The distance center bifocal contact lenses tested in this study achieved greater control over myopia progression and axial elongation (>70%) compared with most published results with multifocal spectacles. Further studies are warranted to identify the critical factors and mechanisms underlying this myopia control effect.

The prevalence of myopia has markedly increased in East and Southeast Asia, and pathologic consequences of myopia, including myopic maculopathy and high myopia-associated optic neuropathy, are now some of the most common causes of irreversible blindness. Hence, strategies are warranted to reduce the prevalence of myopia and the progression to high myopia because this is the main modifiable risk factor for pathologic myopia. On the basis of published population-based and interventional studies, an important strategy to reduce the development of myopia is encouraging schoolchildren to spend more time outdoors. As compared with other measures, spending more time outdoors is the safest strategy and aligns with other existing health initiatives, such as obesity prevention, by promoting a healthier lifestyle for children and adolescents. Useful clinical measures to reduce or slow the progression of myopia include the daily application of low-dose atropine eye drops, in concentrations ranging between 0.01% and 0.05%, despite the side effects of a slightly reduced amplitude of accommodation, slight mydriasis, and risk of an allergic reaction; multifocal spectacle design; contact lenses that have power profiles that produce peripheral myopic defocus; and orthokeratology using corneal gas-permeable contact lenses that are designed to flatten the central cornea, leading to midperipheral steeping and peripheral myopic defocus, during overnight wear to eliminate daytime myopia. The risk-to-benefit ratio needs to be weighed up for the individual on the basis of their age, health, and lifestyle. The measures listed above are not mutually exclusive and are beginning to be examined in combination.

Purpose: To examine the regional distribution of choroidal thickness (ChT) and the diurnal variation in ChT and axial length (AL) over a wide range of myopic refractive error. Methods: ChT was measured in thirty-four healthy young adults (age mean ± SD: 25.2 ± 2.8, range: 18-35 years) using spectral-domain optical coherence tomography and AL using an IOL-Master 500. Participants were divided into three refractive groups: emmetropes, myopes, and high myopes. We evaluated ChT in macular (foveal, parafovea, and perifovea) and peripheral regions (6-mm from the foveal pit) in four quadrants (superior, temporal, inferior, and nasal). To assess the diurnal variation, three measurement sessions of ChT and AL were taken at 8 AM, 12 PM, 4 PM. Results: ChT thins progressively towards the periphery. Superior and nasal quadrants exhibited the thickest (277 ± 73 µm) and thinnest (218 ± 89 µm) choroid, respectively. Higher myopic eyes showed an overall thinner choroid (237 ± 48 µm) compared to myopic eyes (264 ± 78 µm) (P < 0.05). Higher myopes exhibited a significant choroidal thinning in all quadrants except in the temporal quadrant (all p < 0.05). Both ChT and AL underwent a significant diurnal variation (p < 0.05). The ChT and AL diurnal variation amplitudes in higher myopes were significantly reduced (ChT: 14.6 ± 11, AL: 14.5 ± 13 µm), compared to those in emmetropes (ChT: 21.4 ± 15, AL: 21.3 ± 8.5 µm) and myopes (ChT: 19 ± 17, AL: 19 ± 9.7 µm). Diurnal variation amplitude in ChT did not differ significantly across quadrants and choroidal eccentricity regions (p > 0.05). Conclusion:ChT distribution varies based on quadrant and eccentricity; superior choroid exhibited the thickest, and nasal showed the thinnest choroid. Higher myopes experience a reduced diurnal variation in ChT and AL.

AIM: To investigate the practice patterns of optometrists in Saudi Arabia regarding myopia management. METHODS: An internet-based survey was distributed to all practicing optometrists in Saudi Arabia (n=1886). The survey contained questions related to 1) demographics, 2) knowledge about myopia and its associated complications, 3) current clinical care, 4) type and frequency of myopia treatment prescribed, and 5) potential barriers limiting treatment adoption. RESULTS: The completed surveys were collected from 171 optometrists (9.06% response rate, 60% male). Knowledge regarding myopia-associated complications was prevalent but somewhat inaccurate among the respondents. Cycloplegic refraction at initial visit was used by 59% of the respondents. The cover test was the most reported binocular vision test (83%), and 38% of optometrists did not perform any ocular biometrics. Two-thirds prescribed single-vision spectacles for children with myopia. Increased time spent outdoors was selected by 80% of the practitioners who prescribed myopia control treatment as the primary approach. Insufficient support and lack of clinical experience in providing myopia treatment were reported as the most important factors limiting the adoption of myopia management strategies. CONCLUSION: The current optometric practices in Saudi Arabia require further investigation. Optometrists appear to be somewhat aware of myopia and the associated risks. However, most evidence-based myopia treatments are not being locally adopted, primarily because of lack of support, lack of experience, and limited availability.

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