GP lens eye Rounds

MYOPIA MANAGEMENT: Low Myopic Child Case

Will Skoog OD, FAAO

History

11-year-old white female presented for myopia management consultation. She was in 5th grade. She had read about orthokeratology in a magazine advertisement. Her current spectacles were six months old. She is a competitive swimmer and water polo player. She had no history of myopia management. Her mother is nearsighted and her father wears reading glasses.

Examination

• Visual Acuities (VAs)
  • Without correction: OD: 20/100, OS: 20/100
  • With correction: OD: 20/20, OS 20/25
• Lensometry:
  • OD: -2.00DS
  • OS: -2.25 -0.25 x 180
• Manifest refraction:
  • OD: -2.00DS, VA 20/20
  • OS: -2.00DS, VA 20/20
• Slit Lamp Examination:
  • Unremarkable OD, OS
• Topography (Figure 1):

• Axial length
  • OD: 24.91 mm
  • OS: 24.97 mm
• Dilated Fundus Examination (DFE)
  • Unremarkable

Decision-Making Process

Need to consider the refractive error and the corneal topography when deciding between options.
She is a candidate for all myopia management treatments given refractive error and corneal topography.
She is a swimmer and water polo player. This positioned orthokeratology at the top of my list.

Fitting and Evaluation

• Orthokeratology lenses were fit empirically with refraction, simulated keratometry, and horizontal visible iris diameter (HVID).
• Initial lens parameters:

• Dispense Visit
  • OU: Fluorescein pattern: Bullseye pattern with adequate edge lift.
  • VA:
    • OD: 20/20
    • OS: 20/20
  • OR:
    • OD: +0.25 DS
    • OS: plano
• One week follow-up visit (approximately 4 pm)
  • VA without correction
    • OD: 20/20
    • OS: 20/20
  • Manifest refraction
    • OD: plano
    • OS: plano
  • Topography – tangential (Figure 2)

• • She did not bring the lenses with her so we could not evaluate them.
• One month follow-up visit
  • VA without correction:
    • OD: 20/20
    • OS: 20/20
  • Manifest refraction
    • OD: plano
    • OS: plano
  • Topography (Figure 3)

• Fluorescein pattern
  • OU: bullseye pattern, well centered
• VA
  • OD: 20/20
  • OS: 20/20
• OR
  • Plano OU

Clinical Pearls

• It is important to take into consideration the patient’s activities and hobbies when deciding between myopia management options.
• Take multiple topographies per visit!