1. Myopia Management – Soft MF Contact
Lenses
Best Practices When Using Dual Focus or
Multifocal Soft Contact Lenses To Manage Myopia

2. Optometry in the United States
- Doctor of Optometry Degree
- 4 Years of University (Bachelor’s Degree) + 4 Years Doctorate
- Primary Eye Care
- Treatment and Management of Ocular Disease (i.e. Glaucoma)
- Minor surgical procedures ; Lasers, YAG, IPL
- Spectacle refractions
- Contact lens fittings

3. My Practice
• Specialty Contact
Lenses (Sclerals,
multifocals)
• Myopia Management
(OrthoK, MF CL)
• Dry Eye Treatment and
Management
• IPL
• LLLT
• Thermal Evacuation

4. Myopia
• Environmental & Genetic Factors
• Progresses through peripheral hyperopic defocus
• Defocus stimulates elongation of the eye.
• ↑ in axial length = ↑ in risk for myopic macular degeneration,
glaucoma, retinal detachment & cataract.

5. Multifocal Contact Lenses
• Originally designed for presbyopia
• Center-distance or extended depth-of-focus
lenses
• Reduce peripheral hyperopic defocus
(Proclear & Biofinity)
• Can reduce myopia by 50-87.5% (off label)

6. BLINK Study: Bifocal
Lenses In
Nearsighted Kids
Example of how to
layout an image on
this master slide
• Low vs. High Add in 3 years
• Randomized clinical trial
• n= 294
• Ages 7-11 years
*Conclusion: High
add power reduced
elongation the most,
then medium, then
low, but further
research is needed

7. MiSight ®
• Only FDA approved soft CL
proven to slow down myopia
• 52% reduction in average
axial length
• Two treatment zones create
myopic defocus w/ image
focusing in front of the retina
• Two correction zones correct
myopia in all gaze positions Example of how to
layout an image on
this master slide

8. Soft Multifocal
Contact Lenses
• Who is a candidate?
• Visually Significant
Myopia – (> -0.50) with
or without family history
• Current
children/adolescents in
traditional soft contact
lenses

9. My Discussion
• “Myopia is …”
• “Myopia can lead to …”
• “At this point, here are our options”
• Soft Traditional Contact
Lenses: corrects but does not
slow down axial elongation
• MiSight: corrects and slows
down axial elongation
• OrthoK: corrects and slows
down axial elongation

10. Fitting Process
• Same intitial fitting/training
process
• Cycloplegic refraction ( I use wet
refraction with 1% tropicamide
@ 30 min)
• Always check @ 1 week after
dispense.
• Some patients experience
blur at near that usually
subsides after one week of
consistent wear.

11. Practice Implementation
• Global fees for all Myopia Management options
• i.e. orthodontics model
• Our fees are roughly the same for MiSight & OrthoK
• Allows family to make the right decision based on each
child’s needs
• i.e. refractive surgery fees (LASIK vs. PRK)
• All patients leave with a folder that contains studies, FAQ’s
• In-office follow up in one week, then 1wk/1mo/3mo/6mo
• If parent/patient is hesitant to try, follow up in 6 mo

12. Flitcroft, D. I. (2012). The complex interactions of retinal, optical and environmental
factors in myopia aetiology. Progress in retinal and eye research, 31(6), 622-660.
Vongphanit, J., Mitchell, P., & Wang, J. J. (2002). Prevalence and progression of
myopic retinopathy in an older population. Ophthalmology, 109(4), 704-711.
Ogawa, A., & Tanaka, M. (1988). The relationship between refractive errors and retinal
detachment–analysis of 1,166 retinal detachment cases. Japanese Journal of
Ophthalmology, 32(3), 310-315.
Lim, R., Mitchell, P., & Cumming, R. G. (1999). Refractive associations with cataract:
the Blue mountains Eye Study. Investigative Ophthalmology & Visual Science, 40(12),
3021-3026.
Jeffrey J. Walline, OD. “Effect of High vs Medium Add Power vs Single-Vision Contact
Lenses on Myopia Progression in Children.” JAMA, JAMA Network, 11 Aug. 2020,
https://jamanetwork.com/journals/jama/fullarticle/2769263.
References