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6 + 0.75 dioptres
7-8 + 0.50 dioptres
9-10 0.25 dioptres
11 Emmetropia
Any minus refractive error under cycloplegic refraction is indicative of myopia.
particularly in the early school
years, and creating more time for outdoor activities. 17
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• Refraction less than-5.0 dioptres in those aged under one.
• Refraction less than-4.0 dioptres in those aged one to younger than two.
• Refraction less than-3.0 dioptres in those aged two to younger than three.
• Refraction less than-2.5 dioptres in those aged three to younger than four.
Source: American Academy of Ophthal-
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In Australia, vision screening |
mology 2022 18 |
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programs for children play a crucial role in identifying and addressing potential vision issues early on and promoting optimal eye health and visual development. These programs detect myopia, hyperopia and astigmatism, and other more serious eye conditions that may impact a child’ s learning and overall wellbeing. Vision screening programs in Australia vary between states, but most aim to assess visual acuity, eye alignment and other aspects of ocular health.
MANAGEMENT
SMALL degrees of myopia are usually not corrected before the age of four because the eye is still developing and emmetropisation is occurring. However, high levels of myopia that impact visual development need to be addressed to prevent amblyopia. Box 2 lists the 2022 American Academy of Ophthalmology preferred practice guideline recommendations for correction of myopia. 18
In school-aged children, even small degrees of myopia require correction. This is to ensure that the child does not fall behind in their education. For example, if the myopia is not corrected, the child may have difficultly seeing the board clearly in the classroom. It is important that the type of correction provided addresses both the visual symptoms and limits the myopia from progressing.
Research in recent decades demonstrates that traditional single-vision optical correction with minus powered lenses has caused greater increases in myopia over time compared with alternative strategies. 19 However, this research is taking some time to translate into clinical practice. A 2020 worldwide survey of eye care clinicians showed that despite increasing levels of clinical activity for control of myopia, traditional single-vision correction is still the most prescribed method of correction. 20 GPs thus have an important role in raising awareness and encouraging families with school-aged children who have myopia to seek out a range of myopia control strategies. Box 3 lists the more commonly prescribed myopia control strategies that have been shown to be effective.
Most research evidence for the development, progression and management of myopia has been derived from studies in school-aged children. Thus, implementing evidence-based recommendations, particularly around the use of new myopia control strategies for children aged younger than five or for
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Figure 6. Tilted optic nerve with associated peripapillary atrophy( arrows).
Figure 7. Red-free image.
Figure 8. Fundus autofluorescence.
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Figure 9. Myopic fundus with vitreous condensations( green arrows), vitreo-retinal traction
( blue arrow) and myopic macular changes( white arrow).
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young adults aged over 18, is difficult. In these groups, the pattern of onset and progression can be quite different from that in school-aged children.
Exercise caution with the use of atropine eye drops in some cases, for example, those with Marfan syndrome may have cardiac complications, and atropine drops will exacerbate photophobia in children with cone dystrophies or albinism. A case-by-case approach is required, and it is important for clinicians to verify if axial elongation is occurring. This will determine whether active control therapy is warranted in this younger age group.
Although modalities exist for managing myopia in children, their effectiveness in adults remains uncertain because of the limited availability of large-scale clinical studies investigating control of myopia in this age group. Conducting studies in young adults is challenging because the lower progression rates necessitate larger sample sizes and longer study durations to detect significant effects. However, the options offered to children can still be used, particularly if axial length elongation is still being observed. The only caveat here is that myopia control strategies do have side effects, such as optical correcting devices that produce visual artefacts, for example, ghosting and haloes, particularly in the peripheral vision, which negatively impact the wearer experience. 21 Myopia control strategies also tend to be more costly than traditional single-vision lenses that simply correct the visual symptoms. 22 The benefits for active myopia treatment in young adults need to be weighed against patient motivation, costs and tolerance to side effects.
While keratorefractive surgery can enhance vision for adults with myopia, it does not guarantee a permanent halt to the elongation of the eye. As a result, undergoing surgery in early adulthood, such as in one’ s 20s, may lead to the resurgence of myopia later in life. This may result in reduced long-term satisfaction and prompt a reassessment of the cost-effectiveness of the procedure.
Surgery in extreme cases of high myopia
Surgery may be considered for
highly myopic eyes where there is a high risk of retinal and choroidal complications, with the goal
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