Myopia (nearsightedness) has been classified as an epidemic, and is expected to increase to 52% of the worldwide population by 20501. Not only does myopia lead to an inability to function without glasses or contacts, there are also significant health concerns associated with myopic eyes. Myopia drastically increases the risk of potentially permanent vision loss, including retinal detachment, glaucoma, myopic macular degeneration, and complications during cataract surgery2. Given the prevalence and the severity of complications, there is currently much research being done on risk factors. These include one or both parents who are myopic and environmental causes such as excessive near work.
Until recently, nothing could be done to slow down the progression of myopia. However, numerous peer-reviewed studies have been completed demonstrating the effectiveness of 3 treatment options that have been proven to slow down the progression of myopia in children by about 50% each.
The first treatment option that showed consistent effectiveness was low dose atropine. ATOM 1 Study 3, published in 2006, was the first large scale clinical trial that proved the atropine is effective in slowing the progression of myopia in children. This was followed up by the ATOM 2 4 study, which proved that low dose atropine (0.01%) was more effective and less visual side effects than full strength atropine 1%. Then, in 2018, the LAMP Study 5 evaluated different concentrations of low dose atropine, and concluded that 0.05% atropine was slightly more effective than 0.01% atropine without an adverse effect on vision-related quality of life. In summary, low dose atropine appears to slow myopia progression by about 50% with little to no visual side effects, depending on the atropine concentration.
Orthokeratology (Hard contact lenses)
Think of these contacts as retainers for the cornea. OrthoK lenses are only worn at night, where they temporarily reshape the cornea before being removed upon waking up in the morning. This provides the patient with clear vision for the entire next day without having to wear contacts or glasses. More importantly, the improved optics of the cornea is theorized to decrease the signal the eye receives to grow excessively long, thus slowing down the progression of myopia. This has been found to slow the progression of myopia by about 50% 6.
Multifocal Soft CLs
These lenses create a similar optics to orthokeratology, but done using soft, multifocal contact lenses 7 worn daily instead of a hard lens worn at night. These lenses are very similar to lenses adults wear after age 40 to achieve simultaneous distance and near vision without the need for reading glasses. This is typically the first option for more mature kids due to ease of use and similar efficacy.
The decision between these three options for myopia control for your child is determined though an in-depth conversation with Dr. Cap and the patient’s family, factoring in age, maturity, and life-style.
1. The impact of myopia and high myopia. Report of the Joint World Health Organization–Brien Holden Vision Institute Global Scientific Meeting on Myopia. University of New South Wales, Sydney, Australia, March 16-18, 2015. Geneva: World Health Organization; 2017. License: CC BY-NC-SA 3.0 IGO. www.who.int/blindness/causes/MyopiaReportforWeb.pdf
2. Annechien E. G. Haarman, Clair A. Enthoven, J. Willem L. Tideman, Milly S. Tedja, Virginie J. M. Verhoeven, Caroline C. W. Klaver; The Complications of Myopia: A Review and Meta-Analysis. Invest. Ophthalmol. Vis. Sci. 2020;61(4):49. doi: https://doi.org/10.1167/iovs.61.4.49
3. W. Chua, V. Balakrishnan, D. Tan, Y. Chan, ATOM Study Group; Efficacy Results from the Atropine in the Treatment of Myopia (ATOM) Study . Invest. Ophthalmol. Vis. Sci. 2003;44(13):3119.
4. 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 Feb;123(2):391-399. doi: 10.1016/j.ophtha.2015.07.004. Epub 2015 Aug 11. PMID: 26271839. https://www.aaojournal.org/article/S0161-6420%2815%2900675-2/fulltext
5. Yam JC, Jiang Y, Tang SM, Law AKP, Chan JJ, Wong E, Ko ST, Young AL, Tham CC, Chen LJ, Pang CP. 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. Ophthalmology. 2019 Jan;126(1):113-124. doi: 10.1016/j.ophtha.2018.05.029. Epub 2018 Jul 6. PMID: 30514630. https://www.aaojournal.org/article/S0161-6420(18)30285-9/fulltext
6. Lee, Yueh-Chang et al. “Effect of Orthokeratology on myopia progression: twelve-year results of a retrospective cohort study.” BMC ophthalmology vol. 17,1 243. 8 Dec. 2017, doi:10.1186/s12886-017-0639-4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5721542/
7. Multifocal Contact Lenses Slow Myopia progression in Children. National Institutes of Health News Release. August 11, 2020. https://www.nih.gov/news-events/news-releases/multifocal-contact-lenses-slow-myopia-progression-children