The Myopia Epidemic

Myopia (nearsightedness) is on the rise. With our children spending more time in front of screens and less time outdoors, myopia is fast becoming an epidemic. By the year 2050, it is estimated that 50% of the world will suffer from myopia – about 5 billion people.

The consequences of high myopia are more than just thick glasses. Those with myopia have a higher risk of blindness or vision impairment due to retinal detachment, myopic macular degeneration (MMD) and glaucoma. This is due to the continued elongation of the eyeball. This increase in axial length is what increases the risk of these sight threatening diseases.

The consequences of doing nothing about progressing myopia are often devastating. Perhaps the most compelling reason to do something is the fact that a child’s lifetime risk of irreversible damage to central vision (myopic macular degeneration) is 40 times greater in myopia over –5.00D, and over 126 times greater over –7.00D!  Retinal Detachment risk also increases by over 20 times in myopia over –5.00D. This sight threatening condition requires invasive surgical repair within 48 hours in order to avoid permanent vision loss. Even the risk of glaucoma and cataracts increases more than 3 times at just –3.00D. Risk increases further with family history.

Myopia Control Academy

Thanks to recent and ongoing research, there are now treatments to slow the progression of myopia.

At Mission Eye Care, we have doctors residency trained in myopia control using specialty contact lenses and are proud to be the only clinic in Alberta with optometrists credentialed in this field. Our Myopia Control Academy Program will give you and your child the highest level of care. We have the latest technology required to take the baseline measurements needed to accurately monitor progression and modify treatment based on the latest evidence.

If there is any amount of myopia prior to age 11, myopia control strategies are strongly advised. For all patients, at least 1-2 hours of outdoor time every day is recommended as it has been shown to be correlated with later onset and reduced progression of myopia. There is a link at the end of this page with a myopia calculator showing how much your child’s myopia will progress without some form of control. If you have any questions, so far, contact us, or read on!

There are four main options for myopia control, depending on the unique lifestyle and visual requirements of each individual patient:

Soft and Hybrid Multifocal Contact Lenses

There are certain types of soft contact lenses that work to limit the axial growth of the eye by focusing peripheral light in front of the retina. This has been shown to slow down eye elongation and therefore myopia. This method is caused peripheral defocus. Because light still focuses accurately on the central retina, clarity of vision is maintained.

These contact lenses are worn during the day but taken off before sleeping. There are custom options for almost all prescriptions as well as daily disposable lenses such as Misight, which are approved by Health Canada for this purpose.

Studies show that axial elongation (eye growth) is slowed by 46-87% with this method. The most recent study outlining their effectiveness can be found here.

Orthokeratology

OrthoK can be though of as the optical equivalent of dental braces. Treatment involves overnight wear of rigid gas permeable contact lenses that gently reshape the surface of the cornea while sleeping.

Like Soft Multifocal Lenses, the idea is to create peripheral defocus and thereby reduce the stimulus to eye elongation. The advantage to this treatment is that upon waking in the morning, the contact lenses are removed and the cornea retains the molded shape for the rest of the day, eliminating the need for daytime glasses! This is ideal for active kids who may otherwise be limited by eyeglasses during sports and other activities.

Unlike braces, this reshaping is not permanent. The custom retainer lenses must be worn every night to maintain the effect. Studies show that axial elongation is slowed an average of 43% with this method but more recent data suggests it is much higher. Newer lens designs have demonstrated up to 90% reduction in progression in some cases.

For best results, it is recommended to start when the refractive error is less than 4.00D of myopia, and ideally for patients as young as 7-10 years of age. The efficacy and safety of these lenses is well documented, you can read more by clicking the links in this sentence.

Orthokeratology or OrthoK has been around for decades and has traditionally been used for adults as an alternative to wearing glasses or contacts and for those who want a non-surgical alternative to laser eye surgery. Our residency trained optometrists at Mission Eye Care are skilled in all methods of myopia control, including Orthokeratology Calgary care.

Myopic Defocus Eyeglass Lenses

These custom spectacle lenses are a good option for parents that may be hesitant to try the options above. They work on the same principle of peripheral defocus explained above. Proper fitting of the frames and lenses is critical to success. Studies show this option can reduce myopia progression by 30% to as much as 60%. There are 2 lenses available, ZEISS MyoVision Pro™, and the new HOYA MiyoSmart™. Both of these options should be used as part of the our Myopia Control Academy to properly monitor how well they are working. Often, this option is combined with low dose atropine eye drops (see below).

Atropine Eye Drops

Recent studies found that 0.01 to 0.05% atropine decreases progression of myopia by 50-87%. It appears to act by thickening the layer of the eye just under the retina called the choroid. This may increase the structural integrity of the eye and thereby reduce its elongation. Some side-effects of atropine include blurred near vision, less accommodation (focusing ability at near distances), and pupil dilation resulting in light sensitivity. However, these effects are dose dependent and the concentration can be modified based on any symptoms your child may have.

This treatment is recommended for children who are too young or unable to wear contact lenses and is often used in conjunction with some of the treatments above. There are no long term studies on the potential negative effects of this treatment but eye doctors have been using this “off-label” for many years with great success.

Enrollment of your child in our Myopia Control Academy will give your child the best chance of success in reducing myopia progression. We have all the hi-tech instruments to monitor your child’s myopia. Accurate measurements including cycloplegic refraction, corneal topography and axial eye length are all done in order to truly monitor all aspects of progression. Your Optometrist will discuss the above methods, and make recommendations depending on the lifestyle of your child, and the goals of treatment.

Myopia Resources

How often should I have my child’s eyes checked?

The Alberta Association of Optometrists recommends the first eye exam for children at six months of age, then again when the child is two years old, and every year after the age of four. Eye examinations are covered under Alberta Health Care until age 19. You can read more on this, as well as the current recommendations on screen time for kids here.

For additional information, talk to one of our Optometrists at your next appointment and if you like, you can do some of your own research on the sites below:

https://mykidsvision.org

http://www.myopiaprevention.org/index.html

http://www.allaboutvision.com/parents/myopia.htm

https://www.myopiainstitute.org/imi-white-papers.html

Myopia Calculator

Click on this calculator to see how much a myopia control strategy can reduce myopic progression.

(Note: Desktop or tablet screen advised, external link, requires your email to use)