By Dr. Thomas Aller, OD, FBCLA
Myopia, or nearsightedness, is starting earlier in children, progressing more rapidly and reaching higher levels than ever before. Throughout Asia, myopia now affects up to 90% of young adults. This is putting our children’s vision and healthy eyes at significant risk, yet there are non-surgical, effective methods which can control the progression of myopia right now.
Unfortunately, most eye doctors do what we’ve done for a hundred years—prescribe stronger glasses as a child’s vision deteriorates. If your eye doctor seems hesitant, have him read this blog and explain why your child shouldn’t have their myopia progression effectively treated instead of just getting stronger glasses every year.
What is Myopia?
Nearsightedness or myopia occurs when the eye cannot see far objects clearly. There are many problems associated with myopia such as glaucoma, cataracts, and retinal detachments.
Myopia tends to start at around the age of eight, though this typical starting age is trending younger. It then usually worsens gradually over time, though the typical rate of worsening has been increasing. Classically, in textbooks and in optometry and ophthalmology school lectures, it has been described as a simple genetic condition with a predetermined start date and a so called “age of cessation” at age 16.
What the textbooks and many professors haven’t noticed is that the nature of myopia has changed over the last 30 or 40 years. Clearly, genetics plays a role in the fact that children with one or two parents with myopia are more likely to develop myopia. Yet, for several hundred years there have been studies that noted that the more near work one does, the more likely that person will have myopia.
One review study encompassing over 20,000 children, has demonstrated a link between near work and myopia. Other studies have shown a correlation between number of years of school and myopia and other studies have shown a link between IQ and myopia.
Fortunately, along with the realization that genetics may only cause increased risks of myopia has come the realization from the last 30 years of research that there are currently proven methods to either delay the beginning of myopia or to slow the progression effectively once it has started.
What We Can Do
Numerous studies from around the world have proven that the more time a child spends outdoors prior to becoming nearsighted, the less likely they will become nearsighted. This is of value because since myopia tends to increase more rapidly at the youngest ages, delaying the beginning will ensure that the final amount of myopia will be lessened.
Low dose atropine eye drops have been shown to slow myopia by 60 to 70% and studies suggest it is unlikely to cause a rebound effect when it is stopped. Pupil dilation and the difficulty focusing up close, common at higher dosages, is almost unnoticeable at this type of low dose, making it a great option for children.
Multifocal soft contact lenses have also been shown to slow myopia by an average of 50% in multiple studies and children do very well with them. One study on a pair of identical twins showed that the twin that wore multifocal contact lenses had a slight reduction in her myopia after one year while her twin doubled her myopia in the same year with standard contact lenses. Interesting evidence of the effects of genetics in that each twin had the same amount of myopia, yet after wearing different types of contact lenses, their final myopia levels were very different.
Orthokeratology or corneal reshaping involves the wearing of specially designed gas permeable lenses overnight. In the morning, they are removed and the child can see clearly all day long. Kids and parents love the improved vision during the day without the need for glasses and contact lenses which may get in the way for swimming and other sports. Orthokeratology has also been shown in numerous studies to slow myopia progression by 50% on average and this has led to this modality becoming very popular for childhood myopia.
Making “Myopia Control” the Standard of Care
Some doctors and parents may ask, “What is the big deal with slowing myopia?” Numerous models have shown that even a 50% reduction in myopia progression significantly reduces the risks of myopia related eye diseases, many of which can lead to permanent vision loss. The better question is, “Why shouldn’t we make myopia control the standard of care for all children?”
The options to control myopia have proven efficacy, excellent safety records and are all non-surgical. We need to encourage all eye doctors and allied health care professionals, like pediatricians, to think differently about childhood myopia and realize we can help children now and for their lifetime with early intervention and treatment.
Thomas Aller, OD, FBCLA has been in private practice in the San Francisco Bay Area for 34 years. He has been conducting clinical research in myopia control for 25 years. Currently he is a Senior Project Scientist for the Vision CRC and collaborates on the myopia control projects of the Brien Holden Vision Institute.