Myopia Control
What is Myopia?
Myopia (shortsightedness) is not a new condition. When the light that comes into the eye focuses in front of the retina at the back of the eye – the focus falls short of its intended spot – hence the term shortsightedness. This causes a blurry image to fall onto the retina.
When we look at something closer, we usually need to focus harder to see it clearly. If a person is myopic or shortsighted, their eyes are already focused for near. For the myopic person, seeing up close is relatively easy and effortless. The problem is, when the myopic person looks up to see in the distance, even with the eyes relaxed completely, they are still unable to see clearly.
In recent years we have become more concerned about Myopia in our community. Myopia appears to be increasing in our population and starting at a younger age than we would have seen in the past. This leads to more Adults with higher amounts of Myopia. The higher the amount of myopia the more difficult it is to see, and the more likely it is that eye disease will develop later in life.
As optometrists we are very aware of this trend and we want to do our part to help to slow this increase in Myopia in our part of Australia – we want to flatten the myopia curve! How do we prevent myopia from developing in our children?
Myopia development is related to:
- Lifestyle
- Race
- Genetics
Lifestyle is something that we can control. Evidence has told us that the best way to keep the eyes seeing in the distance is to allow them to see in the distance – going outdoors is absolutely recommended! We know that limited outdoor time can result in more myopia. We also know that spending long hours looking at something close is also a risk factor. Examples of close tasks might be reading a book for hours, spending days looking through microscopes, or prolonged use of a phone.
Some rules of thumb for the kids:
- Take a regular break from looking at the book/screen. The 20/20/20 rule is easy to remember:
Every 20 minutes look 20 feet away (that’s 6 metres) for 20 seconds
- Take a note of how much time you spend on a screen – try to spend DOUBLE this amount of time outside. (this is probably not possible in COVID times but it’s a great goal)
We can also help to reduce eyestrain when your child is reading/using screens. We know that in some cases the eyes struggle to focus and point comfortably (accommodative lag and esophoria). It is often these children that will develop myopia as they grow. If we can step in to relieve this eyestrain with a pair of glasses, this can help to keep the eyes comfortable and relaxed and help to keep the distance vision clear. Sounds ridiculous doesn’t it? Give glasses so that the child might not need glasses!
To explain: The glasses we give to a child who has eyestrain are mild lenses to support the focusing system. We do not expect that the child will need these forever, or that these glasses will need to be increased in strength progressively over time. If a child becomes myopic we know that the first pair of glasses to correct myopia is the first of many. The need for glasses will grow, the vision will become more blurry as the child grows and the eye grows.
What can be done if my child is myopic?
Currently ( in May 2021) the best evidence-based methods for controlling the progression of myopia are:
- Ortho K
- Multifocal/peripheral defocus soft contact lenses
- Low dose daily atropine eye drops
- Glasses with peripheral defocus technology DIMS (Hoya Miyosmart )
Ortho Keratology (ortho K) is the wearing of hard contact lenses over night while asleep. The lens is designed to mould the front of the eye into a new shape that allows the eye to see – it really is like a magic fix! It can take some time to get set up with ortho K and it isn’t suitable for everyone. We do find that most of our ortho K wearers love it, no need for glasses during the day! fabulous for sport and for the beach. Best of all your child can go to school for the day with no worries about contact lenses.
Multifocal/peripheral defocus soft contact lenses are lenses of a particular design that are disposable and worn during the day. There are daily lenses that are worn once then disposed of, or a monthly option that is worn during the day for thirty days, cleaned daily and disposed of after one month. Again those who get into the rhythm of wearing soft disposable contact lenses usually love it once they are used to them.
Low dose daily atropine drops are a drop called atropine that is diluted down to a tiny amount. The diluted drop is put into the eye once daily. This has been shown to be effective in reducing the progression of Myopia while causing negligible side effects. The drop is well tolerated, it’s a matter of remembering to put it in once daily – usually at bedtime. The drops need to be made up at a specialist compounding pharmacy. As of August 2020 there are two of these pharmacies in Melbourne. A prescription is required, we are able to write one for you.
Your child will also need glasses to see in the distance. If your child wears the soft contact lenses or the ortho k they will still need to have a pair of glasses as a backup. If they use the daily eyedrops then they will be wearing daily glasses. When someone is a young myope we look carefully at the lens options before prescribing glasses. New lens designs are constantly being developed to help the young shortsighted person. The Hoya Miyosmart DIMS spectacle lens is the most recent addition to the list of useful myopia control treatments. Each of the above options has been well proven to slow/reduce myopia progression by approximately 60%.