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Myopia:  also known as nearsightedness.  Myopia is the most common refractive error of the eye, and it has become more prevalent in recent years.  It occurs when either the eyeball is too long or the cornea has a steep curvature.   This causes light rays entering the eye to focus in front of the retina rather than on the retina.   As a result, you experience blurred vision.   Myopia usually begins in childhood and can progress with age and tends to stabilize in early adulthood.

Risk factors for myopia:  Family history is the main risk factor.   If you parents are nearsighted, you have an increased risk to be nearsighted.   Additionally, studies show that using a computer of long periods may cause eye fatigue that increases your risk for be nearsighted.

How to correct or treat myopia:

  1. Glasses
  2. Contact Lenses
  3. Refractive surgery (LASIK, PRK, Implantable lenses)

How can I help to prevent myopia?

Go outside and play!

Research has shown that although genetics plays a significant role in myopia, there has been a recent dramatic increase in the prevalence of myopia in the US as well as other countries.   They have discovered the cause of this increase points to environmental causes like lack of time spent outdoors.   These studies have shown that children who spend more time outdoors had a reduced chance of becoming nearsighted.

Reduce time on devices

As mentioned above, extended time on computers/devices/tablets/etc has been shown to cause eye fatigue and increase risk of becoming nearsighted.

Now, what can I do for myopia progression in my child?

Myopia incidence and progression, as mentioned above, are significantly increasing in the US and other countries.  Recently, research has dedicated a lot of time and concentration on methods of slowing myopia progression in children.

Why are we so concerned about myopia progression:

There are a number of significant eye problems that sometimes are associated with myopia  (particularly high myopia).   Here are a few examples:

  1. Cataracts.   Highly myopic patients tend to develop cataract sooner than non-myopic eyes.
  2. Glaucoma.   Myopic patients have an increased prevalence of glaucoma (2-3x risk of non-myopic patients).
  3. Retinal Detachment.  Myopia has been found to be a clear risk factor for retinal detachment in studies.  One study published in the American Journal of Epidemiology showed mild myopia has a 4x risk of retinal detachment compared to non-myopic patients and moderate and high myopia has a 10x risk.

What are my options for myopia progression control for my child?

First – what is myopia control?    Myopia control is providing treatment that may be able to slow the progression of myopia.   These treatments can induce changes in the structure and focusing of the eye to reduce stress and fatigue associated with the progression of myopia.

The #1 best thing you can do to help slow the progression is to schedule annual eye exams so your eye doctor can monitor how much and how fast your child’s eyes are changing.

There are currently 4 types of treatment that have shown promise in controlling myopia:

  1. Atropine eye drops
  2. Multifocal contact lenses
  3. Orthokeratology
  4. Multifocal eyeglasses

Atropine eye drops:  this is a very diluted concentration of atropine.

Atropine is a medicine used to dilate the pupil and temporarily pause accommodation to relax the eyes focusing mechanism.  How it works:  Research has suggested that nearsightedness in children may be linked to focusing fatigue.  Atropine disables the eye’s focusing mechanism.  Studies have shown a significant reduction in myopia progression with this method and more lasting effects with a very diluted concentration.

Drawbacks of this treatment include: light sensitivity, blurred near vision, and child may need bifocals during treatment to be able to read clearly.  Additionally, there can be a rebound effect when the medication is stopped.

Multifocal contact lenses:  contact lenses that have different powers in different zones to correct for distance and near.  Multifocal contact lenses, with distance vision in the center, have been shown in multiple studies to significantly decrease myopia progression.

How it works:  the added power (multifocal) in the periphery of the lens provides a myopic peripheral blur.   This myopic peripheral blur is what has been found to reduce progression.

Drawbacks of this treatment include:  adaptation to the lens which seems to be a minimal issue with children, must wear lenses for all waking hours.

Orthokeratology contact lenses:  gas permeable (hard) contact lenses which are worn overnight.

Orthokeratology contact lenses (Ortho-K) has been shown to reduce myopia progression by ~45% in some studies.   How it works:  The reverse curve or shape of the contact lens causes a peripheral myopic defocus.  Again, this myopic defocus is what has been found to reduce progression.

Drawbacks:  lenses are not comfortable and take time to adapt to, increased risk of infection due to sleeping in lenses, can be difficult to get the right fit of the contact lens.

Multifocal eyeglasses:  executive bifocals or progressive addition lenses most commonly used.

Multifocal glasses:  studies have shown ~33% reduction of myopia progression compared to single vision lenses.

How it works: the additional power at near provides a myopic defocus.  The executive bifocal provides the largest area of myopic defocus at near vs progressive addition lenses and flat-top bifocals.

Drawbacks:  multiple studies did not prove to find a statistically significant difference between single vision and multi-focal eyeglasses in myopia progression reduction.   Additionally, the executive bifocal lenses are not as cosmetically appealing for a child as single vision or progressive addition lenses.

Our doctors at Metrolina Eye Associates are well educated and versed in myopia and the for reducing myopia progression.   Be sure to schedule your child’s (and your) appointment to discuss these options.

Michelle Beachkofsky, OD

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