Myopia management is a strategy to slow down the progression of myopia in a child’s eyes. I will discuss the different strategies available and how they work to help stave off worsening myopic vision.
If you struggle to see distant objects clearly, then you have myopia, also known as nearsightedness. This is a common condition that is caused when the eye is longer than it is spherical.
Your ‘football’ shaped eye prevents light rays from focusing correctly on the retina. The retina is the part of your eye that converts light into signals that create images. If left untreated, it often worsens with age.
Your first treatment option may include single-vision glasses or soft contact lenses. However, if your myopia continues to progress, then these options will not be enough! I will share with you techniques to help manage the progression.
While the best treatment for myopia management defers from person to person, the most common forms are multifocal contact lenses, low-dose atropine, and orthokeratology. If your myopia is not managed from a young age, you may develop cataracts, glaucoma, and retinal detachments.
What is myopia management?
Myopia management is a strategy to slow down the progression of myopia. This is done early in a child’s life to prevent the risk of further impairment and secondary conditions.
Myopia is managed through controlling your environment, binocular vision, and using optical treatments. I will discuss all strategies and treatment options to help you decide what may be the best option for you!
What are common treatments for myopia?
Treatment and management of myopia are different. Single vision glasses or contact lenses are your first line of treatment for myopia. These glasses and lenses correct myopia and can help you see better. But, they do not treat the underlying problem and therefore are not a great method for myopia management.
Laser-assisted in situ keratomileusis (LASIK) is a laser procedure that may correct myopia up to -6.00D of sphere and -2.00D of astigmatism. If your myopia is increasing every year, then LASIK cannot be an option for you until it stabilizes. Lasik is a treatment method and is not used for progression management.
What are common treatments used in myopia management?
Bifocal or MultiFocal Contacts
If your myopia is progressing every year, you want to use myopia management to control the progression. One option is bifocal or multifocal contact lenses.
These lenses are split to have two different prescriptions. One for distance and one for near vision. This is beneficial as most myopic patients have decreased accommodative responses. This means they are unable to relax the eye muscles to help them focus at near.
The only FDA-approved lens for myopia management is CooperVision’s MiSight for children who are 8-12 years old at the time of their first fitting.
Orthokeratology or Ortho-K
If you have myopia under -6.00D or astigmatism under -1.75D, orthokeratology is an FDA-approved option for the management of myopia. Orthokeratology or corneal reshaping is a method where a rigid contact lens is worn at bedtime.
This lens flattens the center of the cornea (the front surface of the eye) while you sleep so that you can see clearly during the day. Ortho-K is conducted over a long period of time and requires multiple follow-up appointments at 1 day, 1 week, 1 month, 3 months, 6 months, etc.
Ortho-K lenses are not recommended if you have a history of corneal damage. A common question about ortho-k lenses is why they are safe to wear while sleeping. While you should never wear soft contact lenses at night, ortho-k lenses consist of a material that allows improved oxygen flow to the eye. This, along with the high water content, prevents bacteria growth. Current FDA-approved lenses include Euclid Emerald, Paragon Corneal Refractive Therapy, and Bausch and Lomb’s Vision Shaping Treatment.
Low-Dose Atropine Drops
If you or your kid struggle to put contact lenses in, low-dose atropine drops may be an option! These drops can be used at any age, but like most management options, they are best used for patients aged 5 to 18.
While the mechanism is not well understood, it is thought the drops keep the eye from getting longer. These drops are used for at least 6 months with monitoring. If helpful, they are continued up to the year point.
If progression continues, the drops can be restarted for another 6-month to year period. Low-dose atropine drops have minimal side effects. Some patients may experience dilated or enlarged pupils. Other potential but uncommon effects include allergic reactions.
Interestingly, atropine can also be used for toxicity from pilocarpine, the active ingredient in Vuity drops.
DIMS lenses, although not FDA-approved in the United States are a treatment option for those located in Singapore and China. According to a clinical trial conducted in China, these lenses show slowed progression of myopia. This lens works by causing defocus in the outer visual edge. This is thought to help decrease progression. DIMS lenses may be an option to consider shortly in the United States!
If none of the treatments so far have seemed like the option for you, you may benefit from trying bifocal glasses. While this treatment method is not the top choice among optometrists for preventing degeneration, they are used in situations where it is the only choice.
Why is myopia management important?
The earlier you develop myopia, the quicker it will worsen. It is important that you visit the eye doctor yearly to observe any changes.
High myopic patients are more at risk for conditions down the line. These include irreversible blindness, cataract development, glaucoma, retinal detachment, and macular degeneration.
What is the best myopia control?
There is no one method for myopia control. It is based on many factors that range from your prescription to your lifestyle. What works for someone may not work for you!
The top three options for you to consider are low-dose atropine drops, orthokeratology, and multifocal contact lenses.
Atropine might be the best option for a younger kid or you if you have an aversion to contact lens insertion and removal. However, for slightly older kids or patients with a more active lifestyle, orthokeratology would be a better treatment option.
Due to optics, multifocal contact lenses are only beneficial for patients with low to mild myopia.
Along with these optical treatments, it is also important to manage your binocular vision. Binocular vision is the ability of both eyes to work properly together.
If you have high myopia, it can cause eye turns and accommodation problems. Accommodation is the ability for your eyes to change focus as needed.
Is myopia management necessary?
Myopia management during development is vital in preventing high myopia. High myopia can lead to secondary eye conditions (cataract, glaucoma, retinal detachments).
At what age can you start managing myopia?
Management can begin at any age. Myopia continues to worsen with age but generally stabilizes around adulthood. The earlier you find the correct management method with the help of your optometrist, the better off your eyes will be!
Although better if started early, it can still be used in teenagers whose myopia continues to progress.
Can I reduce myopia naturally?
Near work during eye development can play a role in the development of myopia. Children should spend at least 2 hours a day outdoors to reduce the risk of onset. However, it does not reduce myopia that is already present. Everyone should follow the 20-20-20 rule; look 20 feet away for 20 seconds every 20 minutes. While this will not reduce myopia, it reduces eyestrain, an uncorrected symptom of myopia.
Currently, no data shows that increased nutrition intake can minimize the risk of myopic progression. However, eating healthy and getting the appropriate vitamins is always helpful for general eye health.
What is the highest myopia? Can it be controlled?
High myopia is considered a refractive error greater than -6.00 diopters.
High myopic patients are most at risk for the development of secondary eye conditions. Myopia management does not reverse the effects of Myopia. It is, therefore, best when done at an early age.
While it can be controlled, patients with high myopia may be limited in their treatment choices. Techniques such as orthokeratology or multifocal lenses are not approved for high myopia cases.
Is it possible to slow the progression of myopia?
Yes! It is possible to slow the progression of myopia through treatments such as Orthokeratology, low-dose atropine drops, and multifocal contact lenses. This is best when done during the developmental age but can still be used at any time.
This is the purpose of myopia management. Please discuss a myopia management program with your child’s eye doctor if you think it could benefit your child!