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Myopia Management

Myopia, or near-sightedness, is a growing problem among children. Those with myopia can easily focus on near work, like reading or seeing their phone, while distance vision, like street signs, are blurry and difficult to see.

What Is Myopia?

Myopia occurs when the eyeball grows too long resulting in light being focused in front of the retina instead of directly on its surface.

If you are a parent, it is important to look for the tell-tale signs of myopia like squinting to see distant objects and difficulty seeing the blackboard at school. Poor posture while reading and a lack of interest in outdoor games can also indicate your child may have difficulty seeing distant objects.

It’s natural for myopia to get a little worse throughout childhood and adolescence, but sometimes it progresses too quickly resulting in progressive myopia and higher degrees of near-sightedness. This increases the risk of developing several serious eye conditions which include vision-threatening diseases like retinal detachment, macular degeneration, cataract, and glaucoma later in life.

It isn’t fully understood why some near-sighted individuals develop progressive myopia and others do not. However, we do know that children with a severely near-sighted parent (or parents) have a higher risk of developing the condition.

Global prevalence of myopia

The last few decades have seen a steady rise in the prevalence of myopia across the globe with more than 50% of the global population estimated to be myopic by 2050. (1) A growing body of evidence suggests that behavioural and lifestyle influences (education and environment) along with genetics, are contributing to higher incidences of myopia.

Genetics

Myopia in children increases when parents are myopic. (2) The risk is nearly:

1 in 2

When both parents are myopic.

1 in 3

When one parent is myopic.

1 in 4

When neither parent is myopic.

Children are becoming myopic at a younger age. (3)

This results in faster progression and ultimately a higher level of myopia and increasing dependence on glasses and/or contact lenses with the associated lifestyle challenges this inevitably brings.

Myopia control/management

This is the area of children’s eye care dedicated to slowing down childhood myopia progression. At Horrocks & Boyd, we can prescribe special types of spectacle lenses or contact lenses to help slow down your child’s vision from worsening. We will also talk to you about your child’s visual environment including how much time they spend on screens and reading as well as how much time they spend outdoors.

Myopia control and myopia management is important because it’s preferable to have a lower prescription number, thinner glasses and less frequent changes in glasses prescriptions. Generally, once a child becomes myopic, it tends to progress or get worse every few months. The younger a child becomes myopic, the faster they tend to progress leading to higher levels of myopia. This means it is best to start a myopia management strategy as soon as possible.

Lifestyle

Modern lifestyles may influence the development of myopia.

Low levels of outdoor activity. (4)(5)

Prolonged near tasks such as reading and gaming on portable devices. (4)(6)

Poor lighting levels. (4)(6)

Why do we want to slow down myopia progression?
If your child has to wear spectacles anyway, does it matter if they’re stronger or weaker?

Enhancing quality of life

A child with myopia needs to wear glasses or contact lenses to correct their blurred distance vision. However, if your child has lower myopia, they’re more functional in the mornings before needing to put their spectacles or contact lenses on; they can cope a little better without them rather than being totally dependent on them. Also, if your child does decide to have laser surgery to correct their myopia in early adulthood, a lower prescription means both more likelihood of them being suitable and have better visual outcomes after surgery.

Protecting eye health

In progressive myopia the eye is growing at an accelerated rate. This excessive growth of the eye stretches the retina, the light sensitive layer lining the back of the eye, and the stretching increases risk of eye diseases and vision impairment occurring across your child’s lifetime.

The good news

Together there’s something you can do about it so talk to the team at Horrocks & Boyd about our myopia management options for your child. This could include specific types of spectacle lenses, contact lenses and advice about the visual environment.

Remember, every 1 dioptre less of myopia (-1.00D) decreases dependence on spectacles and the risk of potential eye diseases in later life.

What are the treatments?

Studies have shown that increasing outdoor time slows myopia progression. This means parents can help their child immediately by ensuring they spend more time outdoors. A good time to aim for is 2 hours per day outdoors.

Alternatively there are now more advanced correction methods which not only correct refractive myopia but can reduce the rate of myopia progression for many. These include:

 

Myopia Control Spectacle Lenses

Standard spectacle lenses primarily correct myopia – but they do not assist with controlling myopia progression. Several spectacle lens manufacturers have now developed spectacle lenses with more specialised optics that both correct myopia to allow clear distance vision and help reduce myopia progression

 

Myopia Control Contact lenses

  • Daily Disposable soft contact lenses with specially designed optics that reduce peripheral retinal blur and help reduce eye growth. With fresh new lenses every day, daily disposable contact lenses offer a very healthy and hygienic way to wear contact lenses, especially for younger children.
  • Rigid corneal contact lenses designed to gently reshape the cornea during overnight wear with the lenses being removed in the morning so there is no need to wear any correction during waking hours. This treatment approach is called Orthokeratology and has also been shown in clinical studies to slow myopia progression.

 

Pharmacological therapy

Investigators have looked into using topical low dose atropine eye drops to disable the eye’s focusing mechanism to control myopia. Early results have been impressive at least for the first year of treatment, however atropine eye drops do not currently have regulatory approval for myopia management use in the UK. This is because long-term effects of sustained use of the medication are still unknown as well as longer term treatment effectiveness.

Whilst there isn’t an outright cure for myopia, the different management options available today can slow down the progression of myopia on average by about 60% for many children. Treatment is however unlikely to stop progression completely and pre-exiting myopia will not be reversed. The team at Horrocks & Boyd are happy to answer any questions on the management options we offer and the latest evidence-based research findings to help individualise treatment plans for your child.

References

  1. Holden BA, Fricke TR, Wilson DA et al. Global Prevalence of Myopia and High Myopia and Temporal Trends from 2000 through 2050. Ophthalmology. 2016; 123:1036-42
  2. Morgan P. Is Myopia Control the Next Contact Lens Revolution? OPTICIAN 2016
  3. McCullough SJ, O’Donoghue L, Saunders KJ (2016) Six Year Refractive Change among White Children and Young Adults: Evidence for Significant Increase in Myopia among White UK Children. PLoS ONE 11(1): e0146332. https://doi.org/10.1371/journal.pone.0146332
  4. Gifford P, Gifford KL. The Future of Myopia Control Contact Lenses. Optom Vis Sci.; 93:336-43.
  5. Rose KA, Morgan IG, Ip J, et al. Outdoor Activity Reduces the Prevalence of Myopia in Children. Ophthalmology 2008; 115:1279-1285.
  6. Wolffsohn JS, Calossi A, Cho P, et al. Global Trends in Myopia Management Attitudes and Strategies in ClinicalPractice. Cont Lens Anterior Eye. 2016; 39:106-16.

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