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some debate as to why and how myopia progresses, the evidence is irrefutable that the visual environment we live in, with prolonged indoor use of electronic devices is creating more myopes and more high myopia than ever before. The evidence that myopia progression can be halved with contact lenses is also very strong. Optometry & ophthalmology needs to address the trend towards ever increasing levels of myopia and possible associated clinical sequelae. Eye Care Professionals have a clinical duty of care to protect the health of the patient rather than simply follow the myopic progression of a patient. Nick Dash is an Honorary Lecturer at the University of Cardiff, School of Optometry. He has lectured at locations around the world from Aukland in NZ, to Harvard Medical School in USA to Key Note Speaker at the Hong Kong Optometric Association on topics including Myopia Control, Contact Lens Materials, Sports Vision and How Vision Affects Real World Performance. Complete a short multiple choice test at www.cetpoints.com to earn 1 CET point. References 1 N.S. Logan, P. Shah, A.R. Rudnicka, B. Gilmartin, C.G. Owen, Childhood ethnic differences in ametropia and ocular biometry: the Aston Eye Study, Ophthalmic Physiol. Opt. 31 (2011) 550–558 13 J.J. Walline, K.L. Greiner, M.E. Mcvey, L.A. Jones-Jordan, Multifocal contact lens myopia control, Optom. Vis. Sci. 90 (2013) 1207–1214. 14 P. Cho, S.W. Cheung, Retardation of myopia in Orthokeratology (ROMIO) study: a 2-year randomized clinical trial, Invest. Ophthalmol. Vis. Sci. 53 (2012) 7077–7085. 2 Williams K.M. et al; Prevelence of refractive error in Europe. The European Eye Epidimiology (E-3) Consortium, Eur J Epidemiol. 30 (2015) 305-31 3 Flitcroft, D. I. “The complex interactions of retinal, optical and environmental factors in myopia aetiology.” Progress in retinal and eye research 31.6 (2012): 622-660. 15 Watt K, Swarbrick HA. Microbial keratitis in overnight orthokeratology: review of the first 50 cases. Eye Contact Lens 2005; 31: 201–208. 4 Juvenile Myopia Control, Association of Optometrists, https://www.aop.org.uk/advice-and-support/clinical/scope- of-practice/juvenile-myopia-control (accessed December 2016) 16 Alharbi A, Swarbrick HA. The effects of overnight orthokeratology lens wear on corneal thickness. Invest Ophthalmol Vis Sci 2003; 44: 2518–2523. 5 Web-based, not for profit calculator of myopia www.myopiacare.org (accessed December 2016) 6 17 Turnbull, P.R., O.J. Munro, and J.R. Phillips, Contact Lens Methods for Clinical Myopia Control. Optom Vis Sci, 2016. 93(9): p. 1120-6. Rose KA, Morgan IG, Ip J, Kifley A, Huynh S, Smith W et al. Outdoor activity reduces the prevalence of myopia in children. Ophthalmology. 2008;115:1279–85. 18 Huang, Jinhai, et al. “Efficacy comparison of 16 interventions for myopia control in children: A network meta-analysis.” Ophthalmology 123.4 (2016): 697-708. 7 Wu PC, Tsai CL, Wu HL, Yang YH, Kuo HK. Outdoor activity during class recess reduces myopia onset and progression in school children. Ophthalmology. 2013;120:1080–5. 19 N.A. Brennan, Predicted reduction in high myopia for various degrees of myopia control, Cont. Lens Anterior Eye 35 (2012) e14–e15. 8 J.C. Sherwin, M.H. Reacher, R.H. Keogh, A.P. Khawaja, D.A. Mackey, P.J. Foster, The association between time spent outdoors and myopia in children and adolescents a systematic review and meta-analysis, Ophthalmology 119 (2012) 2141–2151. 20 Walline J et al. Contact Lenses in Pediatrics (CLIP) Study: Chair Time and Ocular Health. Optometry & Vision Science: September 2007 - Volume 84 - Issue 9 - pp 896-902 21 French, A.N. et al. “Time outdoors and the prevention of myopia.” Experimental eye research. 114 (2013): 58-68. 9  J.C. Sherwin, M.H. Reacher, R.H. Keogh, A.P. Khawaja, D.A. Mackey, P.J. Foster, The association between time spent outdoors and myopia in children and adolescents a systematic review and meta-analysis, Ophthalmology 119 (2012) 2141–2151. 10  11 Chung, K. Et al. “Undercorrection of myopia enhances rather than inhibits myopia progression.” Vision research 42.22 (2002): 2555-2559. 12 D. Cheng, G.C. Woo, B. Drobe, K.L. Schmid, Effect of bifocal and prismatic bifocal spectacles on myopia progression in children three-year results of a randomized clinical trial, JAMA Ophthalmol. 132 (2014) 258–264. Walline J et al. The Adolescent and Child Health Initiative to Encourage Vision Empowerment (ACHIEVE) Study Design and Baseline Data. Optometry & Vision Science: January 2006 - Volume 83 - Issue 1 - pp 37-45 22 Bullimore MA, Sinnott LT, Jones-Jordan LA. The risk of microbial keratitis with overnight corneal reshaping lenses. Optom Vis Sci 2013; 90:937Y44. 23 Dart JKG, Radford CF, Minassian D, Verma S, Stapleton F. Risk Factors for Microbial Keratitis with Contemporary Contact Lenses: A Case-Control Study. Ophthalmol 2008;115:1647-54 24 Flitcroft, D. I. “The complex interactions of retinal, optical and environmental factors in myopia aetiology.” Progress in retinal and eye research 31.6 (2012): 622-660. January 2017 | etCETera 17