Defining the Montreal Experience : A Customized Approach to Myopia Control. Part I- Basic Principles And Treatment Algorithm

Myopia management algorithm. Annexe to the article titled Update and guidance on management of myopia. European Society of Ophthalmology in cooperation with International Myopia Institute

“…If one intervention method fails, another maybe tried, or methods can be combined. 1,2,73,74 It should be noted that at present, while these interventions have been shown to be efficacious in many children, children do not all respond equally, and some children do not respond and continue to progress at pace. Eye care practitioners should not over-promise and more research is needed to develop more targeted and personalised approaches to myopia management.…”

“…83 However, it is important to note that in this situation, there are other options available, such as using anti-myopia spectacles or daytime soft anti-myopia contact lenses. 2,73 In the case of astigmatism, anti-myopia spectacles, regular or customised ortho-K contact lenses may be used. 73 Alternatively, astigmatism could be corrected using spectacle lenses in combination with an anti-myopia contact lens or a soft multifocal toric contact lens could be used, because the uncorrected refractive astigmatism may influence axial elongation.…”

“…2,73 In the case of astigmatism, anti-myopia spectacles, regular or customised ortho-K contact lenses may be used. 73 Alternatively, astigmatism could be corrected using spectacle lenses in combination with an anti-myopia contact lens or a soft multifocal toric contact lens could be used, because the uncorrected refractive astigmatism may influence axial elongation. 84 The most serious complication of contact lens wear is microbial keratitis, for which the lifetime risk associated with children using daily disposable soft contact lenses is low (1:431).…”

“…12 Atropine inhibits the progression of myopia in a dose-dependent manner, but it also has dose-dependent rebound effects and dose-dependent adverse events. 1,73,109 Although in the Low-concentration Atropine for Myopia Progression (LAMP) study, the rebound effect was clinically small at all three concentrations (0.01%, 0.025%, 0.05%), discontinuing treatment at an older age and lower concentrations was associated with a smaller rebound effect. 108,109 At a low dosage of 0.01%, atropine has demonstrated conflicting effects on axial elongation.…”

“…118 Combination treatment was found to slow myopia progression significantly more than each treatment alone. 1,73,119 Studies demonstrated that combining low-dose atropine concentration with orthokeratology resulted in greater myopia control effect compared to using orthokeratology therapy alone. [120][121][122] The articles describe the combined effect in different ways.…”