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  • AAO PPP Refractive Management/Intervention Panel, Hoskins Center for Quality Eye Care
    By the American Academy of Ophthalmology Preferred Practice Pattern Refractive Management/Intervention Panel: Deborah S. Jacobs, MD, MSc, Chair,1 Natalie A. Afshari, MD,2 Rachel J. Bishop, MD, MPH,3 Jeremy D. Keenan, MD, MPH,4 Jimmy K. Lee, MD,5 Tueng T. Shen, MD, PhD,6 Susan Vitale, PhD, MHS, Methodologist7

    As of November 2015, the PPPs are initially published online-only in the Ophthalmology journal and may be freely downloaded in their entirety by all visitors. Open the PDF for this entire PPP or click here to access the PPP on the journal's siteClick here to access the journal's PPP collection page.

    1Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
    2Stuart I. Brown Chair in Ophthalmology in Memory of Donald P. Shiley, Professor of Ophthalmology, Chief of Cornea & Refractive Surgery, Vice Chair of Education, Shiley Eye Institute, University of California, San Diego, California
    3Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland
    4Francis I. Proctor Foundation, Department of Ophthalmology, University of California, San Francisco
    5Coastal Vision Medical Group, Irvine, California
    6UW Medicine Eye Institute, University of Washington, Seattle, Washington
    7Division of Epidemiology and Clinical Applications, National Eye Institute, NIH, Bethesda, Maryland

    Highlighted Findings and Recommendations for Care

    The prevalence of myopia is increasing in the United States and other industrialized societies. Increased time spent outdoors appears to be protective against myopia in children. Increased levels of near work are less of a risk factor than previously believed.

    Increased outdoor time and low-concentration atropine have been shown to reduce the likelihood of myopia onset.

    Antimuscarinic eyedrops, multifocal spectacles and contact lenses, and overnight orthokeratology have been shown to be varibly effective in some populations for myopia control, that is, to reduce the progression of myopia in school age children.

    Studies from around the world have confirmed that that the incidence of microbial keratitis has not been reduced with the introduction of new lens types and that overnight wear of any contact lens is associated with a higher risk of infection than daily wear.

    Although there are lenses approved by the FDA for extended wear, alternatives should be presented to patients for whom this mode of contact lens wear is being considered because overnight wear, regardless of contact lens type, increases risk of microbial keratitis.

    Daily disposable contact lenses (rather than planned replacement lenses) are the safest lenses with the lowest rate of complications associated with soft contact lens wear.

    No-rub cleaning, topping off (reuse) of solutions, contaminated lens cases, exposure to tap water, wearing contact lenses in hot tubs and showers and while swimming, and changes in water supply are associated with  Acanthamoeba and fungal keratitis related to contact lens wear in the recent decades.

    Hydrogen peroxide systems are superior to multipurpose solutions for reducing the likelihood of infections or inflammatory complications; they are the preferred mode of nightly disinfection for patients who cannot wear daily disposable lenses, especially if they have had complications of contact lens wear in the past.

    Presbyopia can be managed by using eyeglasses; contact lenses; topical agents; intraocular lenses with multifocal, accommodating, or extended depth of focus features; and monovision strategies with contact lenses or intraocular lenses.

    Adverse events related to FDA-approved drugs and devices should be reported to MedWatch (

    Literature Search

    Refractive Errors PPP - 2022 - Literature Searc