Myopia Management

What is myopia?

Myopia, more commonly known as nearsightedness, is the lengthening of the eye resulting in blurred distance vision. This has been commonly corrected with glasses and contact lenses. Unfortunately, most patients with myopia experience a worsening of vision every year requiring stronger and stronger corrections throughout their childhood and well into their early adult years. Myopia incidence has been increasing at an alarming rate, rising from 25% of the US population in the 1970's to over 40% today. In some countries of the world this rate is over 80%.

What causes myopia?

In short, we don't really know for sure, but there are somethings we in the eye care community feel play a part. Children of myopic parents are more likely to develop myopia. Children that spend more time indoors tend to develop more myopia. Children that spend more time doing near work, either on tablets and video games or reading, writing and drawing, are at a higher risk of becoming nearsighted.

Why is myopia a concern?

Myopia is the 6th leading cause of blindness worldwide. Myopic patients are more likely to develop retinal holes and tears that lead to retinal detachment, which can cause total loss of vision. Glaucoma, a condition causing loss of peripheral vision and eventual blindness, is more common in myopic individuals. Myopic macular degeneration causes central vision loss, similar to age related macular degeneration. Increased Myopia can also increase the risk for Cataracts. Even if you never develop any of the listed conditions, the ongoing cost of new glasses and contact lenses is significant in its own rights.

My child is not myopic, what should I do to prevent them from developing myopia?

First, bring your child in for an examination to assess their personal risk factors for developing myopia. Currently it is recommended that parents get their children outdoors from 90 - 120 minutes a day. Research suggests distance viewing and the brightness of the light outdoors (rather than UV exposure itself), can reduce the prevalence of myopia. So plan on spending as much time outdoors as you can but don't forget your sunscreen and sunglasses. Also, limiting near work like hand held electronics to 2 hours a day as well as taking visual breaks every 30 minutes can be helpful.

My child is already myopic, what can I do?

While we cannot stop myopia from progressing, we are able to slow the progression by a meaningful amount. The most effective methods involve the use of the medication atropine, othokeratology, soft multi-focal contact lenses or even bifocals for some children.

Methods of Myopia Control

Treatment method an Estimated Rate of Reduction:
Bifocal glasses: ~20%
Soft Multifocal Contacts: ~40%
Orthokeratology: ~50%
Atropine 0.01%: ~60%
Atropine 1%: ~90%

Atropine

Atropine is the most effective method in myopia control and first line therapy in several countries where myopia prevalence is approaching 80%. It is thought to block certain receptors in the eye from sending the signal for growth. Atropine is a strong dilation agent and will cause blur and light sensitivity at a 1% concentration without the use of bifocal glasses with photochromic lenses. Research has shown that atropine can be diluted to a concentration that does not cause dilation effects and maintains a meaningful amount of myopia reduction. This form of control is generally recommended for children that are at the greatest level of risk or are not good candidates for orthokeratology or soft multifocal contact lenses.

Orthokeratology

Orthokeratology reshapes the cornea overnight using special activator lenses, leaving the patient with good vision during the day without contacts or glasses. It is thought that the peripheral defocus ring caused by the reshaped cornea prevents the signal for eye growth. This method of control is recommended for active children with moderate myopia and astigmatism who prefer not wear any correction while awake.

Soft Multifocal Contact Lenses

Soft multifocal contacts are thought to work in the same way as orthokeratology, by creating a ring of peripheral defocus. Custom designs are generally used to better match each patient's unique measurements, but even mass produced multifocals have shown good control. This method is recommended for those patients that are not good candidates for orthokeratology.

Bifocal glasses

Bifocal glasses are considered the least effective means to control myopia. Research has shown best results with children with certain eye alignment and focusing postures. This method is recommended only for children adverse to wearing contacts or using eye drops that meet the eye alignment and posture criteria.

What about under correction or eye exercises?

Under correction has been shown to either have no effect or even speed up the rate of myopia progression. There are no exercise methods that have been shown to be effective in reducing myopia.

Does insurance cover myopia control treatment?

There is currently no coverage for myopia control services. Some plans may contribute to the devices used in myopia control treatment though, such as bifocal glasses, atropine medication and multifocal contact lenses. Orthokeratology and the activator lenses used are not covered under any insurance at this time.

Are these methods FDA approved?

None of the aforementioned treatments are FDA approved specifically for myopia control, though they are all FDA approved for the correction of refractive errors or medical treatment. Many commonly used medicines are this way, as drugs and treatments are used every day in new and exciting ways despite being FDA approved for other uses.
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