Myopia (Nearsightness) Management
Nearsightedness, also known as myopia, is an eye condition that causes blurry distant vision. People who are nearsighted have more trouble seeing things that are far away than things that are close up. If it is not treated appropriately, nearsightedness can lead to squinting, eyestrain, headaches, and significant visual impairment.
Myopia Characteristics
Problems: The retinal tissue in myopic eyes has to stretch with eyes continually growing over age. Worsening myopia can lead retinal detachment, myopic macular degeneration and glaucoma.
Prevalence: Almost 50% of the world’s population will be myopic by 2050 (close to 5 billion people). Around 10% of the population (almost 1 billion) has high myopia (-5.00 diopters or worse) and significantly increased risk of permanent vision impairment. High myopia increases risks of myopic macular degeneration (MMD), myopic retinopathy, retinal detachment and glaucoma etc.
Solution: Myopia control interventions.
Risk Factors of Myopia Development and Progression
Parental myopia: One or both parents myopic.
Refractive error: More myopic than age normal or progression worse than 0.75 D/yr.
Ethnicity: East Asian.
Up-close work: Excessive.
Outdoor: Limited exposure.
Onset: 9 yrs or less.
Methods for Myopia Control
Orthokeratology (OK) Lenses
Rigid gas permeable contact lenses worn overnight to reduce nearsightedness by temporarily and reversibly reshaping the cornea (front surface of the eye). Studies showed slowing axial length elongation between 30-60% and slowing myopia progression between 30-56%. Bonus: elimination of day time spectacle wear. We are using BeFree Orthor-K lenses and Abilti Ortho-K lenses.
Soft Contact Lenses
Two or more powers in them which are thought to slow the progression of nearsightedness in children by focusing light at the periphery of the eye in alignment or in front of the retina. Studies showed slowing both myopia progression and axial length elongation. We have been using MiSight and Abiliti™ 1-Day to fit best candidates since they were launched
Atropine
A prescription eye drop used to temporarily dilate (open) the pupil and limit the ability to accommodate (focus). One study showed low-dose atropine slows nearsightedness by around 50% (Chia et al, 2016). It is thought to slow the progression of nearsightedness through interaction with some of the receptors in the eye that control eye growth. Atropine’s mechanism of myopia control requires further investigation.
Access low-dose atropine through a compounding pharmacy.
Spectacles
Studies showed slowing myopia progression of bifocals between 39-51%, progressive glasses between 11-33% and peripheral defocus between 14-30%. We have been using Stellest and MiyoSmart to fit best candidates since they were launched.
Combination E.g. low dose atropine with any one of methods above.
Lifestyle Recommendations to Delay Onset or Reduce Progression of Myopia
Get outdoors time 45-120 minutes per day + UV exposure.
Frequent breaks from close-up work/device time. Do not be prevented from in close-up activity, but regular breaks and fixation changes should be encouraged.
Take visual breaks.
Have good lighting.
Eat well — lower carbs, lower sugar.
Be encouraged to wear myopic correction full time.
No current myopia control treatment can permanently stop or reverse the progression of nearsightedness, although cessation of progression is sometimes observed in clinical practice.