal Lens

Answer 12

uses distance center concentric lens

distance center for m5.yopia control and add on lens periphery so it can spread to peripheral retina

slows progression and slows axial elongation

Question 13

BLINK Study 2020

Answer 13

Distance Rx with +1.50 and +2.50D add

294 kids Ages 7-11 between -0.75 and -5.00D

3 year study showed high add was successful with 0.6D progression and 0.42 axial elongation progression
36% decrease in axial and 43% decrease in MP

Question 14

MiSight Cooper Vision

Answer 14

FDA approved in 2019

Dual focus center distance concentric lens with +2.00D add

59% decrease in myopia progression and 56% decrease in axial length

Question 15

ATOM 1: 2006

Answer 15

346 children ages 6-13 with 1 drop daily with PAL for 2 years

77% reduction in myopia progression

Question 16

ATOM 2: 2011

Answer 16

400 children ages 6-12
Myopia at least -2D and less than 1.50DC

1% showed 0.14D MP
0.01% showed 0.24D MP
Placebo: 0.60D MP

Question 17

optimal atropine dose

Answer 17

0.01?

1% standard?

0.02: lowest without symptoms

Question 18

Myopia Incipient

Answer 18

likely to become myopic

A Insufficiency: low PRA and AMP, high FCC, accommodative infacility

EP’ or low XP’

ATR

Hyperopia on Ret

Tx: low plus lens

Question 19

Spectacle Lens: MyoSmart

Answer 19

Distance rx with +3 add

Tech DIMs: 60% decrease in MP

only in HK, Canada, China