Myopia Management Program
The earlier a child begins to develop myopia, the faster and more severe the progression often occurs (4,5). For example, children who begin developing myopia before age 13 are orders of magnitude more likely to have high myopia later in life compared to a college student getting their first pair of glasses.
As with many medical conditions, genetics and ethnicity are also associated with myopia development.
Myopia in the Parents (7)
- If Neither parent is myopic, the myopia risk for their children is 7%
- If One parent is myopic, the myopia risk for their children is 17%
- If Both parents are myopic, the myopia risk for their children is 40%
Myopia Percentage by Ethnicity of 6 year olds in the United States (22,23) .
- Non-Hispanic white - 1.2%
- Hispanic white - 3.7%
- Asian - 3.98%
- African American - 6.6%
This is likely a proxy measurement for a variety of things but the literature is clear that these are risk factors (8,9,10)
- Higher levels of education
- Better housing
- Higher income
- Occupations associated with extensive near work
From looking at the literature, it is clear that near work DOES increase the risk of myopia development AND progression.
This association seems stronger with electronic devices (tablets, cell phones, video games devices), when holding things closer than appropriate to read, and with extended periods of near work without taking breaks.
- In one study (11), children who read more than two books per week were 3x more likely to develop myopia. This same study found that reading more than 2 hours a day was not associated with myopia progression.
- Another study (12) found that more than 3 hours per day spent on a digital device, on specifically a digital device caused a 2-to-3-fold increase in the development of myopia, in one study with as little as 30-60 minutes of use per day (13).
- The Sydney Adolescent Vascular and Eye Study (SAVES) (14) found that children who became myopic performed two more hours of near work per week than patients who did not become myopic. Although this effect was not as clear or strong for older children.
- There seems to be an association with the duration of continuous near work rather than cumulative duration of near work. Additionally, shorter reading distances have been correlated with faster myopic progression (15).
It has long been suggested that outdoor play reduces the risk of myopia progression in children, research agrees!
“Outdoor activity reduces the prevalence of myopia in children”(16) Conclusions
- 12-year-olds with higher levels of outdoor activity had lower myopia prevalence
- Children with high levels of near work AND low levels of outdoor activity had the most myopia.
- Conversely, children with low levels of near work AND high levels of outdoor activity had the least amount of myopia.
- Regardless of near tasks, children with higher levels of outdoor activity had the lowest risks of myopia
- In the younger children, ages 6 and younger, outdoor time was NOT associated with myopia progression16.
A study of 7 – 12 year-old children found that children who had two additional hours of outdoor activity a week were half as likely to develop myopia (17).
A meta-analysis of seven studies looking at outdoor time and myopia development, concluded that the risk of development and progression of myopia decreased by 2% per additional hour of outdoor time a week (18).
Possible mechanisms? - While this association is clear, the cause is less understood.
- Increased sunlight from outdoor time leads to dopamine release, dopamine release is hypothesized to thicken the globe of the eye which decreases axial elongation reducing myopia prevalence (16,19).
- Visual targets outdoors are typically more diverse and farther away than indoors where objects are closer and cause more hyperopic defocus (20)
- Vitamin D (vitamin made by the skin during sun exposure): While this is likely more correlation than causation, myopic individuals have lower levels of Vitamin D vision normal individuals.
Typically, soft bifocal contact lenses have been used to help contact lens wearers to see up close when near vision begins to fade during the 40’s and 50’s. These lenses are used in myopia control because they decrease hyperopic defocus which is known to accelerate eye growth and myopia (24).
There are several types of Bifocal or Multifocal Contact lenses available for us to try. Even though most bifocal lenses are not FDA approved for myopia control specifically, there are many studies that laud the effectiveness of this treatment approach (25, 26, 27). In 2020, the first Dual Focus contact lens called 1Day MiSight was FDA approved for the purpose of myopia management in the United States.
Soft Bifocal Contact Lenses reduce the risk of Myopia Progression by 45-55%
Orthokeratology (ortho-k) also known as Corneal Reshaping Therapy (CRT) is a non-surgical method of reshaping the front of the cornea to correct for myopia refractive errors. This is accomplished by having the patient where a hard contact lens overnight while asleep. Think of it as a retainer, but for the eyes. During sleep the hard lens gently flattens the central cornea shape. When the lens is removed in the morning, no glasses or contact lenses are needed during the day. The lens is then reused at night to maintain the slightly flattened corneal curvature.
Because of the way an Orthokeratology lens molds the surface of the eye, the resultant corneal shape causes a decrease in hyperopic defocus landing on the retina (30). Therefore, in addition to not having to wear glasses during the day, Orthokeratology has also been shown to be highly effective in the prevention of myopia progression (28, 29).
Orthokeratology reduces the risk of Myopia Progression by 41-51%
Atropine is one medication in a family of medicines used in eyecare to dilate the pupil and temporarily paralyze the focusing system to better visualize the internal parts of eye. The theory of how these medications slow the progression of myopia is unclear and there are several hypotheses from causing dopamine release to causing thickening of the wall of the eyeball (32-37). Regardless of how it curtails myopia progression, it is exceedingly effective. Standard 1% atropine dosing locks down the development of myopia by 80-90%. Unfortunately, high concentration atropine causes significant visual side effects and significant myopia rebound when atropine therapy is stopped (38,39). Diluted solutions of atropine, while not as effective, still show a strong ability stop myopia progression with little to know visual side effects and minimal rebound in myopia progression after discontinuing the eye drop (40,41).
Low dose atropine (0.05 to 0.01%) reduces the risk of Myopia Progression by 40-50%
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Is your child ready to become a member of our Myopia Control Program family?
We're ready to help get your child on the path to minimizing myopia and the ocular health consequences that may result. Schedule your appointment for evaluation today!