酷柏光學邁視兒每日拋 (CooperVision MiSight)

邱正仁 Cheng-Jen ChiuTaiwan Speaker Clinical Insights into High-Myopia Ortho-K: Lens Design Optimization, Cessation Effects, and Axial Length ShorteningOrthokeratology (Ortho-K) has become an important modality in myopia management, yet its performance in high myopia, its behavior after treatment cessation, and the phenomenon of axial length (AL) shortening remain key areas of clinical interest. This presentation summarizes current evidence and clinical experience using Euclid’s advanced designs, including Topaz dual reverse-curve lenses and demonstrate improved patient satisfaction compared with conventional designs. Clinical data indicate acceptable safety with modern high-Dk materials, though high myopes may exhibit increased risks of microcysts or central staining. Discontinuation studies show a mild to moderate AL rebound predominantly within the first 6 months, with younger age (<14 years), shorter wear duration, and absence of bridging therapy as major risk factors. Bridging with 0.01–0.05% atropine or MiSight lenses reduces rebound magnitude. Early monitoring of AL, corneal biomechanics, and topography is essential for differentiating true elongation from pseudo-elongation. Recent longitudinal datasets reveal that a subset of Ortho-K wearers—particularly older adolescents with moderate-to-high myopia—may exhibit sustained AL shortening beyond measurement variability. Studies suggest choroidal expansion, scleral remodeling, optical signaling (reduced lag and increased HOAs), and age-dependent ocular growth dynamics as contributing mechanisms. Together, these findings refine clinical strategies for high-myopia Ortho-K fitting, guide safe cessation protocols, and highlight the possibility of AL shortening and may act as a potential biomarker for long-term treatment responsiveness. MiSight for Myopia Control: Clinical Applications, Combination Therapy, and Discontinuation EffectsMiSight® is a dual-focus soft contact lens engineered to correct refractive error while simultaneously generating consistent peripheral myopic defocus through its alternating +2.00 D treatment zones and central correction zones. Designed for full-day wear—typically averaging 13 hours—the lens offers reliable optical signaling for myopia control while maintaining clear, spectacle-free vision. Clinical experience demonstrates excellent compliance, rapid skill acquisition, and strong suitability for children who prefer daytime correction, have irregular sleep schedules, or experience intolerance to orthokeratology. Optimal fitting involves avoiding over-minus prescriptions to prevent unintended hyperopic defocus, closely monitoring visual acuity and axial length progression, and adjusting power only when combined criteria of decreased visual performance, autorefractor changes, and accelerated axial growth are met. Evidence supports the efficacy of combining MiSight® with 0.05% atropine in children who exhibit insufficient response to pharmacologic monotherapy, particularly among low-to-moderate myopes. In contrast, 0.01% atropine co-administered with multifocal soft lenses does not demonstrate a clear additive effect. Long-term follow-up studies reveal that treatment benefits are retained after discontinuation, with axial length and refractive development returning to age-appropriate physiological rates without rebound. Additional optical analyses confirm that the dual-focus design continues to deliver effective myopic defocus even in children transitioning from orthokeratology, likely due to improved compliance and neural adaptation. Overall, MiSight® represents a safe, effective, and practical modality for pediatric myopia management, offering predictable therapeutic outcomes and stable behavior during cessation or treatment transitions