Myopia Control
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.
Are you a parent who is concerned about your child’s longterm eyesight? Are you frustrated that every year their glasses only get thicker and thicker with no end in sight? Thanks to recent research in myopia control, we now can be proactive with your child’s vision instead of only reactive!
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.
Atropine
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.
What is the most effective Myopia Control method?
In Summary, all 3 of the above treatment options slow down the progression of myopia by around 50%. There is not one option that I favor more than others. During our Myopia Control Evaluation Exam, we will talk about your child’s lifestyle, maturity, and glasses prescription, and decide together which is the best option for your family.
If you are concerned about your child becoming myopic, or if your child is already getting stronger and stronger glasses every year, schedule a Myopia Control consultation was us a Peak Eyecare. We would love to help!
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
Myopia FAQ
Frequently Asked Questions
Why is Myopia Control Important?
Let’s first start with some definitions. Myopia is the term we use to describe the condition of being near-sighted. Generally speaking, this is when it is much more difficult for you to see in the distance than it is up close. Now this does not mean that your near vision is necessarily good, it just means it’s better than your distance vision. If you have mild myopia, classified as a glasses prescription anywhere from -0.50 to -3.00, you need glasses for seeing in the distance, but you can comfortably read a book held at arms length away without the need for glasses. Moderate myopic patients fall between -3.25 and -5.75, and are even more reliant on distance glasses, and can only read small print without glasses if it is held very close. Once myopia progresses past -6.00, it is classified as severe myopia, and glasses or contact lenses are required to see past a few inches.
Moderate to severe myopia has substantial financial implications as well. When myopia increases to -4.00 or greater, glasses lenses get too thick to fit comfortably in a frame. Hi-index lens materials are necessary to keep the lenses thin, but they make your child’s glasses much more expensive. Further, while refractive surgery such as LASIK is an option for many myopic patients, once the amount of myopia progresses past a certain level, LASIK is no longer safe to perform. These patients cannot function without glasses or contact lenses, and will be completely dependent on them for the rest of their lives.
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 has been classified as an epidemic by the World Health Organization, and is expected to increase to 52% of the worldwide population by 20501. Myopia drastically increases the risk of potentially permanent vision loss2. Retinal detachments are the biggest concern, and can affect patients of all ages. In a retinal detachment, the retina (similar in function and location to the film of a camera) starts to tear away from the back of the eye. This can cause immediate vision loss and usually presents with bright flashes of light and a sudden increase in floaters, but sometimes has no symptoms at all. If this is not treated immediately, it can result in permanent blindness. Unfortunately, your risk for a retinal detachment increases in proportion to the amount of myopia you have. High myopia also increases your risk of glaucoma and myopic macular degeneration. These sinister diseases slowly affect your vision over a few years. In most cases the progression is so slow that you will not notice any changes in your vision until it nears end-stage. At that point, there is little we can do from a treatment standpoint. This is why an annual eye exam is important for every person, but it is especially necessary for patients with myopia. We can detect changes in the health of your eyes before you notice any symptoms, and start you on the appropriate treatments promptly.
Is my child at high risk for myopic progression?
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. If either you or your partner have moderate to high myopia, your child is at much higher risk to develop high myopia and the associated complications. Research also found that not spending much time outside also increases the risk of myopia, although the exact mechanism is not fully understood.
Would my child benefit from Myopia Control?
Myopia Control is only effective is there is progression in a patient’s nearsightedness (myopia). Many children are myopic, but show little to no progression over time. It is not necessary to treat these patients. However, the majority of children that are myopic do show a substantial year over year increase in the amount of myopia they suffer from, and these are the patients that early intervention is important for.
To be clear, Myopia Control cannot reduce or even stop the progression of myopia in children. Per the data, it can only slow down the progression of myopia, and it does so by 50%. This means that if a child was normally going to be a -6.00 without treatment by the time they reach adulthood, we would expect that patient to only reach -3.00 if treatment was started promptly. That difference would make a substantial difference in that patient’s long-term eye health and well-being.
What age should Myopia be controlled?
Age also plays a role in determining if Myopia Control Treatment would be beneficial for your child. The biggest impact that we can have in slowing down the progression of myopia is when the eye length is growing the fastest, which is from birth until around age 14. Once the child gets much older than that, there is not much benefit with treatment. This is why it is really important that we determine if your child has progressive myopia as early as possible.
What is the best treatment option for Myopia Control?
Once we determine that your child would benefit from Myopia Control Treatment, the next step is determining which treatment option is the most practical for both you and your child.
What is the best treatment option for Myopia Control?
Once we determine that your child would benefit from Myopia Control Treatment, the next step is determining which treatment option is the most practical for both you and your child.