COOKIE Issue 11: The Myopia Issue

Page 1

It’s about time we made managing myopia a priority

The Silent Pandemic

The Long and Short of Myopia Management

uncontrolled, it might turn into a bad complication, such as cataract, glaucoma, retinal detachment, and myopic maculopathy.

Aparent with a myopic child will most likely walk into an optometry clinic to get the needed intervention. But single-vision lenses are proven to worsen myopia. In fact, single-vision lenses are used as control for research involving strategies and methods to control myopia.

During the 2015 BCLA conference in Liverpool, UK, Prof. Pauline Cho presented strong evidence on how orthokeratology can control myopia progression through myopic defocus — to which the late Prof. Brien Holden asked: "Why are we not doing it?!”

Why aren’t we, indeed?

Based on experience, the following are some of the challenges and reasons why optometrists are still reluctant to practice myopia control — and ways we can work around them.

First, it requires investing time. ODs have to leave their clinics and relearn, learn, and refresh their professional skills. But this has been remedied by the pandemic where online training is possible and sometimes costs nothing. The World Council of Optometry, for example, has put together a series of myopia management online education courses through generous industry support.

Second, the cost of acquiring new tools and equipment is high. When I started myopia management, I didn’t have the latest machine and technology — I used what I have in my clinic: retinoscope, RetiRacks, prism bars, occluders, penlight, Worth four dot, ophthalmoscope, etc. I took small steps by prescribing bifocal executive lenses and orthokeratology. My first topography was a secondhand one I bought from eBay. As my practice grew, the industry supported me by extending good terms very friendly to my cash flow.

Third is chair time — it takes a lot of time to explain to the patient and their family the new tools and technology that we use or why we need to do certain tests and examinations. Anything that’s novel takes time to accept. But patients appreciate that we take the time to explain to them their condition and how, if left

Last but not least is availability and cost of a myopia control strategy. Some countries are fortunate to have all the latest innovations in myopia control strategies available to them. But the majority of developing countries do not even have affordable contact lenses. These are a hindrance for the practitioners. Even if available, the cost of these contact lenses is not affordable to patients because of economic reasons. However, the industry, scientific researchers, and investigators never stop designing, testing, and validating new technologies that are geared toward accessibility and affordability.

Some of the latest innovations and strategies for myopia control are customized, such as orthokeratology lenses for myopia with astigmatism made of highly flexible material and higher Dk — like the SEED ortho-K lenses. Another newbie we can add to our toolkit is the Rodenstock Mycon lenses. MiSight dailies by CooperVision and NaturalVue EDOF have shown very promising results. Hoya MiyoSmart has a good two-year study showing efficacy almost close to that of orthokeratology. Stellest lenses by Essilor claim they slow down myopia progression by 67% compared to single vision lenses. SightGlass is another technology that uses DOT (diffusion optics technology) — a two-year study shows these lenses slow down myopia by 56% when worn full-time.

As I write this piece, I am pretty sure someone might be thinking of a ‘peel’ or an ‘eye drop’ that would potentially stop myopia altogether. Who knows?

For now, there’s a mountain of work to be done, and optometrists must be at the forefront of the continuing search for a solution to the global myopia crisis, dubbed as the ‘other pandemic’.

As always, please enjoy our Myopia Issue.


COOKIE MAGAZINE | April 2023 2
Letter to Readers
The increasing prevalence of myopia globally calls for urgent action, and there is a huge role that the optometric profession can play to combat this common yet alarming eye condition.


Nip Myopia in the Bud? With AMMC®, a first-ofits-kind standardized age-matched myopia control system, we can do just that!

Quarantine Myopia

Childhood myopia is on the march, and new research suggests COVID-19 is the culprit

Fighting Back Against Myopia

Cover Story

The Silent Pandemic

It’s about time we made managing myopia a priority

Carving Her Own Niche From Gretna to the world, Dr. Cheryl Chapman aims to create myopia awareness and foster education among fellow optometrists DOT Lenses

Our new ally in the fight against childhood myopia?

The Myopia Control Era is Upon Us … and an explosion of new treatments and tech is trumpeting its arrival

Challenging the Myopia Status Quo

Myopia expert advises starting small and focusing on creating awareness

The AOA Guide

What you need to know about myopia management

3 COOKIE MAGAZINE | April 2023 In This Issue...
The right tools make all the difference in the thick of the myopia epidemic in the Asia-Pacific region
The Science (and Fashion) of Sunglasses … and how they could help bring the myopia epidemic out into the cold hard light of day
Optometry Enlightenment 06 08 10 14 12
18 22 23 30 Innovation
Glaucoma in Focus Ophthalmologists tackle the 'silent thief of sight’ at APAO 2023 Kudos
25 27


Matt Young

CEO & Publisher

Hannah Nguyen


Gloria D. Gamat Chief Editor

Mapet Poso Editor

Maricel Salvador

Graphic Designer Writers

Andrew Sweeney

Ben Collins

Chow Ee-Tan

Hazlin Hassan

Matt Herman

Sam McCommon

Tan Sher Lynn

Ruchi Ranga

Customer Care

International Business Development

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COOKIE MAGAZINE | April 2023 4 Advisory Board Members
Dr. Carmen Abesamis-Dichoso Abesamis Eye Care & Contact Lens Center, Manila, Philippines Dr. Kristie Nguyen Perez and Associates and Phan-Tastic Eye Care , Florida, USA Dr. Joseph J. Allen Doctor Eye Health, Minnesota, USA Dr. Mark Eltis View Eye Care, Toronto, Canada Dr. Monica Chaudhry Learn Beyond Vision, New Delhi, India Dr. Elise Brisco NearSight, California,

J&J Vision Receives CE Mark Approval for New Corneal Refractive Technology

Johnson & Johnson Vision recently announced that it has received CE Mark approval for its next-generation laser vision correction solution, the ELITA Femtosecond Laser System. The new laser will allow surgeons to perform refractive correction on patients with myopia, with or without astigmatism, via the SILK (smooth incision lenticule keratomileusis) Procedure, a new lenticular procedure.

The ELITA System leverages an ultraprecise laser pulse and fast laser delivery system to deliver a very smooth corneal surface, making lenticular removal extremely easy.

“The ELITA System represents a generational leap in corneal refractive

technology, leveraging advanced technologies and designs to deliver improvements in surgical experiences and patient outcomes,” said Xiao-Yu Song, Global Head of R&D, Johnson & Johnson Vision. “Early clinical results have shown promising visual outcomes and patient satisfaction data, leading us to believe that the ELITA System, and the SILK Procedure, has the potential to elevate the standard of care for patients with myopia.”

The SILK Procedure brings to market a proprietary biconvex lenticule shape that’s designed to offer the following advantages: posterior and anterior surface matching without any corneal folding when the lenticule is removed from the cornea, and better preservation

CUHK Study Proves Low-Concentration Atropine Eye Drops Can Prevent Myopia in Children

The Chinese University of Hong Kong (CUHK)’s Faculty of Medicine (CU Medicine) conducted a randomized, placebo-controlled, doublemasked trial of low-concentration atropine eyedrops to evaluate their effectiveness in preventing myopia.

Results show that among children aged four to nine years without myopia, compared with placebo, nightly use of low-concentration 0.05% atropine eye drops resulted in a significant reduction in the incidence of myopia over two years, from 53.0% to 28.4% (a relative reduction of 46.4%). This is the first study in the world to prove that lowconcentration atropine eyedrops can prevent the onset of myopia. Details of the study have been published in The Journal of the American Medical Association (JAMA).

The CU Medicine research team recruited 474 non-myopic children aged four to nine years at the CUHK

Eye Centre to join the randomized, placebo-controlled, double-masked “Low-Concentration Atropine for Myopia Prevention (LAMP2)” trial from 2017 to 2020. The participants had at least one parent who is myopic. They were randomly assigned to the 0.05% atropine group, the 0.01% atropine group, or the placebo group and had eyedrops applied once nightly in both eyes for two years.

Results showed that the 0.05% atropine group had a significantly lower two-year cumulative incidence of myopia and a lower percentage of participants with fast myopic shift, compared with the placebo group.

Dr. Jason Yam Cheuk-sing, principal investigator of the LAMP2 Study, associate professor from the Department of Ophthalmology and Visual Sciences, CU Medicine, and director of the CUHK Jockey Club Myopia Prevention Programme, stated: “Our previous LAMP1 study proved

of biomechanical strength of the cornea and faster nerve regeneration due to less corneal fibers being cut.

The ELITA Femtosecond Laser System is indicated for myopia patients with or without astigmatism up to -12DS, up to - 6DC, with a sum of sphere and cylinder between -1.00D and -12:00D using minus cylinder convention. It is also indicated for use in LASIK flap procedures. It will soon be available for ophthalmologists in select countries across the Asia-Pacific and Europe.

The ELITA Femtosecond Laser System is not yet approved for use in the United States This content is intended for Healthcare Professionals only, not for the general public.

Industry Update

that low-concentration atropine eye drops can reduce myopia progression and a 0.05% concentration appeared to achieve the best balance between maximizing efficacy and minimizing side effects. The current LAMP2 study has further shown their potential in preventing myopia onset. As our younger generation becomes more reliant on digital devices and we are facing a surge in myopia in the future, our findings suggest low-concentration atropine eye drops are an effective preventive strategy for myopia onset among high-risk children and reduce their risk of suffering from sight-threatening diseases.”

The team plans to launch a LAMP3 study to investigate the efficacy and safety of combining atropine eyedrops with red light therapy.

Interested individuals can contact the research team by WhatsApp (91371925) or email (

5 COOKIE MAGAZINE | April 2023
Industry Update

Nip Myopia in the Bud?

Matched Myopia Control (AMMC®). This framework helps doctors identify potential myopia in children to treat it early.

This framework was developed by Prof. Dr. Hakan Kaymak, who was kind enough to speak with us and describe how the system works, how doctors can use it, and how it can help nip myopia in the bud. Prof. Kaymak is an ophthalmologist, eye surgeon, and head surgeon of Breyer, Kaymak & Klabe Augenchirugie in Düsseldorf, Germany.

So, what makes AMMC® so special?

With AMMC®, a first-of-its-kind standardized age-matched myopia control system, we can do just that!

Pardon the pun, but it's easy to be short-sighted in preventing and treating myopia. It's an enormous and growing problem expected to affect half the world's population by 2050 — that is, if we continue our current trajectory. If prevention and diagnostic protocols are rapidly improved, however, maybe we can turn that trend in the other direction. To do that, doctors will need both the right tools and the right information.

For starters, there was no standardized myopia control system prior to this one. It's the first of its kind. It provides data on the eye’s axial growth based on age and gender. The data is presented in an easy-to-understand visual format that can help doctors explain their child’s situation to parents.

Communication with patients is a crucial point. As Prof. Kaymak told us, “With the new system, it is possible to tell the parents clearly what we want to achieve with our therapy. It is also helpful to improve compliance and adherence, especially when we use atropine eye drops. It is nice for the parents and also for the children to see that they reach the therapy goal and are thus further motivated.”

Catching myopia as early as possible is vital in treating it. The AMMC® system can be used in children as young as six years old, when the biometry and refractive measurements can be performed accurately enough.

Biometry and informed decisions

We're discussing that here, and we've got some good news. Lenstar Myopia (Haag-Streit, Köniz, Switzerland) combines a top-notch tool in the Lenstar 900 biometer with intuitive,

powerful software in EyeSuite Myopia.

And here’s where we tie it back to myopia prevention: A key, exclusive feature in EyeSuite Myopia is Age-

Prof. Kaymak noted that measuring axial length is the key to identifying myopia that results from excessive eye growth, which is, by far, the most common type of myopia. So what measurements are valuable? “For myopia management, myopia and the need for therapy should be judged by axial length measurement,” explained Prof. Kaymak. “If the axial length of


an eye is greater than the average axial length of an age-matched group of emmetropic children, that is those children that remain without any error of vision, an ophthalmologist should consider recommending myopia therapy,” he continued.

Monitoring eye growth and treatment effects are crucial as well. After the initial assessment and commencement of therapy, doctors can use the AMMC® framework to keep track of the course of the therapy. The child’s second visit should take place 10 to 14 months after the first, and biometry will be collected again. The actual eye growth is compared to normative values, which will give an idea of just how effective the therapy has been.

The same process is repeated at subsequent follow-up visits. If the therapy has worked and the goal has been reached? Great! If new therapy is needed, the doctor can discuss with the parents what needs to change.

Note that it’s insufficient to measure axial length growth alone: It must be compared to the normative values of emmetropic children of the same age, gender and ethnicity, since eye growth is quite dependent on a child’s age. This is where the "age-matched" part of AMMC comes in, which is why the system is so valuable.

Catching myopia before it begins

Myopia should be treated as early as possible to prevent it from worsening. We know that. But can it be identified before it even begins?

Yes, says Prof. Kaymak. As he explained, “Well before the children develop myopia as it is expressed in the negative refractive power of the glasses, one can already determine on the basis of the axial length whether an excessive axial length growth will soon give rise to myopia or not.”

The axial length growth difference between myopes and emmetropes is noticeably different two to three years prior to the onset of myopia, Prof.

Kaymak noted — meaning myopic eyes develop quite differently before any refractive change towards myopia takes place.

Preventative treatments

Should biometry indicate that myopia is likely to develop, there are a couple of valuable preventative treatments. Firstly, Prof. Kaymak noted, children need to be outdoors more. We’ve heard ophthalmologists discussing this for some time now, as a landmark 2008 study¹ indicated a significant difference between children of Chinese descent in Singapore and Sydney, Australia. Spoiler: the kids who were outside more had much lower rates of myopia.

Secondly, Prof. Kaymak pointed to studies indicating that prophylactic atropine at 0.05% can reduce the risk of myopia onset by half, as shown in the latest publication in the LAMP2 study.² We should consider starting myopia treatment prophylactically before myopia becomes visible as a refractive error. There is a whole new group of patients to be addressed: Parents with children who have, apparently, healthy eyes.

Knowing is the real battle

In order to treat myopia, doctors and parents must be aware of it. That’s why the biometry assessed by the AMMC® framework is so crucial: It gives a clear indication of just what needs to be done.

Prof. Kaymak urged doctors to get going. As he put it, “I can only recommend starting with this new myopia management soon. Firstly, it is straightforward to use and enables us to communicate clearly with patients and their parents. Secondly, and more importantly, we have the opportunity to help shape the future of all children by preventing them from developing pathological myopia, which is definitely not just a cosmetic problem, but one of the main causes of severe vision loss and blindness in all developed societies.”

Ensuring children maintain quality

eyesight is one of the most laudable goals possible. And now that the tools are improving, it’s more possible than ever.

Prof. Kaymak said it well: "We can actively influence and stop excessive eye length growth with pharmacological and optical correction therapy options. With the AMMC® system, we have the possibility to perform efficient and safe monitoring, which means that we have everything in place to ultimately meet our treatment goal."

The AMMC® method is exclusive to Haag-Streit and is only available, as standard, in the Lenstar Myopia.


1. Rose KA, Morgan IG, Smith W, Burlutsky G, Mitchell P, Saw S. Myopia, Lifestyle, and Schooling in Students of Chinese Ethnicity in Singapore and Sydney. Arch Ophthalmol. 2008;126(4):527-530.

2. Yam JC, Li FF, Zhang X, Tang SM, Yip BHK, Kam KW, et al. Two-Year Clinical Trial of the Low-Concentration Atropine for Myopia Progression (LAMP) Study: Phase 2 Report. Ophthalmology. 2020;127(7):910-919.

Contributing Doctor

Prof. Dr. Hakan Kaymak is an ophthalmologist, eye surgeon, and chief surgeon at Breyer, Kaymak & Klabe Eye Surgery in Düsseldorf, Germany, for the area of retinal, macular, and vitreous body surgery. His range of therapies includes laser treatments, innovative combination therapies, and minimally invasive operations, as well as the prevention and treatment of myopia in children. He has experience from more than 45,000 surgeries. Prof. Dr. Kaymak is the medical director of the Macula Retina Center in DüsseldorfOberkassel and a Professor of Experimental Ophthalmology at the University Eye Clinic Homburg/ Saar. He also teaches at the Ernst Abbe University in Jena and cooperates with Prof. Schaeffel, University of Tuebingen, in the field of prevention and therapy for myopia in schoolchildren.

7 COOKIE MAGAZINE | April 2023

Quarantine Myopia

gradually increased, so too have rates of myopia among children. Everyone from doctors on the frontlines to industry has taken notice, and a slow drip of innovation and novel treatments has ensued.

But with COVID-19, this progressive uptick in childhood myopia turned into a deluge, and researchers the world around have been left scrambling about why, and perhaps more importantly, what to do.

Power and numbers

Childhood myopia is on the march, and new research suggests COVID-19 is the culprit

Lockdowns and logging in to school online have taken their toll on pediatric eyesight. An increasingly alarming number of children need refractive correction, thanks to COVID-19. New research investigates what exactly about the pandemic got us here, and how optometrists on the frontlines can combat this worrying trend.

The situation on the ground is dire, and optometrists like Dr. Monica Chaudhry, director of the MC Vision Institute, are watching the pediatric patients pile up. “What we’ve seen in the last three, four years is amazingly different from the experience we had. We’ve seen numbers increasing in children — number one,” she began.

But the story goes well beyond the sheer amount of patients. “Not every patient we used to find [was] progressive. There were quite a few stable patients. But what we have seen recently, especially after the lockdowns, is power in children increasing from minus-four to minus-eight within a year. This had not been our experience — such drastic progressions,” Dr. Chaudhry concluded

Every generation brings its share of new tools and toys that change the way humans go about their daily lives. From radio to television to the internet and everything in between (yes, even you, cassette tapes), novel technology has carved channels both subtle and sizable onto the wax of human behavior and health.

The advent of the smartphone and its analogs, like tablets and

handheld game systems, has had an indisputably outsized impact on every facet of human existence, including eye health. Access to a constant stream of information has forever altered the way we see the world, but the screens on which we access this information have also changed the way we see, and not for the better.

Eye specialists have long known about the connection between these devices and myopia. As their use has

The data accompanying the flood of both newly myopic children during the pandemic and dramatic progressions in the disease are shocking. According to a recent metaanalysis1 of research done on myopia and the pandemic, the prevalence of myopia increased by 10.49% during the pandemic, and 16.5% more children saw myopia progression during the COVID-19 pandemic than before it.

The factors that increase myopia are nothing new. Increases in screen time and decreases in time spent outside are the active ingredients in the witches’ brew that causes the eyeball to elongate. These factors have long explained the gaps in myopia rates between urban and rural children. They now explain the pandemic myopia explosion, when the virus turned the world into an essentially

COOKIE MAGAZINE | April 2023 8 CHILDHOOD MYOPIA Cool Optometry |

urban population via lockdowns and their knock-on effects.

Time spent outside significantly decreased during the pandemic,1 according to several studies in the meta-analysis. “Being outdoors releases dopamine, which regulates the growth of the eyeball,” Dr. Chaudhry explained — a sentiment echoed by the meta-analysis.1 “A second reason is that when you are outdoors, you are more relaxed and your eye is more focused for distance,” she continued.

world, primary prevention measures like educating professionals who work with children and parents on the importance of putting devices away and getting outside, or at the very least holding them at a distance, are the ideal fix for future pandemics.

But that ship has sailed for the current generation, and secondary and tertiary prevention measures must take center stage in dealing with the current myopia mayhem. Secondary prevention measures involve identifying pre-myopes before symptoms arrive. Guidelines suggested by the study2 involve stepping up screening to include binocular vision, axial length measurements, and cycloplegic refractometry.


1. Cyril Kurupp AR, Raju A, Luthra G, et al. The Impact of the COVID-19 Pandemic on Myopia Progression in Children: A Systematic Review. Cureus. 2022;14(8):e28444.

2. Németh J, Aclimandos WA, Tapasztó B, et al. The impact of the pandemic highlights the urgent need for myopia guidelines: The clinicians' role. Eur J Ophthalmol. 2022;33(2):11206721221143008.

Contributing Doctor

The relaxation of the eye is also the name of the game with screen time. The jury is still out on the effects of blue light being emitted from the screens of phones, tablets, and the like, but the strain put on the eye from excessive near-vision tasks is not.

Myopia progression has been found to increase with mobile phone usage,1 which increased from 52.63% to 68.62% during COVID. “These small digital devices, the distance at which you hold them is getting closer. And when you are looking nearer, your eye doesn’t relax for distance,” Dr. Chaudhry stated.

A gaggle of guidelines

With kids locked indoors relying on near-vision-heavy devices like smartphones for everything from social interaction to education to entertainment, the COVID-19 pandemic was a perfect storm for myopia. With myopia now entrenched, the question remains of what can be done about it.

Another study2 highlights the critical role that primary eye care providers like optometrists can play. In a perfect

Tertiary measures, which aim to slow the progression of the disease, are starting to show much promise. Orthokeratology, a variety of day-use contact lenses, and atropine lead the pack in the early going of the myopia control era. The guidelines2 suggest mass campaigns of education not only on the availability of these novel therapies, but also instructions on how to tailor them to the individual patient.

Time for action

In theory, the tools exist to both nip the blooms of future myopia maelstroms in the bud and treat those who slip through the cracks of prevention programs. But Dr. Chaudhry sees a glaring obstacle. “One of the major add-ons is cost, especially in India,” she opined. “The challenge of bringing awareness, almost all of the money is going there,” she went on. “Even if I build awareness and bring them to the clinic, 80% of my patients cannot afford it.”

The solution for Dr. Chaudhry lies in industry and philanthropy waking up to the reality of myopia and the havoc it can wreak on the future. “By 2050, something like 50% of the population is predicted to be myopic,” she put forward. “The economic burden will be much worse if we don’t get donors and industry into this domain.”

Dr. Monica Chaudhry is a consultant optometrist and educator who has more than three decades of experience as an academic and clinician. With her extraordinary skills in optometry education, she has recently ventured to be a freelancer educator, strategy advisor, and practitioner. She is the founder of an online optometry up-skilling education platform, Learn Beyond Vision. Also, she has instituted some centers of excellence and vision centers, which aim to be a unique referral, academic and research units. She is wellknown contact lens and low vision specialist and has a far and wide patient referral in India. Prof. Chaudhry has served at the All India Institute of Medical Sciences (AIIMS) in New Delhi, had academic experience with various universities, including the Indira Gandhi National Open University (IGNOU) and Amity University (India), and has recently retired as director of School of Health Sciences at Ansal University (Gurgaon, India). In recognition of her contribution to the field of academic medical service, she has been awarded the Shreshtshree Award by the Delhi Citizen Forum, the Australian Leadership Fellowship award in 2012 and the IACLE Contact Lens Educator of the Year (Asia Pacific) award in 2015. Prof. Chaudhry was chairman of the Optometry Council of India. She has been actively involved in organizing conferences, seminars, national and international workshops, faculty development programs and many corporate training programs.

9 COOKIE MAGAZINE | April 2023
“What we’ve seen in the last three, four years is amazingly different from the experience we had. We’ve seen numbers increasing in children.”
— Dr. Monica Chaudhry

Fighting Back Against Myopia

Proper and timely diagnosis of myopia is becoming more important by the day as the disease continues to rage around the world. At an APAO 2023 symposium, leading experts Dr. Foo Li Lian and Dr. Kyoko Ohno-Matsui highlighted what makes the OCULUS Myopia Master the perfect wingman in the myopia dogfight.

Myopia and its emergence around the world need no introduction to doctors in the Asia-Pacific region. As the world licks its wounds from the COVID-19 pandemic, myopia has quickly and quietly become endemic across the globe.

New tools on the market have risen to meet the challenges brought on by the resultant bewildering variety of options now available for myopia treatment. And in an OCULUSsponsored lunch symposium at the 38th Asia-Pacific Academy of Ophthalmology Congress (APAO 2023) in Kuala Lumpur, one of

the gold standards in myopia — the Myopia Master® (OCULUS Optikgeräte GmbH, Wetzlar, Germany) — took center stage.

In a session moderated by Dr. Huy Tran, internationally-renowned myopia maestros Dr. Kyoko OhnoMatsui (Japan) and Dr. Li Lian Foo (Singapore) took a look at the Myopia Master and how it fits into the modern myopia management and control landscape.

The master at work

Dr. Ohno-Matsui of Tokyo Medical and Dental University kicked things

off with her presentation, entitled OCULUS Myopia Master for Myopia Management. Her presentation featured golden nuggets about the Myopia Master that position it as the ideal companion in the era of endemic myopia.

She began by asking one of the most important questions in myopia care — what parameters are critical for myopia management and control in children? She then stressed the primacy of cycloplegic refraction for diagnosis and axial length measurement for monitoring progression.

No matter what the clinicians need to tackle myopia in all of its stages, Dr. Ohno-Matsui showed how the Myopia Master was up to the task. It all starts with prevention. “Children at risk can be identified even before myopia develops,” she explained.

The trouble is that this identification process is complex given how

COOKIE MAGAZINE | April 2023 10
The right tools make all the difference in the thick of the myopia epidemic in the Asia-Pacific region

different eyes are from around the world. She compared Caucasian children with Chinese children, who have longer axial lengths and faster axial elongation to illustrate her point.

But the Myopia Master is on it. “One of the outstanding features of the OCULUS Myopia Master is the availability of these percentile curves, which is essential for myopia management based on axial length,” she stated. Not only does the device allow clinicians to compare patient data with the relevant normative BHVI database, but it also allows for prognostic estimates of the projected degree of future myopia if treatment is discontinued with a 95% confidence interval of +/- 1.85D.

This ability to predict myopia progression is a critical component in another one of the massive hurdles in myopia management and control — educating the parent. Selling a parent on pricey and time-consuming myopia treatment options can be tough, especially if the disease has not yet begun to progress in terms of refractive error. The Myopia Master, however, puts a suite of educational tools at the clinician’s disposal to combat this.

“The Myopia Master also makes it easy for patients and their parents to understand the mechanisms of myopia,” Dr. Ohno-Matsui explained. One particularly useful tool for Dr. Ohno-Matsui is the reports generated by the device. “The results are

displayed in an easy-to-understand manner showing the degree to which environmental factors involved in myopia worsen with age due to events such as studying for entrance exams,” she began.

The Myopia Master is also primed for what’s coming down the road. “Furthermore, as scientific evidence accumulates, risk factors can be customized and added in the future,” she continued. “This allows for precise guidance regarding treatment choices and lifestyle modifications. This device is sure to be a very valuable tool for myopia management,” Dr. Ohno-Matsui concluded.

Taking the plunge with the Myopia Master

There’s never been a better time for plugging myopia management into your practice, and celebrated expert Dr. Foo Li Lian of Singapore National Eye Center explained how the Myopia Master plays a critical role in the integration process.

Dr. Foo began with some sobering statistics about the myopia onslaught: 50% of the world’s population will be myopic by 2050. In Singapore, 80% of the 18-year-old population is currently myopic; and by 2030, 80% of all Singaporeans will have the disease. All of this adds up to a significant burden on public healthcare and a disastrous drop in quality of life and productivity.

After a review of currently available treatment options and a stern warning against non-evidence-based treatment options, Dr. Foo moved to monitoring myopia progression using cycloplegic refraction and manifest fogging techniques. In the past, it was incumbent upon the clinician to chart all of these data by hand. But with the Myopia Master, Dr. Foo explained, all of this is made a snap by digitalizing it all in the device.

Intervention is also a key area that the Myopia Master simplifies in Dr. Foo’s practice. “We always have this dilemma in the clinic — we want to know who the patient we are treating is, when and for what duration to

treat them, and what myopia control treatment to use. We need to balance the potential risks and side effects.”

This is all streamlined by the Myopia Master. “[With the Myopia Master], you can input the risk factors for progression like parental myopia, near-work, and outdoor time together with the clinical data, and they will derive a profile for you that will indicate the risk of myopia progression,” Dr. Foo stated.

Like Dr. Ohno-Matsui, Dr. Foo also stressed the importance of parent education. Parents can have difficulty understanding the ins and outs of axial length, and Dr. Foo praised one particular feature of the Myopia Master that makes this a breeze: “The Gullstrand Refractive Analysis System is very useful for parent understanding of myopia progression,” she explained.

In the end, though myopia is here to stay, we are well-equipped to deal with it. “There is a need for action — even early myopia can benefit from early intervention and early myopia control treatment,” Dr. Foo opined. And with the Myopia Master, taking action to preserve sight has never been easier.

Editor’s Note

The 38th Asia-Pacific Academy of Ophthalmology Congress (APAO 2023) was held on February 23 to 26 in Kuala Lumpur, Malaysia. Reporting for this story took place during the event.

11 COOKIE MAGAZINE | April 2023
“[With the Myopia Master], you can input the risk factors for progression like parental myopia, near-work, and outdoor time together with the clinical data, and they will derive a profile for you that will indicate the risk of myopia progression.”
— Dr. Foo Li Lian
Myopia Master

The Science (and Fashion) of Sunglasses

… and how they could help bring the myopia epidemic out into the cold hard light of day

With growing awareness and concerns surrounding the current myopia epidemic, outdoor time and exposure to light have been touted as one simple yet effective measure for stifling its development.1

Great! Who doesn’t like getting out of the office or classroom, soaking up some rays, and enjoying a beautiful vista or two in the name of eye health, am I right?! Too easy!

But hang on a minute… what about those other nasties that can damage our eyes in the outdoor environment? Over or prolonged exposure to harmful UV light rays can cause additional or even more serious vision impairments!

Just like our skin can get burned if we lie in the sun too long without adequate protection (sunscreen, shirt, hat, etc.), our corneas can also get irritated and inflamed because of UV rays, resulting in photokeratitis or ‘sunburned eyes’. Studies have linked exposure to high levels of UV light with an increased risk of cataract development, and it can potentially escalate macular degeneration as well.

Protect those precious eyes!

Yikes! All sounds a bit grim. But surely a quality pair of sunglasses, combined with a decent wide-brimmed hat should be enough to keep our eyes safe out there in the big wide world?

Certainly. Modern sunglasses are not only a thing of beauty and fashion, but also a highly effective tool for protecting your eyes from the elements. A good pair of shades with a UV400 rating can block 99% to 100% of UVA and UVB rays. Tinted, anti-reflective, polarized, and transitional lenses can also help reduce glare and eye strain in harsh light.

Keep it out? Or let it in?

But wait a minute. If — in light of myopia development — sunshine and outdoor time are good for our eyes, wouldn’t wearing sunglasses be counterproductive in this instance?

Well, not really. Dr. Jeffery J. Walline, associate dean for Research at the Ohio State University College of Optometry in the United States, broke it down for us.

“There is no evidence that indicates that sunglasses either slow or increase myopia progression,” Dr. Walline said. “Some would state that sunglasses may increase myopia progression if the amount of sunlight that enters the eye is reduced. However, there are a couple of primary reasons to believe this is unlikely. First, increased outdoor time has been proven by many studies to delay the onset of myopia, but most studies report that outdoor time is not related to


myopia progression. And second, the amount of light hitting the eyes while wearing sunglasses is greater than the amount of light believed to be necessary to delay myopia onset.”2

them that says ‘UV protection’ or ‘UVA and UVB protection’, then they should provide the protection necessary. If they don’t have a sticker that says ‘UV protection’ in some form, then they aren’t worth the cost involved,” he explained.

So, do we really need to spend hundreds of dollars on the latest shades with all the bells and whistles? While various technologies and trends such as colored tints, anti-reflective, polarized, and transitional lenses can certainly ease the burden on the eyes (especially in extreme situations, like out on the water or in the snow), they are not essential for protecting our eyes from UV rays.

by covering more of the face, thus allowing less light into those precious retinas.

UV light tends to bounce off surfaces and finds its way into the eye through the gaps between your glasses and your face. So this latest trend in outdoor eyewear is not only super fun and fashionable but great for general eye health as well!

It’s a win-win!

So get out there, grab a pair of shades (and maybe a cheeky accessory or two like a hat or scarf), and enjoy the great outdoors! For the sake of your eye health, of course!

He pointed to a fascinating study published in the Translational Vision Science and Technology Journal, The Effects of Different Outdoor Environments, Sunglasses and Hats on Light Levels: Implications for Myopia Prevention, which concludes that we (and children in particular) should be encouraged to spend more time outdoors while using sun-protection measures to prevent myopia.

“Right now, the evidence-based benefit of sunglasses is protection from the damaging rays of the sun. If we want to protect our eyes and preserve our vision, we should wear hats and/or sunglasses,” Dr. Walline continued.

So we can all breathe a sigh of relief knowing we can get outdoors safely as long as we use adequate eye protection to save our corneas from damaging levels of UV light and, at the same time, get that much-needed natural light to help prevent myopia.

So, what should we look for in sunglasses?

We pressed Dr. Walline a little further to see what he thought we should be looking for in a good pair of sunglasses, and his advice was succinct.

“‘It is important that the sunglasses include protection from UV light. If the sunglasses have a sticker on

Ultimately, it comes down to a matter of personal preference and the individual requirements of the consumer. For example, water or snow sport enthusiasts may well want polarized lenses, whereas your everyday wearer heading out for a picnic in the park could probably get away with a more standard lens.

Work those wrap-arounds!

Perhaps a more important aspect of effective sunglass design — and one very dear to our hearts here at Media MICE/COOKIE Magazine — could be, you guessed it, fashion!

Because let's face it, if your sunglasses don’t look great, then you are not likely to get the use out of them your eyes deserve. And the good news here is that, what’s in style right now are not only great-looking frames and lenses, but practical, robust, and ergonomic designs — which also incorporate features that add value to the protective qualities of your sunglasses.

Retro tints, oversized frames, racer or wrap-around glasses, and ecofriendly materials are all the rage this season. This is a move away from the sleek minimalist designs of the last decade or so. The advantage of large/ oversized, or wrap-around sunnies for eye health is that they provide greater protection for the eyes simply


1. Eppenberger LS, Sturm V. The Role of Time Exposed to Outdoor Light for Myopia Prevalence and Progression: A Literature Review. Clin Ophthalmol. 2020;14:18751890.

2. Lance C, Teo A, Vivagandan A, et al. The Effects of Different Outdoor Environments, Sunglasses and Hats on Light Levels: Implications for Myopia Prevention. Transl Vis Sci Technol. 2019;8(4):7.

Contributing Doctor

Dr. Jeffrey J. Walline , OD, PhD, is the associate dean for Research at The Ohio State University College of Optometry. He received his Doctor of Optometry degree from the University of California, Berkeley School of Optometry, and received his Master’s and PhD degrees from The Ohio State University College of Optometry. Dr. Walline has led several pediatric contact lens studies, and he is the study chair of the Bifocal Lenses In Nearsighted Kids (BLINK) Study, a National Eye Institutesponsored randomized clinical trial to investigate the myopia control effects of soft multifocal contact lenses.

13 COOKIE MAGAZINE | April 2023
“Right now, the evidence-based benefit of sunglasses is protection from the damaging rays of the sun. If we want to protect our eyes and preserve our vision, we should wear hats and/or sunglasses.”
— Dr. Jeffrey J. Walline

The Silent Pandemic

It’s about time we made managing myopia a priority

It’s remarkable how quickly we became used to pandemic measures with relative alacrity that working from home and zoom calls all became mundane, run-of-the-mill activities. But does this mean we are now getting accustomed to diseases of pandemic proportions that we don’t recognize them for the threat that they are? The myopia pandemic is real and it’s one of the most troubling trends in ophthalmic care today.

When COVID-19 emerged as a pandemic, governments were quick to act with massive interventions. National lockdowns and restrictions on personal movement were just some of the protocols that were put in place to manage the crisis. Huge upticks in healthcare spending became the norm.

Granted, myopia is not as novel and fatal as COVID-19 so the lack of attention on the public’s part is perhaps understandable, but the condition has already reached pandemic proportions and it now represents a serious threat to global healthcare industries. As such, myopia should be made a priority by optometrists, ophthalmologists, and other key stakeholders, as without profound intervention by medical professionals and governments, most of the global population will be affected by it. That may sound like hyperbole — and perhaps that’s true to a degree, but the facts speak for themselves.

Cover Story

Three out of five people will develop myopia

We spoke with two leading experts on myopia about the spread of the disease in different parts of the world, why we should all be focusing more attention on it, and what can be done to arrest its spread.

Dr. Cheryl Chapman is an orthokeratologist at Gretna Vision Source in Nebraska, USA, and president of the American Academy of Orthokeratology and Myopia Control — and she is particularly concerned about the growing rates of myopia across the world.

“Myopia is on the rise around the world, and, globally, the prevalence of the disease exceeds 28%. Alarmingly, it’s predicted that approximately half of the world's population (five billion people) will have some degree of myopia by the year 2050. Not only are more children becoming myopic, but the rate of high myopia is also increasing,” shared Dr. Chapman.

“In the United States, the number of myopic patients has increased from approximately 25% in the 1970s to over 40% by 2000; and this figure is predicted to climb to 60% by 2050,” she continued.

That’s a huge increase, and it’s not even the tip of the iceberg as North America is far away from being the epicenter of the myopia crisis — that dubious honor belongs to Asia, specifically

the Asia-Pacific region. In this region, myopia is particularly common with prevalence rates of 80% to 90% among young adults. In contrast, the prevalence of myopia is lower in some African and South American countries, with rates typically ranging from 20% to 30%.

Mr. Ryan Ho, optometrist and CEO of Malaya Optical in Petaling Jaya, Malaysia, is on the frontlines in the fight against myopia in Asia. Mr. Ho has witnessed cases of the disease explode both in his country and at his clinic and has noted that it is particularly prevalent in urban areas. He shared that this can be attributed to a number of factors.

“The increasing prevalence of myopia is a major public health concern as it can lead to significant vision impairment and other related health problems. The exact causes of this increase in myopia are still being studied, but it is believed to be associated with a combination of genetic, environmental, and lifestyle factors, including increased screen time and less time spent outdoors,” Mr. Ho said.

“We have seen a significant increase in cases of myopia at our practice over time, especially during the COVID-19 pandemic. Our optometrists are prescribing more myopia control lenses and orthokeratology lenses today than ever before,” he said.

An extra diopter here, even more damage there

Short-sightedness is such a common condition that most members of the lay community wouldn’t look twice at it. And often, they would struggle to understand why so many

clinicians are worried about the disease. Granted, many people who have myopia have relatively mild symptoms that are easily treated with lenses, refractive surgery, etc., but for other patients, the consequences are more severe.

Remember the 60% of the American population that was predicted to become myopic by 2050? Out of this group, one in four would be expected to experience vision loss by age 75 for eyes exceeding 26 mm in length — and the bad news doesn’t end there. That’s according to Dr. Chapman, who paints a very bleak picture of how ocular health in the United States will look at this point due to the ongoing march of myopia.

“For every additional 1.00 diopter of power, the risk of pathology in patients with myopia increases as follows: 58% will experience myopia maculopathy, 20% — primary open-angle glaucoma (POAG), 21% — posterior subcapsular cataract, and 30% — retinal detachment,” Dr. Chapman explained.

“In my daily practice, I have seen an uptick in ocular pathology with older myopic patients, much more so than I did 20 years ago when I started practicing,” she continued. “I believe it is a harbinger of the level of pathology we will see a generation from now as more and more of our young myopic patients age. That’s why I am focused on supporting patients who want to start myopia management therapy, and patient education is provided at every exam we perform,” she said.

The profound impacts of myopia

As you can imagine, the impact of myopia on the society is considerable,

15 COOKIE MAGAZINE | April 2023
“Myopia is on the rise around the world, and, globally, the prevalence of the disease exceeds 28%. Alarmingly, it’s predicted that approximately half of the world's population (five billion people) will have some degree of myopia by the year 2050. Not only are more children becoming myopic, but the rate of high myopia is also increasing.”
— Dr. Cheryl Chapman

both in terms of the resulting financial cost and on quality of life. It’s usually diagnosed in children and causes the most severe symptoms in the elderly, two population groups that are naturally more vulnerable to health complaints. From the small scale to the macro, the impact of myopia on societies across the world is profound.

of the disease may still be lacking, optometrists and ophthalmologists from around the world are now taking action. Myopia dominates the schedules of almost every ocular health conference and congress today, especially in the Asia-Pacific region where the disease is so entrenched.

offering real efficacy to ocular health professionals. She also believes in the importance of following the latest technological developments in this field and being ready to make the best use of them.

“I think it is important for optometrists to be aware of the changing landscape and to realize that myopia management is now considered a basic standard of care. As such, it is important to seek proper education to stay abreast of this rapidly developing subspecialty,” advised Dr. Chapman.

“As myopia can cause difficulty seeing objects at a distance, it can make everyday tasks like driving or watching a movie more difficult. This can lead to frustration and reduced quality of life for those affected. There’s also the increased risk of eye complications as well as associated healthcare costs in some countries,” Mr. Ho said.

“Myopia is a concern not only because of the increased risk of pathology. It is well-documented that myopia affects children's self-esteem and self-confidence. It impacts their social development and affects participation in activities such as theater, dancing, sports, and other active pastimes. It can also affect career opportunities. So there is an intrinsic cost burden to society of high myopia that progresses to vision loss and beyond,”

Dr. Chapman added.

New hope with new options

Myopia is proving to be a difficult condition for governments and medical professionals to manage, and it’s a challenge for overstretched healthcare systems, especially in the wake of COVID-19.

The good news, however, is that while public awareness of the severity

Where once the only options available to optometrists were to increase glasses and contact lens prescriptions as the patients' eyes grow longer in order to maximize their vision, nowadays, there are a number of options on the table.

Dr. Chapman points to orthokeratology, myopia management soft contact lenses, topical low-dose atropine ophthalmic formulations, and myopia management spectacle lenses as all

“A great resource for this is the American Academy of Orthokeratology and Myopia Control (AAOMC). Their annual conference, Vision By Design, focuses on providing unbiased education and creating a strong peer support network among practitioners seeking to improve better outcomes in myopia treatment,” she continued.

As for Mr. Ho, his advice on how to better manage and control the myopia epidemic was focused on the group which is experiencing the greatest rates of the disease — the children. He believes that early intervention is the best policy, especially in urban areas where people appear more vulnerable to myopia. Not only is it all about getting in early, but it’s also about getting into communities and making sure the locals understand the enemy they’re up against.

“At Malaya Optical, we prescribe myopia control prescription lenses or ortho-K lenses to help slow the rate of increase of myopia in kids. We also work to provide vision school for children in harder-to-reach local communities. It’s important to act as a champion for the cause of

COOKIE MAGAZINE | April 2023 16
Cover Story
“As myopia can cause difficulty seeing objects at a distance, it can make everyday tasks like driving or watching a movie more difficult. This can lead to frustration and reduced quality of life for those affected. There’s also the increased risk of eye complications as well as associated healthcare costs in some countries.”
— Mr. Ryan Ho

myopia prevention and reduction,” Mr. Ho enthused.

The way out of the myopia pandemic

If there's a strategy that exemplifies what is likely going to be the only way out of the myopia pandemic — if that’s even entirely possible, it's gonna be education, both in the professional setting and among the general public.

Educating the former is important and, as we’ve covered, myopia is now receiving the attention it deserves, and optometrists are beginning to be made more aware than ever of the perils of the condition. Enlightening the latter, on the other hand, is a more difficult proposition, a task further complicated by the necessity of liaising between healthcare organizations, public regulatory bodies, schools, and clinics, among others.

For Mr. Ho, the path forward is clear: Public awareness programs and education provided by optometric professionals combined with early intervention will alleviate the treatment burden caused by myopia as it’s targeted at the most vulnerable groups. This process has to be ‘from cradle to grave,’ and people working in optometry must consider how to properly teach their pediatric patients about the dangers of myopia, and why it’s so important to treat the disease.

“Myopia as a disease is not receiving the attention it deserves, both from the public and the medical field. We can get it the attention it deserves via more public education, and starting from school and training teachers to detect vision problems at a very young age,” Mr. Ho said.

As for Dr. Chapman, she believes in adopting a cross-discipline, collaborative approach to treating the myopia pandemic, pointing out that it’s thanks to new research and education that new solutions will be found.

Again praising the work of the AAOMC, Dr. Chapman said that organizations like this can provide invaluable support to optometrists, regardless of whether or not they’re based in the US.

The AAOMC and other organizations provide solid support and education, Dr. Chapman said, but it’s up to individual optometrists to take that information and run with it to provide the best possible outcomes for their patients. Where once the medical community lagged behind, it is now recognizing the serious challenge posed by myopia, that spell of ignorance is now broken, and there is good reason to be optimistic about the direction of cooperation, research, and more.

Contributing Doctors

Dr. Cheryl Chapman , OD, IACMM, FIAOMC, FAAO, Diplomate ABO, is the president of the American Academy of Orthokeratology and Myopia Control (AAOMC) and works in private practice in Gretna, Nebraska. She has instituted a full scope Dry Eye Subspecialty as well as a Myopia Management Subspecialty within her practice. Dr. Chapman is the co-founder of Peeq Pro, a designer of the patent pending device, the Peeq Waiva, and a co-creator of multiple products and services for Peeq Pro. In addition to working oneon-one with doctors to implement practice protocols, she lectures within the optometric community as well as to local pediatricians and ophthalmologists. Serving as an adjunct assistant professor at the University of the Incarnate Word Rosenberg School of Optometry, Dr. Chapman also enjoys working closely in training fourth-year extern students in current dry eye therapies, myopia management strategies, and practice management. She is a graduate of the University of Houston College of Optometry.

“We are still in the infancy of modernday myopia management. The growth of new research and studies is exponential and new information is coming out at such a rapid rate that it is difficult to stay informed if you are not extremely focused on it. As such, there is a natural lag with educating the public and medical fields that have their attentions elsewhere,” Dr. Chapman said.

“This firmly places the responsibility in the hands of optometry. We are uniquely poised to make this one of our greatest legacies. Supporting organizations such as the AAOMC is a prime way that optometrists can help bring attention to the myopia pandemic,” she concluded.

Mr. Ryan Ho first undertook a Bachelor of Science in Microbiological Sciences at the University of Kansas, USA, in 1996 before studying Optometry at the International University College of Technology Twintech, Malaysia, in 2008. He is a skilled optometrist with over 15 years of experience. He obtained his first degree in B.Sc. at the University of Kansas, USA, and continued to pursue his passion for his Bachelor of Optometry (Hons) in Malaysia. His opinions on the treatment of Ortho-k, monovision, progressive lens fitting, and myopia in children have been well sought after on national television stations, such as RTM, TV3, and national newswires, as well as publications such as Bernama, The Star, and more. He has helped build Malaya Optical from a family-owned business of three generations to become a two-time award winner of the prestigious Brand Laureate Award. While he is busy running his retail practices, online store, and building an eyewear brand, Mr. Ho makes sure to spend quality time with his family as they are the inspiration behind this brand. During his leisure time, Mr.Ho enjoys riding his road bike on numerous road adventures.

17 COOKIE MAGAZINE | April 2023

Carving Her Own Niche

From Gretna to the world, Dr. Cheryl Chapman aims to create myopia awareness and foster education among fellow optometrists

Dr. Cheryl Chapman had two goals when she was young: To work in healthcare and to be a mother with a large family. Today, the proud mother of six is an optometrist specializing in orthokeratology and a fierce advocate for myopia management. She runs her own clinic, Gretna Vision Source, in Omaha, Nebraska.

The youngest of four children, Dr. Chapman grew up on a farm outside of Omaha. She was a keen learner — she likens herself to a sponge. She would have a one-onone tutoring with a teacher and could learn as fast or as slow as needed, depending on the material.

“Growing up on a farm taught me habits and core values of a strong work ethic. My parents worked hard and the whole family was expected to participate in keeping the farm

running,” shared Dr. Chapman. “They were dedicated to sending their children to college, an opportunity that they never had the chance to pursue themselves.”

Following her own path

After high school, she attended Creighton University in Omaha and received her Bachelor of Science Degree in Biology.

“I loved biology and chemistry in

school and I wanted to be a medical doctor, I was particularly interested in cardiology. However, the lifestyle and length of schooling for a specialty in cardiology was inconsistent with my other life goals — namely, to be a mom and have a large family,” she shared.

Her brother encouraged her to consider optometry, a path that he was considering for himself but did not end up pursuing.


“But there was a lot of pressure at that time to pursue the more ‘prestigious’ degrees. Fortunately, my young self was able to break free from the self-imposed expectations and standards that I thought I was being held to, and I took the unexpected fork in the path,” she continued. “Looking back, I am thankful that I had the moment of clarity that allowed me to give myself permission to do that.”

At university, she met her husband, Tom, who supported her in her decision to further her education at the University of Houston, College of Optometry. The couple welcomed their first son at the end of her second year and their second son was born at the end of her fourth year of Optometry school. They eventually added four more children and are now proud parents to six children aged 12 to 21 years old.

Going above and beyond optometry

Dr. Chapman started out working many part-time jobs to cobble together a full-time schedule. Her husband went back to school to get a JD/MBA after she graduated, so she became the sole breadwinner for several years.

“This ended up being very beneficial because I had the exposure to a variety of different office environments,” she said. “I was able to utilize a lot of the knowledge gained from the different practices when I purchased my own practice in 2006.”

Her clinic, Gretna Vision Source, has grown over the years with new challenges. The biggest trajectory shifts were when she added two main subspecialties — namely, myopia management and

dry eye. In 2019, she teamed up with another optometrist to co-found Peeq Pro.

“We were frustrated by the staggering cost of in-office dry eye therapies and the fact that so many of our patients had MGD (meibomian gland dysfunction),” Dr. Chapman shared. “We wanted to create an at-home eyelid hygiene device that is affordable and ubiquitous and can prevent the onset of MGD. We ended up developing a subscription service to encourage patient compliance with prescribed therapies.”

With the help of a biochemist on staff, they created a very effective and pleasantsmelling foaming eyelid cleanser. “We are now launching our Peeq Waiva device. I tell my patients that the Peeq Waiva is to eyelids like the Sonicare toothbrush is to teeth,” she enthused.

Advocating myopia control and management

To learn more about myopia control, Dr. Chapman attended the Vision By Design Conference hosted by the American Academy of Orthokeratology and Myopia Control (AAOMC).

“The quality of the education was amazing and I knew then this was my calling. I did everything I could to onboard with further education for both myself and my staff, as well as to amp up the technology in my practice in order to deliver the highest level of myopia management possible,” she shared.

Orthokeratology is an arm of myopia management therapies. “It is important because it gives you a tremendous advantage in being able to handle a wide variety of cases where other therapies may not be well-suited for the case parameters or the lifestyle goals of the patients,” she explained.

“I love making a difference for kids — some of my myopia management patients are my very own children,” she quipped.

As myopia management is her passion, Dr. Chapman is mindful of

19 COOKIE MAGAZINE | April 2023
“We wanted to create an at-home eyelid hygiene device that is affordable and ubiquitous and can prevent the onset of MGD. We ended up developing a subscription service to encourage patient compliance with prescribed therapies.”

helping to grow that subspecialty. She envisions a future where myopia management, and orthokeratology specifically, is as common, well known, and sought out by patients as orthodontia.

“I would also like to see optometrists being more highly trained and proficient in billing and coding. When you get good at something and it seems ‘simple’, it is all too easy to underestimate the codes that should be billed, leading to under-coding,” she noted. “Not only is this confusing for patients when they have different experiences at different offices, but it also leads to many optometrists struggling to operate private practice profitably.”

“I think this exacerbates feelings of job dissatisfaction and burnout. It affects the practice owner’s ability to purchase and maintain great new technology for their patients. It also affects how well they are able to compensate and retain good staff,” she added.

Fostering education and peer-to-peer interactions

Dr. Chapman currently serves as the president of the AAOMC. “Our

mission is to foster education, learning, and peer-to-peer interactions in an unbiased forum — free from commercial bias,” she said, adding that the academy is entering a new era of growth and expanding to offer more frequent local education, doctor support, and student resources.

“I feel very strongly about the importance of the role the AAOMC can play to help optometrists achieve their own practice goals as the landscape of optometry is changing,” she continued.

A new initiative by the AAOMC was the launch of a Facebook group called ‘Myopia Management for Everyone’ to create a community that brings together doctors, industry partners, and patients.

“I envision it as a space that will organically grow public awareness, a safe place where patients can ask questions and receive honest answers not only from experts but also from other patients’ experiences,” Dr. Chapman shared. “I hope this becomes a valuable resource for patients as it grows. We send short video content on a scheduled basis to patients via email

and text links to keep them informed and educated,” she added.

She has a staff member who is a certified myopia navigator. The certification was developed by the AAOMC to prove competence by paraoptometrics in this subspecialty.

Dr. Chapman has also taken up a role as a diplomate with the American Board of Optometry, which, she said, has ‘maintenance of certification’ requirements that challenge her to always continue her learning.

According to her, myopia management is the most progressive and rapidly changing topic in eye care.

“One of the new things in the pipeline is the myopia management spectacle lenses. They are still in FDA trials but they are available and widely used in other countries. Another is the low-dose atropine drop that will be available commercially when it completes and passes FDA trials,” she disclosed.

Aiming to live a balanced life

Her work certainly gives her great joy and a sense of purpose.

“It is rewarding as it gives me opportunities to combine a variety of things that are important to me: Being a business owner, an entrepreneur, a wife and mother, as well as having a work-life balance that affords me time to have hobbies and leisure activities,” she shared.

She also greatly enjoys interacting with her patients and feels like she is making a difference in their lives.

“Many of the benefits of what I

“I feel very strongly about the importance of the role the AAOMC can play to help optometrists achieve their own practice goals as the landscape of optometry is changing.”

do today will not be realized until after I am gone and these young children become older adults. In that way, I feel like my work will live on,” she enthused. “Furthermore, if I can help grow the field of myopia management, I feel like my work will have a more exponential impact.”

The biggest challenge for Dr. Chapman is maintaining a work-life balance. “I enjoy what I do so much so that I have to be very intentional about stepping back and making sure that it doesn’t consume me,” she confessed.

Over the years, she has tried building up a practice that allows her to have working hours that are compatible with her family schedule.

“I don’t work evenings or weekends,” she shared. “I hired an associate that can help cover the later afternoon appointment times so that I am able to finish patient care and charting

early enough to leave for my kids’ activities.”

“I am mindful of having family dinner almost every night. At the dinner

Contributing Doctor

table, everyone has a chance to talk, and we go through roses and thorns for the day. And this can be achieved if you work with intention towards this type of schedule,” she concluded.

Pro. In addition to working oneon-one with doctors to implement practice protocols, she lectures within the optometric community as well as to local pediatricians and ophthalmologists. Serving as an adjunct assistant professor at the University of the Incarnate Word Rosenberg School of Optometry, Dr. Chapman also enjoys working closely in training fourth-year extern students in current dry eye therapies, myopia management strategies, and practice management. She is a graduate of the University of Houston College of Optometry.

CooperVision Launches Major US Myopia Control Education Campaign

CooperVision has unveiled a multi-faceted consumer and professional marketing campaign to protect children’s vision and advance myopia control education in the United States to kick off Vision Expo East 2023.

The “Make Children’s Sight Your Fight” initiative is rooted in new CooperVision-commissioned US parent and eye care professional (ECP) research, which shows progress in strengthening awareness and action, while also spotlighting opportunities to do more.

“Protecting children’s vision from getting worse as they grow is something that takes a community — parents, eye care professionals, publishers, and so many others. We want everyone to join us in this fight for early detection and intervention,” said Alex Wilkes, President, Americas, CooperVision.

“MiSight® 1 day launched in the US three years ago and created the fastgrowing myopia control category, and CooperVision is once again leading the way to advance children’s eye health across the nation,” he added.

New CooperVision research shows progress in strengthening awareness and action and emphasizes the critical nature of evidence-based early intervention. Industry data shows 65% of children aged eight to 12 years who have myopia have a prescription between -0.50D and -2.00D. With this information, CooperVision sees an opportunity to impact the lives of children in that age range with early intervention that can prevent the worsening of the disease.

MiSight® 1 day prescribing ECPs are committed to taking action in response to this stark fact, with 76% seeing the need and treating low myopes between -0.50D and -1.00D.

Industry Update

Parent education and easy-to-access resources remain critical to success, with 72% of parents agreeing that if their child has been diagnosed with myopia, they will conduct online research to learn more.

“Make Children’s Sight Your Fight” comprises several avenues to reach the US parent and eye care communities, including media advertising for widespread consumer outreach. The campaign encourages parents to interact with an expanded MiSight® 1-day digital ecosystem, spanning YouTube, Facebook, Instagram, and ECPs can support the campaign by sharing a “Make Children’s Sight Your Fight” social frame with peers and patients on their channels.

For more information, visit https://

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Dr. Cheryl Chapman , OD, IACMM, FIAOMC, FAAO, Diplomate ABO, is the president of the American Academy of Orthokeratology and Myopia Control (AAOMC) and works in private practice in Gretna, Nebraska. She has instituted a full scope Dry Eye Subspecialty as well as a Myopia Management Subspecialty within her practice. Dr. Chapman is the co-founder of Peeq Pro, a designer of the patent pending device, the Peeq Waiva, and a co-creator of multiple products and services for Peeq

DOT Lenses

Our new ally in the fight against childhood myopia?

One of the recent developments in myopia control for children is SightGlass Vision’s diffusion optics technology (DOT) — a joint venture between EssilorLuxottica and CooperCompanies. This technology works to reduce myopia progression in children by incorporating thousands of micro-dots into lenses, which scatter light and reduce contrast sensitivity.

Myopia is an emerging pandemic with rising prevalence worldwide. A meta-analysis by Holden et al.1 predicted that nearly 50% of the world’s population will become myopic by 2050, with 10% of them being high myopes.

Myopia brings a host of hazards, including sight-threatening complications such as retinal detachment, myopic maculopathy, and choroidal neovascularization — not to mention a significant economic burden and social impact.

Managing myopia should begin in childhood

Since myopia typically develops between ages six and 12 and tends to progress or worsen every few to several months until the late teenage years, starting myopia control as soon as possible will result in a better prognosis.

Current methods used to control myopia progression in children include atropine eye drops, ortho-K contact lenses, soft contact lenses, and myopia control spectacle lenses.

Research looking into high myopia and the functioning of retinal signals discovered that long (red) and medium (green) wavelength retinal cones are involved in the emmetropization process and that high contrast patterns in signaling between normal and defective cones may affect axial growth.2

Currently, diffusion optics technology spectacle lenses are the only myopia management treatment specifically designed to reduce retinal contrast signaling,3,4 thereby inhibiting axial growth. This is achieved through the incorporation of thousands of microscopic, light-scattering elements throughout the entire lens (the treatment zone), except for a small clear zone that is aligned with the patient’s pupil.

What studies and optometrists say

SightGlass Vision lenses are made for daily wear for children from six years old onwards, providing both near and far sharp vision, and have been proven effective in inhibiting progressive myopia in children six years and older.

In the CYPRESS clinical trial, the use of investigational spectacle lenses versus control lenses was evaluated


in 256 myopic children between -0.75 and -4.00DS and aged six to 10 across 14 sites in the US and Canada.5 The 12-month results from this ongoing trial demonstrate the safety and effectiveness of DOT spectacles for reducing myopic progression. While SightGlass Vision's DOT Spectacle Lenses are not yet currently FDAapproved or marketed in the United States, it has been approved for sale in Canada and is indicated for the correction of myopia (with or without astigmatism) and for the reduction in the rate of myopic progression in children who are aged six to 13 years old.

So far, optometrists’ experience with SightGlass Vision's DOT lenses has been positive. According to Dr. Kylvin Ho from Burnaby, British Columbia, Canada, the DOT spectacle lenses provide excellent myopia stabilization and almost no side effects. He also finds the mechanism of action unique mostly because other modalities for myopia control relied on optical defocus using plus lenses. He believes this technology will become pivotal in combating myopia in the near future.6

For Dr. Jeff Goodhew and Dr. Tina Goodhew from Ontario, Canada, spectacle lenses are a big part of their myopia management clinic as not every child can wear contact lenses, and many parents are not keen on pharmaceutical therapy. Furthermore, DOT spectacle lenses appear to work well with younger children, which is a plus point, since the more controlled myopia is at a younger age, the more significant the impact that can be achieved.7

1. Holden BA, Fricke TR, Wilson DA, et al. Global Prevalence of Myopia and High Myopia and Temporal Trends from 2000 through 2050. Ophthalmology. 2016;123(5):1036-1042.

2. Neitz M, Neitz J. Intermixing the OPN1LW and OPN1MW Genes Disrupts the Exonic Splicing Code Causing an Array of Vision Disorders. Genes (Basel). 2021;12(8):1180.

3. Novel DOT Lenses from SightGlass Vision Show Great Promise to Fight Myopia. Review of Myopia Management. Available at: Accessed on March 8, 2023.

4. Rappon J, Woods J, Jones D, Jones LW. Tolerability of novel myopia control spectacle designs. Invest Ophthalmol Vis Sci. 2019;60(9):5845-5845.

5. Rappon J, Chung C, Young G, et al. Control of myopia using diffusion optics spectacle lenses: 12-month results of a randomised controlled, efficacy and safety study (CYPRESS). Br J Ophthalmol. 2022;bjophthalmol-2021-321005.

6. Experiencing SightGlass Vision’s Spectacle Lenses. Review of Myopia Management. Available at: Accessed on March 8, 2023.

7. ECPs Share Real-World Experience with DOT Spectacle Lenses. Review of Myopia Management. Available at: Accessed on March 8, 2023.

COOKIE MAGAZINE | April 2023 22
OPTICS TECH Innovation |

The Myopia Control Era is Upon Us

… and an explosion of new treatments and tech is trumpeting its arrival

axial elongation — far from it. In the past, it was all about prevention — and failing that, managing myopia with refractive correction. But thanks to a wave of innovation over the last few years and more on the way, the paradigm has shifted, and we are now on the cusp of the era of myopia control.

The contact conundrum

Daily lenses that can slow myopia progression have long been a holy grail of optical tech for their ease of use and relatively low risk of infection. These days, there is now an array of soft varieties with excellent track records for slowing axial elongation.

CooperVision’s MiSight lenses are the latest lens design in myopia control with their alternating rings of refractive correction and myopiatreating defocus zones. The latest data from a six-year study1 on MiSight has been overwhelmingly positive, with axial length growth slowing by 71%.

Other soft contact lens designs exist as well, like the extended depth-offocus (EDoF) Mylo by mark’ennovy and the NaturalVue by VTI Vision. These all join CooperVision’s longstanding monthly Biofinity, with a distance-center focused design made famous by the BLINK study.2

All of these lenses have their advantages, but challenges abound as well. Contact lenses for young children pose many problems. “There's going to be a learning curve, and you need to have the right patient base,” Florida optometrist Dr. Kristie Nguyen shared. “There’s a lot of screening,” she continued.

The long-feared advance of myopia is upon us, and optometrists around the world are finding themselves on the frontlines. And while parents’ warnings against sitting close to the television still ring in the heads of millennials and Gen Xers, myopia has still managed to park itself in the mainstream of modern culture.

It’s not that prevention has failed.

During pandemic lockdowns and social distancing, eye strain from devices held at near distances increased and time outdoors drastically decreased, throwing gasoline on an alreadyburning fire. These lifestyle changes are now firmly entrenched human behaviors — making myopia a firmly entrenched disease.

The good news is that the last bell hasn’t been rung in the fight against

Education is a factor, too, especially for parents. “You have to educate the parent that to not become myopic in the future, [they have to] get [their children] into contact lenses now,” she explained.

And, of course, with children, compliance and maturity come into play. “When I fit a normal child in contacts, I have to make sure that they can do it themselves,” continued Dr. Nguyen. “They can't just rely on

From spectacles to eye drops and everything in between, the vanguard of myopia control is here — and not a moment too soon. As myopia cases mount around the world, optometrists have a much deeper bag of tricks for halting the progression of the disease.

their parents — so even when I'm adamant about myopia control, if the child is not mature enough, I can't put them into contact lenses.”

Besides these practical factors, cost is another concern, especially in the United States. Prices for the MiSight stateside hover around $1,000, which is comparable to the Mylo where available. Fortunately, Biofinity is significantly cheaper at around $200 per year — though still a significant expense for many.

Old tech, new tricks

Despite the many advantages to myopia control contact lenses, there are clearly drawbacks. Many of these are answered by one of the most intriguing — and anticipated — new additions to the myopia control armamentarium: spectacle lenses.

“They are a game changer,” said Dr. Glenda Aleman-Moheeputh, founder and CEO of iSmart Vision Care and OK Love Myopia Control Experts. “A spectacle option for myopia management will enable more ECPs to help their patients [and is] a great option to get young patients started.”

Many of the big players have their own unique designs. Hoya is one of the pioneers in the myopia control lens game with their award-winning MiYOSMART lenses. The design of these lenses, termed Defocus Incorporated Multiple Segments (DIMS), showed 52% reduced myopia progression and a 62% lowering of axial elongation3 compared to regular spectacles in a two-year study.

Essilor has added Stellest lenses with its Highly Aspheric Lenslet Target (HALT) tech to its already stellar MyopiLux offering, with the company claiming a 67% higher rate of slowing myopia progression.

Though more research on these offerings is ongoing, their ability to solve many of the problems of contacts, such as compliance in children, is clear. “The most recent studies that have come out are promising and show great results on the efficacy of this modality,” Dr. Aleman-Moheeputh asserted. “We

now have an excellent spectacle solution at hand for patients who struggle with putting eye drops in their eyes or are uncomfortable with wearing contacts,” she summed up.

Ortho-K and the combo play

Low-dosage atropine eye drops are in use in many places (though,

Contributing Doctors

Dr. Kristie Nguyen is a boardcertified optometrist. She currently serves as a contract doctor for Perez and Associates and Phan-Tastic Eye Care in Altamonte Springs, Florida, USA. After graduating in the top 10 of her high school class with honors, she went on to obtain her Bachelor of Science degree from the University of Houston, Texas. While at U of H, she volunteered at a local hospital and worked as an optometric assistant. Dr. Nguyen obtained a Doctorate of Optometry (O.D.) in 2005 from Nova Southeastern University College of Optometry in Fort Lauderdale, Florida. She conducted her medical internships at the Chickasaw Nation Health Clinic in Ardmore, Oklahoma and the Lake Mary Eye Care in Lake Mary, Florida. Dr. Nguyen is a member of the American Optometric Association, the Florida Optometric Association, Young ODs of America, OD Divas, Optometry Divas and the Central Florida Optometric Society. In addition, she has been an executive board member for Optometry Divas for the past two years. She is also a brand ambassador for an independent eyewear brand called Kazoku Lunettes and director of business development for an online optical company called Optazoom. She is also an independent consultant for Rodan+Fields, which is a global clinically tested skincare brand. Dr. Nguyen is married and has two beautiful daughters. She enjoys going to the beach, hanging out at Disney, and reading.

notably, not yet in the USA), and their promise has shone brightly in research like the LAMP study.4 New research is now beginning to investigate the addition of atropine to existing monotherapies. “In my own practice, I usually start patients on a monotherapy such as ortho-K, but not all patients will respond well to the lenses. This is when I decide to start a second therapy, such as atropine drops,” Dr. Aleman-Moheeputh noted. “Many practitioners struggle with knowing when to start a second therapy and are apprehensive about using them. However, combination therapies are something that we need to familiarize ourselves with,” she urged.

Dr. Glenda Aleman-Moheeputh , OD, received her Bachelor of Science degree in Vision Science and Doctor of Optometry from Nova Southeastern University (NSU). She has held the role of clinical liaison for Walmart Health Optometry in Florida from 2019-present. She currently serves as a Johnson and Johnson myopia management professional affairs consultant (PAC). She is an active advisor in the advisor committee AAOMC and is an advisor for Nevakar myopia specialists. She is the founder and CEO of iSmart Vision Care, located in Miami, Florida. In her practice, she specializes in providing multiple solutions for myopia management. And in her mission to fight the myopia epidemic, Dr. Aleman-Moheeputh has recently launched her new venture, OK Love Myopia Control Experts. Beyond myopia management and educating patients, OK Love also offers consulting designed to educate fellow optometrists on various methods of implementing myopia control practices. She has lectured extensively nationally and internationally to contribute to educating others in the field of orthokeratology and myopia management in hopes of mitigating the myopia epidemic.

Cont. to P29

Challenging the Myopia Status Quo

Asignificant portion of these myopic children will go on to develop high myopia, which can potentially lead to myopia-related ocular complications, such as myopic maculopathy and retinal detachment all of which, if left untreated, can lead to irreversible vision impairment.

So how do we challenge this status quo?

Myopia expert advises starting small and focusing on creating awareness

By 2050, it is estimated that myopia will likely affect 4.8 billion people worldwide, which will equal half of the world’s population. And in some regions like Asia, up to 90% of children will be diagnosed as myopic.

The medical field abounds with conditions that can have serious consequences, and yet, most patients continue to believe that somehow they just won’t be affected. Take dentistry, for example, how often must dentists extol the importance of flossing to patients? How often do these patients just nod and smile, and promise to brush more regularly and lay off the sugar?

When their check-up is finished they get up to leave, then they happily go back to their sugary ways. And in a year or two, they come back complaining of a toothache.

In optometry, a number of issues like this pose challenges to clinicians to an even greater degree as, unlike the example outlined above, people are less aware of the challenges posed by ocular conditions. Everyone knows that sugar rots your teeth after all, and yet we still love sweets; and people tend to visit their optometrist far less often than they do their dentist.

While there are often lifestyle changes one can make to avoid contracting an ocular condition or disease, sometimes that’s either not possible, or by the time symptoms present themselves it’s too late.

Myopia is one such condition, and much like tooth decay and obesity caused by overindulgence in sugary snacks, it’s not hyperbolic to say that this disease has reached the level of a pandemic.

Optometrists on the frontlines

Optometrists are and will always be on the frontline of treating myopia — so what lessons can be learned now

25 COOKIE MAGAZINE | April 2023

to better prepare their clinics for the future, and help to address the crisis we already face?

We spoke with Dr. Kevin Chan, the senior clinical director at Treehouse Eyes - Myopia Care For Kids, an eye care clinical network with facilities located across 19 different states in the US. He firmly believes that optometrists are the gatekeepers to combatting the epidemic of myopia progression and has spoken about his work in fighting the disease during TedX talks, and as a professional affairs consultant for Johnson & Johnson Vision.

“I am seeing a growing number of children and adolescents with myopia experiencing difficulties in school where they are unable to excel at their best academic potential solely because of poor vision,” shared Dr. Chan. “Socially, they are also more likely to feel withdrawn and isolated secondary to peer pressure. Some children told me that they are generally more reluctant to participate in sports activities simply because they cannot see, or they don’t want to be seen with glasses,” he continued.

Dr. Chan recommends that optometrists intervene as early as possible as the younger the patient is, the more likely they are to experience vision-related challenges and impediments in life, such as driving, working, occupational activities, etc.

Historically, the fact that myopia was perceived or understood as merely a benign refractive error resulted in many of these younger patients falling through the cracks. Dr. Chan described how when he was a student, he was taught that conventional glasses and contact lenses were the ‘easy fixes’ for myopia. But that approach is now too narrow.

“The monolithic background and understanding of myopia have overshadowed the clinical significance and benefits of providing myopia treatment for children. While the conventional belief of myopia has been ingrained in the eye care community and the public, I think

that recent research endeavors and public health advocacy have gradually driven the initiatives of myopia management. It’s good to see that the subject of myopia has gradually resurfaced,” Dr. Chan said.

Every little step is progress

So what tips can Dr. Chan provide based on his own experience? Education, education, and education — for patients and clinicians alike — is at the top of his list. Attending events and conferences to learn from the best and adopt the latest techniques are important, as is being realistic in your aims.

“Start small,” he advised. “Optometrists often presume that myopia management warrants drastic renovation of the office, advanced equipment, or taking on new hires. While these are all important, start with meaningful conversations (not the passive approach, or ‘you may want to consider it if you like’) regarding myopia with your existing patients and their families,” Dr. Chan continued.

“I find peer-to-peer education via conferences and lunch-and-learn events to be tremendously beneficial and impactful. Changing old habits toward myopia is certainly no easy task. It requires conscious and dedicated efforts towards rebuilding and re-branding,” he said.

“The purpose of ‘re-building’ is to provide optometrists and the public an opportunity to challenge the status quo of myopia. ‘Rebranding’ is to help the community acknowledge and affirm the lifelong impacts that myopia management can bring for children and the coming generations,” he added.

A curious village for healthy eyes

In short, Dr. Chan believes in encouraging optometrists toward revolution, an uprising of thoughtful consciousness that dispels the old myths of myopia treatment to provide better, newer treatments and education for patients. He

wants clinicians to concentrate on providing a modality-based approach, one that combines a number of factors to change the mindset of eye care professionals and patients alike. Combined with the tools most optometrists have at their disposal, like orthokeratology, soft multifocal contact lenses, low-dose atropine, and myopia control spectacles, results should be sure to follow.

“The success of myopia management is largely predicated on the treatment optometrists advocate for patients and their families. The more you talk about myopia and plant the seeds early for public awareness, the more likely the family would recognize its benefits and make it a priority that they would be more eager to begin the journey of myopia management for their children,” Dr. Chan concluded.

Contributing Doctor

Dr. Kevin Chan , OD, MS, FAAO, is the senior clinical director at Treehouse Eyes - Myopia Care For Kids, an eye care clinical network with facilities located in 19 different US. As a professional affairs consultant for Johnson & Johnson Vision, he also provides clinical consultation and educational events pertaining to orthokeratology. A graduate of the New England College of Optometry, Dr. Chan is an internationally recognized advocate for increasing awareness of myopia as a disease continuum among practitioners and the general public.

COOKIE MAGAZINE | April 2023 26 MYOPIA MANAGEMENT Enlightenment |
“Conversation ignites curiosity. Curiosity propels action and it takes a whole village to make lasting impacts for myopia!”
— Dr. Kevin Chan

The AOA Guide

several myopia control therapies have shown efficacy of over 0.3 mm (around 0.75 D) over two to three years of treatment.

Recommended myopia treatments

Choosing the right treatment will depend on the individual patient's lifestyle, age, maturity, and refractive error. Below are some treatments highlighted in the guide.

What you need to know about myopia management

Eye care professionals now have the opportunity to slow myopia progression rather than just correct the visual symptoms — this is according to the AOA’s Guide to Managing Myopia: A Clinical Response to the Growing Epidemic.*

Orthokeratology: Gas-permeable lenses worn overnight to temporarily reshape the cornea, allowing clear vision during the day without correction. This treatment is preferred for athletes and those who often do water activities.

Atropine Eye Drops: These allow complete parental control of treatment. Concentrations of 0.025% to 0.05% have demonstrated effective myopia control and limited side effects of photophobia and reduced accommodation. Atropine must be supplemented with glasses or contact lenses and could be combined with other myopia control therapies.

The American Optometric Association (AOA) warns of a rise in myopia cases among children, with numbers having nearly doubled over the past 20 years in both eastern and western societies. Prevalence among young adults is above 80% in many Asian regions, and 50% in the US and parts of Europe, the guide noted.

The AOA guide to managing myopia, created in collaboration with the Singapore Optometric Association, the American Academy of Optometry, and Johnson & Johnson Vision, aims to emphasize the gravity and effects of uncontrolled myopia progression globally, as well as support eye care professionals with the latest clinical guidance in myopia management.

Myopia facts from the AOA

Children in the first wave of high myopia prevalence (those born

after 1970) are now on the cusp of experiencing sight-threatening complications as adults.

There is no safe level of myopia as the elongated eye is susceptible to pathological complications with significant risks to eye health and vision, such as retinal detachment, myopic macular degeneration, primary open-angle glaucoma, and cataracts.

“Any degree of myopia increases the risk of sight-threatening complications, with some complications leading to blindness in adulthood. Each diopter increase in myopia results in 67% increased risk of myopic macular degeneration (MMD),” the AOA guide said.

Over 30% of MMD occurs in people less myopic than -6.00 D.

However, the good news is that

Soft Multifocal Contact Lenses: Originally designed to improve near vision in presbyopic patients, some have been shown to slow myopia progression. Younger children can wear these lenses and do not appear to be at increased risk of infection compared to older wearers.

Myopia Control Spectacles: Specifically designed to slow myopia progression, these spectacles are a safe and easy option for a range of prescriptions.

A significant duty of care

Mr. Muhammad Syimir Shahrul Izam, optometrist at Thomson Hospital Kota Damansara, Malaysia, said: “The booming myopia cases worldwide should be a warning for every optometrist to realize that myopia control should not be considered as an alternative or option in practice. In fact, it is a significant duty of care, especially when managing young patients.”

27 COOKIE MAGAZINE | April 2023 MYOPIA MANAGEMENT Enlightenment |

“The variety of myopia management options available at present is of clinical excitement to eye care practitioners, giving us the chance to provide patients with preventive care while correcting their vision to its best,” he continued.

According to the AOA Guide, increased time outdoors can delay

Contributing Doctors

Dr. Carmen Abesamis-Dichoso received her Doctor of Optometry from the Central Colleges of the Philippines in 1989, and earned her Master of Arts in Teaching from the Central Colleges of the Philippines in 2001. Her specialties include special contact lens design for keratoconus, children and high astigmatism; and visual assessment of the mentally challenged, autistic, ADHD, cerebral palsy and learning disabilities. In addition, Dr. Abesamis-Dichoso has been an orthokeratology practitioner in the Philippines since 2005. Since 1998, she has been self-employed in a private practice at Medical Plaza Makati. She was awarded Outstanding Optometrist of the Year in 2017 by the Optometric Association of the Philippines. Currently, Dr. Abesamis-Dichoso serves as the International Affairs Committee chair of the Optometric Association of the Philippines; director of the Special Olympics Opening Eyes in the Philippines; program manager of Optometric Association of the Philippines Vision Screening Program and provision of eyeglasses with the United Nations Development Program in 10 areas and four Regions in the Philippines; and chairperson of the Special Olympics Healthy Athletes Program in the Philippines. Dr. AbesamisDichoso is a fellow of the American Academy of Optometry; a founding fellow at the Philippine College of Optometrists; a fellow of the International Association of Contact Lens Educators; an AsiaPacific Regional advisor for the Special Olympics Opening Eyes; treasurer at the Asia-Pacific Council of Optometry; and is an Asia-

myopia’s onset and may slow its progression. Mr. Muhammad Syimir couldn’t agree more. He noted that behavioral factors such as longer duration of near work and minimal time outdoors cause the elongation of the eyeball, consequently causing myopia.

If one or both parents are moderately or highly myopic, the tendency for their children to have myopia is higher as well, he added. “This combination of genetic and behavioral factors add weight to myopia progression among children these days, with children as young as three to six years old being prescribed spectacles.”

Mr. Muhammad Syimir also stressed the importance of early diagnosis,

as earlier intervention often leads to better outcomes. “Optometrists should spend more time talking about myopia control to the parents. Parents are encouraged to bring their children for an eye examination as early as three years of age or earlier if the parents notice any behavioral changes, such as holding something very close, sitting very near to the TV, excessive blinking or eye rubbing, and abnormal head tilting,” he continued.

“Looking back 20 years ago, myopia management was not an option. Having family members who are all myopic and needing spectacles from a young age myself, I could relate to how being highly myopic deteriorates the quality of life. Optometrists nowadays have the opportunity to

Pacific Council of Optometry (APCO) representative for the World Council of Optometry, in addition to being a member of the Legislation, Registration and Standards Committee. She has also authored numerous published papers and is a popular lecturer at industry meetings.

Mr. Muhammad Syimir Shahrul Izam is an optometrist who has been practicing for the last eight years. He graduated from the University of Bradford, UK, in 2015 with a BSc (Hons) in Optometry. He is passionate about eye care in children and is currently practicing at Thomson Hospital Kota Damansara in Selangor, Malaysia, providing and promoting myopia management. He is also a member of the Association of Malaysian Optometrists. Previously, he was working as an optometrist and clinical supervisor at SEGi University, Malaysia, and enjoyed sharing his clinical tips and experiences with optometry students. During his leisure time, Mr. Syimir enjoys traveling and exploring new places as well as keeping fit.

Mr. Ryan Ho first undertook a Bachelor of Science in Microbiological Sciences at the University of Kansas, USA, in 1996 before studying Optometry at the International University College of Technology Twintech, Malaysia, in 2008. He is a skilled optometrist with over 15 years of experience. He obtained his first degree in B.Sc. at the University of Kansas, USA, and continued to pursue his passion for his Bachelor of Optometry (Hons) in Malaysia. His opinions on the treatment of Ortho-k, monovision, progressive lens fitting, and myopia in children have been well sought after on national television stations, such as RTM, TV3, and national newswires, as well as publications such as Bernama, The Star, and more. He has helped build Malaya Optical from a family-owned business of three generations to become a two-time award winner of the prestigious Brand Laureate Award. While he is busy running his retail practices, online store, and building an eyewear brand, Mr. Ho makes sure to spend quality time with his family as they are the inspiration behind this brand. During his leisure time, Mr.Ho enjoys riding his road bike on numerous road adventures.

COOKIE MAGAZINE | April 2023 28

further enhance children with better quality of life in the future,” he shared.

Being proactive rather than reactive in treating myopia

Dr. Carmen Abesamis-Dichoso, an optometrist in Makati City, Philippines, said demand was so high during the height of the pandemic that her practice had to set up an additional unit to focus on managing pediatric myopia.

“We always ask patients, myopic or not, especially young parents with children, to bring them to the clinic for a full eye exam. Most of the time, their kids have myopia and are not aware of it,” she said.

In her experience, single-vision glasses and contacts do not work. “In fact, they make myopia worse. We should be proactive rather than reactive in treating myopia, especially in kids younger than six years old,” she added.

Dr. Abesamis-Dichoso recommends the best strategy depending on the patient's lifestyle and what the parents prefer. “The efficacy of each therapy is discussed based on evidence in the literature and clinical experience, and also how well the patient (and the parent) will comply with the prescribed regimen, especially in cases of orthokeratology and soft contact lenses,” she shared.

Meanwhile, Mr. Ryan Ho, owner and senior optometrist of Malaya Optical in Malaysia, hailed the AOA guide as “exactly what we need as an independent optometrist, and this would help set the standards for myopia management. Children today are spending more time on activities that involve close-up work, such as reading, studying, and using electronic devices. This can lead to eye strain and fatigue, which may contribute to the development of myopia,” he noted.

He also agrees with the AOA guide that lack of time spent outdoors is a

big factor. “Spending time outdoors has been shown to be protective against myopia. However, many children today are spending less time outdoors due to the technological and digital age compared to the past, which may contribute to the increase in myopia prevalence,” he continued.

While Malaya Optical currently uses myopia control prescription lenses and orthokeratology to treat myopia, Mr. Ho said it is “very exciting to have soft multifocal contact lenses as part of our new arsenal against myopia progression in children. We would be very enthusiastic about exploring such contact lenses and learning more about them. It's always best to have a few options to treat and control myopia,” Mr. Ho concluded.


* Managing Myopia: A Clinical Response to the Growing Epidemic. Available at: media/documents/Managing_Myopia_Clinical_ Guide_Dec_2020.pdf. Accessed on March 25, 2023.

Orthokeratology, one of the oldest and most reliable forms of myopia control, is also turning over exciting new leaves. “With companies implementing new computer-guided software, exciting developments in ortho-K make fitting lenses easy and more accessible,” Dr. AlemanMoheeputh shared, a noted fan of the tech in her practice. “At the end of the day, ortho-K is my go-to.”

The future fantastic

Of course, this wave of new and updated technologies is just the first crank of the wheel opening the floodgates. Repeated low-level red light (RLRL) is another therapy with a growing body of evidence5,6 for the reduction of axial length progression, and the anticipation for more is palpable.

“RLRL is one of the emerging technologies I am also curious about researching further,” Dr. Aleman-

Moheeputh said. “The clinical trials show promising results as an excellent, safe, and effective option for myopia management.”

Overall, with updates to old favorites like ortho-K, new myopia control twists on classics like contact and spectacle lenses, and newcomers


like RLRL, the future for myopia control blazes brightly. And with multiple modalities that can even be combined, optometrists have the tools to take the fight against myopia instead of staying on the back foot. All of which is good news for the growing legions of myopia sufferers, especially children, worldwide.

1. Chamberlain, P, Bradley A, Baskar A, et al. Long-term Effect of Dual-focus Contact Lenses on Myopia Progression in Children: A 6-year Multicenter Clinical Trial. Optom Vis Sci. 2022;99(3):204212.

2. Walline JJ, Walker MK, Mutti DO, et al. Effect of High Add Power, Medium Add Power, or SingleVision Contact Lenses on Myopia Progression in Children: The BLINK Randomized Clinical Trial. JAMA. 2020;324(6):571-580.

3. Lam CSY, Tang WC, Tse DYY, et al. Defocus incorporated multiple segments (DIMS) spectacle lenses slow myopia progression: a 2-year randomised clinical trial. Br J Ophthalmol. 2020;104(3):363-368.

4. Yam, JC, Jiang Y, Tang SM, et al. Low-Concentration Atropine for Myopia Progression (LAMP) Study: A Randomized, Double-Blinded, Placebo-Controlled Trial of 0.05%, 0.025%, and 0.01% Atropine Eye Drops in Myopia Control. Ophthalmology. 2019;126(1):113-124.

5. Dong J, Zhu Z, Xu H, He M. Myopia Control Effect of Repeated Low-Level Red-Light Therapy in Chinese Children: A Randomized, Double-Blind, Controlled Clinical Trial. Ophthalmology. 2023;130(2):198-204.

6. Jiang Y, Zhu Z, Tan X, et al. Effect of Repeated Low-Level Red-Light Therapy for Myopia Control in Children: A Multicenter Randomized Controlled Trial. Ophthalmology. 2022;129(5):509-519.

29 COOKIE MAGAZINE | April 2023
Cont. from P24

Glaucoma in Focus

Ophthalmologists tackle the 'silent thief of sight’ at APAO 2023

At the Asia-Pacific Academy of Ophthalmology Congress (APAO 2023), held on February 23 to 26 in Kuala Lumpur, Malaysia, ophthalmologists turned the spotlight on glaucoma, the silent thief of sight, during an informationpacked glaucoma symposium, entitled Epidemiology, Risk Factor, Lifestyle and Genetics.

Prof. Dr. Liza Sharmini Ahmad Tajudin from the Department of Ophthalmology and Visual Science, Universiti Sains Malaysia, took on the topic Is Lifestyle Modification in Glaucoma as Important as in Cardiovascular Diseases?

She cited findings from a two-phase Malay Glaucoma Eye Study (20172020 and 2021-ongoing), which included 250 primary glaucoma and 250 controls to identify modifiable risk factors for the development and progression of glaucoma, with intervention on diet, exercise,

navigation, and reading rehabilitation.

She concluded that the impact of lifestyle modification, which is proven to be effective in cardiovascular disease primary and secondary prevention, is not as powerful in glaucoma patients.

“However, there is a potential big impact on patients’ daily living. Patients should keep themselves active and eat healthily,” she said.

Glaucoma home monitoring, is it feasible?

Assoc. Prof. Dr. Jemaima Che Hamzah, senior consultant ophthalmologist/deputy dean (undergraduate), Faculty of Medicine, Universiti Kebangsaan Malaysia, posed the question: Home Monitoring in Glaucoma: Can it be a Reality?

Answering the question affirmatively, she said various devices have been designed to measure intraocular pressure (IOP) at home for 24 hours. For instance, a self-measuring tonometer is easy to use and does not require the use of topical anesthesia.

“Several tablet-based devices and

COOKIE MAGAZINE | April 2023 30 APAO 2023 Conference Highlights |

head-mounted displays have been developed to measure visual field (VF) and can be performed potentially by patients without direct supervision of a healthcare professional,” Prof. Hamzah shared. “Invention of newer ’smart’ technology allows home monitoring of glaucoma by providing a better understanding about the effects of treatment to patients and improve patient care.”

Such tools can also increase patient engagement and help in patients’ adherence to their medication, which can lead to more affordable diagnostic tests available to individuals with limited access to healthcare.

Let’s talk about JOAG and mental health

Meanwhile, Dr. Azhany Yaakub from the Department of Ophthalmology, Universiti Sains Malaysia, presented his talk, Psychosocial Impact of Juvenile Open Angle Glaucoma (JOAG) in Adolescence: A Neglected Area.

She quoted a Singapore study on Young Population with Mental Disorders which shows that the vulnerable age groups for mental disorders are 18 to 34, followed by 35 to 49. A 2017 local survey in Malaysia among adolescents shows that one in five adolescents had depression, two in five were anxious, and one in 10 was stressed.

“JOAG patients are trapped in a chronic and life-long disease. They have to adapt to living with the

disease daily and face treatmentrelated issues, such as medications, procedures, and surgeries, as well as the uncertainty of the future and career undertaking,” Dr. Yaakub shared.

Factors associated with depression, anxiety, and stress in JOAG are severe VF defect, higher numbers of medication, higher level of education, unemployment, and poor income.

“Holistic management of JOAG should include the psychological aspect, which is often neglected,” she added.

The need for cost-effective glaucoma screening

Dr. Ronnie George, director of Glaucoma Service at Sankara Nethralaya Chennai in India, explored the topic, Can We Effectively Screen for Angle Closure? and asked three important questions: “Do we have a good enough test? Is it practical? Is it cost-effective?”

He said none of the tests evaluated achieved the combination of specificity and sensitivity needed for population-based screening, as their current capacity does not realize the objective of case detection in the setting of an ophthalmology clinic.

“An incremental cost-effectiveness ratio value of $90 per qualityadjusted life-year was calculated for a community-screening program for glaucoma in rural India,” he shared, adding that the screening would treat an additional 2,872 cases and prevent

2,190 people years of blindness over 10 years.

On the other hand, the costeffectiveness and cost-utility of population-based glaucoma screening in China combined screening for POAG and PACG in rural China, both of which were below the WHO cost-effectiveness threshold of one to three times rural gross domestic product.

A study on 300 POAG patients

In her talk, Personalized Medicine in Oscular Fibrosis: Myth or Future Biomarker, Dr. Cynthia Yu Wai-Mun, MRC clinician scientist at King's College London, quoted a multicenter prospective longitudinal study by Glaucoma BioResource UK, which involved 300 POAG patients.

She said a Moorfields safer surgery system has identified the following high-risk patients: Afro-Caribbean, previously failed trabeculectomy, cataract surgery within the last six months, inflammatory eye disease, aphakia, and neovascular glaucoma chronic topical medication, among others.

“A large-scale biobank of tissue samples and detailed phenotyping were carried out from 300 patients and we were looking at the surgical risk, progression study, and therapeutic targets for new drugs and devices,” she shared.

She added that the longitudinal study will determine which test displays the strongest association with glaucoma progression and any correlation with IOP and multi-omics molecular data. It will also support the development of new glaucoma therapeutics, implants, and tests.

Editor’s Note

The 38th Asia-Pacific Academy of Ophthalmology Congress (APAO 2023) was held on February 23 to 26 in Kuala Lumpur, Malaysia. Reporting for this story took place during the event.

31 COOKIE MAGAZINE | April 2023
“Holistic management of JOAG should include the psychological aspect, which is often neglected.”
— Dr. Azhany Yaakub
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