AAOMC Newsletter | Issue 2 | 2024 Edition

President'sAddress

AsthepresidentoftheAmericanAcademyof OrthokeratologyandMyopiaControl(AAOMC),Iam thrilledtoinviteyoutoourpremierannual conference,VisionByDesign,takingplaceinDallas, Texas,fromOctober2nd-5th,2024.Thisyear promisestobeanextraordinaryevent,packedwith cutting-edgeeducation,dynamicspeakers,and memorableexperiences

Cutting-EdgeMyopiaManagement

chancetounwindandsocializewithfellow attendeeswhileenjoyingsomelocalflair.Besureto packyourbestTexaspartyattire–cowboyboots andhatsarehighlyencouraged!

KeynoteSpeaker:JakeOlson

Ourconferenceisrenownedforofferingthelatest advancementsinmyopiamanagement Youcan expectin-depthsessionscoveringthenewest research,innovativetechniques,andpractical applicationsthatwillenhanceyourpractice Whetheryouareanexperiencedpractitionerornew tomyopiamanagement,ourinclusiveand comprehensiveprogramisdesignedtocatertoall levelsofexpertise.

BootCampforBeginners

Forthosenewtothefield,ourwildlypopular BootCampforbeginnersisback!Thisintensive programishighlycomprehensiveandisspecifically designedtoequipyouwiththefoundational knowledgeandskillsyouneedtostartmanaging myopiaeffectivelyaswellashowtoimplementit intoyourpractice.It’safantasticopportunityto learnfromexperiencedpractitionersandnetwork withpeerswhoarealsostartingtheirjourneyin myopiamanagement

Texas-ThemedFridayNightBanquet

Don'tmissourFridaynightbanquet,whichwill featurealivelyTexastheme Thisisaperfect

WearehonoredtohaveJakeOlsonasourkeynote speakerthisyear.Jake’sstoryisnothingshortof inspirational.Despitelosinghisvisionto retinoblastomaatage12,hewentontobecomethe firstblindfootballplayertoplayinaDivisionIgame asalongsnapperfortheUniversityofSouthern CaliforniaTrojans Hisjourneyisapowerful testamenttoresilienceanddetermination Youcan getaglimpseofhisincrediblestoryonYoutube

WhyAttend?

AttendingVisionByDesignismorethanjustan educationalopportunity–it'sachancetobepartof thevibrantAAOMCcommunitydedicatedto advancingmyopiamanagement.You'llleavewith newknowledge,renewedmotivation,andanetwork ofsupportivecolleagues.

JoinUsinDallas!

RegistertodayandjoinusinDallasforan unforgettableexperience.Together,wecanshape thefutureofmyopiamanagement

CherylChapman

OD,FAAO,IACMM, FIAOMC,DiplomateABO

President,AmericanAcademy ofOrthokeratologyandMyopiaControl

InThisIssue

Page1 President’sAddress

Page4 PediatricKeratoconus

Page5 SpreadtheLove

Page5 PromotingOutdoorActivities forMyopiaControlinKids

Page6 TheAlignmentZone

Page6 StayUptoDate

Page6 DoubleYourPleasure,DoubleYourFun

Page8 RecentPublications

Page8 AAOMCDoctorFinder

Page12 WelcomeOurNew SocialMediaManager

Page13 MemberSpotlight

Page13 AAOMCTheCorrectedView

Page15 SocialMedia

Page15 Certifications

Page15 MemberSpotlight

Page18 PracticePearls

Page18 TravelPearlsforaSizzlingSummer

Page18 AAOMCStaffMembership

Page18 ComprehensiveMyopiaManagement

Page19 TeaTimewiththeResidents

Page20 GoogleGroup

Page20 MembershipResources

Page20 UnveilingtheOrtho-K.MMWarriors

Page21 WebinarRecordings

Page21 OrderYourOrtho-KBrochures

PediatricKeratoconus

Finding‘Cones”intheHaystack

KevinChan,OD,MS,FAAO,IACMM

KevinChan

Detectionanddiagnosisof keratoconus(KCN)has historicallybeensubjectto findingobservable‘cones’on topographicalmaps In reality,however,itmaynot alwaysbeas‘pictureperfect’ asexpected,particularlyin thepediatricpopulation

Characterizedasanon-inflammatory,bilateral ectaticcornealdisorder,keratoconusisfeaturedby progressivestromalthinningandcorneal irregularity,whichcanincreasethelikelihoodof visionlossifleftundiagnosedoruntreated

Theestimatedglobalprevalenceofkeratoconusin thegeneralpopulationwasoncedocumentedas1 in2,000documentedinthe1980s Atthattime, though,datawaslargelyobtainedbyretinoscopy orkeratometrywithinthecentral3mmofthe corneaonly,whichwaslargelyskewedand unreliable Withenhancedtechnologiessuchas cornealtopographyandtomographyproviding panoramicscansofthewholecornea,growing volumesofevidenceshowedthattheprevalence ofkeratoconushasincreasedto1in750individuals worldwide,dependingongendersandethnicities (HashemiH,etal Cornea 2020) Asifthisisnot concerningenoughforyou,arecentstudyby Harthanetal (2024)reportedinaUS-basedschool clinicthattheprevalenceofkeratoconusin childrenisexceedinglyhigherthanoncethought–ie nearly1in334 Becauseofthelackofarobust databaseforpediatrickeratoconus,thisdatashed somelightthatchildrenwithseemingly‘normal’ corneacouldbeeasilyoverlookedforsubclinical keratoconus.Thus,theycouldbenefitfrombaseline screeningforKCNpreemptivelywheneverpossible.

Onsetandprogressioniskeywhenitcomesto differentiatingbetweenpediatric(PKCN)andadult keratoconus(AKCN).PKCNisgenerallymore aggressiveandinverselyproportionalwithageof

onsetcomparedtoAKCN.Déjàvu?The progressionrateofmyopiainchildrenisalso predicatedbypatient’syoungage(Muttietal. 2024;Chiangetal.2021)–i.e.Theearliertheonset ofmyopia,thegreatertheoddsofdevelopinghigh myopiainadulthood.

FIVEkeyclinicalindicatorsofPKCN(vs.AKCN): Higheraveragecentral(vs.peripheral)corneal keratometry 1.

2Ectasiaismorecommonlylocatedcentrally . Morerapidposteriorcornealelevationthanthe anteriorcounterpart 3.

5.

4Lessvisuallycompromisedvs.adults(AKCN) . Atopic-basedcomorbidities–morecommonly coexistwithvernalkeratoconjunctivitis(VKC) andallergicconjunctivitis(SAC)

Whilekeratoconusislargelyperceivedasan‘anterior’ cornealdisorder,whatislessknownisthatitsimpact wassuggestedtoextendbeyondthecorneaand continuelongitudinally(Ernstetal.2011),i.e.axial myopia.Asthedevelopmentofmyopiaand keratoconuscoincideinpediatricandadolescent stages,unsurprisingly,potentialpathogenesisand pathophysiologyofbothentitiesmaysharemuch moreintricaterelationshipsthaninitiallythought. Researchrevealedthattheonsetandprogressionof myopiacanbeimplicatedbasedonvariousstagesof cornealbiomechanics(Sedaghatetal.2021;Hanetal. 2020).Forthat,cansubclinicalKCNinadvertentlyplay aculpableroleinthiscontext?Whiletheverdict remainsuncertain,theroleofcornealtomographical (inadditiontotopographical)assessmentby Belin-Ambrósioenhancedectasiadisplay(BAD)has becomeincreasinglypivotalwhenitcomestopatient candidacyandtreatmentoutcomesby orthokeratology.

Pediatrickeratoconusisgenerallymoreinsidious tomanifestcomparedtomyopia,thereforemore challengingtomakedefinitivediagnoses.Let’s rethinktheconceptof‘findingthecones’–when, inmostcases,itismorelike‘findingtheconesin thehaystack’,particularlyamongchildren.Timely diagnosisandinterventioniskey Cross-linking andspecialtylensesshouldbeinyourtoolboxfor at-riskpatients So,whenyoudiagnosemyopiain childrennexttime,besuretolookoutforcluesof PKCNaswell

HashemiH,HeydarianS,HooshmandE,SaatchiM,YektaA,AghamirsalimM,ValadkhanM,Mortazavi M,HashemiA,KhabazkhoobM ThePrevalenceandRiskFactorsforKeratoconus:ASystematic ReviewandMeta-Analysis Cornea 2020Feb;39(2):263-270 doi:101097/ICO0000000000002150 PMID:31498247

HarthanJS,GellesJD,BlockSS,TulloW,MorgensternAS,SuB,ChungD,YuA,GreensteinSA,HershPS, EidenSB.PrevalenceofKeratoconusBasedonScheimpflugCornealTomographyMetricsina PediatricPopulationFromaChicago-BasedSchoolAgeVisionClinic EyeContactLens 2024Mar 1;50(3):121-125 doi:101097/

ICL0000000000001072 Epub2024Feb7 PMID:38345011,SedaghatMR,Momeni-MoghaddamH, AzimiA,etal Cornealbiomechanicalpropertiesinvaryingseveritiesofmyopia FrontBioeng Biotechnol 2021;8:595330 doi:103389/fbioe2020595330,HanF,LiM,WeiP,MaJ,JhanjiV,WangY Effectofbiomechanicalpropertiesonmyopia:astudyofnewcornealbiomechanicalparameters BMCOphthalmol 2020;20(1):459 doi:101186/s12886-020-01729-x,MuttiDO,SinnottLT,CotterSA, Jones-JordanLA,KleinsteinRN,MannyRE,TwelkerJD,ZadnikK Predictingtheonsetofmyopiain childrenbyage,sex,andethnicity:ResultsfromtheCLEEREStudy OptomVisSci 2024Apr 1;101(4):179-186 doi:,101097/OPX0000000000002127 PMID:38684060;PMCID:PMC11060695 Chiang WY,ChenYW,LiuYP,LiuYH,WuPC EarlyAgeoftheFirstMyopicSpectaclePrescription,asan IndicatorofEarlyOnsetofMyopia,IsaRiskFactorforHighMyopiainAdulthood JOphthalmol 2021 Jun22;2021:6612116 doi:101155/2021/6612116 PMID:34258048;PMCID:PMC8260292

PromotingOutdoorActivitiesfor MyopiaControlinKids

PracticeTipsforParents

Dr.ShermanTung,ODFAAOFIAOMCIACMM

Dr.ShermanTung

KnowaDoctororParaoptometricthat youthinkwouldenjoythecamaraderie andbenefitsofTheAAOMC?

Inthefast-pacedworldoftoday,childrenareoftenengrossedinvarious afterschoolactivities.Asparents,weunderstandtheimportanceof encouragingourkidstospendmoretimeoutdoors,especiallytoslowdown theprogressionofmyopia,particularlyinpremyopes.However,merely suggestingoutdoortimemaynotresonateeffectivelyunlessit'stranslated intoSMARTtasks(Specific,Measurable,Attainable,Realistic,andTimely).Here aresomepracticaltipsthatIoftensharewithparentstoincorporateoutdoor activitiesintotheirchildren'sroutines.

WalkingtoSchool:Encourageyourchildtowalktoschoolifit'sfeasible Ifthedistanceistoogreat,consider havingparentsparktheircarseightblocksawayfromtheschool,promptinga20–30-minutewalk Notonly doesthisincreaseoutdoortime,butit'salsoanexcellentstrategytoalleviateschooltrafficcongestion 1

JoiningOrganizedSports:Engaginginorganizedsportsisafantasticwaytocommittoaspecific outdooractivity.Sportssuchasgolf,soccer,orbaseballnotonlyensureregularexposuretothe outdoorsbutalsocontributetothedevelopmentofhand-eyecoordination.Thisconsistentschedule canmakeasignificantimpactonmyopiacontrol.

3.

2. QuantifyingOutdoorTimeOutsideofSchool:Insteadofvaguelysuggestingtwohoursofoutdoortime eachday,specifythatthistimeshouldbeoutsideofschoolhours.Thisclarityensuresthatparentsand childrenaremindfulofallocatingdedicatedoutdoortimebeyondtheschoolsetting.

4.

WeekendFamilyGatherings:Planregularfamilygatheringsonweekendsthatinvolveoutdooractivities, suchashikesorbicyclerides.Thisnotonlyprovidesanopportunityforqualityfamilytimebutalso ensuresthatchildrenareactivelyengagingwiththeoutdoors.

GettingaPet:Considergettingapet,whichnaturallynecessitatesoutdooractivities.Pets,particularly dogs,requirewalksatleasttwiceaday.Thisnotonlybenefitsthechild'soverallhealthbutalsoensures regularexposuretonaturallight.

5. Incorporatingthesesuggestionsintoyourchild'sroutinecanplayacrucialroleinmyopiacontrol.By makingoutdooractivitiesmorespecificandintegratedintodailylife,wecancreatelastinghabitsthat contributetotheoverallwell-beingofourchildren.So,whynotgivethesetipsatryandmakeoutdoortime ameaningfulandenjoyablepartofyourchild'sroutine?

InviteThemtoJoin!

DoubleYourPleasure, DoubleYourFun?

ACaseReport

Dr.AndrewBrauer

Nomatterwhatanyonesays,ortho-kis hard That’sactuallyabigpartofthe appealforme(alongwiththelifechangingbenefitstothepatient,of course) Nomatterhowprecisethe instrumentsorsophisticatedthelens designalgorithms,therewillalwaysbe surprisesandcasesthatdon’tgoas planned Sometimes,you’llhavetomake decisionswithouthavingallthe

information,andthere’salwaysahumanelementwithwhich tocontend It’sthesecasesthatcanteachusthemostand keepthingsinteresting

Today’spatient(let’scallherLily-notherrealname)isa12 yearoldwhitefemale Diagnosedwithapproximately-150 dioptersofmyopiaOUatage9,shespentthenexttwoyears beingtreatedwithatropine0025%OUqhsandthensoft multifocalcontactlenses Unfortunately,compliancewas poorwithbothofthese,andLilyprogressedto-250during thattime Lily’smother(ahighmyopeherselfpriortolasik), didn’twantherdaughtertofollowthesamepathandnowfelt thatortho-kmaybethebestoption Tothegreatcreditof Lily’spreviousOD,heprovidededucationonortho-kasan optioneventhoughhedoesnotprescribeithimself

Soatage11,Lilyandhermothercametoseeme,andthe decisionwasfinalizedtostartortho-kinshortorder Witha relativelylow,sphericalrefractiveerrorandbaseline topographyasshown,thislookedtobeaslamdunk (Note: Onlyoneeyewillbepresented,butbotheyesweresimilarall throughout)

OD:-250DS(4412/4455)

OS:-250DS(4439/4459)

HVID:120mmOD,OS

Pre-treatmentaxialand elevationdata,respectively:

IdesignedLily’sinitialpairof ortho-kretainers(MoonLens, ArtOptical)inan114mmdiameter,

Dr.AndrewBrauer

chosenas95%ofthemeasured12.0mmHVID.Ialsooptedfora 5.0mmtreatmentzonesizeduetothedesiretopushample effectiveaddpowerintoLily’srelativelysmall(~4mminroom illumination)pupils.

Lily’sdispensevisitwasachallengeforher,asisnotunusualfora youngpersonstartingGPwear.Betweenrapidblinksandlotsof epiphora,Iwasabletosnapthefollowingfluoresceinimage.I notedthattheretainerlookedabitlargerthanI’dintended,with lessedgeliftthanintended,butotherwisedismissedtheunusual NaFlpatternasanartifactofexcessivetearingandanentrapped airbubble.Seeingnothinglikelytocauseanycornealharm, weproceededasplanned.

Informationaboutdoubleredringsinortho-kissparse,butIwas abletofindtwopotentialexplanations:

2.

1. Theretainerhasanentrappedairbubble,whichdisrupts normalfluiddynamics.

Theretaineristooflat,causinganincompletesealwherebythe tissuemovedoutwardfromthecenter,andthetissuemoved inwardfromtheperipherydonotmeet.

Withtheknowledgeofhowtheretainerslookedatdispense,it seemsquitelikelythatthisisacaseofetiology#2.Thetopography data(whichagain,wasverysimilarOD,OS),overlaidalmost perfectlyontotheatypicalNaFlpattern,suggestingthatitwas neitheramisrepresentation,noranisolatedincident.

Wereviewedapplicationtechnique,andLilywas…non-committal… abouthowoftensheforgottofillherretainerswithPFATs.A consistentairbubblecertainlycouldexplainthedoubleredring andthediscomfortshefeltwhilewearingtheretainers.Afterour quicktalk,Lilyaffirmedthatshe’dstayfocusedandgether retainerscompletelyfilledwithPFATsbeforeapplyingthemto hereyes.

Anecdotally,itappearsdebatablewhetheranyfixbeyondproper insertiontechniqueisneededtoresolvethedoubleredrings. Inthiscase,Ielectedtoreducethediameterfrom11.4to11.0and flattenthealignmentzoneanglebyadegree.Ithoughtthiswas likelytoimprovecomfortandreducethechancesthatairwould continuetobetrappedundertheretainer.Thenewretainers on-eyedidindeedlookmorelikethepatternthatweallaimfor.

Fromthenextvisitthroughher6monthcheck-up,Lily’sreported comfortwasmuchbetter,visionremainedexcellent,andtheposttreatmenttopographydatatookonamoretypicalformwithone exception:nowtherewasasecondredringperipherally!Wasthis somecrazyplottwist?Wasthisadouble-red-ring-explanation-#1 (excessivelyflatretainer)allalong?

Inshort,Idon’tthinkso.Uponreflection,Ibelievethattheinitialretainersmayhaveactuallybeenperfect fromtheverystart,andIwouldhavehadaone-and-doneonmyhandsifI’ddonenothingbutre-educate onproperapplicationtechnique.MaybeIwasrelyingonbadinformation(howaretainerlookedafter beingimproperlyapplied),andmaybeIgotcarriedawaychasingatextbookNaFlpattern.Asitturnedout, needingonerevisiontoreachanoptimaloutcomeisstillanexcellentresult.

"Do we leave well-enough alone with the parameters that are working, or do we pull her original pair back out of the drawer? "

Lily’snextannualexamiscomingupinaboutamonth. Assumingshe’sdoingaswellafter12monthsofortho-k wearasshewasafter6months,I’llhaveadecisionto make.Doweleavewell-enoughalonewiththeparameters thatareworking,ordowepullheroriginalpairbackoutof thedrawer?Maybejustforaquickassessment?There’sthatpeskyhumanelementagain.I’llkeepyouposted.

Biography:Dr.AndrewBrauerworksforhiswifeNicoleinaprivatepracticeintheChicagosuburbof Westmont,wherehespecializesinortho-k,myopiamanagement,andsclerallenses.Heenjoys collaboratingwithindustrypartnersandhelpingcolleaguesincorporatespecialtylensesintotheirown practices.Awayfromoptometry,hisfavoritethingtodoisspendtimewithhisamazingwife,three fantastickids,andbestfriendThunder(ablacklabmix).

RecentPublications withDr.LangisMichaudandDr.PatrickSimard

Dr LangisMichaud ODMSc FAAO(Dipl) FBCLAFSLSFEAOOFIACMM

Dr PatrickSimard, OD,MSc,MBA,FAAO, FBCLA,FIACLE,IACMM

ArticleOne|MyopiaProgressionFollowing0.01%Atropine CessationinAustralianChildren:FindingsfromtheWestern Australia-AtropinefortheTreatmentofMyopia(WA-ATOM)Study SSLee,VKNilagiri,GLingham,MBlaszkowskaetal-ClinExp Ophthalmol.2024

Background: Areboundinmyopiaprogressionfollowingcessationof atropineeyedropshasbeenreported,yetthereislimiteddata ontheeffectsofstopping001%atropinecomparedtoplacebo control Thisstudytestedthehypothesisthatthereisminimal reboundmyopiaprogressionaftercessationof001%atropine eyedrops,comparedtoaplacebo

AAOMCDoctorFinder

Haveyouupdatedyourinformation ontheAAOMCDoctorFindersince thenewwebsitewaslaunched?

DoctorFinder

OurnewDoctorFinderevenallows practitionerstodenotewhichlenses theyarecomfortablefittingtomake transferofcareasmoother, easierprocess.

Methods:

Childrenwithmyopia(n=153)wererandomisedto receive0.01%atropineeyedropsoraplacebo(2:1 ratio)dailyatbedtimeduringthe2-yeartreatment phaseofthestudy.Inthethirdyear(wash-out phase),allparticipantsceasedeyedropinstillation. Participantsunderwentaneyeexaminationevery6 months,includingmeasurementsofspherical equivalent(SphE)aftercycloplegiaandaxiallength (AL).ChangesintheSphEandALduringthewashoutphaseandthroughoutthe3yearsofthestudy (treatment+wash-outphase)werecompared betweenthetreatmentandcontrolgroups.

Results:

Duringthe1-yearwash-outphase,SphEandAL progressedby-0.41D(95%CI=-0.33to-0.22)and +0.20mm(95%CI=-0.46to-0.36)inthetreatment groupcomparedto-0.28D(95%CI=0.11to0.16)and +0.13mm(95%CI=0.18to0.21)inthecontrolgroup. Progressioninthetreatmentgroupwassignificantly fasterthaninthecontrolgroup(p=0.016forSphE and<0.001forAL).Overthe3-yearstudyperiod,the cumulativemyopiaprogressionwassimilarbetween theatropineandthecontrolgroups.

Conclusion:

Thesefindingsshowedevidenceofrapidmyopia progressionfollowingcessationof0.01%atropine. Furtherinvestigationsarewarrantedtoascertain thelong-termeffectsofatropineeyedrops.

Thisisaninterestingarticleshowingasignificant reboundeffectwithdiscontinuationof0.01% atropineafterafewyears.Butwhatdoesrebound mean?Infact,itcanbe3things.First, the participantevolvesmorethanwhentreated,but similartothecontrolgroup,keepingthedifference betweenbutunchanged;Secondoptionistosee therateofevolutionhigherthanthecontrolgroup, duringthefollowingmonths/yearsaftercessation, stillkeepingsomebenefitsfromthetreatment. Third,thetreatmentgroupevolvessofastthatit reachesthesameresultasthecontrol,asifithad neverbeentreated.Thereisnoconsensusonthis definitionandeachauthormayuseitsownone. Finally,weshouldalsoevaluatetheeffectofretreatmentonaxiallength.Article2providesan answertothisquestion.

TAKEHOME:

2.

Thisstudyreinforcestheneedforprolonged atropineadministrationtoavoidarebound effect,evenwhenusinglowerconcentrations.

1. Itisalwayspossibletoresumetreatmentwith atropineifthereisanabnormalcourseofAL afterithasbeendiscontinued.

ArticleTwo|Five-YearClinicalTrialofLowConcentrationAtropineforMyopiaProgression (LAMP)Study:Phase4Report

XJZhang,YZhang,BHKYip,KWKametalOphthalmology2024

Purpose:

Toevaluate(1)thelong-termefficacyoflowconcentrationatropineover5years,(2)theproportion ofchildrenrequiringretreatmentandassociated factors(3)theefficacyofprorenata(PRN) retreatmentusing0.05%atropinefromyear3to5.

Design:

Arandomized,double-maskedextendedtrial.

Methods:

Childrenaged4-12yearsoriginallyfromtheLowConcentrationAtropineforMyopiaProgression studywerefollowedupfor5years.Duringthethird year,childrenineachgrouporiginallyon0.05%, 0.025%,and0.01%atropinewererandomizedto continuedtreatmentandtreatmentcessation. Duringyears4and5,allcontinuedtreatment subgroupswereswitchedto0.05%atropinefor continuedtreatment,whilealltreatmentcessation subgroupsfollowedaPRNretreatmentprotocolto resume0.05%atropineforchildrenwithmyopic progressionsof0.5Dormoreoveroneyear. Generalizedestimatingequationswereusedto comparethechangesinsphericalequivalent(SE) progressionandaxiallength(AL)elongation amonggroups.

OutcomesMeasures:

(1)ChangesinSEandALover5yearsindifferent groupsover5years;(2)Proportionofchildrenwho neededretreatment;(3)ChangesinSEandALin continuedtreatmentandPRNretreatmentgroups fromyears3to5.

Results:

269(82.5%)of326childrenfromthethirdyear completed5yearsoffollow-up.Over5years,the cumulativemeanSEprogressionswere-1.34±1.40D, -1.97±1.03D,and-2.34±1.71Dforthecontinued treatmentgroupswithinitial0.05%,0.025%,and 0.01%atropinerespectively(P=0.02).Similartrends wereobservedinALelongation(P=0.01).Amongthe PRNretreatmentgroup,87.9%(94/107)ofchildren neededretreatment.Theproportionofretreatment acrossallstudiedconcentrationsissimilar(P=0.76). TheSEprogressionsforcontinuedtreatmentand PRNretreatmentgroupsfromyears3to5were0.97D±0.82D,and-1.00±0.74D(P=0.55),andtheAL elongationswere0.51±0.34mm,and0.49±0.32mm (P=0.84),respectively.

Conclusion:

Over5years,thecontinued0.05%atropine treatmentdemonstratedgoodefficacyformyopia control.Themajorityofchildrenneededtorestart treatmentafteratropinecessationatyear3. Restartedtreatmentwith0.05%atropineachieved similarefficacyascontinuedtreatment.Children shouldbeconsideredforretreatmentifmyopia progressesaftertreatmentcessation.

ClinicalTranslation:

TheoriginalLAMPstudyusedlowdoseatropineasa monotherapytocontrolmyopiaonAsiankidsand adolescent.Ingeneral,itshowedthata 0.05%concentrationofatropineprovidedbetterAL controlthanthelowerconcentrationsof0.025%or 0.01%Thesefive-yearresultsindicatethatrestarting treatmentpromptlyafterdiscontinuation,when progressionorareboundeffectismeasured, providesthesameresultsasthecohortthat continuedtreatment.Knowingthat87.9%of childrenwhodiscontinuedtreatmentrequiredretreatment,itmaybeappropriatetoestablishan absoluteagefordiscontinuingatropineratherthan discontinuingtreatmentifaxiallengthisstableafter afewyearsbelow16yearsofage.

Takehome:

1.

Thereintroductionoflow-doseatropineshortly afteritsdiscontinuation,whenALisnot progressingnormally,isagoodoptiontoregain goodcontrol.

2.ALstabilityover2yearsmaynotbethebest determinantofatropinediscontinuation. Considerationshouldalsobegiventoageand growthpotential.

ArticleThree|TheCornealBiomechanical DifferencesafterWearingOrthokeratologyLenses andMultifocalSoftLensesinChildren: ASelf-ControlStudy

LFu,YJiang,HLian,JLou,RChenetal-ContLens AnteriorEye2024

Purpose:

Tocomparethechangesincornealbiomechanics afterorthokeratology(OK)lensandDefocus IncorporatedSoftContact(DISC)lenstreatment.

Methods:

Of28myopicchildrenwererecruited,withoneeye wearingOKlensandtheothereyewearingDISC lensforoneyear,andthedataafterdiscontinued for4weekswerealsocollected.Majoroutcomes werecornealbiomechanicsandaxiallength(AL) elongation.

Results:

Throughoutthefollow-upperiod,theDISCgroup hadlongerthefirstapplanation(A1)time,largerA1 deformationamplitude,A1deflectionlength(A1 DLL),andA1deflectionamplitudethantheOK group ALelongationwaslessintheOKgroupat eachvisit(allP<005)butfasterintheOKgroup thanintheDISCgroupafterdiscontinuation(P= 0006) Moreover,ALelongationwasrelatedto baselineA1time,A1velocityandwholeeye movementmaxintheDISCgroup,andintheOK group,wasrelatedtothebaselinethesecond applanation(A2)DLL,A2deltaarclengthand stiffnessparameterA1(allP<005)

Conclusion:

Thecorneawasmoredeformableafterwearing DISClensthanOKlens,andcornealbiomechanical parameterswereassociatedwithALelongation EyesshowedlessALelongationduringOKlens treatmentwhilefasterALelongationafter discontinuationthanDISClens Thebaseline cornealbiomechanicsmayhelptopredictAL elongationinmyopiccontrolstrategies

ClinicalTranslation:

Itusedtobethoughtthatdirectpressureappliedto thecornealepitheliumduringorthokeratology coulddamageorevenwarpthecornea.Thisstudy suggeststhatitisnottrue,showingthat orthokeratology,unlikesoftcontactlenswearsuch astheDISClens,doesn'taltertheocular biomechanicsmeasuredwiththeCorvis.Other factorsmaybeinplay,likeoxygenpermeability duringtheday,softlenstighteningwithdrynesss, lidspressure,etc.Itisareminderthatweneedto keepanopenmindaboutthemechanismof cornealreshapingwithorthokeratology.

TAKEHOME:

1.

Eyeisacomplexenvironmentanditisnot alwayspossibletoisolateoneelementfromthe othercontributors.2)Regardlessofthedevice usedformyopiacontrol,regularfollow-upvisits areessentialtotracksubtlechangesthatcan haveanimpactoneyehealthovertime.

ArticleFour|RedLightInstrumentsforMyopia ExceedSafetyLimits

LAOstrinandAWSchill-OphthalmicPhysiolOpt2024

Purpose:

Low-levelredlight(LLRL)therapyhasrecently emergedasamyopiatreatmentinchildren,with severalstudiesreportingsignificantreductionin axialelongationandmyopiaprogression.Thegoal ofthisstudywastocharacterisetheoutputand determinethethermalandphotochemical maximumpermissibleexposure(MPE)ofLLRL devicesformyopiacontrol.

Methods:

TwoLLRLdevices,aSky-n1201aandaFutureVision, wereexamined.Opticalpowermeasurementswere madeusinganintegratingsphereradiometer througha7-mmdiameteraperture,inaccordance withANSIZ1361-2014,sections323-324 Retinal spotsizesofthedeviceswereobtainedusinga modeleyeandhigh-resolutionbeamprofiler Cornealirradiance,retinalirradianceandMPEwere calculatedforaneyepositionedattheocularsof eachdevice

Results:

BothdeviceswereconfirmedtobeClass1laser products.FindingsshowedthattheSky-n1201a deliverslaserlightasapointsourcewitha654-nm wavelength,0.2mWpower(Ø7mmaperture,10cmdistance),1.17mW/cm2cornealirradianceand 7.2W/cm2retinalirradiance(Ø2mmpupil).The MPEforphotochemicaldamageis0.55-7.0sfor2-7 mmpupilsandforthermaldamageis0.41-10sfor 4.25-7mmpupils.FutureVisiondeliversthelaseras anextendedsourcesubtending0.75×0.325°.Ithas a652-nmwavelength,0.06mWpower(Ø7mm aperture,10cmdistance),0.624mW/cm2corneal irradianceand0.08W/cm2retinalirradiance(Ø2 mmpupil).MPEforphotochemicaldamageis50625sfor2-7mmpupils.

Discussion:

ForbothoftheLLRLdevicesevaluatedhere,3min ofcontinuousviewingapproachedorsurpassed theMPE,puttingtheretinaatriskofphotochemical andthermaldamage.Cliniciansshouldbe cautiouswiththeuseofLLRLtherapyformyopiain childrenuntilsafetystandardscanbeconfirmed.

ClinicalTranslation:

Thisstudyremindsustobecautiousabout implantingnewtechnologyuntilthesafetyissueis confirmed.Despitemanyarticlesshowing significantaxiallengthcontrolwithLLRLtechnology, therearenocleardataontheeffectofthisenergy levelonrepeatedexposureovertime.Italsoraises thequestionofwhetherthemyopia-controlling effectisadefensemechanismagainst unsustainableenergylevels.Toconfirmthelongtermsafetyofthistechnology,furtherstudiesusing OCTimagingandvisualthresholdtestingare needed.

Takehome:

Neverbethelastpersontohavetreateda youngpatientbeforeheorshebecomes visuallyhandicaped.Thisisespeciallytrueifthe treatmentyouareprescribinghasnolong-term studysupportandisnot,atthismoment,partof thestandardofcare.

ArticleFive|FactorsInfluencingTreatmentZone SizeinOrthokeratology

JessicaGruhl,FrankWidmer,AnnaNagl,Stefan Bandlitz-Cont.LensAnt.Eye,2023Aug;46(4):101848

Purpose:

Theaimofthisstudywastoanalyzetheinfluence ofcornealtopography,contactlensparameters anddegreeofmyopiaonthetreatmentzone(TZ) andperipheralplusring(PPR)sizein orthokeratology.

Methods:

Inthisretrospectivestudythetopographiczonesof therighteyesof106patients(73female,22.16± 8.96years)wereanalyzedinthetangential differencemapoftheOculusKeratograph5M (Oculus,Wetzlar,Germany).UsingtheMB-RulerPro 5.4software(MB-Softwaresolutions,Iffezheim, Germany)thehorizontal,vertical,longest,shortest diametersandareaoftheTZ;horizontal,vertical, totaldiametersandwidthofthePPRwere measured.Correlationsweredeterminedbetween thesezonesandthesubjects'baselineparameters (myopia;cornealdiameter,radii,astigmatism, eccentricity,sagittalheight;contactlensradii, toricityandtotaldiameter)forthreebackoptic zonediameter(BOZD)groups(5.5,6.0and6.6 mm).Astepwiselinearregressionanalysiswas performedtotestforTZandPPRpredictability.

Results:

InthegroupofBOZD6.0correlationswerefound betweentheamountofmyopiaandtheshortTZ diameter(r=-0.25,p=0.025);thesteepcorneal radiusandtheverticaldiameter(r=-0.244,p= 0.029),thelongestdiameter(r=-0.254,p=0.023) andthearea(r=-0.228,p=0.042)oftheTZ;the amountofastigmatismandPPRwidth(r=0.266,p =0.017);eccentricityofthesteepcornealmeridian andPPRwidth(r=-0.222,p=0.047).BOZD correlatedsignificantlypositivelywithallzones(p< 0.05).Thebestpredictionmodel(R2=0.389) resultedwiththeTZareaastheoutcomevariable.

Conclusion:

Theamountofmyopia,topographyandcontactlens parametersinfluenceTZandPPRinorthokeratology. DescribingtheTZbyitsareamayprovidethemost accuraterepresentationofitssize.

ClinicalTranslation:

Thedesignofanortho-klenssayslittleabouthow itreshapesthecornea.Twopatientswiththesame refractivecharacteristicswillnotexperiencethe sameeffectwhenwearingthesamelens.The characteristicsofthecorneaandelementsrelated tothewearingenvironment(lengthandpositionof sleep,ageofthelenses,care,etc.)haveamuch greaterimpactonthefinalresult.Thisarticle remindsusoftheimportanceofmeasuringthe effectsoflensesonthecorneatoassesstheir potentialimpactonmyopiacontrolandnotjustto lookatthelensproperties

Takehome:

Itiscriticaltounderstandhowtointerpretthe differentialtangentialmapduringfollow-upto optimizeOKoutcomes.2)Treatmentzonearea (vspupil)maybethenewstandardfor evaluatingOKlensperformance.

WelcometotheTeam!

BriannaGloster,aSpelman Collegegraduate,isan innovativedigitalcreator specializingindigitalmarketing andsocialmediastrategies. Withextensiveexperiencein Marketing&Communications, PublicRelations,Events Coordination,Brand Development,and Entrepreneurship,Briannaexcelsinblendingtraditional approacheswithmoderndigitaltechniques.Herpassion forcreativityallowshertocollaborateeffectivelywith clients,helpingthemachievetheirmainobjectivesand buildtheirbrandpresence.Briannaisdedicatedto educatingclientsonmaximizingtheirsocialmedia engagementandleveragingitforbusinesssuccess.Her diverseskillsetandcommitmenttoresultsmakehera valuableassetinthedigitalmarketingarena.

MemberSpotlight

AnInterviewwithDr.TakeiaLocke,OD,FCOVD fromAtlanta,GA.

Dr TakeiaLocke

Pleaseshareabitaboutyour familyandeducation background?

AfterAttendingHoward UniversityforUndergraduate Studiesandreceivingadegree inHealthManagement,I attendedNovaSoutheastern Universityandcompleteda residencyinPediatricsand VisionTherapy Shortlyafter

Howdidyougetintooptometry?

WhenIwas8,IstoletheE,FP,TOZ,LPED,PECFDvision chartfrommyfather’sprivatepractice AtthetimeI posteditattheendofmybednexttoJanetJackson andwassureIknewthecharttoptobottom WhenI finallywenttoanOphthalmologypracticetoseeifI neededglasses,IfeltIacedthetest Iknewtheletters already,butsomehowleftwitha-400prescription ThepurposedrivenpathcontinuedasImatriculated throughhighschool Iwasselectedtoworkatan Optometrypracticeinmytownfilingchartsasthey movedtoEMR Ibuggedeveryoneinallareasofthe officetolearnwhattheyweredoingfromthelabtothe frontdeskwhenIfinishedreturningchartsfortheday I hadahardtimebreakingmyselfawayfrom Optometryeversince

Howhasyourcareerjourneybeenovertheyears? Wasitsmoothsailingmainly?

TheCorrectedViewistheofficial podcastoftheAAOMCwithourhosts Dr.AnithPillaiandDr.DwightBarnes

"When I finally went to an Ophthalmology practice to see if I needed glasses, I felt I aced the test. I knew the letters already, but somehow left with a -4.00 prescription. " residency,IrealizedthatIcouldnotpracticefullscope Pediatriccareinacorporatesettingandopeneda privatepractice Istartedmyfamilythefollowingyear andhavefourkidsages11,10,7and3

Mycareerhasbeenfarfromsmoothsailing!Istruggledwithsomeofthe ethicsinacorporatepracticeandanOphthalmologypractice Iwastold severaltimeshowdifficultitwouldbetohaveaprofitablePediatricand VisionTherapypractice,butIopenedoneanywaywiththefocusonthis underservedgroup ItwasastruggleinthebeginningandIstillthinkwe haven’thitourfullpotential I’vewrestledwiththevalueofourprofessionas manyothershaveanddecidedthatwehavetofindwaysoutofinsurance chokeholdswhenIfoundmyselfchasingmytailandunfulfilled Despite thestruggles,thebestpartofmydaywasandisengagingpediatricand

specialpopulationpatients.Likeanybusinessowner,jugglingtheCEOandODhatshasnotalwaysbeeneasy, butfindingthepurposeandstayingtruetoourvalueskeptmeshowingupandhasresultedingrowinga practicethatIamtrulyproudofandenjoyshowingupfor.Therewardshavefaroutweighedthestruggles!

Pleasetellusaboutyourpractice?Whatmakesituniqueordifferent?

WeareafamilypracticewithafocusonallthingsPediatrics,FunctionalandNeuro-Optometriccare.Both MyopiaManagementandVisiontherapyhavebeenanintegralpartofourpractice.Westrivetoidentify problemsthatareplaguingourpatientsandattractpatientsfromhoursawaybecauseofthespecialized care.Wearegrowthfocusedandenjoygrowingourstaffmembersaswewatchourpatientsgrow.Ourcore valuesstemfromthebeliefthat“Everyonedeservesachance!”Webelievethatwithcomprehensiveanalysis andexplanationwecangiveourpatientsafairchancewithoutvisionasabarriertotheirgoals.

YouareanOrthokeratologistorMyopiaManagementSpecialist,canyoupleaseshareabitmoreaboutwhy youchoosethissubspecialty?

MypersonalstoryasaMyopeiswhatdrivesmetodoallIcanformypatients.Iamhighmyopewithblindness inmyfamily.IalsofitthebehavioralandbinocularprofileofaMyope.InOptometryschooltheydiscoveredI hadConvergenceExcessandIwasanavidreaderasachild.Ithinkofwhatcouldhavebeenifmycarewas approacheddifferentlyandhavedecidedthatmypatientsdeserveaholisticandcomprehensiveapproach.I avoidedcertainsports,Istruggledwithmyvisionasaswimmer,Ihatedmyglassesandnowmyvisionis progressivelygettingworse.IfsomeonewouldhaveofferedOrthokeratology,Iwouldhavebeenagreat candidateandIknowmyparentswouldhaveoptedin.

Ialsoenjoythateverydayisdifferent,everypatientisdifferentandprefertoavoidmonotonyasan Optometrist.Thissubspecialtyallowsmetoworrylessaboutwhatisrequiredbyinsuranceandallowsmeto considerwhatisbestformypatientandtheirfamily.Thereisabitmorecreativityinvolvedthanmanaginga glaucomaordiabeticpatient,andIenjoytheconstantlearninginthisspecialty.

Inwhatwaysdoyoubringabouteducationtoyourpatits?

Myrulewithmypatientsis“Theyareyoureyes,soyouneedtoknowwhatIknow.”Thatsaid,Itrytosimplifythe informationandcomparetoconceptspatientsarefamiliarwith.Ishowexamplesonthescreentosimulatea child’svision,aredatausingtheMyahcharts,researchwiththemyopiacalculators.Ireadtheroomto understandwhatwillspeaktoparentsinawaythatsticks.Forexample,ifIamgettingablankfacebackwith thesimulationonthecomputer,Iwillpulloutlensesfortheparentstolookthrough.Ihavesampleaxiallength chartstoshowwhatslowingprogressionlookslikeonarealpatient.Wesupporttheinformationgivenby followupcallsifneeded,butourgoalistogetthepatientandparenttounderstandthatasanexpertIwill guidethemtowardswhatisbestwithapersonalizedcareplandesignedtoworkforourlongtermgoalsand theshorttermfamilylifestyle.

Whatarethemostrewardingaspectsofyourcareerandwhataresomeofthechallenges youfaceinyourpractice?

Thechallengesaretypicallyconsistencywiththestaffinmessagingandmarketingthespecialties Because wearefullscope,ittakesextratrainingtimeandpatiencetobeabletodelegateasmuchasIwouldliketoin allaspectsofthepractice Westillfacechallengeswithinsuranceplansaswehavenotmovedtobeing completelyfreeofthemyet Therewardsareworkingwithkids-wehavefun,learnfromeachotherandlaugh "...it takes extra training time and patience to be able to delegate as much as I would like to in all aspects of the practice."

Wegettobuildrelationshipsandwatchkidsthriveduringandafterour treatmentinschoolandsportsandlife Weseeimprovementsintheir confidencelevelsandshareintheirsuccessinameaningfulway

Myopia Management forEveryone

Jointhisunbiasedpatientdoctorgrouptoseewhat patientsaresayingabout myopiamanagement

Howdoyoumanagetobalanceyourcareerandyour personallife/family?

Iseepatients3.5daysaweekandleave1dayfor CEO/Administrativework.Iwouldliketoshifttolesspatient caredaysbyreducingourprimarycarepatientsonmy scheduleandhiringanassociatetodothat.Ilearnedthatthe bestwaytobalanceistoacceptthattherewillbetimesthat thingsarenotbalanced.Myfamilycomesfirst,Ischedule aroundtheimportantactivitiesandvolunteeratschool. Havingaspecialtyandprovidingexcellentcareallowsmeto sethoursthatIamcomfortablewith.Ihaveaverysupportive patientbase.Theydon’tcomplainifIamoutforachildwho maybesickorifItakespringbreakoff.WhenIamspending timewithmyfamily,Idomybestnottodividemyattention. Foryears,mykidsdidnotknowIamanownerandDoctor. TheyseemeasamombecauseIprioritizethemwhenIam awayfromtheoffice.Asfortheself-carethatisaworkin progress.Ivaluemyprofessionaldevelopmenttimeandfeed myneedforpersonalandprofessionalgrowthwithaudible, booksandpodcasts.Ihavebeenamemberofvarious businessgroupsandthosethingsfillmycupmorethan “NetflixandChill”days,soIamgratefulwhenIcanreada greatarticleorgotoanamazingconference.

Whatdevelopmentorchangeswouldyouliketoseeinthe fieldofoptometryinthefuture?

Ourprofessionisstagedtoblossomifwecancollectively decidethatweareahighlyspecializedandvaluablepartof thebroaderhealthcareprofession Wecanreversethe trajectoryof‘freeeyeexams’and‘BOGOglasses’byshowing ourpatientsandpeersthattheknowledgewehaveaboutthe visionsystemisunmatchedbyanyotherhealthcare provider Joiningforcescollaborativelywithinourown professionbyusingeachotherasreferralsourcesand outsideofourprofessionbysharingcaseswithother professionsisinthebestinterestofthepatient Iwouldliketo seemorecollaborationamongstprofessionalsinthefuture

MemberSpotlight

AnInterviewwithNicoleHealatBayviewVisionCare inToronto,Ontario

Please,introduceyourself.Tellusalittlesomethingaboutyourstory. I'mNicoleHeal,andI'vebeenservingastheClinicManageratBayview VisionCareforthepasttwoyears I'mproudtocallToronto,Canadamy home Overthelast12years,I'vehadtheprivilegeofworkinginvarious facetsoftheoptometryfield

Tellusalittlebitaboutyourroleinyourpractice?

Astheofficemanagerinouroptometrypractice,Iwearmanyhats Ioversee theday-to-dayoperations,andsupportourstaff,associatesandtheowner inanyaspectthatIcan.Mygoalistocreateaseamlessandefficient environmentforourpatients,staffandouroptometrists.

Astheofficemanager,IamparticularlyinvestedinmyopiamanagementbecauseIunderstandthe long-termimplicationsofmyopiaanditspotentialimpactonourpatients'visionandoveralleyehealth I'veseenfirsthandhowmyopiacanprogressandleadtomoreseriousvisionproblemsifleftunmanaged Therefore,Imakeitaprioritytoensurethatourpracticeiswell-equippedtooffereffectivemyopia managementservices

Howdidyougetinterestedinworkinginthefieldofoptometry?

Istumbledintotheworldofoptometrybychance ItallstartedwhenIbeganhelpingoutinafamily friend'sopticalshop,initiallyasashort-termendeavor Surprisingly,fiveyearslater,Iwasstillthere,having absorbedatremendousamountofknowledgeabouttheoptometryindustry

Duringmytimethere,Inotonlyassistedtheowner'sfamilyinvariousaspectsoftheirbusinesses,including independentandchainoptometricpractices,butalsoplayedaroleinorganizingandrunningcontinuing educationseminarsforoptometristsandopticians Thisexperienceprovidedmewithawell-rounded understandingofthefield

Afterthebusinesswassold,myjourneyledmetofocusonindependent optometry,ultimatelyleadingmetoBayviewVisionCare Workingwith thisteamhasbeenincrediblyrewarding Theyarenotonlyhighlyskilled butalsodeeplysupportive TheownerandIshareasimilarvisionforthe business,andheplacesgreatimportanceonfosteringaculturewhere employeesgenuinelycareaboutboththepatientsandthesuccessofthe practice.Thisalignmentinvalueshasbeenakeyfactorinmycareerprogression.

"my journey led me to focus on independent optometry, ultimately leading me to Bayview Vision Care."

NicoleHeal

Arethereanychallengesthatyouhavehadto overcomeinyourcareerjourney?

Twokeypointsstandoutforme.Firstly,keeping pacewiththeadvancementsintechnologyandthe ever-changinglandscapeofoptometry.Staying aheadofthecurveinthisdynamicfieldisa constantbutwelcomechallenge. Secondly,findingapracticethattrulyresonates withmeonapersonalandprofessionallevel.I've becomeincreasinglyselectiveaboutmyworkplace, aimingtobepartofsomethingexceptional, forward-movingandthatfostersgenuine workplacesatisfaction.Ifeelincrediblyfortunateto havelandedinmycurrentrole,whereallthese elementsalignseamlessly.

Whatdoyoubelieveisthemostimportantthing youdotosupportyourdoctorandyourpractice?

ThemostimportantthingIdotosupportthedoctor andourpracticeistoensuresmoothoperationsof theoffice.Istrivetocreateawelcomingand efficientenvironmentforourpatients,whichinturn allowsouroptometriststofocusonproviding high-qualitycare.Ialsoworkcloselywithourstaff toensuretheyhavetheresourcesandsupportthey needtoexcelintheirroles.Myfocusliesinhandling thefinerdetails,sohecanconcentrateonthe biggerpicture.Ihelphimdevelopsystemssothat wecanachievegoals.

Whatinspiresyouthemostinyourfieldofwork? Whatinspiresmethemostinmyfieldofwork, particularlyinthecontextofmyopiamanagement, istheopportunitytomakealastingpositiveimpact onourpatients'lives.Myopiaisaprevalenteye condition,anditsmanagementiscrucialfor preventingpotentialvisionproblemsinthefuture Knowingthatourpracticeisattheforefrontof myopiamanagementandthatweareactively helpingchildrenandyoungadultspreservetheir visionandeyehealthisincrediblymotivating It's inspiringtowitnessthetangibleresultsofourefforts asweguidepatientstowardshealthiervision outcomes Ultimately,ourworkinmyopia managementalignsperfectlywiththecoremission ofoptometry toenhanceandprotectthegiftof sight This,inturn,fuelsmypassionanddedication tothefield

Whatisonepieceofadvicethatyouwouldgiveto aparaoptometricthatisworkinginapracticethat offersMyopiaManagementservices? Firstandforemost,-andIswearthisisn’tanad.I stronglyrecommendconsideringcertification throughtheCertifiedMyopiaNavigatorcourse.This courseoffersatreasuretroveofknowledgethatI personallyfoundimmenselyvaluableinthiseverchangingfield.It'sbothcost-effectiveandtimeefficient,makingitoneofthebestinvestmentsI've encounteredintermsofknowledgeacquisition.

Havingadeepunderstandingofmyopiaandits treatmentsthroughthiscertificationwillgreatly enhanceyourabilitytoengageinmeaningful discussionswithpatients.Itempowersyouto providethemwiththemostrelevantinformation andguidance,whichultimatelybenefitstheireye carejourney.

"Having a deep understanding of myopia and its treatments through this certification will greatly enhance your ability to engage in meaningful discussions with patients. "

Howdoyoumanagetobalanceyourcareerand yourpersonallife/family?

I'vefoundabalancethatsuitsmewell.I'mluckyto havestrongsupportbothathomeandatwork. Therearetimeswhenfamilyneedspullmeaway fromworksuddenly,andit'salwaysmetwith understanding.Conversely,youmightcatchme watchingeyecarelectureswhileputtingmychildto bedorrespondingtoworkemailslateatnight. Inessence,Idon'tcompartmentalizeworkand personallifestrictly Instead,bothmyfamilyandmy jobarehighpriorities,andtheyoftenoverlap This blendallowsmetoexcelbothinmypersonaland professionallife

PracticePearls

MatthewMiller

"Usingtechnologytoouradvantage,weexploredthe utilizationofartificialintelligencetomanageour office’sansweringmachinemessage Whileinitial skepticismiscommonregardingartificialintelligence, theresultsspeakforthemselves:thegeneratedaudio isremarkablyrealisticandofsuperiorquality comparedtorecordingsmadewithinouroffice"

CheckOuttheAudioMessage

HaveAPracticePearlYouWouldliketoShare?

Sendyourpearlstomegan@aaomc.org

TravelPearls

foraSizzlingSummer

Manypeoplearegoingonvacationin thenextseveralmonths

Whataresomeofyourfavorite TRAVELTIPS??

Herearemine:

Dr.MarieHoma-Palladino, OD,FIAOMC,IACMM

Takeyourortho-korsoftlensesinyourcarryonbag

Takeanextraplunger

HydrogenPeroxidecanNOTbetakeninyourcarry on-MUST beinyourcheckedluggage

Useaflatcaseinsteadoftheperoxidecasetocarryyour ortho-kfilledwithaMulti-purposesolution

Ifyouneedtotravelfromplacetoplaceandwanttohave yourorthoKlensesintheirH202container,fittheholderin anemptymedicine/pillbottlewithascrewlidThat preventsthecasefromleakingintoyourcarryon Takeasparesetofcontacts,ortho-k,glasses!

Internationaltravel:whenyouarriveatyourdestination:take a“nap”withyourortho-kinyoureyesfor1hourorso-itwill renewyourvisionlongenoughtogetyoutotheeveningeven ifyoudonotsleep,keepyoureyesclosedandlistentomusic, book,meditation,apodcast,etc. Donottrytoinsertyourorthok-ontheplane. Takeandweargoodqualitysunglasses!

Incaseofemergencyremember,weattheAAOMChavealarge grouphereandanInternationalgroupofpractitionerswhoare morethanwillingtohelpout! Happytravels!!

ManagingMyopiaOne ChildAtATimedescribes themostrecentscientific advancesandtranslates themintoaunique clinicalapproachwecall TheMontrealExperience.Withmorethan15 yearsofexperienceincontrollingmyopia andtreatingseveralhundredchildrenand youngadults,theauthorshavedeveloped apracticalandsuccessfulapproach.Using specificcasesthatexplainstheirMyopia andMyopiamanagement,takingsomeof themysteryoutofthetopicauthorsare providingthereaderwithinsightand confidencetohelptheirpatients.

TeaTimewiththeResidents

FourTakeawaysfromResidency forSpecialtyClinicalCare

EmilyGottschalk, OD,FAAO,DiplABO

Myaimincompletingacorneaandcontactlensresidencywastodevelopskillsthat wouldallowmetoprovidespecialtycare Wellintomyfirstyearofpractice,Ican reflectbackonthetakeawaysfromresidencythatmadeforasmoothtransition

MarketableSkills

Duringresidency,Ifocusedmyjobsearchonpracticesettingsthatcouldaccommodate myinterestsinspecialtycontactlensesandmyopiacontrol Thisincludedproviding techniciansupportforinsertionandremovaltrainingandinstrumentationlike topographerandbiometer Isharedmyopiamanagementcasesfromresidency includingorthokeratologyfits,multifocalsoftcontactlenses,anddualtherapywith contactlensesandatropinetoshowwhatIhadmanagedandwaslookingto accomplishinpractice Clinicsweremotivatedtoincorporateanewdoctorwhocould expandtheirspecialtyservicesandcareforanewpatientpopulation

HittheGroundRunning

Equippedwithayearoffocusedcorneaandcontactlenstraining,Iwaseagertoseespecialtycasesfrom myfirstdayinpractice.Duringresidencyallofmyclinicalcarewascompletedincontactlensandmyopia controlclinics.IspenttimeeachweekatArtOpticaltrainingwiththeirconsultationteamonspecialty contactlenscases.Strongrelationshipswithindustryandunderstandinghowtoworkwithcontactlenslabs allowedmetoassistinsettingupsystemswithinmyclinicalsettingtostreamlinefittingandorderinglenses.

PatientEducation

Thereareaplethoraofresourcesonhowtobecomeproficientinfittingorthokeratologyandmultifocal contactlensesandprescribingatropineformyopiamanagement.Patienteducationcanbethemost challengingaspect,notablytheinitialpitchandtheconsultationvisit.Workingwithmysupervisorstaught metoinitiatetheseconversationsduringroutinepediatricexamsaswellaswithparentswhowerehigh myopesandhadchildrenthatshouldbeassessedformyopiaprogression.Consultationvisitswithfamilies includedreviewingthefullrangeofmyopiacontroloptions(availableintheUS).DuringresidencyIlearned howtosuccinctlydiscussmyopiacontrol,answerparentquestionsanddirectfamiliestocredibleresources.

ANetworktoPropelMeForward

Inmyfirstyearofpractice,Iambuildingonmyfoundationfromresidencyandlearningmorethanever.I haveanetworkofmentors,co-residentsandindustrypartnersthatIcanreachouttoforguidancein practicebuildingandchallengingpatientcases.ResidencyconnectedmewithacommunitythatI continuetolearnfrom.Recently,Isawan8-year-oldfemalewhohadnothadaneyeexamsinceage5 andwascomplainingofpoordistancevision.Therehadbeen3Dofmyopicprogression.Duringtheinitial visitIinitiatedaconversationwiththefamilyaboutmyopiacontrol.Theywereexcitedaboutcontactlens optionsasthepatienthadstartedplayingsoccerandwasnotwearingherglassestoplay Thepatient wasfitinorthokeratologylensesandwillcontinuetobemonitoredformyopiaprogression Corneaand contactlensresidencypositionedmetobeabletomeettheneedsofpatientsrequiringspecialtycareas earlyasmyfirstyearofpractice

Biography:Dr EmilyGottschalkgraduatedfromtheUniversityofWaterlooSchoolofOptometryandVision ScienceandcompletedaCorneaandContactLensResidencyattheMichiganCollegeofOptometry She isoriginallyfromToronto,Canada,andcurrentlypracticesatRochesterRegionalHealth/ReedEye Associates,ahospital-basedOD/MDpracticeinRochester,NY Theresheutilizesherresidencytrainingto fitthefullrangeofmedicallynecessarycontactlenses,manageocularsurfacedisease,andprovide myopiamanagementincludingorthokeratologylenses

GoogleGroup

HaveyouSignedUp?

Beanactiveparticipantorjustwatch andlearnwiththisinteractive communityofexperts Ifyouare missingoutonthisvaluablemember resource,emailmegan@aaomc.orgto jointheGoogleGrouptoday

CaryM.Herzberg O.D.,FIAOMC,IACMM PastPresidentIAOMC

Youguysandgalsrealizeyou’re different?Thatthecolleaguesyou hangwithwhodon’tdoOK and/orgetinvolvedintheAAOMC havefundamentaldifferences withyouandhowtheyapproach Optometry.Wearean organizationofrisktakersandthe oneswillingtolivewithinwhatI refertoastheuncertainty principlesthatgoverncorneal moldingpracticeandmyopia management

Youguyshavethatspecialqualitytheydescribeasthe “rightstuff”andifyouletyourexpressivenaturecome outitwillmanifestinyourabilitytotakerisksinlifeand practicebychallengingthepresentCW.Ilearnedthis earlyonbeforeIstartedthisorganization.Asfirsta memberandthenthePresidentoftheNationalEye ResearchFoundation(NERF)foundedbyNewtonK Wesley.Ortho-Kspecialistslikeourselvesweresooutof thecookiecuttermoldoftypicallywhatgraduatedfrom ourschoolsofOptometry.Thiswastheearly1980’swhen risingobesitywasjustnudgingthescalesandpatients werevisitingeyecareprofessionalsforstrongerscripts astheirvisiondemandsinpartrelatedtothe introductionofdesktopcomputingwerechanging.

Don’tforget,there'sadedicated sectionwhereyoucanpostjoblistings andmanageyourownposts.Notethat whilememberscanonlymanagetheir ownlistings,alljobpostsarevisibleto thepublic.

Jobseekerscanapplybyemailing theirresumesdirectlytothejob poster'semailaddress.

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Ittookmeadecadeaftergraduationtofinallyfigurethis out.IthoughtforthelongesttimeIwascrazy.AfterallI questionedandrefusedtofollowtheconventional wisdomofthedaythatwhenindoubtyoujustthrow moreminusatit.Whetherwithglasses,contacts, behaviormodificationwerebesidethepointbecause myopiait'sallgeneticsandit'sjustgoingtogetworse.It wasn’tjustmycolleagueswhosaidthisitalsocame frominstitutionslikeOSUandtheresidentexpertsatthe time.Iwasnevercomfortablewithhowwedobusiness inOptometrybypushingtheminuslikeadrugdealer.So whenItalkedwithmycolleaguesatmeetingsorgolf eventsitbecameprettyobviousIwasonanIslandallby myself.

Itwasonlyafterjoiningseveralhundredorsoofmy colleaguesinNERFthatIactuallyrealizedthatIwasn’t justoffthereservationbutonajourneyofselfdiscovery.

HereisalistoftraitsthatIbelieveresonateforusand areimportantinourcharacterdevelopmentasOK/MM specialists.

1Unafraidtofail . 2Maverickspirit .

3Highmarksforindividualism .

4Creativethinking . 5StrongVisualizationskills .

6Entrepreneurialspirit .

7Non-conformist .

ThisisaspecialformulaoftraitsthatmakeupwhatI refertoasOrtho-K/MMwarriors.Agroupof over-achieverswhopushthelimitsofourspecialtyand profession.Whoarenotboundbytheselfimposed shacklesthatlimitothers.Whoarenotafraidtofailin theirquestbecauseit’snotfailuretillyougiveup. IobservedthisthroughalmosteighteenyearsthatIled you.Andyouneverdisappointedasweclimbedourway tocreatingthegreatestorganizationandspecialty meetingontheplanet.Letusonceagainflexthatspirit aswereclaimlostturfandhelpourcolleaguesintheir searchfortheholygrailofwhatismyopiamanagement.

HaveyoumissedanAAOMCwebinar?Weoffer theseonourMemberSitetoallmembers Be suretologintotheAAOMCwebsite,andyou canaccesstheserecordingsforfree!

WatchingDr NicholasDespotidis’swebinar “AnswerToYourQuestionsConcerningMyopia Management”andstaytunedformoreinthe comingmonths

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