Myopia Progression Prevention (Preventing Nearsightedness)
What is Myopia?
Myopia is also called near-sightedness. It means a person can see close objects well but cannot see clearly things in the distance without glasses or contact lenses. How far away a person can see without glasses depends on how severe the myopia is. Nearsightedness is common. About 30% of all people have myopia. It usually starts during the school-age years.
What causes myopia?
Doctors are not sure what causes myopia. It is often hereditary. Some research has shown prolonged reading or near work and reduced amounts of outdoor time are associated with myopia.
Can myopia be prevented?
There is no way at this time to prevent myopia, but recent studies have shown there may be ways to slow its progression. Wearing glasses does not seem to affect the myopia or its development.
- Increase daylight exposure
- Reduce prolonged intense periods of near work
- Use diluted atropine eyedrops: Atropine 0.01% slows myopia progression by at least 50%. Atropine in higher concentrations also slows progression but also can cause pupil dilation, light sensitivity, and blurred vision. Atropine 0.01% solution causes minimal pupil dilation, no light sensitivity, and no near visual loss compared with higher doses. The treatment time period in published studies was 2-3 years, but it may require longer period of time since the eyes are still growing through the teenage years. Make sure to use atropine under a doctor’s guidance.
- Orthokeratology (OrthoK): Wearing reverse geometry contact lenses overnight temporarily flattens the cornea and provides clear vision during the day without glasses or contact lenses. Reduction in myopia (up to −6 D) can be achieved, but it is not clear whether the effect is sustained after stopping the OrthoK. A few studies have shown permanent changes consistent with reduced myopia. Unfortunately, sleeping in contact lenses increases the risk of bacterial corneal infection which can be very serious and cause scarring and permanent visual impairment.
How is myopia treated?
Depending on the age of the child and the severity of the myopia, glasses are usually the first treatment. Young children usually handle myopia well and most often do not require glasses because most of their world is in arm's reach. By school age, distance vision becomes more important and myopia more disabling. Children with myopia often wear glasses only for reading the blackboard and remove them when reading books or playing. This is OK. Myopia usually increases through the late teenage years and glasses often become more necessary as a child becomes older.
What about contact lenses?
Once a child is wearing glasses most of the time, contact lenses are a reasonable option. They require motivation on the part of the parent and the child. There is no magic age at which contacts become "OK". In general, when a child is old enough to remember to brush their teeth every night without being reminded and clean their room without being told, they probably are responsible enough to care for contact lenses. This is usually around 12 years of age.
Contacts require separate fitting and teaching appointments. The glasses prescription can be used to determine the power of the lenses, but additional measurements are required. Refractive laser surgery is not recommended for mild to moderate myopia in children under 18 years of age because the eyes are still growing. Refractive surgery is only appropriate in children when one or both eyes have severe myopia, and the child cannot or will not wear glasses due to severe tactile aversion.