The most common question eye doctors hear is probably, "Did my vision change?" Those of use who grew up nearsighted became accustomed to hearing that our vision was getting worse each year. We almost accept that as a fact of life. But, what if we could slow down those vision changes? What if your child doesn't have to become as nearsighted as you? We're excited to share with you the most current research investigating the most effective ways to slow down the progression of nearsightedness.
What is myopia?
Myopia, the clinical term for nearsightedness, is caused when light is focused in front of the retina, making distant objects appear blurry. This is often caused when the eye grows too long or if the cornea (front surface of the eye) is too steep. The main contributors to the development of myopia are genetics and environment. The rate of progression can be influenced by age of onset, ethnicity, parental nearsightedness, and the current rate of change. In the past three decades, the prevalence of myopia in the United States has almost doubled, making it now 42%!
Why does it matter?
Nearsightedness is more than just a nuisance. Studies show that higher amounts of myopia result in a significantly higher risk for sight-threatening diseases such as retinal detachment, glaucoma, and cataracts, just to name a few. Because of this, much research is being done to determine the most effective ways to delay the onset of myopia, as well as slow its progression.
What can we do?
Clinical studies have determined that ocular elongation is controlled by visual signals. Therefore, current treatment options mainly target ways to adjust how visual signals are displayed to the retina. Our goal is to slow the growth of the eye, thereby slowing the progression of nearsightedness and reducing the risk of future eye conditions. The most effective options to consider are:
Bifocal glasses have been shown to reduce myopic progression by 20-50%. Because the bifocal displays some of the visual signal in front of the retina, the growth signal is not as strong. Bifocal glasses have minimal risks and are great for kids who are not yet ready to try contacts. However, some kids might not like wearing glasses or the appearance of bifocals.
Multifocal soft contacts reduce myopia progression by 40% on average. They also work by displaying some of the visual signal in front of the retina to reduce the growth signal. Multifocal contacts, like all contact lenses, do have a low risk of microbial infection. They are great for active kids who don’t want to wear glasses.
Orthokeratology is a gas permeable contact lens that reshapes the cornea during sleep. It has been shown to slow myopia progression by about 40% using a similar method as the multifocal options above. Ortho-K (as it is often called) also has a low risk for microbial infection. Most patients feel like the quality of vision is slightly better compared to multifocal contacts. This is another option for kids who don’t want to wear glasses, play sports, or suffer from allergies or dryness.
Atropine drops contain a very diluted dilating agent that can slow myopia progression up to 50%. The mechanism behind this effect is not yet understood. This method is often combined with any of the above glasses or contact lens options to maximize the effect. The side effects of these drops are minimal but in some kids, they may increase pupil size or slightly reduce near focusing ability.
The first step to determine if your child needs myopia control is a risk assessment. Dr. Pulsfus may ask you or your child about family history, ethnic background, time spent indoors or outdoors, and your child’s glasses prescription history. If the risk of myopia progression is high, you and Dr. Pulsfus can discuss these therapy options to determine which will be most suitable for your child. Once a treatment plan is established, we will monitor the progression of your child’s nearsightedness every 6-12 months. It is important to understand that our goal is to slow the rate of progression and that complete halting of progression is unlikely.