What is myopia?
Myopia (or nearsightedness) is a condition where distant objects are blurrier than near objects. It’s a condition in which the optical system of the eye causes incoming light rays to focus in front of the retina, instead of focusing directly on the retinal surface. Various factors can cause this abnormal focus of light rays, including abnormalities of the lens or cornea, or by an eye that is abnormally long. A person with myopia can typically see clearly up close – when reading a book or looking at a laptop screen – but words and objects look fuzzy on a whiteboard, on television, across the room, when looking outdoors or when driving.
What is High Myopia?
High myopia, also called pathologic myopia, is when there is near-sightedness of -6.00 diopters or more or the length of eye measures greater than 26.5mm. Children who have parents with high myopia and/or those who start to develop nearsightedness early in childhood are more likely to develop high myopia over time.
Why is myopia a concern?
The rate of myopia is growing across the world, increasing from 22% of the world’s population in 2000 to 33% in 2020 – half of the world’s population expected to be myopic by 2050. Most myopia is caused by the eye length growing too quickly in childhood. The eyes are meant to grow from birth until the early teens and then cease, but in myopia the eyes grow too much and/or continue growing into the teenage years. Once a child becomes myopic, their vision typically deteriorates every 6-12 months, requiring a stronger and stronger prescription. Most myopic children tend to stabilize by the late teens and early 20’s. Excessive eye growth raises concern because even small amounts of stretching can lead to increased likelihood of vision threatening eye diseases in later life, such as myopic macular degeneration, retinal detachment, and cataract.
What are the chances of my child developing myopia?
There is a strong genetic link to myopia, so if either parent is nearsighted, the child is more likely to become nearsighted.
Can my child do anything to slow down myopia?
There is currently a lot of research being done to understand myopia progression in children. We now know that lots of time spent working at near focus on things less than one foot has shown to worsen myopia.
Teach kids the 20-20-20 rule: for every 20 minutes of screen time, look 20 feet away for 20 seconds. Outdoor time is beneficial because it seems to slow progression. Keep computers and other digital devices 18 to 24 inches away from face. Set time limits on screen time. Remind kids to blink when watching tv or using computers. Adjust screen brightness and contrast so the eyes are comfortable.
Why manage myopia in children?
Myopia progresses fastest in younger children, especially those under age 10. This means that the most important opportunity to slow eye growth is when children are younger. Myopia management aims to apply specific treatments to slow excessive eye growth to a lesser rate. Experts agree that myopia management should be commenced for all children under age 12, and typically continue into the late teens.
The short-term benefit of slowing myopia progression is that a child’s prescription will change less quickly, giving them clearer vision for longer between eye examinations. The long-term benefit is reducing the lifetime risk of eye disease and vision impairment. This risk increases as myopia does with the good news being that reducing the final level of myopia by only 1 diopter reduces the lifetime risk of myopic macular degeneration and the risk of vision impairment by 20%.
Treatments for slowing myopia progression.
Standard, single-focus long distance spectacles or contact lenses do not slow down the progression of childhood myopia.8 Instead, specific types of spectacles, contact lenses and eye drops called atropine have been proven to slow myopia progression in children.
The best option for your child will depend on their current prescription and other vision and eye health factors determined in their eye examination. Your eye care practitioner will discuss the options with you to determine the best option. Treatment options vary across the world due to availability, supply, and regulatory reasons. It is important to note that no treatment can promise the ability to stop myopia progression in children, only to slow it down.
Contact Lenses
Standard single-focus contact lenses do not slow the worsening of childhood myopia, but specific designs do. These specific designs can both correct the blurred vision of myopia and work to slow down myopia progression.
MiSight® 1 day contact lenses are the first and only soft contact lens FDA approved to slow down the progression of myopia in children. The child wears contact lenses during the day and removes them at night. These lenses have an optic zone concentric ring design with alternating vison correction and treatment zones.
Risks and safety
Contact lens wear increases the risk of eye infection compared to wearing spectacles, with the risks being:
- 1 per 1,000 wearers per year for reusable soft contact lenses
- 1 per 5,000 wearers per year for daily disposable soft contact lenses
With proper hygiene and maintenance procedures, this risk can be well managed – especially by avoiding any contact of water with contact lenses or accessories. Other side effects of contact lenses to control myopia can be temporary adaptation to the different experience of vision, which typically resolves in 1-2 weeks.
Benefits
There are many benefits to children wearing contact lenses:
- Wearing contact lenses improves children’s self confidence in school and sport, and their satisfaction with their vision – as much as it does for teens.
- Children aged 8-12 years appear to be safer contact lens wearers than teens and adults, with a lower risk of eye infection.
- Children only take 15 minutes more to learn how to handle contact lenses than teens.
Atropine eye drops
Atropine eye drops in strong concentrations (typically 0.5% to 1%) are used to temporarily dilate the pupil of the eye and stop the focusing muscles working in a variety of clinical applications. Atropine eye drops for myopia control, though, are a low concentration (0.01% to 0.05%) with much fewer such side effects. Atropine Eye drops are specially formulated, low dose eye drops must be compounded through a specialty pharmacy. The drops are instilled into the eyes each night, slightly dilate the pupil, and causes the eyes focusing mechanism to relax. This in turn, significantly reduces myopia progression in children. Spectacles or contact lenses are still needed to correct the blurred vision from myopia, as atropine only acts to slow myopia progression.
Risks and safety
The risks and side effects of atropine are as follows:
- Potential side effects of increased sensitivity to light due to larger pupil size, which is typically resolved with light-sensitive glasses or sunglasses.
- Problems with close-up focussing, which is typically resolved with glasses providing a stronger power for reading. One study found this only occurred in 1-2% of children treated with low-concentration atropine.
- Eye irritation or mild allergy, which can occur in 2-7%, although this can depend on the formulation of the atropine.
Atropine can be toxic and even fatal to small children if it is ingested in high quantities by mouth, but high quantity absorption via the eye is unlikely. Medication safety in the home is extremely important.
Benefits
Atropine eye drops are typically used at nighttime, before sleep, so are only utilized in the home environment. They are also ideal if the effective spectacle or contact lens options for myopia control are not suitable or not available for your child.
Spectacles
Standard single-focus spectacles do not slow the worsening of childhood myopia, but specific designs do. Myopia controlling spectacles can both correct the blurred vision of myopia and work to slow down myopia progression. They are safe to wear, and adaptation is typically easy, with the only side effects being related to the limitation’s spectacles pose for sport and active lifestyles.
Unfortunately, these types of lenses are not available at this time in the USA, we hope the FDA will be approving them in the near future.
To schedule your Myopia Management Consultation, you can call our office at (305)662-8390 or email us at [email protected]