It is hard for the academic literature to stay up to speed with the developments in our field. It oftentimes takes several months or even longer to see an article in print in our profession from the moment it was first submitted. If you include the time required to analyze the results and to write the article, especially if different co-authors are involved - it may take literally a year or more before something is published (sometimes years). In clinical practice, we want to rely on the latest developments - such as in myopia progression, for instance. But at the same time we need decent and reliable information so we don't get ahead of ourselves. Take corneal cross linking as another example. The newest technique that tries to stabilize keratoconus involves the 'epi-on' method, in which the epithelium does not have to be removed. While this method has gotten a lot of attention and momentum, only a handful of prospective, controlled studies on trans-epithelial cross linking are available at the moment. So how do we advise our patients? The same is true for myopia control - probably the most exciting development in our field maybe ever. But it may take another 5 years or so before we will see some evidence in the literature. What can we tell our patients in the meantime?

International Society of Refractive Surgery Outlook - August 2011  

Flat-out one of the best lectures that I've ever attended is the one by Earl Smith III on myopia development and the potential optical treatment methods for controlling myopia. The Brien Holden Institute said about this: 'Professor Earl Smith III has been reshaping the way we think about our eyes for most of his career. In particular, our understanding of myopia has been revolutionised by his insights.' Under the title 'A Case for Peripheral Optical Treatment Strategies for Myopia,' Optometry & Vision Science published a paper based on Professor Smith's American Academy of Optometry Prentice Award Lecture in 2010.The paper is currently available in full format via the link below. In a table summarizing the relative efficacy of optical treatment strategies for slowing myopia progression, orthokeratology is among the current methods showing best results. The primary changes in corneal topography with orthokeratology are typically within the central 20°of the visual field; this typically leads to a change from relative peripheral hyperopia found at baseline to relative peripheral myopia after orthokeratology treatment, which is the refractive state that normally reduces axial growth in laboratory animals, according to Smith. The article also refers to a study from Japan by Kakita et al, in which larger reductions in progression rate were observed in individuals with higher degrees of central myopia.

 Optometry & Vision Science, September 2011 

In (R)GP lens fitting, respecting the cornea is of the utmost importance. Not only can it improve comfort of lens wear, it better protects corneal integrity (e.g. less chance of unwanted corneal irregularities) and even improves corneal physiology. Hence, digital fitting is on the rise. The same may now be true for scleral lenses. Optical Coherence Tomography (OCT) makes it possible to measure the shape of the anterior sclera. A poster by Hong-Gam et al at the most recent ARVO (association for research in vision and ophthalmology) meeting focused on this and demonstrated the success of using digital scleral lens fitting in 6 eyes of 5 patients. Greg Gemoules was one of the first to describe digital scleral lens fitting in the journal Eye & Contact Lens and now uses it routinely in his practice. Now we are waiting for better imaging techniques that will allow us to do full 'scleral topography' in all meridians. To be continued.