Myopia Management

Myopia is blurry long-distance vision, often called “short-sighted’’ or “near-sighted”. A person with myopia can see clearly up close – when reading a book or looking at a phone – but words and objects look fuzzy on a blackboard, on television or when driving.

But a pair of glasses aren't the whole story.

The prevalence among Australian 12 year olds has doubled in 6 years. Myopia in kids tends to progress or get worse throughout childhood, and higher levels of myopia are associated with higher eye disease risks in adulthood.

If your child already wears glasses, you can do something to stop their vision worsening. If they don't you can assess their risk of developing myopia.

Currently Myopia affects around 80 million children worldwide. This figure is expected to reach about 5 billion people worldwide – or 50% of the population! The average onset of Myopia is also is also progressively getting younger; in 1983 it was 11 years old, whereas in 2000 it was 8 years old. Take breaks from close work and device use and have good lighting. It is vital to take breaks from lots of near work and look to the distance.

What are the dangers of myopia?

For children, the main difficulty occurs when looking at the board at school and being able to keep up with school work. Glasses can cause a hindrance to sports and 40% of children report that they feel uncomfortable wearing glasses.

However, the biggest risk comes much later. Adults who are myopic have a much higher risk of blindness. For those who have high myopia (over -5.00), there is over 20 times more likely to have a sight-threatening disease (retinal detachment, myopic macular degeneration or cataract) compared to a person who is not myopic.

What should you be doing to help your child?

Get outdoors

Children are spending less time outdoors than before. Being outdoors, in the presence of bright natural sunlight helps to protect the eyes from developing myopia ⁽⁸⁾. A child should be spending at least 90 mins a day outdoors and they will still receive the protective benefits even if they are fully sun smart (ie hat, suncream, sunglasses)

Hold books or devices further away

The research shows that the increased effort required when reading material is held too close can increase the amount of myopia ⁽¹⁰⁾. The distance between your child’s knuckle and the elbow (the Harmon distance), is the same distance they should be holding a book.

Take breaks from close work and device use.

It is vital to take breaks from lots of near work and look to the distance. The easiest thing to remember is 20/20/20. Focus on an object at least 20 feet away for 20 seconds every 20 minutes. Taking a 10-15-minute break every 50 minutes also helps to improve concentration as well as helping muscles of the eye.

Speak to an expert in myopia control

There is now a lot of scientific research, studies and treatments that show the progression of myopia can be slowed substantially. Eyes@Optometry are proud to be on the forefront of the treatments available and our practice offers reliable, safe and proven treatment options for myopia control. Call us now for more information about how to protect your child’s sight.

What options are available to manage myopia?

Encourage time outdoors
It is recommended that children spend at least 90 minutes a day outdoors to decrease their risk of developing myopia.

Regular glasses or contact lenses
These will help your child see clearly and will often need updating frequently as they grow. Regular glasses have little or no effect on slowing down the speed of myopia progression. Our Optometrists will no longer recommend glasses as the best option for treatment of Myopia.

Speak to us about Myopia Management
There is now a significant body of scientific research that shows that the development of myopia can be DELAYED substantially by modifying your environment/behaviours and that implementing evidence base treatments can SLOW DOWN the progression of myopia once diagnosed.

Treatment Options

Eyes@Optometry are proud to be on the forefront of the treatments available and our practices offer reliable, evidence base advice and treatment options for myopia control.

We have a range of treatments that are available:

Mi Sight Soft Daily Disposable Contact Lenses

Mi Sight contact lenses have a special optical design that allows children to see clearly while slowing down myopia progression by more than half! (Possibly up to 72% when worn as directed).

Our Myopia Management System is a holistic approach to minimizing the progression of myopia by combining Mi Sight contact lenses and lifestyle strategies for better eye health.
• Reduces the chance of developing high levels of myopia (-6.00D or more) which may lower the incidence of eye diseases associated with short-sightedness such as retinal detachment and glaucoma.
• May improve the self-esteem of children and teenagers in terms of their ability to participate in sporting activities and their social acceptance.
• Daily disposable lenses mean there’s no cleaning, disinfection or worrying about lost lenses.
• Low dehydration rates, delivers suitable oxygen transmission for daily wear and provide good all-day comfort and eye health.

ATROPINE Eye Drops to reduce Myopia Progression

Using low dose Atropine Eye drops once a day, at night time, has been shown to slow down the progression of childhood Myopia by around 50% when used as directed. ⁽¹³⁾⁽¹⁴⁾ These eye drops are a convenient treatment choice if your child is not yet ready for contact lenses, or Myopia reducing spectacles are not an option. They must continue to wear their everyday distance glasses while undertaking Atropine treatment, so they have clear comfortable vision.

Your Optometrist will write a prescription for the Atropine Eye Drops, which you can take to your chemist to fill. Occasionally these drops need to be produced by a Compounding Chemist and we can help to organize this. Low dose Atropine has minimal effects on pupil size, accommodation, and near vision and appears to be well tolerated by patients. When initiating Atropine treatment, we schedule a review appt the day after commencing the drops, then at 1 week, 3 months and 6-month intervals to check your child is comfortable. In the long term 6 monthly reviews are advised.

How do Atropine Eye drops slow down Myopia Progression?

Atropine works by blocking the chemical acetylcholine, which relaxes the ciliary muscle of the eye and causes the pupil to dilate. This acts to reduce the axial elongation or “growth” of the eyeball, which in turn slows down the progression of myopia.

Orthokeratology

Orthokeratology (Ortho-K) is a way of temporarily reversing myopia by using specially designed, oxygen permeable rigid contact lenses that temporarily reshape the cornea while the wearer sleeps. After removing the lenses in the morning, vision is generally corrected to 20/20 without the need for glasses or contact lenses during the day.

Over time, clinicians observed that myopic children using OrthoK contact lenses were not progressing as quickly as those wearing standard types of correction, like distance spectacles or soft contact lenses. Several Studies have now shown that wearing OrthoK contact lenses can successfully reduce the rate of myopia progression in school aged children by 45%⁽¹³⁾

How do they work

Ortho-k induces peripheral myopic defocus along the horizontal and vertical meridians.⁽¹⁵⁾ This increased myopic defocus along with reduced peripheral hyperopic blur leads to a decreased stimulus for eye growth, thus halting myopia progression. While each lens design has its unique parameters, commonly shared features of commercially available ortho-k lenses include the following: a larger diameter, small treatment zone (optic zone), and a secondary or reverse curve steeper than the base curve.

Before, after and difference topographical maps of a cornea that has undergone orthokeratology

Ortho K lenses need to be fitted by a qualified Optometrist. Utilizing state of the art technology they will take baseline measurements to assess your child’s suitability for this myopia treatment. After the initial assessment your Optometrist will create a custom Ortho K Lens that is worn only at night time. A schedule of regular review appointments will also be made to ensure your child has comfortable, clear vision and to ensure the treatment is working successfully.

The cost of Fitting and purchasing Ortho K lenses is $1500-2000 per year.

Hoya MiyoSmart Spectacle Lenses

We now have advanced spectacle lens technology available to help reduce the progression of your child’s myopia. HOYA MiyoSmart spectacle lenses are an effective, non-invasive method to manage myopia which can be fitted to a myopic child at any age, like regular single vision distance lenses. Hoya MiyoSmart lenses use an award-winning DIMS (Defocus Incorporated Multiple Segments) technology, which means the lens has a central optical zone for correcting refractive error and a surrounding area of multiple segments of constant myopic defocus which extend to the mid-periphery of the lens. This provides clear vision and myopic defocus simultaneously at all viewing distances and has been shown to slow myopia progression on average by 59% and slow axial eye growth on average by 60%⁽¹⁶⁾.

The MiyoSmart lens is a really smart way to address myopia. It’s safe for active kids with its light, impact-resistant polycarbonate material and a low-maintenance multi-coat that is water repellent and easy to wipe. It also includes 100% UV protection. The MiyoSmart lens is a really smart way to address myopia. It’s safe for active kids with its light, impact-resistant polycarbonate material and a low-maintenance multi-coat that is water repellent and easy to wipe. It also includes 100% UV protection.

Our team of Optometrists and Optical Dispensers have all met the mandatory accreditation criteria to dispense MiyoSmart lenses. Please feel free to visit us in store or call if you would like any further information on this amazing new Myopia prevention lens.

How old does my child need to be?

Children from the age of 6 are suitable to be wearing contact lenses

How do I know if my child will be able to wear lenses?

This is easy. We offer a free comfort trial when your child has an eye test with us. This means we’ll apply the lens to their eyes and see how they find them. As long your child is comfortable, we perform an assessment and consultation to ensure the fitting is good and then we will make an appointment to teach them how to handle the lenses. This includes looking after them and applying and removing the lens. As part of the consultation, we give you a week’s supply of the lenses to use at home and school. We perform final checks at the end of the trial week to make sure your child is 100% happy and that the lenses are safe for your child to wear.

How are these lenses different to normal contact lenses?

Research has found that there is an area of blurry vision in the periphery of our vision that drives extra growth in the eyeball. This leads to the progression of myopia. When you are short-sighted, this area of vision is one of the factors responsible for the changes. It doesn’t matter if you wear your glasses or not, the vision can still get worse. The myopia control contact lenses change in the vision in the periphery while still keeping the central vision clear. This suppresses the additional lengthening of the eyeball thus reducing the rate of change.

What is the proof that myopia control contact lenses work?

These techniques and contact lenses have been development for over 10 years. There have been published studies that have followed children for over 4 years while wearing these lenses ⁽¹²⁾. The children in these studies responded very well to lenses and about 40% of the kids demonstrated no clinically significant increase in short-sightedness over 3 years. The other 60% of participants progressed by only -0.75DS over the 3 year study period which is HALF the expected myopic progression rate compared to untreated children.

Is there a risk of infection?

They are single use (daily) so every lens they wear is sterile and clean before insertion. The risk of an infection is minimal, when used as directed, and often young children as young as 6 can be responsible for washing their hands and looking after the lenses. In fact, the risk of infections is often shown to be lower in children then adults. For reassurance, we offer unlimited emergency appointments if ever there is a concern.

Are they easy to take in and out?

How long will my child need to wear them for?

Will my child need glasses too?

How much do they cost?

What is the process to get the contact lenses?

References

1. Orthokeratology to control myopia pregression: AMeta Analysis. Sun, Yuan, et al. s.l. : PloS one, Vol.10.4(2015): e0124535
2. The impact of myopia and high myopia. Report of the Joint World Health Organization-Brien Holden Vision Institute Global Scientific Meeting on Myopia.
3. Six Year Refractive Change among White Children and Young Adults: Evidence for Significant Increase in Myopia among White UK Children Sara Jayne Mccullough, Lisa O'Donoghue, Kathryn J Saunders
4. Mumsnet research on behalf of Johnson and Johnson Visioncare: Parent’s & children’s views and attitudes about vision correction. 2013
5. Myopia and incident cataract and cataract surgery: the blue mountains eye study. Invest Ophthalmol Vis Sci. 2002 Younan C1, Mitchell P, Cumming RG, Rochtchina E, Wang JJ.
6. The relationship between refractive errors and retinal detachment--analysis of 1,166 retinal detachment cases. Ogawa A1, Tanaka M.
7. Prevalence and progression of myopic retinopathy in an older population, April 2002 Jerry Vongphanit, Paul Mitchell, Paul Mitchell, Jie Jin Wang
8. Risk Factors for Open-Angle Glaucoma in a Japanese Population. October 2006 Yasuyuki Suzuki et al
9. Myopia prevalence in Canadian school children: a pilot study February 2018 Mike Yang, Doerte Luensmann, Desmond Fonn, Lyndon W Jones et al
10. Violet Light Transmission is Related to Myopia Progression in Adult High Myopia December 2017 Hidemasa Torii, Kazuhiko Ohnuma, Toshihide Kurihara et al
11. Effect of Accommodation on Peripheral Eye Lengths of Emmetropes and Myopes 2017. Aldossari H, et al
12. The impact of myopia and high myopia: Report of the Joint World Health Organization – Brien Holden Vision Institute Global Scientific Meeting on Myopia. University of New South Wales, Sydney, Australia. 16-18 March 2015
13)Kang P, Swarbrick H. New Perspective on Myopia Control with Orthokeratology. Optom Vis Sci 2016;93:497-503.
14)Kang P, Swarbrick H. Peripheral refraction in myopic children wearing orthokeratology and gas-permeable lenses. Optom Vis Sci 2011;88:476-82.
15) Walline JJ, Jones LA, Sinnott LT. Corneal Reshaping and Myopia Progression. Br J Ophthalmol 20 009;93:1181-1185.
16) Lam CSY, Tang WC, Tse DY, et al. Defocus Incorporated Multiple Segments (DIMS) spectacle lenses slow myopia progression: a 2-year randomised clinical trial British Journal of Ophthalmology. Published online first: 29 May 2019. doi: 10.1136/bjophthalmol-2018-313739

Study From Coopervision.

What causes myopia?