Myopia Control: Can we help our kids be less nearsighted?

 

The US is getting more nearsighted as a population:  40% of people in America are nearsighted, compared to only 25% in 1970.  The reason we are progressing in our nearsightedness? Kids spend too much time indoors and don’t spend enough time in the sun.  Research shows that it is the interaction of the sun with the peripheral retina that either stimulates or inhibits the increase in the axial length of the human eye.  Increased axial length = increased myopia.  Besides sending our kids out to play, what else can we do?  What if your child is already nearsighted?  How can we prevent progression?

eye protection for children

Four ways have been studied when it comes to changing myopia (nearsighted) progression:

  • Atropine (and eye drop)
  • Multifocal contact lenses
  • Orhto-keratology lenses
  • Multifocal Eyeglasses

Some of these methods work better than others:

Atropine

A 0.01% drop of atropine will slightly dilate your child’s eye, and decrease the amount of focusing he can do.  This relaxation of the eye leads to a decrease in progression 81% of the time.  While this sounds fantastic, it only happens in the first year.  And after the first year, kids tend to “catch up” to their counterparts.  The drops also make reading a little harder and increase light sensitivity, which decreases outside time, the “natural” way to decrease progression.

Multifocal contacts

These lenses have a center near design with a blurred periphery.  This blur in the periphery decreases the stimulus to increase axial length.  Children who use these lenses had 54% less progression than their peers, and the results continued year over year, with no decrease after the first year. Children who wear these lenses have excellent vision both in the distance and up close, and the contacts are available as both a monthly replacement (with nightly removal) and a daily lens.  They are comfortable and convenient.

Ortho-Keratology

I think the best way to think about ortho-k lenses is to consider them a retainer (like you have after braces).  They provide freedom from glasses and contacts during the day as well as a 50% reduction in the progression of myopia.  A rigid lens (or a series of lenses) is inserted at night before bed.  Over time, the lens reshapes the cornea and changes the prescription: kids who are nearsighted wear the lenses overnight and in the morning they are 20/20 without correction.  They don’t wear the lenses during the day, but need to put it in every night. This change in their corneal shape also decreases the likelihood of myopia progression.

RGP lens

Multifocal Eyeglasses

Multifocal eyeglasses provide less results than any of the methods above.  If a patient’s eyes cross at near, or their focusing system isn’t working, then I put bifocals in their glasses (either lined or progressive) to solve those problems. Otherwise, I believe the decrease in myopia progression is minor and quite useless, especially compared to the other methods.

Overall, my goals in decreasing myopia progression are:

  • Keep kids in lighter, thinner, more comfortable lenses
  • Have kids’ uncorrected vision be better and more functional
  • Keep kids’ prescription in the range of LASIK for the future

I believe LASIK is a great way to free yourself from glasses and contacts, but your prescription can’t be too high.  By using the above measures, potentially your child will be more successful with LASIK or PRK in the future, and get rid of their distance glasses for good!