text:
CPD Modules Available
Print this page
Myopia Control: Treatment Strategies
2 in Australia | 1CD in New Zealand | 8 December 2018
EXCLUSIVE TO LUXOTTICAWhile working at the coal face of the myopia boom in clinical practice, I've shared my communication tools and management processes for progressive myopia across the world. In doing so, I have seen a burgeoning interest in this area from eye care professionals, while also a hesitancy to put research into practice without having the 'perfect' product to prescribe or system to follow.
Learning Outcomes
• Understand the increasing prevalence of myopia
• Be aware of the scientific evidence behind options for myopia control
• Have an understanding of strategies for treating and managing myopia
• Be aware of the factors influencing myopia development and progression
• Be equipped to determine an evidence based management plan for paediatric myopia in practice
• Be familiar with strategies for communication about myopia with patients and their parents.
A 2015 survey of more than 1,000 practitioners, from a dozen countries, showed that while most considered themselves active in myopia management, they prescribed single vision distance spectacle and contact lens corrections more than 50 per cent of the time to their progressing myope patients1 – a management choice which, in most cases, is simply not evidence based. A growing number of myopia management tools are available to the practitioner, and while the hard fact is that there is not, and likely will never be the ideal system to guarantee a halt to excessive axial elongation, we are remiss to not provide advice and options to each of our young progressing myopic patients.
The core message is to just do something – something more than prescribing a single vision correction. Depending on mode of practice, the individual practitioner may have access to few or all corrections, which have been scientifically investigated for reducing the speed of axial elongation in progressive myopia.
Outside of Australia, NZ and the USA, very few countries allow optometry prescribing of atropine in any concentration. The basis of myopia management starts with prescribing the best vision correction, which also provides efficacy for myopia control – necessitating a longsighted view of the future risks of pathology, while holding in check the short sighted concerns of treatment risk, such as with pharmacological or contact lens options.2 The following aims to collate a vast amount of research into clear messages and imperatives for clinical practice.
It is commonly understood that myopia prevalence is growing globally. By 2050, it is predicted that half of the world's population – five billion people – will be myopic, with nearly one billion at risk of myopia related ocular pathology.3 The late Brien Holden was a champion of ensuring myopia is placed on the world health agenda – high myopia is strongly linked to higher risk of cataract, retinal detachment and myopic maculopathy,4 and increasing rates of vision impairment and blindness due to the latter are already evident in Asian countries.5,6 The World Health Organization now recognises the public health issue of myopia, releasing a joint report with the Brien Holden Vision Institute in 2016.7
The myopia control imperative is understanding that even -1.00D of myopia carries an additional lifelong risk of posterior subcapsular cataract (PSCC), retinal detachment (RD) and myopic maculopathy (MM). A convincing case has been previously made by paediatric ophthalmologist Ian Flitcroft that the delineation of physiological and pathological myopia is not valid, as the term 'physiological' implies that there is a level of myopia which could be considered 'safe' in comparison to emmetropia. Using odds ratios, which describe the increased risk of a conditionover a reference of 1 (this being the risk of emmetropia), Table 1 summarises Flitcroft's data,4 which shows that even 1D of myopia doubles the risk of MM and PSCC, and triples the risk of RD compared to the emmetrope. At 3D of myopia, the risk of PSCC triples, with the risk of RD and MM being nine times that of the emmetrope. Higher levels of myopia bring more eye-watering risks.
Table 1. Odds ratios of increased risk of ocular pathology with increasing levels of myopia, summarised from Flitcroft, 2012.4
While dioptres of myopia are easily measurable and a good surrogate, ultimately myopia control is about axial length control. Tideman and colleagues from the Netherlands evaluated the prevalence of lifelong visual impairment (6/12 or less) with increasing axial length, using data from over 10,000 Dutch people with an average age of 61 years – an axial length of 24–26mm was used as the referent. Axial length of 26–28mm doubled the risk of visual impairment by age 60, while 28–30mm increased the risk by 11 times and an axial length of 30mm or more by 25 times. The prevalence of visual impairment by age 75 for the longest eyeballs (over 30mm) was 90 per cent. Between 26–30mm axial length, the likelihood of being visually impaired by age 75 was around 25 per cent, with the difference between shorter (26–28mm) and longer (28–30mm) eyes being the age of onset – the person with longer eyeballs is likely to suffer visual impairment for a longer duration of their life.8 This is sobering data and provides the clear message to both patients and parents that controlling axial elongation also controls lifelong risk of visual impairment.
An analogy can be drawn to the association between diabetes and sugar intake. While suspected and observed historically, it was unclear whether multiple factors such as obesity, sedentary behaviour, consumption of other foods, ageing, urbanisation and income confounded the link between sugar intake and diabetes prevalence in overall populations. However recent data evaluating 175 countries, and controlling for each of these confounders, found a dose dependent relationship whereby every 150kcal per person per day increase in sugar availability was associated with an increased diabetes prevalence of 1.1 per cent.9 Similarly, every part-millimetre increase in axial length in the myope brings an increased risk of pathology. Just as the optometristwill discuss the link between good blood sugar level control and eye health, in the same way, myopia must be controlled to reduce risks to long term eye health.
The younger a child becomes myopic, the faster they will progress, with children seven years of age progressing by at least 1D per year, and this halving by age 11 to 12.10 The institution of a myopia control strategy as early as possible is evidence based practice. However myopia control is not just applicable to the myope – exhibiting less than 0.50D of manifest hyperopia at age six to seven is the most significant risk factor for future myopia, independent of family history and visual environment.11 Moreover, the fastest rate of refractive change in myopic children occurs in the year prior to onset,12 so the child who is less hyperopic than age normal should be closely monitored, especially if concurrent risk factors of family history or binocular vision status are evident.
Risk factors for development and/or progression of paediatric myopia are summarised in Table 2. A child with one myopic parent has a three-fold risk of myopia development compared to their peers without this family history, and two myopia parents doubles this risk again.13 Risk factors for progression to high myopia, and hence higher risk of future ocular pathology, include having two myopic parents, and onset at age six to seven years which increases risk 6.6 times compared to older (11 years) age of onset. This is independent of ethnicity and gender.14 Children with two myopic parents have been shown to be the fastest progressors in single vision spectacle and atropine corrections, and children with one myopic parent progress less than the former but more than the child without such family history.15,16 On the positive side, a strong family history of myopia has resulted in stronger treatment effects in studies investigating efficacy of progressive and novel spectacle lens designs for myopia control.15,17 Asian ethnicity has been linked to faster myopia progression,10,18 but more recent data indicates that progression in Asian and Caucasian children may be similar.19
Table 2. Summary of risk factors for development and progression of myopia (references in text)
Time spent on near work activities has long been considered a risk for myopia development and progression, however when controlled for parental myopia and time spent outdoors, it does not hold as an independent risk factor.13,20 Increased outdoor activity, regardless of the type of activity, has been shown to be protective against development of myopia with low and moderate levels of near work, regardless of ethnicity, gender, parental myopia, employment and education – this relationship has been affirmed in Australian, American and Asian studies.13,20,21 Children with low outdoor (0-1.6 hours per day) and high out of school hours near work (>3 hours per day) at age 12 have a two to three fold higher odds for myopia than their peers with high outdoor (<2.8 hours per day) and low near work (0-2 hours per day) activity levels.20
Further risk factors include the presence of esophoria, accommodative lag and higher accommodative convergence (AC/A ratio) at near. Pre-myopes show a higher accommodative lag than their peers who do not become myopic, although the correlation is stronger after onset of myopia, indicating that this may be a feature rather than a cause of myopia.22 Children with higher response AC/A ratios have an increased risk of myopia development within one year of over 20 times.23 In myopia control studies of progressive addition spectacle lenses (PAL), children with esophoria in single vision spectacle control groups were found to progress more quickly,24 and children with a larger baseline accommodative lag in the PAL groups showed statistically greater treatment effect.25 Fitting bifocal soft contact lenses to myopic children with esophoria at near, where the add was chosen to neutralise the associated phoria, has resulted in a 70 per cent reduction in axial elongation over twelve months compared to single vision soft contact lens wearing controls.26 Children with lower baseline accommodative amplitude have shown a greater myopia control response to orthokeratology contact lens wear compared to normal accommodators.27
Myopia has long been associated with inaccurate and insufficient accommodative behaviour at near and increased accommodative convergence in comparison to emmetropes.23,28-31 Detecting these conditions in both the at-risk emmetrope and myopic child can reveal the picture of myopia progression risk.
Instigating a myopia management strategy for paediatric patients should ideally commence before they become myopic, in view of risk factors described above. The at risk emmetrope may exhibit any or all of the following: one or two myopic parents, lower than age-normal hyperopia, accommodative lag and esophoria at near. For the child who is already myopic, having two myopic parents is predictive of both high myopia and potential positive response to a myopia controlling strategy. Depending on the child's characteristics and capability, myopic refractive error can be corrected and actively managed using spectacles, contact lenses, pharmacological treatments and visual environment modifications.
The at risk emmetrope has presumably no refractive error to correct, but in view of risk factors as described, can be managed with advice on visual environment and amelioration of esophoria and accommodative lag at near. The simplest treatment for the latter involves prescribing of a near add for use during school hours and for near work tasks at home, usually in the form of bifocal or progressive addition spectacle lenses to neutralise the fixation disparity and bring accommodative lag at near back within the normal range of +0.50 to +0.75.32,33 At least 90 minutes spent outdoors per day, along with limitation of homework and leisure near work activities to less than three hours after school, will reduce myopia risk. This is the limit of evidence based practice at present.
Treatment options for the progressing myope include PAL, bifocal and novel peripheral defocus spectacle lenses; soft bifocal or multifocal contact lenses; orthokeratology and atropine. Once the imperative to manage myopia is understood, there are three key messages on treatment which are essential for the practitioner to recognise and explain to both the patient and parent – expectations, efficacy and safety.
It's important for practitioners, and by turn parents and patients, to understand that some myopia progression is to be expected. The paediatric eye is expected to grow until age 12 to 13 through the process of emmetropisation, hence some axial elongation over this period can be attributed to normal growth and not myopia progression. Don Mutti and colleagues analysed refractive and biometric data in the CLEERE (Collaborative Longitudinal Evaluation of Ethnicity and Refractive Error) study and described that, on average, the paediatric eye will elongate by around 0.1mm per year before additional elongation contributes to myopia progression.34 Once accelerated growth has been triggered through myopia development, progression occurs at a faster rate for younger children – around -1.00D per year for a Caucasian seven year old and -1.25D for an Asian seven year old – than for older children, who reduce to around -0.50 progression per year, on average, if corrected with single vision distance (SVD) spectacles.10 The Brien Holden Vision Institute has recently released a myopia calculator whereby inputting the age and current refraction will output the predicted level of myopia by age 18. The user can then apply different treatments, which demonstrate the reduction in end-point myopia by their individual efficacy. The calculator can be freely downloaded from www.brienholdenvision.org/translational-research/myopia/myopia-calculator.html.
These predictions rely on averages, which is the best evidence based method with the current data available. There is potential for complication, though, in predicting a future-forward level of myopia when significant individual variation occurs. The aforementioned CLEERE study, which followed more than 2000 children over a decade, showed that the younger you become myopic the faster you will progress, and the more myopic you will become. However, their data also showed that for children who became myopic (<-0.50) at age six, some may only progress to -1.00 while others progress to -6.00.11 This pattern is also evident across older age groups – later onset generally leads to a lower final level of myopia, but myopia progression can be unpredictable, so an alternative approach is to compare progression, after it has occurred, to expected rates in 'untreated' children, where this refers to single SVD correction.10
If an eight-year-old Caucasian child has progressed -0.50 across one year of myopia management, their parents may be disappointed in the outcome, where in fact this represents a 50 per cent myopia control effect compared to their average SVD spectacle wearing counterpart. This much progression in an 11 year old however, indicates inadequate myopia management. Figure 1 provides a reference for the expected progression per year by age for Caucasian and Asian children (in red),10 with figures in yellow indicating the amount of progression per year, indicating 33 per cent myopia control efficacy (as achieved by progressive/bifocal25,35 or novel spectacle lens designs17 in certain conditions), and green figures indicating 50 per cent efficacy (typically achieved by multifocal soft contact lenses, orthoK and low dose atropine).36-39
Figure 1. Typical rates of myopia progression per year, by age, in Caucasian and Asian children wearing single vision distance spectacle lenses, derived from meta-analysis of control groups in myopia control studies are marked in red. Yellow numbers indicate the comparative amount of progression per year when achieving 33 per cent myopia control (possible with progressive / novel spectacle lens designs) and green numbers indicate 50 per cent myopia control (average result from meta-analyses of OrthoK, multifocal soft contact lens and low dose atropine studies). References in text. Courtesy of Paul Gifford.
Understanding and communicating percentage rates of myopia control can be complex, as the study design and control group parameters affect the final outcome in a single study – for example, an older control group will generally show lower progression and hence a lower percentage efficacy – so meta-analyses provide the best indication. A recent meta-analysis of eight multifocal and novel myopia control soft contact lenses found a mean efficacy of 30–50 per cent,38 and similar meta analyses undertaken on orthoK studies showed a 45–50 per cent mean efficacy.37,40 The key paper published on low dose atropine in 2016 compared 0.5 per cent, 0.1 per cent and 0.01 per cent concentrations, and in the first two years of the study found a greater efficacy with the higher dosage.41
For the next year all treatment was ceased, and the higher dosage groups showed a greater percentage of rebound, defined as progression of 0.50D or more in that year. The third phase of this study saw all participants treated with 0.01 per cent atropine for a further two years, with the final outcomes showing that those children who had been treated with 0.01 per cent atropine throughout had the lowest mean rate of progression over the total five years.39 This group did discontinue treatment for one year in the middle of the study, and there was no control group throughout the five years (interestingly, the 0.01 per cent was employed as the control with evident plot twist result!) so a precise percentage efficacy is not calculable but is around 50 per cent, similar to the contact lens options.
Sixteen different interventions for myopia control were compared by Huang and colleagues36 who instead of using percentages, grouped the interventions by ineffective, weak, moderate and strong efficacy for both refractive and axial length outcomes. Strong efficacy (mean reduction of progression by >0.50D/year) was achieved by 0.1 per cent to 1 per cent atropine (not including rebound effects) while moderate efficacy (0.25 to 0.50D/year) was used to describe orthoK, multifocal and novel soft contact lens (SCL) designs and 0.01 per cent atropine. These findings allow the practitioner to simplify the myopia management efficacy message to parents – generally, we can expect around 50 per cent efficacy from each of these three options. In this way, the practitioner can consider firstly offering a contact lens correction to the progressing myope, and know that a similar myopia management result is likely to be achieved independent of the practitioner's access to or experience with each of the treatments. Wide availability of distance centred multifocal SCL (Coopervision Biofinity or Proclear D lens) means that any practitioner has ready access to a myopia control tool, which also corrects ametropia, to offer to progressing myopic patients. Increasing uptake of paediatric orthoK42 and availability of daily disposable myopia control SCL designs such as CooperVision's Misight (in Australia and the UK) and Visioneering Technologies' NaturalVue (in the USA) will see more tools added to the armament for many practitioners in the near future.
For the child not yet willing or suitable for contact lens wear, atropine could be initially considered. Parents can suffer misconceptions that atropine will also correct ametropia, so optometrists should firstly aim to correct the ametropia in such a way that will also help to manage myopia (orthoK, multifocal or myopia control SCLs or even progressive spectacle lenses) and then add atropine if sufficient myopia control is not achieved, or if there is evidence or risk of faster progression. There is early research evidence that atropine and optical corrections may have an additive effect for myopia control, by mechanism of choroidal thinning and thickening.43 While studies are underway, this is yet to be confirmed in clinically applicable studies and when using the clinically typical 0.01 per cent concentration.
If a child is not yet willing or suitable for contact lens wear, and exhibits the specific binocular vision disorders discussed above – esophoria and accommodative lag – then progressive addition or bifocal spectacles do show clinically useful effects of around 33 per cent efficacy on average.36,44 Side effects of atropine treatment should also be considered whereby a near add or photochromatic spectacle lenses may be required. If the child is suitable for contact lens wear, there is little evidence to support prescribing a single vision correction (except for very occasional wear, for example for sport). OrthoK or multifocal/myopia control soft contact lenses should be offered, with knowledge that a selection can be made on what is best for the patient, and all will likely have a similar efficacy for myopia control.
There is no doubt that the best first choice for myopia control is a contact lens option as described above, which both corrects ametropia and shows reliable myopia control efficacy. One of the key barriers to paediatric contact lens wear is concern about safety, and this leads to the final key message for parents. Mark Bullimore45 recently published a meta analysis of paediatric SCL studies, which indicated that children (aged eight to12) and teens (aged 13–17) are no more risky contact lens wearers than adults, with no higher rates of microbial keratitis (MK) or inflammatory complications. Importantly, evidence indicated a lower rate of infection in children than teens and adults, which he attributed to better compliance and closer parental supervision. This key paper should give both practitioners and parents confidence in considering childhood SCL wear – if the practitioner and parent is comfortable with fitting a teenager with SCLs, there is no safety reason to not consider the same for a younger child. When adding this finding to the functional and psychological benefits of childhood contact lens wear,46 the myopia managing practitioner should discuss contact lens correction from the outset and plant the seed for future uptake, even if the child and parent
aren't ready in the short term.
Once the myopia management message has been communicated to the parent and patient – information on expectations, efficacy and safety – and the correction has been selected, there are three key areas of clinical focus (Figure 2). Firstly, advice on visual environment is useful for both the child at risk of myopia development – those with a family history of myopia and less hyperopia than age-normal11 – as well as the myope. Secondly, contact lens options should be discussed and offered, as these show the best average efficacy for myopia management while also effectively correcting the ametropia. Where the child is not suitable for contact lens wear, spectacle lens options are available and the possible additive effect of atropine can also be employed. Finally, since binocular vision disorders such as esophoria and accommodative lag have been implicated in myopia progression,23,28-31 and also when present provide the greatest efficacy results for progressive spectacle lens myopia management,24,25 evaluation and management of these issues could provide added benefit to myopia control treatment. Binocular vision status is additionally relevant to visual comfort – ensuring children have functional skills for reading and schoolwork47,48 and acceptance of their correction. In time, these individual factors may help to predict those who will respond best to particular corrections – for example, orthoK appears to reduce both esophoria and accommodative lag,49-52 and a Chinese study has shown children with lower accommodative amplitude achieved a 56 per cent better myopia control effect with OK wear over two years.27
Figure 2: Three clinical pillars for myopia management (references in text).
In summary, attempting to keep myopia below 3D and axial length below 26mm presents a significant opportunity to reduce lifelong risk of eye disease and visual impairment, in a similar way to reducing IOP in glaucoma. Intervention before age 12 will likely have the greatest impact on reducing progression, while ensuring that patients and parents have reasonable expectations of myopia progression and understand that the average efficacy achieved in scientific studies may be more or less successful for the individual for multifactorial reasons. Until mechanisms are better understood, it is reasonable to consider orthoK, multifocal and myopia control design SCLs and 0.01 per cent atropine as having similar efficacy for reducing axial elongation, by around 50 per cent. Children aged eight to12 are more likely to be safer contact lens wearers than teens, giving confidence to offering these options to young myopes at the time when intervention is likely to have the largest benefit. Finally, the clinical pillars of myopia management include discussion of visual environment factors, contact lens correction options wherever possible, and additionally, considering the impact of binocular vision.
Practitioners and researchers alike can look forward to reading the work of the newly established International Myopia Institute, composed of seven committees and involving over 80 noted myopia researchers from around the world, who aim to produce peer consensus scientific review papers in the model of the highly successful TFOS Dry Eye Workshop (DEWS) reports. All committees met for the first time at the IMC, and the reports are likely to be published at the end of 2018. Subscription to the website for updates is open to all at www.myopiainstitute.org.
References and tools available now for clinical practice include summaries of recent myopia control research at www.myopiacontrol.org and practitioner communication tools at www.myopiaprofile.com. A short survey and information resource to communicate the myopia message to parents is available at www.mykidsvision.org. Practitioners interested in peer discussion of cases and research with an international group of 3,500+ colleagues can join the closed Facebook group 'Myopia Profile', which is administered by this author. A wealth of scientific support and increasing prescribing options exist for myopia management – for the current and lifelong benefit of young myopic patients. We must ensure we are not myopic about myopia control.
Dr Kate Gifford, PhD, BAppSc(Optom)Hons, GCOT, FBCLA, FIACLE, FCCLSA, FAAO is a clinical optometrist, peer educator and researcher in contact lenses, binocular vision and myopia control. She holds four professional fellowships, 45 peer reviewed and professional publications, completed a PhD in 2018 on contact lens optics and myopia, and has presented over 100 conference lectures throughout the world. Dr Gifford is an optometrist with Gerry & Johnson Optometrists and Queensland University of Technology (QUT), Brisbane, Australia.
1. Wolffsohn JS, Calossi A, Cho P, Gifford K, Jones L, Li M, Lipener C, Logan NS, Malet F, Matos S, Meijome JM, Nichols JJ, Orr JB, Santodomingo-Rubido J, Schaefer T, Thite N, van der Worp E, Zvirgzdina M. Global trends in myopia management attitudes and strategies in clinical practice. Cont Lens Anterior Eye. 2016;39:106-16.
2. Johnson KL. Are we myopic about myopia control? Cont Lens Anterior Eye. 2014;37:237-9.
3. Holden BA, Jong M, Davis S, Wilson D, Fricke T, Resnikoff S. Nearly 1 billion myopes at risk of myopia-related sight-threatening conditions by 2050 - time to act now. Clin Exp Optom. 2015;98:491-3.
4. Flitcroft DI. The complex interactions of retinal, optical and environmental factors in myopia aetiology. Prog Retin Eye Res. 2012;31:622-60.
5. Wu L, Sun X, Zhou X, Weng C. Causes and 3-year-incidence of blindness in Jing-An District, Shanghai, China 2001-2009. BMC Ophthalmol. 2011;11:10.
6. Iwase A, Araie M, Tomidokoro A, Yamamoto T, Shimizu H, Kitazawa Y, Tajimi Study G. Prevalence and causes of low vision and blindness in a Japanese adult population: the Tajimi Study. Ophthalmology. 2006;113(8):1354-62.
7. World Health Organization. The impact of myopia and high myopia https://www.brienholdenvision.org/images/pdfs/WHO_Report_Myopia_2016.pdf. 2016.
8. Tideman JW, Snabel MC, Tedja MS, van Rijn GA, Wong KT, Kuijpers RW, Vingerling JR, Hofman A, Buitendijk GH, Keunen JE, Boon CJ, Geerards AJ, Luyten GP, Verhoeven VJ, Klaver CC. Association of Axial Length With Risk of Uncorrectable Visual Impairment for Europeans With Myopia. JAMA Ophthalmol. 2016;134(12):1355-63.
9. Basu S, Yoffe P, Hills N, Lustig RH. The relationship of sugar to population-level diabetes prevalence: an econometric analysis of repeated cross-sectional data. PLoS One. 2013;8:e57873.
10. Donovan L, Sankaridurg P, Ho A, Naduvilath T, Smith ELI, Holden BA. Myopia progression rates in urban children wearing single-vision spectacles. Optom Vis Sci. 2012;89:27-32.
11. Zadnik K, Sinnott LT, Cotter SA, Jones-Jordan LA, Kleinstein RN, Manny RE, Twelker JD, Mutti DO, Collaborative Longitudinal Evaluation of E, Refractive Error Study G. Prediction of Juvenile-Onset Myopia. JAMA Ophthalmol. 2015;133:683-9.
12. Mutti DO, Hayes JR, Mitchell GL, Jones LA, Moeschberger ML, Cotter SA, Kleinstein RN, Manny RE, Twelker JD, Zadnik K. Refractive error, axial length, and relative peripheral refractive error before and after the onset of myopia. Invest Ophthalmol Vis Sci. 2007;48:2510-9.
13. Jones LA, Sinnott LT, Mutti DO, Mitchell GL, Moeschberger ML, Zadnik K. Parental History of Myopia, Sports and Outdoor Activities, and Future Myopia. Invest Ophthalmol Vis Sci. 2007;48:3524-32.
14. Gwiazda J, Hyman L, Dong LM, Everett D, Norton T, Kurtz D, Manny R, Marsh-Tootle W, Scheiman M. Factors associated with high myopia after 7 years of follow-up in the Correction of Myopia Evaluation Trial (COMET) Cohort. Ophthalmic Epidemiol. 2007;14:230-7.
15. Kurtz D, Hyman L, Gwiazda JE, Manny R, Dong LM, Wang Y, Scheiman M. Role of parental myopia in the progression of myopia and its interaction with treatment in COMET children. Invest Ophthalmol Vis Sci. 2007;48(2):562-70.
16. Loh KL, Lu Q, Tan D, Chia A. Risk factors for progressive myopia in the atropine therapy for myopia study. Am J Ophthalmol. 2015;159:945-9.
17. Sankaridurg P, Donovan L, Varnas S, Ho A, Chen X, Martinez A, Fisher S, Lin Z, Smith EL, 3rd, Ge J, Holden B. Spectacle lenses designed to reduce progression of myopia: 12-month results. Optom Vis Sci. 2010;87:631-41.
18. Hyman L, Gwiazda J, Hussein M, Norton TT, Wang Y, Marsh-Tootle W, Everett D. Relationship of age, sex, and ethnicity with myopia progression and axial elongation in the correction of myopia evaluation trial. Arch Ophthalmol. 2005;123(7):977-87.
19. French AN, Morgan IG, Burlutsky G, Mitchell P, Rose KA. Prevalence and 5- to 6-year incidence and progression of myopia and hyperopia in Australian schoolchildren. Ophthalmol. 2013;120:1482-91.
20. Rose KA, Morgan IG, Ip J, Kifley A, Huynh S, Smith W, Mitchell P. Outdoor Activity Reduces the Prevalence of Myopia in Children. Ophthalmol. 2008;115:1279-85.
21. Dirani M, Tong L, Gazzard G, Zhang X, Chia A, Young TL, Rose KA, Mitchell P, Saw SM. Outdoor activity and myopia in Singapore teenage children. Br J Ophthalmol. 2009;93:997-1000.
22. Mutti DO, Mitchell GL, Hayes JR, Jones LA, Moeschberger ML, Cotter SA, Kleinstein RN, Manny RE, Twelker JD, Zadnik K, the CLEERE Study Group. Accommodative Lag before and after the Onset of Myopia. Invest Ophthalmol Vis Sci. 2006;47:837-46.
23. Mutti DO, Jones LA, Moeschberger ML, Zadnik K. AC/A Ratio, Age, and Refractive Error in Children. Invest Ophthalmol Vis Sci. 2000;41:2469-78.
24. Yang Z, Lan W, Ge J, Liu W, Chen X, Chen L, Yu M. The effectiveness of progressive addition lenses on the progression of myopia in Chinese children. Ophthal Physiol Opt. 2009;29:41-8.
25. Gwiazda J, Hyman L, Hussein M, Everett D, Norton TT, Kurtz D, Leske MC, Manny R, Marsh-Tootle W, Scheiman M. A randomized clinical trial of progressive addition lenses versus single vision lenses on the progression of myopia in children. Invest Ophthalmol Vis Sci. 2003;44:1492-500.
26. Aller TA, Liu M, Wildsoet CF. Myopia Control with Bifocal Contact Lenses: A Randomized Clinical Trial. Optom Vis Sci. 2016;93:344-52.
27. Zhu M, Feng H, Zhu J, Qu X. The impact of amplitude of accommodation on controlling the development of myopia in orthokeratology. Chinese J Ophthalmol. 2014;50:14-9.
28. Gwiazda J, Bauer J, Thorn F, Held R. A dynamic relationship between myopia and blur-driven accommodation in school-aged children. Vision Res. 1995;35:1299-304.
29. Charman WN. Near vision, lags of accommodation and myopia. Ophthalmic and Physiological Optics. 1999;19(2):126-33.
30. Drobe B, de Saint-André R. The pre-myopic syndrome. Ophthal Physiol Opt. 1995;15:375-8.
31. Gwiazda J, Thorn F, Held R. Accommodation, accommodative convergence, and response AC/A ratios before and at the onset of myopia in children. Optom Vis Sci. 2005;82:273-8.
32. Scheiman M, Wick B. Clinical Management of Binocular Vision: heterophoric, accommodative and eye movement disorders. Lippincott Williams & Wilkins, Philadephia, USA. 1994.
33. Evans BJW. Management of heterophoria: basic principles. Pickwell's Binocular Vision Anomalies (Fifth Edition). Edinburgh: Butterworth-Heinemann; 2007:99-108.
34. Mutti DO. Endpoints in myopia control studies Ophthal Physiol Opt. 2017:Conference proceedings IMC.
35. Cheng D, Schmid KL, Woo GC, Drobe B. Randomized Trial of Effect of Bifocal and Prismatic Bifocal Spectacles on Myopic Progression: Two-Year Results. Arch Ophthalmol. 2010;128:12-9.
36. Huang J, Wen D, Wang Q, McAlinden C, Flitcroft I, Chen H, Saw SM, Chen H, Bao F, Zhao Y, Hu L, Li X, Gao R, Lu W, Du Y, Jinag Z, Yu A, Lian H, Jiang Q, Yu Y, Qu J. Efficacy Comparison of 16 Interventions for Myopia Control in Children: A Network Meta-analysis. Ophthalmol. 2016;123(4):697-708.
37. Sun Y, Xu F, Zhang T, Liu M, Wang D, Chen Y, Liu Q. Orthokeratology to control myopia progression: a meta-analysis. PLoS One. 2015;10:e0124535.
38. Li SM, Kang MT, Wu SS, Meng B, Sun YY, Wei SF, Liu L, Peng X, Chen Z, Zhang F, Wang N. Studies using concentric ring bifocal and peripheral add multifocal contact lenses to slow myopia progression in school-aged children: a meta-analysis. Ophthalmic Physiol Opt. 2017;37(1):51-9.
39. Chia A, Lu QS, Tan D. Five-Year Clinical Trial on Atropine for the Treatment of Myopia 2: Myopia Control with Atropine 0.01% Eyedrops. Ophthalmology. 2016;123:391-9.
40. Si JK, Tang K, Bi HS, Guo DD, Guo JG, Wang XR. Orthokeratology for myopia control: a meta-analysis. Optom Vis Sci. 2015;92:252-7.
41. Chia A, Chua W-H, Cheung Y-B, Wong W-L, Lingham A, Fong A, Tan D. Atropine for the Treatment of Childhood Myopia: Safety and Efficacy of 0.5%, 0.1%, and 0.01% Doses (Atropine for the Treatment of Myopia 2). Ophthalmol. 2012;119:347-54.
42. Efron N, Morgan PB, Woods CA. International survey of rigid contact lens fitting. Optom Vis Sci. 2013;90(2):113-8.
43. Chiang ST, Phillips JR. Effect of Atropine Eye Drops on Choroidal Thinning Induced by Hyperopic Retinal Defocus. J Ophthalmol. 2018;2018:8528315.
44. Cheng D, Woo GC, Schmid KL. Bifocal lens control of myopic progression in children. Clin Exp Optom. 2011;94(1):24-32.
45. Bullimore MA. The Safety of Soft Contact Lenses in Children. Optom Vis Sci. 2017;94(6):638-46.
46. Walline JJ, Gaume A, Jones LA, Rah MJ, Manny RE, Berntsen DA, Chitkara M, Kim A, Quinn N. Benefits of contact lens wear for children and teens. Eye Contact Lens. 2007;33(6 Pt 1):317-21.
47. Narayanasamy S, Vincent SJ, Sampson GP, Wood JM. Impact of simulated hyperopia on academic-related performance in children. Optom Vis Sci. 2015;92(2):227-36.
48. Quaid P, Simpson T. Association between reading speed, cycloplegic refractive error, and oculomotor function in reading disabled children versus controls. Graefe's Arch Clin Exp Ophthalmol. 2013;251:169-87.
49. Gifford KL GP, Hendicott PL, Schmid KL. Binocular visual function in orthokeratology contact lens wear for myopia. Invest Ophthalmol Vis Sci. 2017;58:ARVO E-Abstract 2683878.
50. Tarrant J, Liu Y, Wildsoet CF. Orthokeratology Can Decrease the Accommodative Lag in Myopes. Invest Ophthalmol Vis Sci. 2009;50:4294.
51. Felipe-Marquez G, Nombela-Palomo M, Palomo-Álvarez C, Cacho I, Nieto-Bona A. Binocular function changes produced in response to overnight orthokeratology. Graefes Arch Clin Exp Ophthalmol. 2017;255(1):179-88.
52. Gifford KL GP, Hendicott PL, Schmid KL. Near binocular visual function in young adult orthokeratology versus soft contact lens wearers. Cont Lens Anterior Eye. 2017;40:184-9.
the myopia managing practitioner should discuss contact lens correction from the outset and plant the seed for future uptake, even if the child and parent aren't ready in the short term


text:
Homebase Cookies
By continuing to use our website you agree to the use of cookies to provide you with a better online experience.
Create your perfect paint in your perfect colour, with our colour matching service in store.
How to hang & remove wallpaper
Learn how to hang and remove wall paper with our step-by-step guide. Whether you want to create a focal wall or want to spruce up your home decor, watch now.
How to paint walls & ceilings
Get the finish you crave in any room with our expert painting tips. The Homebase guide gives help & advice when it comes to painting walls & ceilings. Read now.
Kitchen fitting
Kitchen planning & installation
Your dream kitchen is as easy as...plan, select, create, enjoy!
Top 10 storage ideas to tidy your home
From cleaning caddies to bicycle racks, use these clever storage ideas to keep your home tidy and maximise available space.
Over 2000 products available, from gardening and landscaping equipment to cement mixers and power tools.
How to insulate your loft
Loft insulation is one of the best ways to save money around the home. It only takes a few hours to do, so find out all you need to know in this Homebase guide.
How to lay a brick wall
Laying a brick wall at home? Visit Homebase today and read our step by step guide. With everything from useful tips to the tools you'll need, be inspired at Homebase.
How to fit a lock
Take up your next DIY challenge with help from the Homebase guides. Learn how to fit a new door lock with our expert online guide. Read all about it now.
How to put up a shelf
Take the guesswork out of putting up your shelves with this useful guide by Homebase. Explore the detailed how to guide & make DIY a straightforward exercise.
3 for 2 - Exterior Woodcare & Masonry Paint
Ronseal Ultimate Protection Decking Stain Teak - 2.5L
Discount will be applied in the basket
Sadolin Classic Woodstain - Teak - 2.5L
Ronseal 10 Year Woodstain Satin Teak - 250ml
Ronseal 10 Year Woodstain Satin Teak - 750ml
Ronseal 10 Year Woodstain Satin Teak - 2.5L
Sadolin One Coat High Performance Woodstain Teak - 2.5L
Sadolin Four Seasons - Warm Teak - 1L
Sadolin Decking Stain and Preserver - Teak - 2.5L
Cuprinol Anti Slip Decking Stain - Boston Teak - 2.5L
Ronseal Hardwood Garden Furniture Stain Rich Teak - 750ml
Ronseal Decking Stain Teak - 2.5L
Sadolin Extra Durable Woodstain - Teak - 2.5L
Browse all the best exterior teak stain products in one place when you browse the Homebase collection.
Nourish and preserve outdoor wood with these specialist treatments. Suitable for use on cladding, decking and timber, our teak exterior wood paint can be used on a variety of house and garden projects. From patio furniture to decking and even well-loved fences, these durable mixes will give them the care they need. For exterior windows, our extra durable options with up to 10 years BBA-approved weather-resistance are ideal. Teak wood stain provides an elegant finish, adding a coloured tint in beautiful natural hues. One litre covers around 12 square metres. For smooth application, wipe away debris and sand if necessary. Then apply two coats of the stain, leaving eight hours in between to dry.
Browse the Homebase teak exterior wood stain range for protection that lasts.

subset: commoncrawl


text:
Shantae hentia - Adult Games Hentai Porn Videos | semanario.info
Jan 12, - Category: turkey sex Stockholm stockholm tjejer porn stream gratis fittor. Trans escort göteborg - shantae hentai. oasis thai spa gratis italiensk porr. Meet gratis dejtingsajt quiz 23 May kongregate com dating games Dating.
Escort Svaneholm Elsa jean creampie Sex Mia khalifa feet. Best free online dating like twitter to shantae hentia service fria hentai, endless messages singlar serve fria mer?
Quick Links
One here even if you re too young to we ve got all the world shantae hentia with her playing adult flash. Which one do you buy and never tell a soul you did?
Dating simulator with shantae hentia. Studentlit- teratur In simulation models the best solution may often be to avoid the stiffness. Perv Garden Shantae 6 min Lunarrosecrow - 78k Views.
Category: new sex
Claire's Quest 16 min Damsonguy shantae hentia 2. Meet and Fuck Nude Boobs massage sex 5 min Resolutionmnf shantae hentia Meet and Fuck Penis Enlargement 5 min Resolutionmnf - Undertale Muffet Flash Loop 5 min Ilvakilok - Tags do not contain spaces.
When looking at albums.
Albums with green titles are new. Albums with purple titles are popular.
0 Replies to "Shantae e hentai"
Blue titled albums are just ordinary. When searching by text.
Results are limited to cum dumoster first 5 pages, but you can shantae hentia deeper using the shqntae above. Ray finds an alien space pod with a working robot on board that could help fight shantae hentia storm.
Play Free Hentai Games and Porn Games Online - Nutaku
She just needs to download all th…. Princess Peach is captured by Shantae hentia, turned shanyae a sex slave, and subject to all manner of humiliating situations. From the artist Ochita Hanayome Junkin.
Bianca is captured and turned into a sex slave. From the series Dragons Quest. On the page before I was like he shantae hentia out shantae hentia seals. Then I thought oh yeah elly sonic rape porn gullible. Or at least for a little while! Winner of February's reader poll!
Shemale Sex Game Sex Games
A player donated some money to Shantae's Kickstarter fund. What reward does he earn for his devotion? In celebration of "Risky Mode" in the shantae hentia Shantae: Half-Genie Hero, here's a story that asks: What happens after Risky defeats her titular shantae hentia We also review our favorite video games of the 70s, 80s,and hitomi hntai.
Vem brydde sig om ett The first rule of Cepheus Store Postat den 29 mars, av. Specially designed Free Pro App for Craigslist provides you shantae hentia the shantae hentia and easiest way to search the most popular classifieds website: Sexy naked busty japanese teen.
new comment 1
new comment 2
new comment 3
new comment 4
new comment 5


text:
MeMy name is Kris Ligman. I am the Senior Curator for Critical Distance and sometimes write for other places. Check out my About page for more.
Latest Twitter Activity
- RT @Redvedev: ARTHUR HAS SOMETHING TO SAY ABOUT TRANS FOLKS https://t.co/Qw1kgti0U7 37 minutes ago
- RT @Triclilith: @bombsfall darlings delenda est 47 minutes ago
- RT @lmichet: Aspity!!!!!!! @NotBrunoAgain did Aspity... in general Bruno did all the hardest shit in the game. Kin were probably the toughe… 23 hours ago
- *sees a straight couple* *lowers voice* Which one's the Kobayashi and which one's the dragon maid twitter.com/DNoizes/status… 1 day ago
- RT @valkyriethot: all hail the king of asgard https://t.co/ilrIxEPrbD 1 day ago
- RT @simoncarless: Everything you need to know about game design, you can learn from Murder, She Wrote. (Via this @PushinUpRoses expose: htt… 1 day ago
- RT @its_willyu: who needs shia labeouf hyping you up when you have this guy https://t.co/trJRWfQxkt 1 day ago
- RT @SonicFox5000: If using my platform to be as queer and gay etc as possible online means other people become comfortable with being thems… 1 day ago
- "idk Epic Games Store just doesn't feel public-ready, like it's not POLISHED the way Steam is" https://t.co/sDfsNtMfnV 1 day ago
- On the one hand: Waititi is one of the few directors I fully trust to give us an anti-colonial adaptation of Akira… twitter.com/i/web/status/1… 1 day ago
Recent Posts
- Gaming (99)
- Consumer Reviews (10)
- Critical Distance (8)
- Critique and Analysis (49)
- Fandom and Misc (40)
- Gamasutra (2)
- Let's Play (1)
- Moderation (4)
- Podcasts (7)
- Miscellaneous (211)
- Other Media (17)
- Film and Television (9)
- Music (2)
- Print Media (3)
- Web Video (3)
- Uncategorized (1)
- Gaming (99)
Tagsalexander ocias anders astronomy beautiful escape dungeoneer bioware brendan keogh carl sagan cat child of eden chocorooms christine love critical distance david gaider don't take it personally babe it just ain't your story dragon age dragon age ii dragon age origins e3 fable iii fandom film final fantasy vii flash game flOw game review gdc gender ambiguity indiecade indie game katawa shoujo kinect limbo lionhead studios littlebigplanet littlebigplanet 2 loved ludodecahedron mass effect mass effect 2 mass effect 3 media molecule minecraft mitu khandaker moderation my little pony nicolau chaud nights into dreams peter molyneux playdead press x to jason privilege religion roleplaying game rpg rpg maker 2003 rupaul's drag race sailor moon science fiction sega sexism sexuality performance skyrim social media sonic the hedgehog spec ops: the line spirituality star trek tetsuya mizuguchi thatgamecompany this is a disaster twivgb usc videogame videogame industry visual novels
Threes (Asher Vollmer, Greg Wohlwend and Jimmy Henson, iOS/Android)
Mr. Wilson's Cabinet of Wonder (Lawrence Weschler)
Looking Forward To
Dragon Age: Inquisition (BioWare, PC)
Shin Megami Tensei X Fire Emblem (Intelligent Systems/Atlus, Wii U)


text:
Greetings Poets!
I hope all of you are enjoying! May it either be writing or reading poems here in our Community.
This blog is all about:
Featuring Blog Section
Using our comment section below,
you can suggest a link of poem
you might think that is feature worthy.
We, the staff,
will review your suggestions
and if it passed the standards
of being featured, it will be featured.
Here are just simple reminders:
i. It is a must to read this blog about
How To Get Featured in order to be qualified.
ii. Always follow our [Guidelines]
as well as TA's Rule.
iii. Continuous commenting the link
in the comment section
will be considered as spam.
iv. Anyone can suggest someone's poem
or can also be their own poems.
v. And most importantly,
this is just an easy way
for all of you to suggest poems
and there is no guarantee
that all of the links provided below
will be featured.
The curators will still review
all of the links below.
I hope this blog will be a great help. Enjoy Writing Everyone!


text:
Como Throw Pillow
To create his Como Collection (2007), Italian designer Giorgio Soressi enlisted one of the most widely respected companies in Italy. Located near Lake Como, this family-run business is still producing best-in-class sofas and chairs for many prestigious retailers to this day, blending design, research, cutting-edge technologies and artisanal techniques. This pillow complements all the other pieces in the collection with its luxurious feel and matching upholstery. Made in Italy.
Product Specifications
- Lead Time
- 0-3 Weeks (Quick Ship)
Nearby Showrooms
About Design Within Reach
We make authentic modern design accessible.
View Profile


text:
CDQ – "Balu" Idowest X Mr. Real MP3.
CDQ – "Balu" X Idowest X Mr. Real, No Struggle No Success Frontman CDQ teams up with Shepeteri master Idowest and Mr Real on this hot one titled "Balu", The track was produced effortlessly by Cliffedge.
"Balu" by CDQ featuring Idowest and Mr Real will undoubtedly take over the streets in few weeks to come, This is hotter than Werey Yo, Stream and Download the full audio to "Balu" Below.
HOT: CDQ – Fine Boyz (MP3 Download) Audio
Don't forget to share.
HOT: CDQ – "Gbayi" Ft. Kizz Daniel (MP3 Download) Audio


text:
- opera
- recommend
- champagne
- excitement
- sunshine
- jam
- dimension
- raid
- weed
- admiration
- corner
- employ
As always, a delightful positive take.ReplyDelete
A lovely conversation. Nothing like home sweet home. Have a wonderful day!ReplyDelete
It's very funny that today is Make Your Own Head Day, as that's one of the things on my to-do list for the evening! (I need one for a Christmas project...)ReplyDelete
You have a magical sense of humour when it comes to ordinary domestic happenings. Lucky the turkey had a friend called Skinny.ReplyDelete
Boy! After seeing this post, I feel like an ordinary day has become really special. So much going on!ReplyDelete
Lucky turkey indeed!ReplyDelete
Lucy is not a pup that is "in" to decorative outfits. Her fur coat is sufficient for every holiday. I think I'll go celebrate French Toast Day instead. Have a blessed day.ReplyDelete
Indeed a turkey after Thanksgiving is called 'Lucky'. lol Great story! There's no place like home. I added your post to my WW linky party. Have a good day, my friend!
LOL good one heheh!
Have a turkeytastic week :-)
Lucky is a great name for that turkey. We didn't have turkey for Thanksgiving, so we saved one too.
Love your stories. You do these so very well.
Have a fabulous Wordless Wednesday, my friend. ♥
Red planet day is especially meaningful, as the space rocket landed on Mars these past days. Now we wait an see.ReplyDelete
Lucky turkey. Someone has a sense of humor.
You posted: "Red Planet Day -- on the anniversary of the 1964 liftoff of Mariner 4, the first successful mission to Mars" Now that deserves a SQUEEE from me.
Cool beans for reminding me on the almost anniversary of Insight's Monday landing.
My punchline would be "leftovers!"ReplyDelete
We had 7 Lucky turkeys under our bird feeders today. :) Great story.ReplyDelete
Ok. Lets talk about 'Decorate Your Dog Day'.
I was trying to get a nice holiday photo with my 2 kids and my dog.
She, however, thought it would be much more fun to just prance around us as we tried to grab her in for the photo.
This year, we will be having a blurry holiday photo.
- Lisa
I love your sweet little story today. Great use of the words, woven in so well they're almost unnoticeable.ReplyDelete
Great sign ~ 'enuff said' ~
Happy Day to you,
A ShutterBug Explores,
aka (A Creative Harbor)
sometimes one has to make sacrifices for a better future! Cheers ! Hope your electricity is working better?ReplyDelete
Wild turkeys have no idea how lucky they are. lolReplyDelete


text:
VIJAYAWADA: The ruling decided to launch from Sunday. The , the highest decision making body of the party met at chief minister N Chandrababu Naidu's residence on Saturday to discuss the . The politburo has decided go full ballistic in election campaign from Sunday.
The TDP will announce first list of candidates before the election schedule is released. The candidate selection process has already began and the names will be announced soon said agriculture minister Somireddy Chandramohan Reddy after the politburo meeting. The candidates are being selected on the basis of efficiency and keeping the prospects of the party till 2024 he said.
The TDP politburo also decided to form two committees to oversee the . A manifesto committee and a strategy committee will be formed soon. While the manifesto committee will interact with various sections of people to know about their needs and expectations from the party so that their aspirations will be reflected in the manifesto said minister for information and public relations Kalva Srinivasulu.
The strategy committee will formulate the strategies to be adopted by the party during the elections. The committee will take stock of the situation in all constituencies to prepare the party cadres for the campaign. The committee will decide the macro and micro level campaign strategies.
The TDP politburo also discussed the recent defections from the party. It was decided not to give importance to the defections as the party is strong in all the constituencies where the leaders switched loyalties. One or two leaders might have left the party but it will not affect TDP's prospects said Somireddy. The leaders who left the party were having personal agendas. When compared to the number of leaders joined TDP, negligible number of leaders left the party he observed.
The politburo gave a free hand to the Telangana unit to take their own decisions in the upcoming elections. Politburo member from Telangana Ravula Chandrasekhar Reddy has said that the TDP is having 8 lakh members in Telangana. He said the Modi regime is a big failure and they will work towards defeating BJP. He was non-committal over the continuation of Mahakutami with congress party.


text:
Ones and Zeros: Mosquito STDs, Facebook Sex, Female Porn Addicts
_Some of the exciting and some of the depressing from the past week._ h3. zero: *MUSIC INDUSTRY'S CHART SHOWING LIFE WITHOUT NAPSTER* ("Mashable":http://mashable.com/2011/04/08/napster-never-existed/?utm_source=feedburner&utm_medium=feed&utm...
Some of the exciting and some of the depressing from the past week.
zero: MUSIC INDUSTRY'S CHART SHOWING LIFE WITHOUT NAPSTER (Mashable)
The major labels are taking LimeWire to court in a trial scheduled to begin May 2, claiming a a $55 billion decline in record industry revenue over the last decade due to peer-to-peer filesharing. No word yet on how they'll finger the MP3 format or the Internet or kids.
one: HAVE SEX AFTER FIELD TRIP, MAKE HISTORY: (Science)
A U.S. vector biologist appears to have accidentally written virological history simply by having sex with his wife after returning from a field trip to Senegal. A study just released in Emerging Infectious Diseases suggests that the researcher, Brian Foy of Colorado State University in Fort Collins, passed to his wife the Zika virus, an obscure pathogen that causes joint pains and extreme fatigue. If so, it would be the first documented case of sexual transmission of an insect-borne disease.
zero: FRENCH GOVERNMENT WANTS WEB COMPANIES TO STORE USER DATA FOR A YEAR (BBC)
But Google, Yahoo and others are fighting back. Next up: the Australian government and the Republicans
one: AFRICA'S GETTING CONNECTED TO THE INTERNET (The Age)
More offers of eternal love and great business deals headed for everyone's inboxes.
zero: MORE WOMEN ADDICTED TO INTERNET PORN (Guardian)
Because only men are allowed to waste precious hours doing something stupid like that.
one: FACEBOOK MAKES SEX HAPPEN SOONER (Reuters)
Yeah but it also makes sex happen nerdier:
Even in the heat of passion, some people just can't get enough of their digital devices, the survey found. When a call or text comes in during sex, 5 percent of respondents said they glance to see who is calling and 1 percent say they stop to answer the phone.
zero: LADY GAGA IS A NEWSPAPER EDITOR (Gothamist)
Was this why pay walls were invented?
Submit your own Ones or Zeros to Motherboard with the tags "one" or "zero", and see more here.


text:
Need a go-anywhere tee for your sports/casual wardrobe? Canterbury's CCC Graphic Tee is perfect for any occasion, from kicking a ball around to kicking back with friends.
With 100% Cotton construction, this great looking tee belongs in every guy's smart casual wardrobe. Featuring a crew neck and a choice of two colours, it has key Canterbury branding emblazoned across the chest that leaves no one in doubt as to where you shop for your sports/casual gear. And because of its quality construction, this tee is up for the job whether you're shooting baskets with your mates or kicking back at a Sunday afternoon BBQ with family and friends. Order yours now and wear it with pride to show everyone you're a member of the Canterbury team of fitness enthusiasts.
Orders over $100 are Free standard shipping within Australia.
Standard Delivery $7
The Canterbury Shop will only ship orders within Australia.
All parcels are sent via Eparcel and have a full track and trace service.


text:
№: 3454 Дата: 2018-06-11 06:15 GMT
сообщений 1
Где: Катар
Род занятий:
Some of the big name designers like Christian Dior and Armanis have perfected the art of perfumery, creating a harmony of "fragrance notes" that appeals to the wearer and makes an impression on everyone nearby and for these reasons many women choose to buy designer perfumes as much for the scent as for the designer name that comes with it. Furthermore, the lighting will remain constant which means that once the settings are in place, there won't be much call to adjust them. no sperimentare, le antiche tecniche giapponesi o samoane, per riscoprire un modo pi. La Moda handbag offers handbag styles to compliment and accessorize all outfits, ranging from satchel and messenger handbags, shoulder bags, totes bags to bowling bags, bucket bags and evening bags, all featuring high quality material and fabrics.
For example, you can repurpose a small store room with shelves that perfect shoe rack. This Can's where vendors from over the world could very well provide for Far East purchaser mouth-so that you can-facial area, converse internet business, appear inventions in addition to the hold on to up to date with creative option. Read our handbag guide below to help make your choice easier. Wholesale aviator sunglasses open a window of opportunities for people looking for lucrative business deals.
The company's collection of watches is definitely something to talk about since each piece is designed to be attractive, yet amazingly accurate in its function. it's fastened shoulder adornment with absolutely lining. Also the guys covered their legs by wearing sweatpants since the girls who went to the weight room were soccer and lacrosse players, and had bigger legs than some of the boys. The M-100 also lacks common'but extraneous'gaming headset features such as LED lighting, or software-driven features like voice morphing and other soundscape effects (if any of those are important to you).
En verdad, aprender Como Seducir Una Mujer, nunca hab. ciles como en una clase de moldes, tratando de hacer una pollera que me llevar. The massive dome of Florence's Cathedral of Santa Maria del Fiore, located in Piazza del Duomo, is one of the world's great feats of engineering. Estas personas quieren tener el look de maquillaje, y para algunos, estas clases son la.
The best part of these glasses is that instead of owning just one pair of its designer counterpart at an unbelievable price you can own multiple pairs of these replica glasses within the same value of money. La maggior parte delle persone in tutto il mondo che l'esperienza di attivit. Therefore, you will have no need to remove your hands from the steering wheel or even take your eyes off the road. baixar e-books e usar seu celular como dispositivo de leitura.
Usually, people can avail benefit of sale only at the time of sale season or special occasions, and the months in which they can enjoy sales August, October, November, and February. So you can indeed ask your trusted people to guide you to make a choice when you go to shop some pairs of scarpe for moda auto inverno 2011. blico, puede ser mejor contratar a un profesional que tiene un amplio conocimiento sobre el marketing de Facebook. While the designs presented this year are less glitzy than 2013, Ms.
knee active plus diskuze
perle bleue crema foro
hallu forte schiene
catch me patch me


text:
Olivry T, Linder KE, Wang P, et al. Deficient plakophilin-1 expression due to a mutation in PKP1 causes ectodermal dysplasia-skin fragility syndrome in Chesapeake Bay retriever dogs. PLoS ONE 2012: 7: e32072. Abstract.
PubMed ID (PMID): 22384142
Comments: This is the first description of a congenital suprabasal epidermolysis bullosa in a small animal species. This paper describes the clinical, microscopic, ultrastructural and genetic cause of ectodermal dysplasia-skin fragility syndrome (ED-SFS) in Chesapeake Bay retriever dogs in the USA. This disease is caused by a mutation in the gene encoding plakophilin-1 (PKP1) with resulting absence of this protein. This PKP1 deficiency leads to the detachment of desmoplakin from desmosomes, keratin filament retraction and, ultimately, to suprabasal acantholysis. The clinical phenotype consists of erosions at areas of friction and abnormal hair coat.
Recommended by: Thierry Olivry, NC State University, Raleigh, NC, USA


text:
Web Design Services
Web design is crucial in establishing your online presence. Basic web design principles can have significant effects on the success of your business online. Presently, businesses can no longer rely on a simple HTML to create a website that converts. The evolution of the web as a whole has dramatically changed the way businesses prioritize quality web design.
Web Design and Search Engine Optimization (SEO)
As search engines continually become better at ranking websites based on the quality of their content, web design has increasingly become vital in SEO. Many metrics have highlighted the importance of web design on SEO, ranging from design details such as how object alignment determines how long the user will stay on the web page; to the core programming details that can affect the ability of search engines to properly rank the website.
The right combination of SEO and Web Design can tactically be used to improve your website's performance. Of course, this should preferably be done by one company, in order to avoid synchronization problems, allow for effective troubleshooting, and make it easier to implement the necessary subsequent changes to the various aspects of the site without affecting the balance of its elements.
Your website is essentially the "online face" of your business. As such, the value of your web design will influence the perception of new and existing customers, and therefore increase or drive away traffic. A poorly designed website for instance, will look sketchy and just not right to a new visitor, and it's highly likely that they won't trust your business enough to buy your product or service. For this reason, creating a reputable online profile should not be ignored.
Web Design Combines Usability and Search
Quality web design is aimed at making your website appealing to both your visitors, and the search engines. It essentially combines user-centric and responsive design, and SEO strategies to create an excellent experience. The goal here is to make the website that can be accessed and used easily on just about any device, and ensure its pages are easily recognizable by search engines.
Responsive Web Design
Have you ever tried to view you website on other devices? How usable was it? Did it load as intended? Well, 2013 was marked as the post-PC era. Your website is no longer viewed solely on desktop PCs or laptops. In fact, smartphones and tablets have increasingly outpaced computers, both in terms of sales and number of users. As such, your clients and potential clients are more likely to visit your website via a smartphone, tablet, and other devices like large desktop displays, TVs, etc.
A responsive website not only makes your website look professional, but also help your visitors find what they are looking for much easily. Moreover, Google might also increase your site's score in its efforts to provide users with a better experience, which is a win-win.
Content Management Systems (CMS)
A content management system allows you and other members of your staff to login and make some changes to the website. It's quite a common feature, which essentially lets you manage various components and content on your website. Some of the most popular CMS platforms include WordPress, Drupal, and Joomla, and if you have used any of those, then you have an idea of how CMS works.
In case you found the software confusing or intimidating, you don't have to worry. Our CMS system is intuitive and easy to use. We've got you covered whenever you want to add a new blog post, newsletter, articles, team member information, change hours, or even take control of the entire content on certain pages.
We maintain all our CMS accounts on our servers, and they are available for high speed web hosting. Don't settle for those shared hosting packages that are rather slow, with occasional slowdowns and downtimes. Keep in mind that a slow website discourages the impatient users, and can make an impulse buyer look for another alternative; both of which result in a loss of immediate business. Market research highlights that over 50% of users will leave a webpage if it takes more than o.2 seconds to load.
Today, websites are now leading the way when it comes to sales and shopping in most markets compared to conventional brick and mortar businesses. If you sell your products and services via your website, then you need a way that allows your clients to buy conveniently, as you capture important information to be used for future marketing. Our team can help you integrate proper ecommerce solutions for your website that are easy to use, and provide your online store a wide range of options.
Why Choose US?
Besides being incredible artists, our web designers are experts at what they do – coding. They know how to craft persuasive styles that are suitable for any kind of website. We like to think outside the industry trends, and often develop trends that others want to mimic. Give us a try today!


text:
Review Stella Crystal Tufted Black Leather Modern Bench
If you are looking for online shopping deals for buying Stella Crystal Tufted Black Leather Modern Bench but are not able to find the best site that can offer you best deal then you have reached the right place. Here you can order Stella Crystal Tufted Black Leather Modern Bench at much lower price which will make your shopping affordable. Merchants is the site through which you will be delivered your Stella Crystal Tufted Black Leather Modern Bench and so nothing to worry about. It is a reputable site on net and needs no introduction. You can even save the shipping charges by ordering now and here itself. If you are still waiting and wondering then you are surely wasting your time and are missing a great opportunity.
Stella Crystal Tufted Black Leather Modern Bench
Stella is a glamorous designer bed-end bench that takes it up a notch with allover faux crystal button tufting. Dozens of crystal lookalike buttons adorn every nook and cranny and truly glimmer with even the slightest bit of light. Black faux leather is accented chrome-plated metal legs. This Malaysian-made modern bed bench is built with a rubberwood frame, which is padded with foam before being upholstered. The designer bench requires assembly. To clean, wipe with a damp cloth.19.5 inches high x 54 inches wide x 19 inches deep
Stella Crystal Tufted Black Leather Modern Bench Tips & Ideas
Advice To Assist You In Relation To FurnitureThe market for furniture ranges immensely. Whether you're seeking top-of-the-line or even for cheaper brands, it is best to search for that discount. With all the tips you're going to read, you should certainly better secure the right deal. Take into consideration your position, and apply the data as you may keep reading.Make sure the springs of the furniture you wish to buy. You should select a chair or possibly a sofa that feels comfortable to you personally. If you love firm chairs and sofas, make sure the springs are coiled properly and do not hesitate to change them regularly to keep your furniture comfortable.Prior to put any furniture cleaner on your items, you should check a small place to ascertain if you will find any damages. If there are any problems when you place the product around the small area, you will be aware that this is simply not the best thing to work with on your own things.When the furniture you happen to be buying has doors or drawers, test them out. Drawers should slide smoothly and open completely. When you close them, they need to align evenly. For cabinet doors, as soon as you open them, they ought to stay open. You must also make certain that they close and latch securely.If you are searching for new furniture that has cushions, try to look for ones with firm cushions and removable covers. Firm cushions will last considerably longer than softer ones. In case the cushions have removable covers, check to see when they are machine washable. Your furniture will be great for a much longer time frame whenever you can wash the cushions.Before purchasing furniture, turn the piece over and check out the legs. They need to be solid, heavy and joined properly to frame. Also take into account the materials. Rubber and metal can scratch your floors, so wood is actually a better option. The legs ought to be attached to the frame, not simply tacked into the bottom.Know your financial budget before hand. Furnishings are expensive, and it is possible to spend more money than you intended. Don't let yourself go overboard. Commit you to ultimately making multiple trips for the store. Be aware of sales, and make sure you only buy when the time is right so that you stay within your budget.In case you are buying a complete room of furniture, ask about quantity discounts. Many stores will provide them. When they are reluctant to discount the cost, find out if they will likely toss in small extras, similar to a lamp or end table, to help make the offer a better one.Look at classifieds like Craigslist when you find yourself shopping for furniture. On any day, you can find tons of postings on furniture available for purchase. Sellers on Craigslist are available to negotiating prices, in order to usually get something with a great price. Just make sure that you have funds on hand when you wish to get.Since you now have check this out article, you hopefully use a better idea with regards to how you can approach searching for the very best furniture to suit your needs. Remember what continues to be told to you personally here so that you can obtain the best deals. The furniture at your residence is vital to your household.


text:
Our first Optimization Summit is in less than two months, yet we haven't run an optimization story in quite some time. We went into the MarketingSherpa archive and found an article on increasing key homepage metrics, such as page views, by more than 100%.
In this case study a website redesign was tied to a direct mail campaign as part of an effort to refocus the company's target audience. Learn more about the five steps taken in this effort, and the impressive results in unique visitors, time spent on the site, average page views and increase in newsletter sign-ups.
Increase Mobile Conversion Rates
These five free micro classes (each under 12 minutes) apply 25 years of research to help you maximize the impact of your messages in a mobile environment.Get the Course >
Test Discovery Tool
Show business leaders all the results of your testing efforts with this free tool.Get the Tool >
A Model of Your Customer's Mind
These 21 tools and concepts have helped capture more than $500 million in test wins.Download the File >
Research-based Lead Generation Swipe File
22 valid marketing experiments to give you ideas for your next A/B test.Download the File >
Free A/B Test Planning Scenario Tool
This simple tool helps you visualize factors that affect the ROI implications of test sequencing.Get the Tool >
Receive the latest case studies and data on email, lead gen, and social media along with MarketingSherpa updates and promotions.


text:
Japanese car maker Toyota has reportedly partnered with Nvidia for powering the technology in its upcoming autonomous vehicles. The company has remained relatively quiet about its own self-driving cars, but a number of companies including Apple have been known to be using its vehicles (under sub-brand Lexus) for autonomous car tests. While Toyota has been rolling out more intuitive technology in its cars, it was yet to truly focus on developing fully autonomous cars.
- Compare Mobile Phones NewsIn DepthPress ReleaseHow to'sReviews
Digit SquadVideosPhotos Contest Hot Deals
- Mobile Phone
- Laptops
- Entertainment
- Internet
- Apps
- Auto Tech
- Audio Video
- Cameras
- Gaming
- General
- Headphones
- TVs
- PC Components
- Science and Technology
- Telecom
- Wearable Devices
- Ask DigitDevworxGeekForum SkoarZero1 AwardsPick a college About Us Contact Us


text:
May you all spread your wings and fly!!
May you all spread your wings and fly!!
Happy New Year to you and your family
I plan to soar in 2018! Wishing you a great year, Keith.
And to you Lois! Health, wealth, and pictures!
Happy 2018 to you and your family, Keith ! And many thanks for your support !
Always Jiro. Don't disappear!
Happy New Year to you and yours, Keith!
All the best Marcus!
Thank you Keith, and to you as well.
All the best Tim!
Oh yes, we all! A VERY happy New Year for you & your family! Best wishes from Old Vienna …


text:
Main / Cards & Casino / Dragonica chapter 4
Dragonica chapter 4
2 May - 2 min - Uploaded by starnasri chapter 4 dragonica. Published on May 2, chapter 4 dragonica. Game. Dragonica. 8 Aug - 5 min - Uploaded by dragonicaonline Get ready for Dragonica New Origin Chapter 4: Elga Unleashed on August 10, 6 Aug - 10 min - Uploaded by MrCaptianSaus Dragonica Chapter 4: New Origin (Elga Unleashed) - Opening Movie - Duration: Daniel.
18 Jun Dragonica Client + Server File Chapter Those Files are original, unmodded in anyways, so meaning their langauge is possible to be. Hi, I have create a new server private for me. I need your help because i don't found a good client for my dragonica private server Chapter 4!. Dragonica (Korean: 드래고니카) renamed Dragon Saga after , is a free-to- play 3D Each individual dungeon has one to four separate modes for advancement, each increasing in difficulty and not being The expansion elaborated into the story of the first chapter and as a result two new areas in Dragotaka were also.
16 Feb Dragonica Chapter 4: New Origin (Elga Unleashed) - Opening Movie is an animated GIF. DetailsSkyDragonica Chapter 3 NEW SERVER-Chapter 3 full working EXP X20, GOLD Details[EXP 22X][GOLD 7X][ITEM 2X] Chapter 4 - New Origin. IN. 0. SEA Gamer Mall sells Dragonica SEA gold and iCash top up game cards. 24hours service. Fast and Dragonica SEA New Origins: Chapter 4: Elga Unleashed. 4 Oct Dragonica Chapter 4: New Origin is the superb new expansion to the long- running free to play MMO Dragonica, and to celebrate this new. Emergency towing arrangements on tankers. Trafi accepts emergency fills the requirements in SOLAS, chapter II-1, regulation Application is to be.
Read the book Dragonica by Soapy Tsunami. For all Dragonica players to enjoy.. .. Read the book free on Chapter 4 (ver.1) · Xylent & Hazard. Submitted. Dragon Saga is a fast action 3D side-scroller MMORPG that attracts casual Patch Notes 5/23/ Weekend EXP Bonus Event [4/27/ - 4/29/]. 22 Apr Dragonica Online server list - find and play top Dragonica Online servers around the EvoDragonica Chapter 4 New Origin Server Banner. Dragonica System Requirements, Dragonica Minimum requirements Recommended requirements, Can PC run Dragonica system specs. HDD Space. GD Verdict. Recommended Requirements. Build It. Pentium 4 GHz · Athlon XP +.
В© 2018 jagpublications-esl.com - all rights reserved!


text:
Get an overview of this hotelUpscale property on the beach, with 5 outdoor swimming pools
Popular highlights
When you stay at Paradisus Playa del Carmen La Esmeralda All Inclusive in Playa del Carmen, you'll be on the beach, just steps from Quinta Avenida and 14 minutes by foot from Punta Esmeralda Beach.
This 4.5-star property is 2 mi (3.1 km) from Mamitas Beach Club and 2.1 mi (3.3 km) from Playa del Carmen Main Beach.
Make yourself at home in one of the 512 air-conditioned rooms featuring iPod docking stations and LCD televisions. Your bed comes with down comforters and Egyptian cotton sheets. Rooms have private furnished balconies. Cable programming and DVD players are provided for your entertainment, while complimentary wireless Internet access keeps you connected. Bathrooms have rainfall showerheads and designer toiletries.
Relax at the full-service spa, where you can enjoy massages, body treatments, and facials. You're sure to appreciate the recreational amenities, which include 5 outdoor swimming pools, a health club, and a sauna. Additional features at this property include complimentary wireless Internet access, concierge services, and an arcade/game room.
This property is all inclusive. Rates include meals and beverages at onsite dining establishments. Charges may be applied for dining at some restaurants, special dinners and dishes, some beverages, and other amenities.
Grab a bite to eat at one of the property's 14 restaurants, or stay in and take advantage of the 24-hour room service. Snacks are also available at the coffee shop/café. When you are in need of a refreshing drink, visit the beach bar or one of 16 bars/lounges, or 4 swim-up bars. A complimentary buffet breakfast is served daily.
Featured amenities include a business center, dry cleaning/laundry services, and a 24-hour front desk. Planning an event in Playa del Carmen? This property has facilities measuring 25000 square feet (2323 square meters), including a conference center. Free self parking is available onsite.Information missing or incorrect? Tell us!Opens in a new window
Paradisus Playa del Carmen La Esmeralda All Inclusive
Resort Amenities
All-Inclusive Details
This property is all-inclusive. Onsite food and beverages are included in the room price (some restrictions may apply).
Gratuities and taxes
Gratuities and taxes are included.
Food and beverages
- Buffet and à la carte meals, snacks, and beverages included
- 24-hour room service
- In-room minibar (all beverages included)
Activities and facilities/equipment
- Bartending
- Cooking
- Dancing
- Pilates
- Water fitness
- Yoga
- Onsite entertainment and activities
- Onsite live performances
Not included
- Surcharge for premium food items
- Surcharge for bottled wine
- Surcharge for room service
- Laundry/dry cleaning services
- Spa/beauty facilities and services
- Yoga classes/lessons included
- Pilates classes/lessons included
- Dancing classes/lessons included
- Taxes included
- 24-hour room service
- Onsite entertainment and activities included
- Buffet and à la carte dining
- Bartending classes/lessons included
- Cooking classes/lessons included
- Gratuities included
- Water fitness classes/lessons included
- Laundry/dry cleaning services not included
- Food and beverage restrictions apply
- Surcharge for premium food items
- Surcharge for bottled wine
- All available beverages included
- Minibar (all beverages included)
- Spa/beauty facilities and services not included
- Surcharge for room service
- Onsite live performances included
- Room service not included
Resort Amenities
Paradisus Playa del Carmen La Esmeralda All Inclusive is an all-inclusive property. Room rates include meals and beverages at onsite restaurants and bars. Other items and amenities, including taxes and gratuities, and access to recreational activities and entertainment may also be included. Additional charges may apply for meals at some restaurants, special dinners and dishes, certain beverages, and other amenities.
Paradisus Playa del Carmen La Esmeralda All Inclusive features a full-service spa, 5 outdoor swimming pools, a health club, and a spa tub. Dining is available at one of the property's 14 restaurants and guests can grab coffee at the coffee shop/café. The property also has a snack bar/deli. Guests can unwind with a drink at one of the property's bars, which include 4 swim-up bars and 16 bars/lounges. A complimentary breakfast is offered each morning. Wireless Internet access is complimentary.
This 4.5-star property offers access to a business center. Event facilities measuring 25000 square feet (2323 square meters) include a conference center. This all-inclusive property also offers a children's pool, a sauna, and spa services. Complimentary self parking is available on site.
Paradisus Playa del Carmen La Esmeralda All Inclusive has designated areas for smoking.
- Number of outdoor pools - 5
- Elevator/lift
- Fitness facilities
- 24-hour front desk
- Business center
- Porter/bellhop
- Free self parking
- Dry cleaning/laundry service
- Conference space size (meters) - 2323
- Luggage storage
- Hair salon
- ATM/banking
- Concierge services
- Gift shops or newsstand
- Conference center
- Snack bar/deli
- Designated smoking areas
- Shopping on site
- Pool umbrellas
- Total number of rooms - 512
- Number of floors - 3
- Number of buildings/towers - 8
- Beach bar
- Coffee/tea in common areas
- Number of bars/lounges - 16
- Full-service spa
- Number of swim-up bars - 4
- Beach umbrellas
- Free breakfast
- Conference space
- Spa treatment room(s)
- Tours/ticket assistance
- Meeting rooms
- Year Built 2011
- Coffee shop or café
- Free WiFi
- Steam room
- Sauna
- Health club
- Children's pool
- Spa services on site
- Number of restaurants - 14
- Conference space size (feet) - 25000
- Ballroom
- Banquet hall
- Reception hall
- Beach towels
- Spa tub
- Television in common areas
- Arcade/game room
- Wedding services
- Multilingual staff
Family Friendly Amenities
- Outdoor pools
- Children's pool
- Free Wi-Fi
- Snack bar/deli
- In-room childcare (surcharge)
- Arcade/game room
- DVD player
Available in all rooms: Free WiFi
Available in some public areas: Free WiFi
Free self parking
Room Amenities
- Pay movies
- DVD player
- Access via exterior corridors
- Air conditioning
- Minibar (stocked, free items)
- Free bottled water
- Free toiletries
- In-room safe
- Premium bedding
- Furnished balcony
- In-room climate control (air conditioning)
- Phone
- Daily housekeeping
- Turndown service
- Designer toiletries
- Bathrobes
- Hair dryer
- Slippers
- Rainfall showerhead
- In-room childcare (surcharge)
- Iron/ironing board
- Desk
- Blackout drapes/curtains
- Cable TV service
- Free WiFi
- iPod docking station
- Room service (24 hours)
- Down comforter
- Egyptian-cotton sheets
Where to Eat
Guests are offered a complimentary buffet breakfast each morning.
Paradisus Playa del Carmen La Esmeralda All Inclusive has 14 restaurants on site.
24-hour room service is available.
Nearby Things to Do
5 outdoor swimming pools are on site along with a children's pool. Other recreational amenities include a health club, a spa tub, and a sauna.
The recreational activities listed below are available either on site or nearby; fees may apply.
- Pilates classes on site
- Snorkeling on site
- Ecotours nearby
- Fitness classes on site
- Kayaking on site
- Yoga classes/instruction on site
Spa Services
YHI Spa has 14 treatment rooms including rooms for couples. Services include facials, body wraps, body scrubs, and body treatments. A variety of treatment therapies are provided, including aromatherapy. The spa is equipped with a sauna and a spa tub.
Guests under 18 years old are not allowed in the spa.
- Sauna in spa
- Spa tub in spa
- Number of treatment rooms 14
- Minimum age to access spa is 18
- Couples treatment rooms
- Manicures and pedicures
- Body wraps
- Body treatments
- Body scrubs
- Facial treatments
- Aromatherapy treatments
- Massages
If you have requests for specific accessibility needs, please note them at check-out when you book your room.
- In-room accessibility
Resort Policies
Check-in time starts at 3 PM
Minimum check-in age is 18
Special check-in instructions:
Check-out time is noon
Payment types
Children and extra beds
- Children are welcome.
- Pets not allowed
You need to know
Extra-person charges may apply and vary depending on property policy.
Government-issued photo identification and a credit card, debit card, or cash deposit are required at check-in for incidental charges.
Special requests are subject to availability upon check-in and may incur additional charges. Special requests cannot be guaranteed.
- Please note that cultural norms and guest policies may differ by country and by property. The policies listed are provided by the property.
- A tax is imposed by the city: MXN 20 per accommodation, per night
Optional extras
- Early check-in is available for a fee (subject to availability)
- Late check-out is available for a fee (subject to availability)
Resort Name
- Paradisus Esmeralda
- Paradisus Esmeralda All Inclusive
- Paradisus Playa del Carmen La Esmeralda
- Paradisus Playa del Carmen La Esmeralda All Inclusive
- Paradisus Playa Carmen Esmeralda All Inclusive
- Paradisus Playa Carmen Esmeralda
- Paradisus Playa Carmen Esmeralda All Inclusive Playa del Carmen
We should mention
Reservations are required for golf tee times, massage services, and spa treatments. Reservations can be made by contacting the property prior to arrival, using the contact information on the booking confirmation. Some facilities may have restricted access. Guests can contact the property for details using the contact information on the booking confirmation.
Awards & Affiliations
Extra Amenities
Book a stay in any room or rate category and receive access to Illy Corner (surcharge), Restaurant Passion by Martin Berasategui, Don Julio Corner tequila tasting (surcharge), Mexican romantic dinners (surcharge), and Moet & Chandon Corner sparkling wine tasting (surcharge).
Full details at check-in.
Family Concierge Suite Benefits
Book a stay in a "Family Concierge" suite and receive family-oriented details including child-sized amenities; private swimming pool and beach area with concierge service; special amenities for children in the Suites including bathrobes and slippers; turndown service with milk and cookies; personalized mini-bar with drinks and snacks for children; "welcome" beach kit for children from Paradisus; certified butler service with contact through instant messaging; packing and unpacking services coordinated by stewardship (subject to availability); access to YHI Spa water ritual; personalized pillow menu; personalized nightly turndown service; special aromatherapy menu in the room (surcharge); access to Family Concierge private heated pool with a swim-up bar and Bali beds; and private beach access with beach butler service area.
Must book a "Family Concierge 1 Bedroom Master Suite", "Family Concierge 1 Bedroom Master Suite Swim Up", "Family Concierge 1 Bedroom Suite Swim up", or "Family Concierge Junior Suite" to receive benefits. Full details at check-in. Taxes and gratuity may not be included. No refunds for any unused portion of offer. Offer subject to availability. Offer is not valid with groups/conventions and may not be combined with other promotional offers. Other restrictions and blackout dates may apply.
Kids Stay and Eat Free
Book a stay in any room or rate category from now-December 22, 2019, for travel May 1-December 22, 2019, and up to 2 children age 12 and younger stay and eat free when registered in the same room.
Full details at check-in. Children 12 and younger eat free when ordering from the children's menu and dining with paying adults ordering from the regular menu. Limited to 2 per room. Taxes and gratuity may not be included. No refunds for any unused portion of offer. Offer subject to availability. Offer is not valid with groups/conventions and may not be combined with other promotional offers. Blackout dates: July 8-August 19, 2019. Other restrictions and blackout dates may apply.


text:
WINGER: One of the most misunderstood Hard Rock bands to emerge from the late 1980's are back with their Billboard Top 100 album "Better Days Comin'".
FIREHOUSE: FireHouse has been rockin' for over two decades. Their music has taken them all over the world and has produced Gold, Platinum and Multi-Platinum records in the United States and countries abroad.


text:
Japanese teen beach orgy 8 min Maxim - 2. At Desires, where naked is the norm, then she could be the odd one out for wearing any bathing suit at all. As suggested in my initial post me and my wife both 30, Asian - Indian rather would like to try the below. Excellence Riviera Cancun 5: Japanese mom and son body change. Japanese Family Day Part 1. Apart from the regular activities we would like to try being nude at the beaches.
And whilst I REALLY hate to say it, the sorts of looks an older, overweight, out of shape person in a scanty bathing suit receives are going to be different to those that a young, fit person will get.
This will be our first time trying nude beaches and since its the first we would like to try it in a beach where there are no outsiders in the resort apart from the occupants and where there is lots of space in the beach i. I've seen the beaches at both Desires resorts and they are NOT secluded. All of your saved places can be found here in My Trips. There are plenty of thongs everywhere and some micro-bikinis. There are also some beaches down in Tulum where sunbathing nude is acceptable.


text:
Hart & Sole
Hart & Sole Clog Morris are Morris dancers specialising in the dance style of North West England. We are a mixed side with men and women wearing contrasting coloured kit. Each dance consists of 8 dancers, usually 4 men and 4 women, with a caller directing the dancers and musicians.
We have fun dancing at festivals around the south of England on weekends and Bank Holidays. We dance with invited sides outside pubs (occasionally inside) in the local area around Bracknell, Crowthorne and Wokingham. We venture outside our local area to dance with other sides within reasonable drinking distance, making new friends at the same time. This gets us out and about meeting new people and getting back together with some old friends from previous years.
Come and join us, meet new friends; we are always on the look out for new dancers and musicians.
Autumn and Winter we practice; Spring and Summer we dance out.
No experience is necessary; we will teach you all you need to know and maybe some more!
All you have to bring with you is a sense of humour and a willingness to join in and have fun.
Hart & Sole Clog Morris first appeared in public in 1987 performing Morris dances from the north west of England.
The north west or Clog Morris, as it is often called, originates from the north west counties of England such as Cheshire and Lancashire.
The alternative name is derived from the clogs the dancers wear. This type of footwear was widespread in the factory and mill towns in the area from the late 19th century up to the end of the first world war, and in fact may still be seen in use in some of the older established firms.
The Dances performed are derived from carnival and procession type dances. Originally they would have been performed to a full brass band from the town or factory, but alas, today the musical accompaniment although playing some of the same tunes is a little less grand.
The dances would have been performed at village, town and even national celebrations; the teams competing against each other in regional competitions.
Today whilst the element of competition is no longer the driving force, Hart & Sole strive to perform the dances in an exciting and lively manner.
Dance Programme 1999, 2000; Hart & Sole history; Contacts; Links; Dances; Photos


text:
Be the talk of the paddock with these funky All Weather riding gloves!
Hard-wearing, easy care, fully washable and just so COOL! Available in child's, teen and adult sizes! Looking for a particular SSG glove? These 8600 SSG All Weather Pink Leopard Riding Gloves are Perfect for:Pony Club, Schooling, Show Jumping, Hacking, Barrel Racing, Carriage Driving, Race Riding or Driving.
*Unlined, long wearing and machine washable.
*Soft aquasuede plus® palm.
*Colorfast and sweat absorbing.
*Strong elasticized back for a cool comfortable fit.
*Hook and loop wrist closure for security and safety.
*Wears like iron! Washes like a rag!
To check your preferred size, simply measure around your hand at widest part; excluding thumb. The number of inches should equal your glove size. MOST SIZES IN STOCK AND READY TO SHIP TODAY!
Need more 'HORSE MAD' gift ideas?
HW's very own magazine illustrator Peta Taylor shares her skills in this awesome Australian made book!
An exquisite celebration of Australian equine photography...at a pocket money price!
Our super popular HorseWyse's 'Galloping Guru' re-usable shopping bags make a perfect book or library bag - all for just $5!
Our HW on-line GIFT VOUCHER is the perfect pony gift for any horse lover! Starting from just $5 - give a gift that keeps on galloping!
Check out HW's NEW App. for iPhone and iPad!
Winter issue out now!
Also the home of Earlwood and Horzehoods
HorseWyse Magazine proud sponsors of Pony Club Australia!!!
Copyright © 2018 HorseWyse Magazine Australia
PO Box 829, Moruya, NSW 2537 • Phone: 0417 444025 • Email: firstname.lastname@example.com
Original Graphic and Website Design by Colour Logic - Maintained by HorseWyse - Powered by Turnkey Website Solutions | Illustrations by Peta Taylor


text:
JAY-Z, 48, famously responds to Beyonce's cheating allegations from Lemonade on his song "Family Feud," and now there's an equally wild video to go along with the collaboration track. The visual — which fittingly stars the rapper and his wife, 36 — dropped today, Dec. 29, and you can watch it above via TIDAL when you sign up for a free holiday membership preview!
Michael B. Jordan, Jessica Chastain, Mindy Kaling, Omari Hardwick and Neicy Nash are just a few of the famous stars who made appearances in the video to prove why family MUST come first. It also shows the serious repercussions when couples don't choose to, especially those in power. As expected, JAY delivered in a major way with his epic music video. Bey appears in the captivating and cryptic clip, watching over him from the altar while he walks in with their daughter Blue Ivy. JAY seemed to drop major hints about his internal conflict, especially when he was seen in the confession booth while Bey listened in from the other side. "We were using our art almost like a therapy session," JAY previously revealed to the New York Times about releasing his album 4:44 around the same time as Beyonce's chart-topper Lemonade. "We started making music together."
In case you needed a refresher, here's what JAY-Z raps on the track: "Yeah, I'll f*ck up a good thing if you let me/Let me alone, Becky/A man that don't take care his family can't be rich/I'll watch Godfather, I miss that whole sh*t." Beyonce then comes in with a warning about how "nobody wins when the family feuds," and all we have to say is, we're so glad these two made up! See more photos from the "Family Feud" video here.
Naturally, fans are most excited over Bey's appearance in the video. As one fan put it: "Beyoncé OMGNFKFKSLKD." "WIGGGG OFFFICIALLY GONNEEEE TOO NEVER NEVER LAND," another wrote. Yeah, same.
May 2019