Chapter 1: WHAT DO WE KNOW
This chapter explores IMI white papers published in 2019 and recently available updates (2021). In addition, it explores the clinical guidelines for contact lens prescribing (CLEAR). Each of the major recommendations from these dense, documented texts is translated into clinical language and practice implications.
Chapter 2: BASIS FOR MYOPIA MANAGEMENT
This chapter reviews the basic elements of the literature: the emmetropization cascade and the mechanisms underlying myopia onset. It emphasizes, once myopia has developed, the expected values of axial length and diopter progression in emmetropes and myopes. In particular, it introduces the concept of growth charts of the eye as the basis to guide myopia management. More specifically, the text demonstrates how these charts should be used in the clinic and how they can influence the nature and intensity of myopic management. Who should be offered this myopic treatment, when should it be initiated, and when should it be discontinued? These are important questions that are answered here. The chapter concludes, like all the others, with a series of take-home messages targeting the important elements to remember.
Chapter 3: THE MEANS AT OUR DISPOSAL
The question that is most often asked by eye care professionals (ECPs) is to know what is the best strategy to put in place in order to effectively manage myopia. This question is both simple and complicated to answer. Complicated since, as it has been demonstrated in the previous chapters, each child is unique and evolves his own scenario. It is therefore necessary to personalize the treatment because a method that will be customized for another will not necessarily apply to his case. Also simple because there are not a lot of tools at our disposal. Any winning strategy starts with accurate baseline assessment. This chapter will determine how to achieve optimal results.
Chapter 4: DIAGNOSIS AND TREATMENT PLAN
Once the theory has been mastered, and the techniques for acquiring relevant clinical results have been learned, the next step is to establish a personalized management plan. This chapter describes the approach developed at the University of Montreal and known as The Montreal Experience. It proposes a decision tree that explains how to apply the concept of the three pillars that are the control of the environment, the control of the binocular vision and finally the control of the blur. This approach takes into account the main risk factors for progression and also involves recommendations on lifestyle.
Chapter 5: PUTTING THEORY INTO PRACTICE
Does the Montreal Experience model really work? This chapter presents the results of a retrospective study conducted over a 2-year period, which proves that the personalized treatment approach is effective. The fact that OK custom lenses provide the best myopia management is an illustration that customization of products and approaches is probably preferable. The chapter concludes with the presentation of 14 cases that, although often imperfect, illustrate the reasoning behind the clinical approach