Highlights from Dr. Walline’s webinar included the following:

He presented pertinent information pertaining to the effects of the following on myopia progression:

Soft multifocal contact lenses

• In averaging the results of 17 studies – including four of his own - over an average of slightly over 2 years comparing soft multifocals to spectacles or single vision contact lenses, the refractive error difference was .3D and the difference in axial length was .14mm.
• Center-distance design important for children; may need to over-minus by -0.50D and use a higher add power

Orthokeratology

• Effective in high myopia even if it does not correct all myopia
• Today individuals with high levels of astigmatism can be successful with orthokeratology
• Does not appear to be a significant effect between orthokeratology and soft multifocals; orthokeratology recommended when parents want to manage all lens wear, the child swims frequently, and they have difficulty with dexterity. Soft multifocals are recommended when the parents wear soft lenses, they are highly myopic, and they mainly want to wear glasses.

Low concentration atropine

• Similar in slowing myopia progression than the other modalities; however, eye growth is often not slowed as much
• For optimum effect on both refractive error and eye growth, .05% is recommended

Red light therapy

• This has recently been shown to reduce myopia progression (3 minutes twice per day)
• Jury is still out; we don’t know the long-term effect on retinal integrity

Spectacles

• Lenslets have demonstrated a meaningful effect on both myopia progression and axial length
• Not yet available in the United States

Combinations therapy

• Does appear to be more effective when combining low dose atropine and orthokeratology; very little effect with soft multifocals

Delaying myopia onset

• Forcing children to spend more time outdoors appears to delay the onset of myopia but it does need to be forced.

SPOTLIGHT ON EDUCATION PART II:

"Keratoconus Simplified: What You Need to Know to Get Through Clinic"

Dr. Karen Lee

Highlights from Dr. Lee’s presentation included the following:

DESCRIPTION, DIAGNOSTIC, AND TESTING

• Definition
• Medical History
• Ocular History
• Preliminary Findings
• Refractive Findings
• Slit Lamp Findings
• Topography: importance in diagnosis
• Progression

MANAGEMENT

Corneal Collagen Crosslinking

• Procedure
• When to use
• Effectiveness
• Scleral lenses effective after treatment

Contact Lenses: the role and fitting of each of the following were discussed with an emphasis on video and graphics:

• Custom soft
• Corneal GP lenses
• Sclerals
• Piggyback
• Hybrids

Surgical Intervention

BOTTOM LINE

Spectrum of Treatment Options in Keratoconus

• Subclinical: Spectacles, soft lenses
• Early: Soft lenses, custom soft lenses, keratoconic soft lenses, corneal GPs, cross-linking
• Moderate: Corneal GPs, keratoconic GPs, piggybacks, hybrids, surgical intervention
• Severe: Sclerals, impression-based lenses, surgical intervention