Myopia Management Updates

Everyday we gain a little more knowledge about myopia, and it reshapes our understanding of the condition.  For decades, myopia was dismissed as a refractive error until we understood more about how it alters the anatomy and health of the eyes. Myopia has now been reclassified as a health condition that optometrists need to manage and treat.

As such, we now know that prescribing a pair of glasses to a developing child is no longer the best way to treat their vision.  While glasses may offer an immediate desired effect, it is no longer considered the best long term option.

Myopia Management is a growing field, and every year more and more optometrists join the movement of managing myopia to prevent, or at least greatly slow down, the progression of myopia in their patients.

The World Society of Pediatric Ophthalmology & Strabismus recently released their myopia consensus for 2023,  which included a list of treatment options that works for Myopia Management. Here is a summary of what was discovered:

1. Behavioral Modification:

First, spending more time outdoors has been found to prevent the onset of myopia in young children.  If both parents are near-sighted and the child is not, spending at least 2 hours in daylight daily can prevent the onset of myopia.  The effect on already myopic children is debatable.  

Reducing the time on NEAR digital devices, such as smartphones and tablets, and upclose work can help slow down the progression of myopia. For children, the recommended working distance between their eyes and what they are focusing on should be approximately 8 inches or more.  Personally, I recommend children to use their devices 14 inches away or more; not only to slow down myopia, but to reduce stress on their visual system (by lowering convergence and accommodation).

Additionally, reducing the amount of near work in dim lighting and taking short, frequent breaks every 30 minutes when reading to relax the eyes can have tremendous effects on myopia and how the eyes feel at the end of the day (fatigue, dryness, strain, etc.)  

2. Optical solution 

There are a number of relatively new optical lenses designed to slow the progression of myopia.  The two most tested lenses at the moment are the D.I.M.S. & H.A.L. lenses, but neither option is available in the United States at this time.  I am anxiously awaiting for this technology to be available to introduce it to my patients.

3. Contact Lenses

There are two types of contact lenses designed and approved to slow down the change in myopia.  Soft contact lenses including MiSight and NaturalVue MF have proven to drastically slow down the change in prescription if used daily.  Ortho-keratology (Ortho-K or CRT) lenses are hard lenses that correct the vision while the child is asleep.  These contacts are especially beneficial to patients with prescriptions that have mild to moderate myopia. 

4. Pharmacological treatment: 

The use of 1% Atropine drops nightly in one eye over a 2-year period has shown to inhibit myopic progression by 77% and reduce axial length elongation.  Unfortunately, there are reports of an inverse, REBOUND effect where myopia progresses aggressively when drops were stopped, especially in patients that were previously on higher doses of atropine.  

Atropine in lower doses, while having lesser efficacy compared to higher doses, has shown to be safer as the rebound effect was minimal. 0.01% Atropine caused minimal pupil dilation (less than 1 mm), minor loss of accommodation (2-3 D), and no near vision problems (children on atropine 0.01% did not need progressive additional lenses).  Nevertheless, in more recent studies examining the rate of axial elongation, 0.01% Atropine had minimal benefit.

My Recommendations:

My first line of defense against myopia starts by modifying a patient's behavior and tendencies; which alone has shown to have a huge impact on the prescription. Secondly, I will consider the use of contact lenses to slow down myopia. And, if contact lenses are not an option then I will recommend a progressive lens design as single vision lenses have no effect on myopia management. Personally, I resort to the use of Atropine and other pharmaceuticals as a last resort when the myopic progression is very severe and other methods have not been effective.

To read the full 2023 report go to this link 

https://www.wspos.org/swdcore/uploads/WSPOS-Myopia-Consensus-Statement-2023-1.pdf

If your child is between the ages of 4-16 and they are nearsighted, please do not hesitate to call us to schedule a myopia management consultation and find out what options they have to stabilize their prescription and monitor their ocular health.