Eyeworld

63 EW REFRACTIVE SURGERY October 2016 should be part of a public health strategy to reduce the risk for high myopia and future vision impair- ment and blindness, Prof. Naidoo said. Eyecare practitioners also must work together to plan com- prehensive eye services to manage and prevent myopic-related ocular complications, said Sally Dillehay, OD, chief medical officer and vice president, regulatory and clinical affairs, Visioneering Technologies, Alpharetta, Georgia. "We need to start looking at children who are 6 years old and who are still +0.75 D hyperopic but who are predicted to go on to become myopic," she said. If practitioners can keep a –1.00 D myopic child from progressing above –3.00 D, the risks for myopic maculopathy, retinal detachment, and posterior subcapsular cataracts are lowered, she said. "The old adage that people don't die from a simple lack of good vision and therefore vision is not a priority is obsolete," Dr. Leasher said. "Without being too alarmist, it's time to stop ignoring refractive error as a non-communicable im- portant health condition." EW References 1. Holden BA, et al. Global prevalence of myopia and high myopia and temporal trends from 2000 through 2050. Ophthalmology. 2016;123:1036–42. 2. Huang J, et al. Efficacy comparison of 16 interventions for myopia control in children: A network meta-analysis. Ophthalmology. 2016;123:697–708. Editors' note: Dr. Dillehay has finan- cial interests with Visioneering Tech- nologies. Prof. Naidoo has financial interests with Brien Holden Vision Institute. Dr. Tan has financial inter- ests with Eye-Lens Pte Ltd (Singapore). Drs. Chuck, Leasher, and Modi have no financial interests related to their comments. Contact information Chuck: lmarkens@montefiore.org Dillehay: sdillehay@vtivision.com Leasher: leasher@nova.edu Modi: Annie.Harris@nyumc.org Naidoo: k.naidoo@brienholdenvision.org Tan: donald.tan.t.h@singhealth.com.sg time outdoors and to reduce screen time. Leaders at Brien Holden Vision Institute are developing extended depth of focus lenses to reduce the stimulus to eye growth by providing a focused retinal image across the whole retina, Prof. Naidoo said. At the Singapore National Eye Centre with Dr. Tan, low-dose (0.01%) atropine drops are used in children with progressive myopia. Singapore began examining its my- opia problem 10 years ago, Dr. Tan said. Messages are sent to children and schools on how to maintain good eyecare habits by increasing outdoor activities, reducing near work, and getting regular eye checks. Dr. Tan and fellow researchers are starting new low-dose atropine trials that will treat younger children, at about 5 years old. "Low-dose atropine drops have now been proven to be able to reduce myopia progression in children, both effectively and safety, and other myopia control approach- es such as peripheral defocus contact lenses and some spectacles may also be showing promise," Dr. Tan said. Regarding various myopia-tar- geted strategies, there are still ques- tions regarding when and which therapy to start, treatment duration, when to stop treatment, and the extent of rebound myopia with ces- sation of therapy, Dr. Modi said. A review that compared 16 myopia control interventions found that atropine, pirenzepine, and progressive addition spectacle lenses were effective for targeting refrac- tion. 2 For targeting axial length, atropine, orthokeratology, peripher- al defocus modifying contact lenses, pirenzepine, and progressive addi- tion spectacle lenses worked best. Researchers found the most effective interventions overall were muscarin- ic antagonists such as atropine and pirenzepine. Still, a global campaign to address the issue is needed, Prof. Naidoo said. "Given the short-term approach of most governments, this is a difficult task. We will need to have an advocacy campaign in eyecare to really make a difference," he said. Slowing the rate of myopia with the use of optical and therapeu- tic strategies can be effective and AMOILS Minimize total procedure time Avoid alcohol damage to surrounding tissue No need for subsequent scraping Uniform epithelium removal in only 5 - 7 seconds Improved clinical outcomes of CXL and PRK with T. 800.461.1200 www.innovativexcimer.com e time scra r ping mes m COME VISIT US AT CHICAGO, USA 2016 OCT 15-18 BOOTH #4244 AAO

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