Nearsightedness (Myopia)

Myopia (or nearsightedness) is a refractive error that affects an estimated 40% of Americans. If you are nearsighted, close objects look clear but distant objects appear blurred. 

Some children have a progressive form of nearsightedness, or myopia, that gets worse throughout childhood. Pediatric Myopia sufferers usually have no difficulty seeing up close; however, their vision is blurred in the distance. Very often, children with nearsightedness do not complain about their difficulties. Children with nearsightedness may require glasses or contacts to help them see in the distance. While distance vision can be corrected with updates in glasses or contact lens power, these traditional options do not aid in slowing the progression of nearsightedness.

What causes myopia (nearsightedness)?

  1. Currently, research indicates that myopia is likely caused by a combination of both genetic factors inherited from one or both parents, and environmental factors such as spending less time outdoors and increased periods of near work.
  2. Anyone can become nearsighted. If both parents are myopic, there is a 50% chance a child will become nearsighted. If one parent is myopic, there is a 33% chance. If neither parent is myopic, there is still a 25% chance that the child will become nearsighted.
  3. The amount of nearsightedness typically continues to increase late teen years or even early-20s.

What non-medical treatments can I utilize to slow my child’s eye growth over time?

  1. Spend time outside each day. Research has shown that children who spend more time outdoors are less likely to become nearsighted. The link between sunlight and progression is still being investigated, but the American Academy of Pediatrics recommends a minimum of 1 hour outside each day for healthy children. Walk the dog, ride a bike, play in the backyard, or read a book outside in the shade. It is the brightness of natural sunlight that is beneficial, not the UV light - so be sure to protect yourself from the sun with sunglasses, hats, etc.
  2. Take regular breaks from close work approximately every 20 minutes, to look at something 20 feet away, for 20 seconds or more. This is known as the 20/20/20 rule and can also help combat digital eye strain. This applies to use of tablets/iPads, cell phones, books, painting, drawing or anything else that you spend prolonged periods of time on up close.
  3. Keep a good working distance. Holding things closer to your face causes your eyes to strain and work harder to see. The recommended distance is approximately the same as the length of your forearm (from elbow to knuckles).

Why is it important to slow down the progression of myopia?

  1. Correcting nearsightedness with glasses, regular contact lenses, or refractive surgery (such as LASIK) prevents visual symptoms such as blurry vision, but it does not prevent it from getting worse.
  2. There is a strong association with higher amounts of nearsightedness and the risk of certain eye diseases as your child gets older. This includes macular degeneration, retinal detachments, glaucoma, and cataracts which can all potentially cause blindness. Reducing the overall amount of nearsightedness will reduce the overall chance of developing one of these vision threatening conditions. 
  3. Having a lower degree of myopia is also associated with less visual disability when not wearing correction (i.e. waking up in the morning, showering, etc.) and has been associated with a better quality of life.
  4. A lower degree of myopia leaves the option of low risk refractive error surgery on the table for your child when they become an adult, with ideal LASIK candidates being around -4D of nearsightedness.

What are the options for myopia management? Are they safe?

  1. Although research has shown these treatments to be successful, the U.S. Food and Drug Administration has only approved MiSight daily disposable soft multifocal lenses specifically for myopia management. The rest are all considered off-label. All treatments, however, are regularly used in other aspects of eye care and have shown no greater risk for using them for myopia management versus those other things. The following therapies have shown to be similarly effective in cumulative absolute reduction in elongation (CARE).   
  2. Options available through TEG include contact lenses and eye drops
    1. Dual-focus contact lenses
      1. These are a daily wear contact lens that cannot be slept in.
      2. These contact lenses bend light in a specific way to help relax your child's focusing system and create peripheral defocus.
      3. Currently, MiSight by CooperVision is the only FDA-approved contact lens for myopia management, and is only available in a daily disposable design.
    2. Low dose atropine eye drops
      1. While the exact mechanism is unknown, these drops work to slow eye growth by acting on the white shell of the eye (sclera) either directly or indirectly.
      2. There are possible side effects including blurred near vision and light sensitivity. Since the drops are used at bedtime, these potential side effects are very minimal. The use of sunglasses or reading glasses can be used as needed if these occur.
      3. Low dose atropine drops are not commercially available, and therefore must be ordered through an online compounding pharmacy.
    3. Corneal Reshaping (Ortho-K) contact lenses
      1. These are rigid lenses that your child sleeps in at night and removes while awake. They reshape the cornea (front surface of the eye) while your child sleeps so that they will not need glasses or contact lenses to see clearly during the day.
      2. These also create peripheral defocus similar to multifocal lenses.

How long does my child need these treatments?

Nearsightedness can progress into the late-teen to early-20s. The exact amount of time your child will need treatment is unknown and varies from child to child. As part of our program, we will record measurements of the length and power of your child’s eye over time to help inform our clinical decision making. However, you can expect to continue whichever method of treatment is best for your child into their teenage years.

Learn More about our Pediatric Myopia Management Program Here.

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