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MANAGEMENT OF PROGRESSION AND DRY DISEASE Investing in your practice with MYAH may be the right choice for you. BY SARAH FARRANT, BSC, MCOPTOM, DIPTP (IP), FBCLA, AND EDWARD FARRANT, BSC, MCOPTOM, DIP GLAUC, DIPTP (IP)

ye care providers face a series of assigned a follow-up regimen after baseline patients in this same questions when considering equipment data collection. age group with only upgrades. Will a new device result slight hyperopia also in more robust data collection and Early Diagnosis and Follow-Up have an increased risk streamlined efficiency? Can a single Returning patients whose condition is being of becoming myopes Eplatform contain multiple modalities that observed or who are undergoing treatment (pre-myopes).2 All address several disease states? Will an upgrade are best cared for when longitudinal data these patients are make it easier for me to communicate with are examined for trends. MYAH’s Parental referred to as pre- my patients and drive compliance with the Report shows changes in axial length and myopes and benefit treatments I recommend? When it comes spherical equivalent (when imported) over from closer axial length monitoring. to MYAH® (Topcon Healthcare Inc., Tokyo, time, allowing clinicians to better initiate and Together with axial length measurement, Japan), the answer to all three questions is yes. evaluate therapy. The initial dataset from the the corneal data provided by Placido disc This new device can be a good solution Myopia Research Group of Erasmus University topography, including anterior corneal for clinicians already managing or thinking Rotterdam, Netherlands became known as curvature and aberrations, add relevant about expanding their clinical routine to see the Tideman curves. Percentile charts for axial information about the elements contributing patients with myopia progression or dry eye length show the risk of developing myopia to myopia progression. Corneal abnormalities, disease (DED). and high myopia, according to the patient such as , can also lead to an age and gender (Figure 1). Tracking myopia increase in myopia, and therefore it is MODERN MYOPIA MANAGEMENT progression in patients with early disease important to screen for keratoconus before Innovative clinicians seek to leverage or in patients with risk factors may lead to considering myopia management. In addition, the latest technological advancements to timelier intervention. such corneal conditions benefit from early provide patients with cutting-edge therapy Risk factors for developing future myopia diagnosis to enable the most effective manage- for myopia management. Having access to a include patients between the ages of 6 and 7 ment, which may include corneal cross-linking. greater array of high-quality data deepens a with a family history of myopia and patients clinician’s understanding of the interactions who experience an increase of at least -0.50 D Adjusting Treatments between patient history, myopia progression in in a year. Interestingly, Clinicians tracking the effects of low-dose risk, and intervention results. Capturing Axial Length Given the understandable emphasis on axial length in myopia management,1 we need technology that easily and accurately captures data for new patients and compares those data over time for returning patients. MYAH axial length acquisition is fast, allowing its measurement in children, which can often be a challenge if it takes too long or needs repeating for better accuracy. New patients with myopia benefit from risk of axial length progression evaluation, since it can be estimated from baseline data relative to reference data. Similarly, patients with already known risk factors Figure 1. The MYAH Parental Report produces an easy-to-understand longitudinal analysis of axial length, compared with extensive and associated with myopia progression can be exclusive normative data, showing the risk of developing myopia and high myopia according to the patient age and gender.

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therapy may find the dynamic Meibography pupillometry to be a useful tool for dose The Meibography acquisition captures titration. This function may also be employed real-time snapshots of a patient’s by clinicians who use to Meibomian gland anatomy. Many clinicians manage myopia, where the size in use the percentage Meibomian gland relation to the size and position of the loss, as calculated by MYAH’s software, to treatment zone is key. provide evidence of the need for in-clinic MYAH also helps eliminate some of the treatments for DED, to supplement patient- guesswork when fitting or managing patients administered treatments. with orthokeratology by capturing topographic data for use in the built-in Ocular Surface and Blink Analyses fitting simulator, or automatically exporting to A detailed report on the characteristics and a wide range of lens provider sites. This both dynamics of a patient’s tear film is important increases patient comfort and streamlines when diagnosing and treating DED. visits, reducing the number of trial lenses. Evaluations of noninvasive tear break-up time In addition, having the opportunity to show (NITBUT), tear meniscus height, blink analysis, both qualitative and quantitative data to the and how corneal aberrations and hence visual patient can be very useful for their education. quality changes between blinks, can all be Figure 2. Clinicians use the MYAH Dry Eye Summary Report to The recently added Parental Report focuses performed by MYAH. have an overview of a patient’s tear film and ocular surface. This on the patient, or in the case of paediatrics, The NITBUT identifies which areas of the comprehensive assessment improves clinic workflow and facilitates the clinical decision on the disease diagnosis and management. their parents (incorporating Figure 1). The patient’s ocular surface are first affected by report helps understand the risk of myopia, quick tear film evaporation. The analysis precision of evaluation and care may find as well as the impact of any intervention. On of NITBUT together with the patient’s that the MYAH is a worthwhile investment top of that, it has personalized messages for interblink interval, allows automatic for their practice. Given the range of patients the paediatric patient, assisting in treatment calculation of the ocular protection index who can benefit from the multiple modalities engagement and compliance. (OPI), which clinicians can use to determine contained in the platform—from paediatric the risk of potential corneal damage pre-myopic patients to long-term DED DRY EVALUATION secondary to ocular surface disease. This patients—return on investment can be The heterogenous and multifactorial is also a particularly advantageous tool for quickly realized. In addition, you will be using nature of DED can frustrate both patients detailed patient discussion regarding the cutting-edge technology to improve your and eye care providers. However, the importance of developing good blinking clinic workflow and at the same time, provide field has grown in its understanding and habits and intervening to improve NITBUT. the best solutions to your patients. n measurement of the disease’s anatomic links Dry Eye Summary Report 1. Tideman JW, Snabel MC, Tedja MS, et al. Association of axial length with risk of (eg, Meibomian gland dysfunction, blink uncorrectable for Europeans with myopia. JAMA Ophthalmol. patterns) and clinical characteristics (eg, non- Different dry eye assessment tools 2016;134:1355-1363. 2. Jones-Jordan LA, Sinnott LT, Maney RE, et al; the Collaborative Longitudinal Evaluation invasive tear break-up time, tear meniscus performed during an examination can be of Ethnicity and Refractive Error (CLEERE) Study Group. Early childhood refractive error height). MYAH captures data points related combined into a single report on MYAH and parental history of myopia as predictors of myopia. Invest Ophthalmol Vis Sci. to all these factors, assisting clinicians to offer (Figure 2). Having access to NITBUT, 2010;51(1):115-121. early diagnosis, classification, and targeted blink analysis, tear meniscus height, and therapy tailored to their patients’ individual Meibography information for both at SARAH FARRANT, BSC, MCOPTOM, needs—all while occupying a small footprint a glance, takes the dry eye evaluation to a DIPTP (IP), FBCLA in an otherwise crowded clinic. higher level. It not only improves the dry n Optometrist, Earlam and Christopher Optometrists and Showing and explaining these data to eye evaluation and the clinic workflow, but Specialists, Taunton, patients assists in their understanding of it is also a powerful tool for illustrating the n [email protected] their disease status and improvements with alterations caused by dry eye to the patient. n Financial disclosure: Consultant (Alcon, Johnson & treatment. These metrics are a great way This helps them better understand their Johnson Vision, Novartis, Thea, Topcon) to maintain patient clinical situation, aiding discussions about engagement with the in-office treatment options such as intense EDWARD FARRANT, BSC, MCOPTOM, treatment, especially for a pulsed light (IPL) and increasing compliance DIP GLAUC, DIPTP (IP) condition in which symp- with any at-home treatment. n Optometrist, Earlam and Christopher Optometrists and toms can take a long time Contact Lens Specialists, Taunton, United Kingdom to improve and treatment SINGLE PLATFORM, MULTIPLE MODALITIES n [email protected] compliance is so crucial. Eye care providers seeking increased n Financial disclosure: Consultant (Santen, Topcon)

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