5
A functioning foveais not essential for
normal axial development.
Smith et.al.
Peripheral retinal receptors provide the signal for the eye to grow (or to stop growing).
Study
Eye
Control
Eye
7
Single Vision LensesInduce Peripheral
Hyperopic Defocus
Childhood refractive errors are diagnosed
at an earlier age:
– School Screening
– Ophthalmic Advertising
• We correct the child’s central vision HOWEVER
spectacle lenses increase peripheral hyperopic
defocus.
Peripheral retinal receptors provide
the signal for the eye to grow (or to
stop growing).
11
Myopia Control: OpticalIntervention
Question: Why is Orthok working better?
Peripheral defocus Theory – myopia progression is
Related to peripheral defocus (off-axis 30 degrees) image
It is irrelevant to fovea (on-axis) vision!
15
Introducing ArtMost®
SMR Lenses
Speciallydesigned SCL for slower myopia progression
SMR = Soft Myopia Retention
What do you mean by specially designed?
It simulates GOV®
Ortho-k TxZ (Peripheral defocus)
Peripheral rim: 8 ~ 20 diopters steeper even in low myopia
It’s design also execute PVS®
Multifocal for reading
To learn from anisometropia that less myopia progression happens in the eye with less M-signal (ICS
while reading).
Using PVS®
optics for less M-signal in myopia retard
It is a soft lens – easily to be accepted by Kids
16.
16
We use SCLto simulate Ortho-K for myopia control!
--ArtMost®
SCL Perfectly simulates Ortho-K treatment
Rigid Ortho-K Treatment
ArtMost®
SCLPVS-SoftOK
with planned flexure for
Ortho-K Simulation
17.
17
We design aSCL with RGP features
-- ArtMost®
SCL correct corneal cylinder without toric design
• ArtMost®
SCLcan correct corneal astigmatism WITHOUT toric design!
•This is because of the Planned Flexure Technology creates tear lens
underneath the lens.
•So we can make SCL like RGP’s characteristic
•Tear lens (from tear reservoir) underneath the lens also improve
comfort & wetting!
•ArtMost®
SCL can correct Corneal astigmatism 1-2 D.
•So you know how convenient it is for regular practice.
18.
18
It could bea Soft Scleral lens for irregular corneas!
--ArtMost®
SCLfor post surgery & ectasia rehabilitation
Post RK Moderate cones
Corneal cyl. 5.5 D
19.
19
Clinical application tosimulate Ortho-K
for myopia control
Benefits
Comfort for daywear
PVS Multifocal
Simulate Ortho-K TxZ
Excellent centration
Bigger OZ for better far vision
Comfort & Astigmatism correction
Unlimited power range
-9.25-0.75x10
-10.25-0.25x0
21
STEP 1: UNDERSTANDINGTHE RISK OF MYOPIA
Risk factors for developing Myopia
Age: 5-9 Yrs
Ethnicity: Asian
Current Progression: Progression more or equal to -1 Diopter
Family History of Myopia: At least One Myopic Parent
Time Spent Outdoors: Less tan 1.5 Hrs per day
Time Spent on Near Work: More than 2.5 Hrs per day
Risk Factors Overall Risk of developing Myopia
0-2 Low risk of fast progression
3-4 Medium risk of fast progression
5-6 High risk of fast progression
23
PROCESS TO BEFOLLOWED FOR MYOPIA CONTROL
ENROLMENT
ONLINE APP
Myopiaprofile.com
Breinholden calculator
COUNSELLOR
TENT CARD
Tent Card: Tent card helps to evaluate risk factors.
Patient with High risk referred to Counsellor for
explaining Online app.
https://myopia.care/index
https://calculator.brienholdenvision.org/
24.
24
AFTER ENROL MENT
RoutineEye Examination
Thorough History: Power change, Parental Myopia, Atropine or other drugs.
Measurement of UCVA & BCVA
Objective and Subjective refraction with cyclopegia.
Assessment of Binocular vision: Esophoria, Accommodation lag, etc. Managing
Esophoria and accommodation lag provide additional benefit for Myopia Control.
Axial Length Measurement
Corneal Topography
28
Communication with Parents:Risk
It is found in one study that less than half of the parents considered Myopia as a risk
factors. This potential knowledge gap needs to be addressed when implementing any
therapies for Myopia onset and progression.
As a practitioners we need to balance the importance of myopia prevention, while also
being realistic about the necessary level of concern and the amount of control.
Delaying or preventing myopia can reduce the risk of high myopia.
Myopia increases future risk of eye conditions.
Simple strategies can be used to delay the onset of myopia.
We can manage myopia and slow progression.
Slowing myopia reduces risk of High Myopia.
29.
29
1. Explain reasonsfor initiating Myopia Control at beginning: Explain the reason why r
u recommending Myopia Control before initiating the treatment and possible
consequences of not controlling Myopia.
2. When Progression occurs, explain effectiveness of corrections: Explain what will
define success before initiating treatment
30.
30
3. Develop anddocument an agreed myopia management plan before initiating the
treatment: All the appropriate choices should be presented to the parents and the child
so that they can be aware of all the options, before a plan is made and agreed upon.
Give a copy of the same.
4. Prescribe the most effective treatment at outset.
#11 So, an interesting story happened. When the orthok started to be noticed by practitioners about her ability for myopia control, many researchers started to ask “why”? The most popular answer was proposed by Dr Earl Smith’s peripheral inwards focus theory. His theory was further elaborated by my university classmate Dr Pauline Kang. She joined the research team of University of New South Wales with Professor Helen Swabrick in Australia.
However if this is the key, then it should be able to work on spectacle. But how come the multifocal that was developed base on the peripheral inward focusing theory not working? Again, we can kind of feel the answer may not necessary the optics only!
#15 So, since we have discussed the most effective myopia control method is still Ortho-K, we may wonder: if I simulate Ortho-k TxZ on top of the cornea by soft lenses, can I still achieve the same or similar myopia control rate as what Ortho-K can do?
Some of you may have tried to use multifocal design SCL for myopia control purpose. So far, among all CL specialists in the world, many people have applied central distant soft lens design trying for slow down myopia progression. I also noticed that some researchers have done some study on this part and shared some useful tips with us. The slower rate is between 30-50 %. However, we have also discussed that not all the Ortho-k can achieve the same myopia control rate and this could be due to the TxZ shape. We have also showed that if we apply PVS designed Ortho-k, the myopia control rate can be increased to about 90% retardation rate.
Therefore, if we can simulate PVS Ortho-k result on the soft lens, can we still achieve better myopia control rate?
#16 We may design inward focusing for research and clinical practice While contact lenses and Orthokeratology could both achieve the same purpose.
#17 The planned flexure turns the front surface into a desired contour while also forms a tear space underneath the lens that may correct cornea cylinder without toric design. It correct refractive errors like a GP while in soft material. The inward focusing surface for imitating Ortho-K TxZ looks great in topography and functions amazingly for presbyopia.
#18 In milder cone as that in OD, only 0.05mm thicker CT (SEC1) is required while the severer cone of OS needs 0.1mm thicker in CT and hence use SEC2.
#19 Soft lens may simulate Ortho-K for myopia control. The simulated TxZ displays excellent PVS multifocal.
#20 We compared the axial length elongation of the 8 cases with that published in else researches and found SoftOK lenses slowed down axial elongation even more than that of atropine and Ortho-K.
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