Myopia Progression Control

If you are near-sighted then you probably remember the feeling you had as a youngster when your eye doctor told you that your prescription had increased again that year. And as a parent, if one or both parents are nearsighted then there is a much greater chance that your child will be nearsighted too. Studies have shown that if a child has one parent who is nearsighted, the child is twice as likely to develop myopia than if neither of the child’s parents are nearsighted. If the child has two nearsighted parents, the child is over five times more likely to develop myopia. As we wrote about in an earlier blog, the prevalence of myopia in young persons has increased at a significant rate in recent years. It is now commonly referred to as an “epidemic” and it is predicted that a full one-half of the world’s population will be myopic by the year 2050! This is important because of the costs and care associated with more kids having near-sightedness but there are also health concerns.

High myopia is a risk factor for developing glaucoma, retinal detachment, myopic retinal degeneration, and cataracts. The risk for these conditions increases with the magnitude of the myopia. Therefore decreasing the amount of myopia present decreases the relative risk for developing these serious problems. Why myopia control? If a child’s myopia increases from a minimal level to high myopia (defined as more than -6.00 Diopters) the risk of retinal detachment increases by 20-fold!

There are three approaches to controlling myopia progression:
1. Limit screen time
2. Spend more time outdoors
3. Doctor-prescribed methods of myopia progression control

Who should undergo a myopia control program?
1. Strong family history of myopia
2. Increasing myopic prescription in a young patient
3. Myopia diagnosed at a young age
4. Less than desired amount of far-sightedness at a young age

Myopia usually results from the eye being too long. Just like feet get bigger and children get taller, the nearsighted eye tends to get longer over time. This means nearsighted children often need to get stronger glasses every year as their eyes continue to grow. Various approaches exist to attempt intervention and control of myopia progression in younger patients. These interventions include: multifocal glasses, gas permeable contact lenses, undercorrection of myopia, orthokeratology (hard contact lens that are worn overnight to reshape the patient’s cornea), soft bifocal contact lenses, and topical pharmaceutical treatment. The latter two having been shown to be the most effective approaches.

Topical (eye drop) pharmaceutical treatment for myopia progression control:

Atropine eye drops are similar to the medication we use during eye exams to dilate pupils. Therefore atropine can cause light sensitivity and blurred near vision. However, a low dose of atropine (0.01%) has been shown to mostly avoid these undesirable side effects. Less than 8% of children notice near blur and light sensitivity. And in those cases, the symptoms can often be managed with spectacles.

Daily treatment is continued until the child’s myopia has been stable for two years or until the end of adolescence. Treatment with low concentration atropine eye drops has been shown to decrease myopia progression by 60-77%.

Soft bifocal contact lenses for myopia progression control:

Bifocal contact lenses were developed for patients over the age of 40 who are looking to avoid wearing reading glasses. Alternatively, the way these contacts bend light that enters the eye has also been shown to have a beneficial effect in controlling myopia progression in younger patients. Bifocal contacts have been shown to slow myopia progression by 50%.

Fitting younger patients (ages 8-12) in contacts lenses requires more supervision and awareness of contact lens overwear complications. Like contact lens wearers of any age, these young patients feel that contact lenses improved their social acceptance, appearance, ability to play sports and overall satisfaction with their vision correction.

There is evidence in scientific journals to support the use of bifocal contacts and low-dose atropine for controlling myopia progression. However, the FDA has not specifically approved any contact lenses or eye drop for this purpose. Therefore, this treatment is considered “off-label” and requires adequate education and conversation between patient, doctor, and parents to determine if this treatment would be prudent in each specific instance.

If you are interested in learning more about the options for myopia control and if a prescribed control program may be a good choice for your child, schedule an eye exam with one of our doctors and we will discuss those options and answer any questions you or your child may have.