Introduction to Myopia Control - Dr. Jeffrey Walline

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Introduction to Myopia Control
Jeffrey J. Walline, OD PhD
Associate Dean of Research, The Ohio State University College of Optometry


The prevalence of myopia is on the rise, and we must do something to reduce the potentially sight-threatening side effects of myopia.

This lecture will discuss ineffective means of myopia control so optometrists know what NOT to implement, as well as provide information about how to use the most successful methods of myopia control, including soft multifocal contact lenses, orthokeratology contact lenses, and atropine eye drops. We will discuss the mechanism of how they may work, how to optimize myopia control, and how to manage these treatments.

In the end, optometrists will be more capable of educated discussions of myopia control with parents and feel more confident in providing myopia control treatments.


 
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Introduction to Myopia Control
Jeffrey J. Walline, OD PhD

The prevalence of myopia is on the rise, and we must do something to reduce the potentially sight-threatening side effects of myopia.

This lecture will discuss ineffective means of myopia control so optometrists know what NOT to implement, as well as provide information about how to use the most successful methods of myopia control, including soft multifocal contact lenses, orthokeratology contact lenses, and atropine eye drops. We will discuss the mechanism of how they may work, how to optimize myopia control, and how to manage these treatments.

In the end, optometrists will be more capable of educated discussions of myopia control with parents and feel more confident in providing myopia control treatments.


[please place all discussion about this lecture in this thread.]

...and NOTHING behavioral will help? He's cheating his audience of a whole school of thought, that I practiced for 47 years. He needs to to bring in guest speakers, but that will never happen, will it?

Everyone interested should familiarize themselves with the Myopia Manual. An unbiased physicist reviews the literature.: www.myopia-manual.de.
 
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Steve Silberberg

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Dr. Bowan: My lecture dovetails with Dr. Walline's : I cover functional approaches and in fact my opinion is that it is a whole person approach whether it be Atropine, Soft MF's or Ortho-K thye are not used in a vacuum Without liestening to his lecture it is unfair to criticize.
I went to SUNY in the days that is was heavily into behavioral vision You know all the names. Won the Frederick Brock award etc. etc. They spoke of Myopia control but I was not impressed with the techniques than or the results. Sure as an example if a child showed "Eso" tendencies than + for near even today should be incorporated into a myopia control regimen but nowadays we understand that peripheral + with soft MFs works far better ACCORDING TO MANY STUDIES.

I'm sure Dr Walline will engage you further
 
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...and NOTHING behavioral will help? He's cheating his audience of a whole school of thought, that I practiced for 47 years. He needs to to bring in guest speakers, but that will never happen, will it?

Everyone interested should familiarize themselves with the Myopia Manual. AN unbiased physicist reviews the literature.: www.myopia-manual.de.

Merrill -- GPLIwire2017 is a Specialty Contact Lens conference. So no surprise about the lack of VT.

We'd be happy to add VT topics to the next CEwire conference, though!
 

Merrill Bowan

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FROM THE MYOPIA MANUAL: By physicist Klaus Schmid, PhD (MORE READABLE .PDF OF BELOW AVAILABLE HERE: http://www.myopia-manual.de/private/recommendations-2017.pdf) (1485 references.) The Myopia Manual, 2017. 385 pp. www.myopia-manual.de. An unbiased view of the topic of Myopization.


OVERALL RECOMMENDATIONS



Recommendations for preventing or inhibiting the progression of myopia


Recommendations from the optical side (mainly to compensate the negative effects of excessive near work)


For near work keep a reasonably large distance to your book / paper /
computer screen, even when wearing plus additions.

Note: Reading in bed leads mostly to a distance, which is too near.


Do not use glasses or contact lenses, which are stronger than necessary, i.e. avoid any overcorrection. You might use "main glasses / contact lenses" which are slightly under-correcting and you use additional glasses for perfect distant vision.



If you are not myopic yet, better use plus glasses for extensive near work.


If you are already myopic, use bifocal or progressive glasses or bifocal
contact lenses, or use plus glasses additionally to your contact lenses for extensive near work.

Interrupt your near work every 30 minutes by focusing on distant objects and relax your eyes especially in the evening before going to sleep.


Wearing plus glasses for a short time every day may be of some help.


Cold-color light should be preferred to warm-color light.


Do not read and don't do near work at bad light, 500 Lux are the minimum, but substantially higher levels are recommended depending on the visual task (e.g., for detailed drawing work 1,500 to 2,000 lux).



• Some exercising of the accommodation by alternating focusing near and far objects can be helpful (but don't expect miracles from classes which are offered about this issue).



Take care to have enough sleep at the proper time and in darkness. Do not keep a light switched on in the kid's room at night (there is a controversy in the literature about night lights, but better be on the safe side).



• Perform regular physical exercises, especially outdoors, and use sunglasses in rather bright sunlight only


+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
• Discuss with your ophthalmologist the application of atropine drops.


• Consider rigid gas permeable contact lenses (RGP). Soft contact lenses were not reported to show a positive effect, but soft bifocal contact lenses showed a positive effect, too.

• Consider orthokeratology.



Table 22 Optical recommendations for preventing myopia or inhibiting the progression of myopia




Recommendations for preventing, or inhibiting the progression of myopia


Recommendations from the behavioral and the nutritional side (mainly to reduce an elevated personal emmetropization factor)

Reduce negative mental stress, possibly by appropriate physical and mental exercises, and playing.


Physical exercises can as well have a positive impact on the blood circulation in the eye, and promote NO metabolism.



Especially Outdoor activities were shown to be very effective to prevent myopia (preferably 2 to 3 hours a day).



Avoiding stress can prevent a potential risk for your professional career.



Keep a healthy and balanced diet, which is low in sugar and low in refined carbohydrates (incl. white wheat), low in sodium, low in fat except omega-3 (fish) oil, and have plenty of (if possible unprocessed) vegetables and fruits.



There are many books for a healthy diet on the market, with tables showing the contents in specific nutrients1404.



If the progression of your myopia is worrying you, additional supplements of multiple vitamins (especially the vitamins E, B2, B6, folic acid), minerals (especially of calcium, selenium, copper and zinc) and especially also of flavonoids are recommended.



Only for the B vitamins doses substantially higher than the recommended daily doses may be helpful931, 932 (for flavonoids no recommended doses are available).



Especially if your ancestors came from regions with plenty of sun, you may easily have an individual lack of vitamin D. A 25(OH)D blood test is highly recommended. In general, our ancestors spent by far more time outdoors, which gave them plenty of vitamin D. Therefore it is recommended to have your Vitamin D status checked and to take supplements in case the level is not optimal.



Do not take higher doses of vitamin A than the recommended daily allowance for it and keep the appropriate balance between copper and zinc, and
calcium and magnesium.

See section 4.6 for maximum amounts.


Table 23 Behavioral and nutritional recommendations for preventing myopia or inhibiting the progression of myopia
 
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I look forward to presenting in this forum! This is a very creative venue, and my hope is that it will lead to some useful information that you can use in practice on your next patient.

Thank you Dr. Bowan for the link to Klaus Schmid's review. It is very comprehensive!

Dr. Bowen is correct in assuming that I will not present much on behavioral myopia control because my presentation will be based on evidence from the peer-reviewed literature, with an emphasis on controlled clinical trials. These studies are the gold standard of evidence, so I can be confident in the results that I present.

When behavioral myopia control produces results that are published in the peer-reviewed literature, I will certainly make people aware of the benefits. As it is right now, I frequently hear that myopia control results are invalid because an individualized add power has not been used. However, everybody has a different idea regarding on what the individualized add power should be based (reduction of eso fixation disparity, accommodative lag, esophoria, etc.), and nobody has published a study comparing individualized add powers to a single add power. I know there is much more to behavioral myopia control than an add power, but I won't discuss this in lectures until there is evidence presented in the peer-reviewed literature.

Thanks to everyone for your interest in myopia control and optometric passion!!
 

Larry Bickford O.D.

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Science is good. Peer-Reviewed Science is better.

Sometimes. How often have I seen a peer-revieved article that was ill-conceived, poorly documented, N=4, and basically BS? Then cited by the clueless media. There's a point to be made for a few thousand years of repeatable anecdotal evidence as well.

But science is good.

Meanwhile, as far as behavioral training, one thing I do with kids (but not for too much longer :eek:) is get down on the floor and demonstrate to the kid that reading/drawing while lying on the floor on your belly places your eyes inches away from the book/crayons. Then I sit up, my eyes crossed and looking stressed. Then to the desk in a comfortable chair sitting with good posture. Then have the kid grab a book while sitting in a chair. Demo correct placement distance and posture. "Better for your eyes and your whole body!"
 
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Merrill Bowan

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...and nobody has published a study comparing individualized add powers to a single add power. I know there is much more to behavioral myopia control than an add power, but I won't discuss this in lectures until there is evidence presented in the peer-reviewed literature.
Thank you for your efforts in your response.

When the CITT study takes fifteen years and sixteen million, your grandchildren will have grandchildren before that question is answered, so all the docs are safe from having to change their minds (see the quote under my signature, below).

As a card-carrying product of the sixties, I have license to use the old trite phrase, "If you're not part of the solution, you're part of the problem." As a modern clinical researcher, I get to pull people up by their short hairs by saying, "There's no evidence that evidence-based science is valid." (Not a greatly popular phrase yet, but no less true -I've posted Boston OMD David Hunter's editorial on it twice on this site.)

One study used +1.75 adds on everybody, and that's much too high. +0.75 adds are prolly weaker than would be useful except for some esos.

So if your goal is to be RIGHT, stay as you are. If, however, your goal is to help your patient, you need to know that there are NO certain answers. If you're determined to be your patient's advocate - as so many are - you need to consider objective-based research right there in your chair - why did they turn to myopia as a solution to their environmental conundrum? By nature? By nurture? Some combination? It's not simple, but nor should we toss out the baby with the bathwater.

Jus' sayin'....
 

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Merrill -- GPLIwire2017 is a Specialty Contact Lens conference. So no surprise about the lack of VT.

We'd be happy to add VT topics to the next CEwire conference, though!

Adam, the title above says it's on myopia control. Not contact lenses.I was going by what I read. I guess the vast majority of OD's would not think of functional vision as a valid means of control. Rightly so. It's bad-mouthed.

In the first paper I had published (on myopia control), only one of my references on bifocal control even MENTIONED the height of the seg, more crucial than power, to my way of practice. When bifocals don't work, more often than not, it's because kids overlook them. They MUST be set at trifocal height - to the pupil.

In my paper, my informal Meta-study showed almost a 60% treatment effect of bifocals in the existing literature in 1981. The paper is linked in my biography in my website below.

My real delight as I retired was that I discovered/realized that miniprisms may have a significant effect in PREVENTING myopia.

But who is there to listen?
 
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I look forward to presenting in this forum! This is a very creative venue, and my hope is that it will lead to some useful information that you can use in practice on your next patient.

Thank you Dr. Bowan for the link to Klaus Schmid's review. It is very comprehensive!

Dr. Bowen is correct in assuming that I will not present much on behavioral myopia control because my presentation will be based on evidence from the peer-reviewed literature, with an emphasis on controlled clinical trials. These studies are the gold standard of evidence, so I can be confident in the results that I present.

When behavioral myopia control produces results that are published in the peer-reviewed literature, I will certainly make people aware of the benefits. As it is right now, I frequently hear that myopia control results are invalid because an individualized add power has not been used. However, everybody has a different idea regarding on what the individualized add power should be based (reduction of eso fixation disparity, accommodative lag, esophoria, etc.), and nobody has published a study comparing individualized add powers to a single add power. I know there is much more to behavioral myopia control than an add power, but I won't discuss this in lectures until there is evidence presented in the peer-reviewed literature.

Thanks to everyone for your interest in myopia control and optometric passion!!

Thanks again to Dr. Walline for a great lecture (and follow-up interview.)

We've posted part of the presentation at the top of this thread, hope it inspires people to get involved with myopia control!
 
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Adam, the title above says it's on myopia control. Not contact lenses.

BTW, I haven't listened to the entire talk, but from the 10-minute excerpt I think he looks beyond contact lenses & into pharmacological approaches. Not sure about behavioral, etc... Maybe Dr. Walline could give his opinion on the topic?
 

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BTW, I haven't listened to the entire talk, but from the 10-minute excerpt I think he looks beyond contact lenses & into pharmacological approaches. Not sure about behavioral, etc... Maybe Dr. Walline could give his opinion on the topic?
He doesn't discuss it much concentrating on the 3 prime methods but very completely
 

AdminWolf

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We met up with Dr. Walline at the academy meeting last night, always good to see folks in person (I work with so many docs with CEwire and GPLIwire and I only know them by voice :) )
 

AdminWolf

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Forget the Snicker bar, you're traveling with the champagne and caviar set.
LOL, the AAOF put on a fun event at the Field Museum last night, many of the 'old pros' were on hand.

It was strange being there with it so empty -- could get up close to the T-Rex without jostling my way through :)
 

Greg Gemoules

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LOL, the AAOF put on a fun event at the Field Museum last night, many of the 'old pros' were on hand.

It was strange being there with it so empty -- could get up close to the T-Rex without jostling my way through :)

I'm glad you didn't say "old relics." The symbolism would have been too much.
 
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