Myopia management, primarily with the use of orthokeratology contact lenses, was the hot topic of discussion at a Myopia Management CPD evening hosted by the Cornea and Contact Lens Society of Australia (CCLSA) on 13 September.
There’s never a dull moment in optometry and the CCLSA Myopia Management event, held at the Sky Phoenix Restaurant in Sydney’s CBD, was no exception. During a vibrant evening, Dr Kathleen Watt, Mark Koszek and Kendrew Smith delivered thought-provoking presentations followed by a discussion where they were joined by Dr Oliver Woo, Heidi Hunter, and Dr Margaret Lam.
when working with OK, patient selection, accurate map data, centration, and knowing your lens designs are critical to success
From left, Dr Oliver Woo, Heidi Hunter, Mark Koszek, Dr Kathleen Watt, Kendrew Smith and Dr Margaret Lam.
The speakers provided the latest information on myopia management to a packed restaurant of around 70 delegates. Dr Kathleen Watt alerted attendees to new research on the potential impact of red light, diet, and sleep patterns on myopia.
Additionally, she highlighted ocular and systemic conditions that may provide clues to optometrists diagnosing a child with myopia, as identified in a 2001 study.
That study reported that: “Only nine (8%) of the children had ‘simple high myopia’ with no associated ocular or systemic associations. In 54% there was an underlying systemic association with or without further ocular problems (e.g., developmental delay, prematurity, Marfan, Stickler, Noonan, Down syndrome) and in the remaining 38% there were further ocular problems associated with the high myopia (e.g., lens subluxation, coloboma, retinal dystrophy, anisometropic amblyopia). A family history of high myopia did not preclude associated abnormality: in four cases, the diagnosis of a systemic condition in the child led to the identification of the disease in at least one myopic relative. Asian (p < 0.001) and male (p < 0.05) patients were overrepresented in the series.”1
Dr Watt spoke about the available treatments for myopia and their relevant workups, and the importance of monitoring axial length as a sign of myopia progression but noted that axial length can change without any corresponding change in refraction.
She said that a very useful tool to have in a clinic, when communicating with parents about their child’s myopia, is a chart showing normal axial growth. Much like a baby’s blue book, the optometrists can show where the patient sits on the chart, over time, as their myopia progression is diagnosed and managed.
TIPS AND TRICKS FOR ORTHOKERATOLOGY
Mark Koszek delved into the detail of orthokeratology (OK) to manage myopia, stressing the importance of accurate corneal topography and centration for lens treatment success. Trialing a lens on a child can also be helpful before ordering OK lenses as some children will need time to adjust to the idea of wearing lenses and others may flatly refuse.
While prescribing OK contact lenses is complex, he said the advent of Eyespace – a software program that enables optometrists to design and fit bespoke contact lenses for individual patients with numerous ocular conditions – has taken much of the need for manual lens design out of the equation. Drawing on patient cases, Mr Koszek provided tips and tricks to help optometrists design the most effective lens for each patient and avoid fitting errors.
Kendrew Smith
While some eye care professionals are concerned about the risk of infection from the use of OK lenses, Mr Koszek said that in 23 years of treating patients with OK he has not had any serious cases of infection, most likely thanks to regular monitoring and comprehensive patient education. He which includes never rinsing lenses with water, regular replacement of the lens case, and not wearing contact lenses when ill with upper respiratory infections that can be easily transmitted. Mr Koszek said it is also important to remind patients to disinfect their contact lens remover.
When first fitting an OK lens he said to do all your aftercare before the lens warranty expires (usually within 90 days). He recommends aftercare the day after fitting, then in one week, four weeks and 10 weeks, followed by annual reviews. The tests to be performed at every aftercare review are vision, corneal staining and topography and don’t forget to examine the retina.
Mr Koszek expects OK lenses to last for 18 –24 months, however this will be determined by lens wear and tear, any lens warping and whether or not the patient’s refraction changes in this time. The panel members had different views on the expected lifespan of an OK lens, ranging from six months to two years, or more. The most important consideration is patient safety – lenses should be replaced if there is any risk of corneal insult or infection occurring.
Kendrew Smith, Managing Director of Innovative Contacts and Eyespace, and a gold sponsor of the Myopia Management CPD evening, took the opportunity to describe Eyespace’s services and the support it provides to optometrists when prescribing bespoke contact lenses.
Stating, “the foundation of your house is the patient”, Mr Smith explained that when working with OK, patient selection, accurate map data, centration, and knowing your lens designs are critical to success. Patient education and engagement – so that they know what the treatment process is and why compliance is important – is also essential.
To proactively trouble shoot any issues, a thorough knowledge of OK lenses is vital, because “patients won’t always tell you everything when talking about any issues they’re having with their OK lenses”.
Simon Hanna, National Professional Services Manager, Vision Care from gold sponsor Bausch + Lomb, spoke about Ultra One Day contact lenses, which are being re-launched post-pandemic. Mr Hanna detailed the features behind this advanced silicone hydrogel lens, which “boosts water content and maintains it”.
Two innovative technologies – advanced MoistureSeal and ComfortFeel, inspired by the TFOS DEWS II Report – contribute to nine out of 10 wearers reporting these lenses to be “incredibly soft and comfortable to wear”. According to Bausch + Lomb research, three out of four wearers surveyed in the company’s research reported their eyes felt comfortable throughout the day, with studies showing 96% moisture retention of Ultra One Day lenses for up to 16 hours.
Balraj Singh, Managing Director from Aspen Pharmaceuticals – an event silver sponsor – spoke about the arrival of Eikance 0.01% in Australia. Delivering a very simple message at the end of an informationpacked evening, he said Eikance 0.01% is a preservative free, non-invasive tool for myopia management that is available in convenient single-use minims packaging, via prescription, in every pharmacy.
Hero image: Dr Kathleen Watt
Reference
- Marr JE, Halliwell-Ewen J, Fisher B, Soler L, Ainsworth JR. Associations of high myopia in childhood. Eye (Lond). 2001 Feb;15(Pt 1):70-4. doi: 10.1038/eye.2001.17. PMID: 11318301.
