What is Myopia
Myopia, or short sightedness or nearsightedness, causes blurry vision at far distances and occurs when the eye grows too quickly – as the eye grows longer the prescription will increase. In childhood, as the body grows, the eyes also grow which is why childhood myopia tends to progress more quickly, especially in younger children.
Early intervention and treatment is essential. Highly myopic eyes are more at risk for serious eye diseases later in life, such as retinal detachment, myopic maculopathy, glaucoma, and cataracts. LASIK or other corrective surgeries do not reduce these increased risks, even if it can correct the vision.
Effective treatment can slow, or even stop, the growth of your child’s eyes. These children must also be monitored more frequently to allow for changes in treatment, if needed.
Myopia is a Growing Problem
Rates of myopia are increasing. Currently 1 in 3 children are myopic and we are seeing larger amounts of myopia beginning at younger ages.
Myopia is predicted to be a major public health issue. Experts expect the myopic population will grow from 2-billion people today to 5-billion by the year 2050. The growing prevalence of myopia is discussed in more detail on the International Myopia Institute website: https://myopiainstitute.org/myopia/
Our Myopia Management strategies utilize the latest research on how to slow the onset and progression of myopia. You can perform an initial assessment of your child’s risk factors for myopia here: https://www.mykidsvision.org/en-us
What You Can Do
Keep glasses and contact lens prescriptions up to date
Studies show that blurred vision can cause the eye to grow more quickly. Keep up with regular annual eye exams.
Spend more time outdoors
Research shows that kids who spend 2 hours per day outdoors, or 15 hours per week, are less likely to develop myopia.
Myopia management programs
For most myopic children, glasses alone will not prevent the eyes from growing each year, so we offer individualized programs based on the latest research to target and treat myopia progression. Your doctor will help guide you toward the program that best fits your child’s needs.
How the Myopia Management Program Works
The first step in the process is to call our office to schedule a myopia management evaluation. An evaluation prior to beginning myopia management treatment is necessary to determine key risk factors and measurements of the eyes to monitor for progress throughout treatment and to determine which myopia control options might work best for your child. This visit includes tests that are not part of the typical eye exam as well as a dilated refraction using 1% cyclopentolate, which relaxes the focusing system as completely as possible to allow for the most accurate baseline measurement of your child’s natural prescription. This drop will dilate the eyes for up to 12 to 24 hours. You must have had a comprehensive examination within 3-months of obtaining a myopia management evaluation. If you had an eye exam elsewhere, your records must be forwarded to us. Please give us a call for further information on the fees and details of this myopia management evaluation.
Upon completion of this evaluation, your eye care practitioner will determine the most suitable myopia management treatment option for your child (see below). Most treatments will be recommended for at least 2 years or until the age of 18, whichever is longer. The risks (if applicable) for each treatment, and the predicted outcomes are shown below.
Daytime soft multifocal contact lenses (FDA-approved MiSight contact lenses)
Soft multifocal contact lenses are worn during the day only and are often prescribed to help people over 40 years of age read clearly as well as see in the distance. They are also effective in slowing myopia progression for children by changing the way light enters the eye and where it hits the retina. Your child’s vision may be slightly less clear with these contact lenses, but this is usually not a problem and adaptation quickly occurs. There are no additional risks compared to other contact lenses.
Nighttime orthokeratology (ortho-K) lenses
Orthokeratology lenses are worn overnight and taken off in the morning. This can be thought of as an eye brace that temporarily reshapes the cornea while your child sleeps. This altered shape corrects their myopia so that prescription glasses and normal daytime contact lenses don't need to be worn during the day. Some adaptation is required during the first two weeks of lens wear and there is a small chance of an eye infection with ortho-K lenses, although this risk is very low (less than one case per 500 years of wear).
Low-dose atropine eye drops
Atropine eye drops are normally used to relax the muscles in the eye. This enlarges the pupil and relaxes the muscles in the eyes that help you focus for near tasks. Typically, atropine is used in concentrations of 0.5% to 1%. However, the concentrations used for myopia management are 0.01% or slightly higher, which has resulted in little to no side effects. If there are any, this may include mild eye irritation, mild blur when reading, or light sensitivity. These drops must be obtained from a compounding pharmacy with sterile facilities. Glasses can reduce symptoms if your child notices poor reading vision or lights seem too bright. However, the longest studies have been 5 years and longer-term effects are unknown.
Bifocal / progressive / peripheral defocus glasses
Various types of glasses show some efficacy with myopia control. “Bifocal” or “progressive” glasses are designed to provide the full distance prescription at the top of the lens and a different prescription for myopia control at the bottom of the lens. Peripheral defocus glasses provide clear distance vision through the center of the lens, and a ring of higher prescription to help control the myopia towards the edge of the lens. Bifocals and certain types of peripheral defocus glasses appear to be most effective. These lenses may be most useful if you prefer not to have your child wear contacts or use eye drops. Some adaptation is required to the near / peripheral part of the lens but there are no other risks to this treatment compared to normal spectacle lenses.
For myopia control to be effective, your child needs to use the treatment as recommended by your practitioner. This may include:
- appropriate wearing time or dosage:
- Ortho-K / low-dose atropine: each night
- Multifocal soft contact lenses: 8-10 hours per day, at least 6 days per week
- Spectacle options: wear during waking hours
- proper hygiene when handling / cleaning contact lenses or instilling eye drops
- using contact lens solutions as recommended
- replacing lenses / eye drops as per replacement schedule
Please note: all contact lenses and eye drops used by this clinic for myopia management are approved by the US Food and Drug Administration Home Page (FDA) for general use. However, they have not specifically been approved to slow the progression of myopia, so their use is considered “off label”. Off-label use is legal and does not necessarily mean that the treatment is being used inappropriately, especially if its use is based on firm scientific evidence. The only exception is MiSight soft contact lenses, which was recently approved by the FDA specifically to reduce the progression of nearsightedness.
Fees for the different options of treatment will be discussed at the myopia management evaluation, once your doctor has made a recommendation on treatment.
Additional PubMed abstracts regarding myopia and myopia management can be found here:
Myopia Control: Why Each Diopter Matters
Effect of Outdoor Activities in Myopia Control: Meta-analysis of Clinical Studies
Efficacy Comparison of 16 Interventions for Myopia Control in Children: A Network Meta-analysis
A 3-year Randomized Clinical Trial of MiSight Lenses for Myopia Control
Low-Concentration Atropine for Myopia Progression (LAMP) Study: A Randomized, Double-Blinded, Placebo-Controlled Trial of 0.05%, 0.025%, and 0.01% Atropine Eye Drops in Myopia Control
Two-Year Clinical Trial of the Low-Concentration Atropine for Myopia Progression (LAMP) Study: Phase 2 Report
Maximum Atropine Dose Without Clinical Signs or Symptoms