What you need to know about myopia
It is a global issue affecting people of all ages and has been declared as an epidemic by WHO. In the last 20 years the prevalence in North America has increased by 50%.
It is predicted that by 2050 there will be ~5 billion people worldwide with myopia. Myopia doesn’t just mean having to wear glasses or contact lenses, myopia also means an increased risk to eye health in adulthood.
Each diopter increase in myopia results in 67% increased risk of myopic macular degeneration (MMD).
Risk factors for myopia progression
Earlier age of onset of myopia
Glasses Prescription
Excessive time indoors
Excessive time performing nears tasks
Disruptions in diurnal/circadian rhythms via Lights at night
Myopic parents
What can we do about this?
Eye care professionals now have the opportunity to slow myopia progression rather than just correct the visual symptoms
Increased time outdoors can delay myopia’s onset and may slow its progression. We recommend at least 2 hours a day. The 20-20-20 rule suggests taking a break every 20 minutes, looking at something at least 20 feet away, for 20 seconds to reduce fatigue and eye strain
Several myopia control therapies have shown efficacy of over 0.3 mm (around 0.75 D) over two to three years of treatment
Importance of early treatment: every diopter matters
Other than a lower final prescription in adulthood, eye growth is slowed. A longer eye length is associated with an increased risk for developing ocular disease such as cataracts, glaucoma, myopic maculopathy, retinal detachments, and can result in visual impairment
Clinical treatment should begin for all myopic children 12 years of age or less and begin lifestyle guidance at a minimum for pre-myopic children
Progression is highly likely once a child is identified as pre-myopic or myopic
Reducing myopia by even just 1.00 D decreases the chances of a patient developing myopic macular degeneration by ~ 40%
Average myopia control treatment effect
Multiple studies find a reduction of a ~0.75D in elongation (0.3mm) over 2-3 years. To date the maximum documented effect observes was ~1.00D (0.44mm) over 7 years, which suggests that treatment should begin as early as possible.
Combining multiple treatment strategies may be more effective at controlling myopia progression than a single treatment therapy.
Monitoring
Myopia control therapy use, maintenance, and compliance should be monitored frequently after treatment initiation or modification every six (6) months at the least once treatment is finalized.
Close monitoring helps to maintain compliance, identify risky behaviours, and address any problems as early as possible, ensuring safe and consistent use of the myopia control therapy.
Knowing efficacy is similar across treatments, the patient’s lifestyle, expectations, motivation, and their abilities are critical in choosing the right treatment.
Myopia Control Recommendations
1. Spend at least 2 hours a day outdoors
Increased time outdoors has shown to slow progression
Illuminants rich in blue light, like from the sun, can protect against myopic eye growth when the eye is exposed to slow changes in luminance contrast as might occur with near work
2. Reduce blue light from electronic devices and indoor lights 3 hours before bed
Light and blue light increases eye growth when exposed in the evening
3. Perform near tasks later in the day and take frequent breaks from near tasks
Reading activities (imposing Hyperopic defocus) should be done later in the day as near tasks have shown to increase eye growth in the mornings only
The 20-20-20 rule suggests taking a break every 20 minutes, looking at something at least 20 feet away, for 20 seconds to reduce fatigue and eye strain
What if lifestyle changes aren't enough?
1. Orthokeratology (OrthoK)
Non-Surgical approach to freedom from glasses
These are custom designed rigid contact lenses that reshape the eye while they sleep to allow your child to see throughout the day while slowing progression of myopia.
2. Peripheral defocus soft contact lenses
Daily disposable contact lenses to ensure the best oxygen permeability, comfort and hygiene
3. Peripherial defocus optical lenses for glasses
Simplest method to control myopia for patients who aren't ready for contact lenses yet
4. Low Dose Atropine eye drops
Can be used independantly or in combination with one of the methods previously mentioned to control myopia using multiple mechanism of action to control myopia progression further