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Myopia New Aioc

This document provides information from a presentation by Dr. Neha Midha on controlling pediatric myopia. It discusses the large expected increase in myopia prevalence globally by 2050. Risk factors for myopia like parental history and near work are summarized. Potential interventions like orthokeratology, atropine drops, and increasing outdoor activity are presented along with supporting studies. The impact of uncontrolled myopia on vision, quality of life, and economic costs are also highlighted.

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29 views44 pages

Myopia New Aioc

This document provides information from a presentation by Dr. Neha Midha on controlling pediatric myopia. It discusses the large expected increase in myopia prevalence globally by 2050. Risk factors for myopia like parental history and near work are summarized. Potential interventions like orthokeratology, atropine drops, and increasing outdoor activity are presented along with supporting studies. The impact of uncontrolled myopia on vision, quality of life, and economic costs are also highlighted.

Uploaded by

neha midha
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
You are on page 1/ 44

HELLO!

AVANTIKA EYE CARE &


GLAUCOMA SERVICES

I am Dr. Neha Midha


MBBS MD(AIIMS) DNB FICO(UK) MNAMS

Director: Avantika Eye Care and Glaucoma Services

Ex.Senior Resident RPC, AIIMS (Glaucoma and Pediatric


Ophthalmology)

Ex-Glaucoma Fellow, Clinique Montchoisi, Switzerland

1
Arresting Pediatric Myopia:
Ideal Prescription Methodology
How Big Is the problem?

3
By 2050
In 2000

4758,000,000
Whoa! That’s a big number

165,000,000
4
PROPOSED THEORIES
6
POSSIBLE INTERVENTIONS
SPECTACLES CONTACT LENSES

LIFESTYLE PHARMACOLOGICAL
HYPEROPIC
DEFOCUS

9
10
SPECTACLES
12
For Accommodative Lag:

• Progressive Addition lenses

• Bifocals

• Do NOT under correct Myopia.

• Cost/Availability is the limiting factor

13
CONTACT LENSES
Flattening or
reshaping the
anterior corneal
surface in an effort
to adjust the eye’s
refractive power.

Myopic
progression shown
to be reduced by
approximately
45%.

15
• Multifocal Contact Lens
• MiSight by Cooper Vision
• 8y of age, -0.75 to -4D
with astigmatism <-0.75

Hygiene.

Proper training

Availability

Affordability

16
PHARMACOLOGICAL
TREATMENT
Low dose
Atropine
Pirenzipine
Timolol
Tropicamid
e with
bifocals

No proven role
18
⊡ ATOM 1: 1% Atropine effective
⊡ ATOM 2: 0.01% Atropine effective but axial length
elongation persisted.
⊡ LAMP1: 0.05% atropine most effective
⊡ LAMP2: 0.05% MOST effective (2x compared to
0.01), decreases progression by 64.5%

19
• It is useful in SIMPLE SCHOOL MYOPIA

• Not for myopic astigmatism/


hypermetropia/pathological myopia

• One drop, once at night, for 2 years, for


children <16yrs of age.

• Explain about rebound, in case of non


compliance

• Explain about 1% vs 0.01% (Rs. 30 vs 200)

20
• In case of non responder—

• Check compliance

• Morning dose

• BD dose

• Increase strength 0.05%

21
LIFESTYLE CHANGES
• Decrease screen time <30 mins/day on phone.
• Switch to bigger screens
• Enroll in book/toy library
• Give options—when u say NO to screen!
• Outdoor activity 14hours/week, significantly decreases myopia
progression.
• Atleast 1 hr/day
• Sports complex/night time play: Not helpful
• Terrace
TAKE HOME!

⊡ Chose the correct patient in ⊡ Affordability has to be kept


terms of age, refractive error, in mind
progression, parental history
⊡ Outdoor play: Do not
⊡ One or more methods can be underestimate! Holistic
combined if one fails. benefits!

⊡ Ensure/reinforce
Compliance!

25
THANKS!

Any questions?
You can find me at
[email protected]

26
27
28
THANK YOU
ORTHOKERATOLOGY
Flattening or reshaping the anterior corneal surface in an effort to adjust the
eye’s refractive power.

 Children’s Overnight Orthokeratology Investigation (COOKI) pilot study

 Stabilizing Myopia by Accelerated Reshaping Technique (SMART) study

 Corneal Reshaping and Yearly Observation of Myopia (CRAYON) study

These studies have shown safety and efficacy of ortho-k for myopia control.

 Orthokeratology to Control Myopia Progression: A Meta-Analysis--


Myopic progression was shown to be reduced by approximately 45%.
OUTDOOR ACTIVITY

Role of outdoor activity in decreasing incidence and progression of myopia


has been established by various studies:

 The Beijing Children Eye Study

 North India Myopia Study

 Sydney Adolescent Vascular and Eye Study

 Avon Longitudinal Study of Parents and Children

 Collaborative Longitudinal Evaluation of Ethnicity and Refractive Error


Study
 90% to 95% of teenagers and young adults are myopic in China and
Seoul 1

 It is projected that myopia will affect one-third of the world's


population, 2.5 billion people by the end of this decade.1

 Beijing Childhood Eye Study : Prevalence of myopia ≤-1.00 D, ≤-


6.00 D and ≤-8.00 D in the was 64 %, 53 %, 4.3 % and 1.0 %
respectively. 2

 North India Myopia study: 13.1% of children of age 5 to 15 years


were myopic.3
It is estimated there were 1406
million people with myopia (22.9%
of the world population) and 163
million people with high myopia
(2.7% of the world population) in
2000. We predict by 2050 there will
be 4758 million people with myopia
(49.8% of the world population) and
938 million people with high myopia
(9.8% of the world population).
Parental Myopia
 Proportions of myopia were 6.3% in school children
aged 13.7±0.5 years whose both parents are
emmetropic, 18.2% in children with one myopic
parent, and 32.9% in children whose both parents
are myopic.1

3X
 Compared with children without myopic parents,
those with one myopic parent are twice as likely to
be myopic, and those with two parents myopic are
three times more likely to be myopic themselves.2

Invest Ophthalmol Vis Sci. 2002;43 (12:3633–3640.


1

Optom Vis Sci. 2012;89 (10:1487–1496.


2
Socioeconomic Factors
 Gender : Girls > Boys

 Higher levels of education

 Private school > Government school

 Urban > Rural

 Constricted living space

 Higher individual monthly income


Near Work and Outdoor
Activity
Use of accommodation
 Average 15-year-old in Shanghai now spends 14 hours per week on
homework, compared with 5 hours in the United Kingdom and 6 hours in
the United States.

 NIM study: increased myopia in children studying/reading > 5 hours per


day, watching television > 2 hours / day and with playing
computer/video/mobile games. An inverse association with outdoor
activities/playing in children playing > 2 hours in a day.

 Physical activity and myopia in Danish children-The CHAMPS Eye


Study: No association found
Light-Dopamine hypothesis
 Increased amount of time spent outdoors in sunlight reduces myopia
prevalence rates possibly due to release of dopamine from the retina on
exposure to light.

 Dopamine (DA) is an important neuro- transmitter in the retina that


mediates diverse functions including retina development, visual signaling,
and refractive development

 Ashby and Ohlendorf showed that High illumination levels slowed the
development of experimentally induced myopia in chicks by about 60%
compared with normal indoor lighting conditions

 Ashby and Schaeffel showed that injecting a dopamine-inhibiting drug


called spiperone into chicks' eyes could abolish the protective effect of
bright light. Thus proving light-dopamine hypothesis.
Impact of myopia
 Loss of productivity owing to visual impairment caused by myopia, the
cost of treatment for comorbidities of myopia.

 The estimated loss in global GDP owing to uncorrected myopia was


US$202 billion annually

 Myopes, especially high myopes, tend to suffer from compromised quality


of life owing functional, psychological, cosmetic, and financial factors.

 Myopia has been associated with various ocular comorbidities like


peripheral retinal degenerations, retinal detachment, glaucoma, myopic
CNVM.

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