Myopia Control Update
Understanding Myopia Control: Latest Treatment Options to Slow Myopia Progression
Myopia, or near-sightedness, is one of the most common eye conditions affecting an increasing number of children and young adults worldwide. Myopia causes distant objects to appear blurry while nearby objects remain clear. While it’s often corrected with glasses or contact lenses, what many people don’t know is that myopia can progressively worsen over time, particularly in childhood. This raises the risk for more serious eye conditions such as retinal detachment, glaucoma and cataracts later in life.
Fortunately, recent advancements in myopia control offer hope in slowing down its progression, especially for children in their crucial development years.
Some of the latest treatment options available:
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Use of Atropine Eye Drops
One of the most effective treatments for slowing myopia progression is the use of low-dose atropine eye drops. Atropine, an antimuscarinic agent, has been studied extensively and is proven to significantly reduce the rate of myopia progression in children. Studies show that 0.01% atropine is effective in slowing myopia progression without many of the side effects seen at higher concentrations.
How it works: Atropine helps to relax the eye muscles and reduce the elongation of the eye (which causes myopia), though the exact mechanism is still being studied. We have seen excellent results over the last 7 years, since implementing this into our treatment regime for patients with progressive myopia. First data on low dose Atropine being used to treat myopia was published in 2015. This was a 5-year study performed on children in Singapore to assess the efficacy of atropine on slowing myopia progression https://bjo.bmj.com/content/104/3/363.abstract. The research since has continued to provide promising data in much larger numbers worldwide.
Pros: Minimal side effects when using low-dose formulations, effective in children over several years, easy to use.
Cons: Requires daily use, may lead to rebound effects once discontinued.
At Sydney Ophthalmic Specialists, we review all of our patients being treated with low dose Atropine every 6 months. We monitor the length of the eye using A-scan ultrasound. This allows us to track any growth during the treatment period and assess whether this lies within a normal / acceptable range. We carefully monitor patients throughout their treatment and continue to monitor them following the cessation of drops, to ensure that we are alerted to any rebound refractive error.
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Defocus Incorporated Multiple Segments (D.I.M.S) spectacle lenses
Myopia control interventions, such as DIMS spectacle lenses have been adopted in school-aged children to reduce the prevalence of myopia and its complications.
Unlike single-vision lenses with only one corrective zone, spectacles with the patented D.I.M.S. technology means the lenses have a clear zone with central power and a myopic defocus zone. This provides clear vision and myopic defocus simultaneously at all viewing distances. Myopic defocus has been shown to inhibit eye growth (axial elongation), which in turn slows down myopic progression. (https://www.eyecarekids.com.au/miyosmart)
MiYOSMART spectacle lenses are an example of lenses that use DIMS technology and are readily available throughout Australia. Hoya have also released a range of MiYOSMART Sun spectacle lenses that combine myopia control with UV protection. Their aim in creating these lenses is to encourage as much outdoor play as possible, having learnt a lot about the beneficial effects of outdoor activity in reducing the risk of myopia – see next paragraph for more on this! Please ask your optometrist about DIMS lenses when you are next updating your child’s glasses.
Image of the optical physics of a myopic eye being treated with a standard lens versus a DIMS lens. Image courtesy of eyecarekids.com.au
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Lifestyle Modifications
Recent studies highlight the importance of outdoor activity in reducing the risk of myopia progression. Exposure to natural light and focusing on distant objects may help delay the onset of myopia and slow its progression.
Recommendations:
- Spend at least 1-2 hours outdoors daily.
- Encourage breaks from prolonged near tasks such as reading or screen time, following the “20-20-20 rule” – every 20 minutes, look at something 20 feet away for 20 seconds (which is the equivalent of looking at something ~6 meters away).
Pros: Non-invasive, no cost, generally beneficial for overall physical health and mental wellbeing.
This may be more challenging for children with busy schedules or those who live in urban environments with limited access to outdoor spaces. Nevertheless it is important to make every effort to get children outside & active for the multiple benefits it provides.
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Orthokeratology (Ortho-K) Lenses
Ortho-K involves wearing specially designed rigid gas-permeable contact lenses overnight, which temporarily reshape the cornea. This provides clear vision during the day without the need for glasses or contact lenses. Research has found that Ortho-K can slow the progression of myopia in children.
How it works: The lenses flatten the cornea, reducing its curvature and correcting myopia temporarily. The reshaping effect diminishes throughout the day, requiring nightly wear.
Pros: Provides clear daytime vision without glasses or contact lenses and has been proven to slow myopia progression.
Cons: Ortho-K requires diligent nightly lens wear, involves higher costs and requires more regular follow-up visits. There is a risk albeit low, of infection if lenses are not cared for properly. For these reasons, we do not tend to recommend Ortho-K for our young patients when treating their myopia.
The Importance of Early Intervention
It’s important to note that while these treatments won’t cure myopia, they can significantly slow its progression. Early intervention is key to protecting long-term eye health. If your child has been diagnosed with myopia or shows signs of vision problems, consult with an eye care professional to discuss the best myopia control strategy tailored to your child’s needs.
The field of myopia control is evolving rapidly based on ongoing research. By slowing down the progression of myopia, we can reduce the risk of future eye health complications and ensure better vision outcomes for children as they grow.
Do you have concerns about your child’s vision? Book an appointment with one of our paediatric ophthalmologists to explore the most suitable treatment options for your family.