Myopia
What is myopia?
Myopia (nearsightedness) is when the image from an external object is focused by the cornea and lens of the eye in front of the retina instead of on it. A person can see up close but not far away, unless he or she wears glasses. It occurs when the cornea is too curved or the eye is too long.
What causes myopia?
The exact cause of myopia is uncertain, but it derives from both environmental factors (near work and reading vs play) and genetic factors (parents with nearsightedness).
Myopia can increase yearly into the late teen years or possibly even the early 20s.
How do you treat myopia?
Myopia is treated with single vision glasses. But that only corrects the vision at a point in time. Glasses may not slow down the progression.
Since the number of children who are nearsighted is increasing, new treatments to slow myopia progression include:
Visual behavioral modification
Dilute atropine eye drops
Contact lenses
Why should we try to slow down the progression of myopia (prevent it from getting worse over time)?
The higher the degree of myopia, the higher the likelihood of developing other eye problems, such as retinal detachment. The latter occurs due to the eye getting too long thus stretching out the retina lining the inside of the eye so that it is thinner than normal and is more prone to developing a hole which can lead to a retinal detachment.
What options are available to slow myopia progression?
Behavioral modification:
Less near work, more time outside (1-2 hours, especially close to dawn or dusk), and taking breaks. Rules such as the 20:20:20 rule (look 20 feet away, every 20 minutes, for about 20 seconds) or just taking a 15 minute break from reading and near work every 45 minutes can be helpful.
Eye drops (Low Dose Atropine):
Slow eye growth by acting on the white wall of the eye (sclera) either directly or indirectly.
An every night drop before bed time eye drop of low dose atropine (0.01% to 0.05%) is prescribed by your eye specialist. Sometimes covered by insurance but not always.
Possible side effects include blurry near vision and light sensitivity. This is usually minimal with the 0.01% atropine drops. Sunglasses or reading glasses can be used if needed.
Your eye specialist will determine the correct dosing and monitoring, which may be as much as every 6 months initially.
Low dose atropine has shown about 50% effectiveness in current research for slowing down the progression of myopia compared with doing nothing. However, different studies have shown different results, such as whether it works in Asians but not in other ethnic groups.
Soft multifocal (bifocal) contact lenses:
The contact lens bends light in a specific way to relax the child's focusing system and create peripheral defocus which slows myopia progression.
Children are fit in the soft contact lens by a contact lens specialist. We don't do that in our clinic but refer you to a specialist for that if needed
There are some risks associated with wearing contact lens such as corneal infection, so the risks and benefits have to be weighed.
How long does my child need these treatments?
The exact amount of time your child will need treatment may vary, but usually there needs to be an initial commitment of 1 to 3 years.
Repeated dilation and refraction and axial length (how long the eye is) measurements with a special instrument (A-scan ultrasound or optical biometer) may be needed to monitor myopia progression and treatment results.
The following American Academy of Ophthalmology Video may be helpful.