Myopia Management & Control
Myopia usually develops in childhood and can progress as children go through their growth years. Ongoing studies are finding new methods to delay the onset and slow the progression of myopia. New specialty contact lenses, glasses as well as eye drops have been shown to be successful in reducing myopia in children. If caught early enough, the result will be smaller prescriptions and less frequent lens changes.
What is Myopia ?
Myopia (nearsightedness) is the condition where the light focuses in front of the retina. As a child is growing if the length of the eyeball continues to grow their myopia will increase. The sight threatening complications of myopia are caused primarily by the stretching of the eye. Evidence based treatments are now available to significantly reduce growth of the eye in children, reducing the stretching of the retina.
Myopia Management and Control
There are multiple factors that contribute to myopia developing in childhood. Lifestyle factors that increase risk need to be identified and adjusted as much as possible to help delay the onset and slow progression of myopia. If a child has been identified as at risk or is already developing myopia, a myopia management exam should be arranged. If a child is at risk, the axial length (length of the eye) of his or her eye needs to be monitored closely to allow our doctors to arrange for treatment when necessary. A child at low risk can often be seen yearly. If their risk is moderate to high they would usually need to be seen every 6 months.
Assess you childs risk here
Risk Factors
A child with one myopic parent has 3x the risk of developing myopia and 6x the risk if both parents are myopic
The macula represents the central 10* of a persons visual field and is the part of the retina that provides 20/20 vision. The other 170* field of vision is supplied by the mid peripheral and peripheral retina. Having a background that is far away is one of the simplest and cheapest lifestyle changes that can delay the onset of myopia. It is recommended 1-2 hours a day is spent outdoors.
The smaller and closer your near electronics and work, the greater the stimulus for myopia to increase. Working in a cubical should be avoided during childhood. It is preferable for a child to work in front of a large window if possible. This allows them to have a far distance background as well as to take breaks and look in the distance occasionally
The more time spent on small electronic devices the greater the risk of myopia increasing. Using a small electronic device in the dark results in 100% near stimulus and removes the peripheral distance stimulus thus creating an increase in myopia. It is recommended that close work outside of school should be limited.
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How Myopia Develops
In babies and toddlers light focuses behind the retina. This is called hyperopia.
As a child grows the eye will lengthen to the point where the light focuses directly on the retina. This is called emmetropia and no glasses are required.
If the childs eye continues to lengthen the light will focus in front of the retina. This is called myopia and requires glasses to see clearly in the distance.
Treatment Options
Traditional single vision corrections bring clear vision to the central macula but the mid peripheral lens focuses behind the retina. The macula represents the central 10* of a persons visual field and is the part of the retina that provides 20/20 vision. The other 170* of vision is supplied by mid peripheral and peripheral retina. Because the majority of the stimulus is focused behind the retina, the eye is stimulated to continue to grow longer. Regular glasses and contacts should be avoided if your child is still at risk of myopia increasing.
MiyoSmart is a myopia treatment spectacle lens where the central lens focuses on the macula and the peripheral lens focuses in front of the macula. With all of the light focused on or in front of the retina there is no longer stimulus for the eye to grow longer and myopia to increase. Studies show this significantly reduces increases in myopia. Click here for info on Miyosmart lenses.
Abiliti and MiSight are daily disposable contact lenses for the treatment of myopia. The central lens focuses on the macula and the peripheral lens focuses in front of the retina. With all of the light focused on or in front of the retina there is no longer stimulus for the eye to grow longer and myopia increasing. An appointment will be booked for fitting of the lens and training in handling. We would typically proceed with a 6 month supply and follow up every 6 months to monitor axial length and prescription with adjustments to treatments as necessary.
Atropine is an antimuscarinic drop that was traditionally used for dilating the eye. Studies show low dose atropine to be successful in reducing increases in myopia. Studies are ongoing to evaluate its effect on axial length. Tapering off is necessary when discontinuing atropine in order to avoid a rebound which could cause myopia to increase.
