What is myopia? 

Myopia is the clinical term for nearsightedness. Nearsighted eyes see nearby objects clearly, while objects far away are blurry without glasses. In order to see clearly, the eye uses the cornea (the clear window in the front of the eye) and the lens inside the eye to adjust the focus of the light entering the eye.(1,2) The clearest images are seen when light is focused accurately on the back of the eye (the retina). If the eye is too short or too long, the ability to accurately see the world decreases because the cornea and lens cannot focus the light onto the back of the eye.(3) Myopia usually results from the eye being too long. Just like feet get bigger and children get taller, the nearsighted eye tends to get longer over time. This means nearsighted children often need to get stronger glasses every year as their eyes continue to grow.  

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Myopia or nearsightedness, has become a major problem in today's world. Researchers estimate that by 2050, 4.7 billion people will be diagnosed with myopia (which is almost 50% of the world population!)  In the United States alone, cases of myopia have nearly doubled since the 1970s. Even the World Health Organization lists myopia as an epidemic!

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What causes myopia? 

Researchers are not sure exactly what causes myopia, but it is understood that genetics play an important role. Studies have shown that if a child has one parent who is nearsighted, the child is twice as likely to develop myopia than if neither of the child’s parents were nearsighted. If the child has two nearsighted parents, the child is over five times more likely to develop myopia.(4) Environment also seems to play a role in the development of nearsightedness.5,6 Research has found that more time spent outdoors may protect against nearsightedness; factors like circadian rhythm (internal biological clock) and parents’ education level may also play a role.(5,6) 

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How can I correct myopia? 

Myopia causes far away objects to look blurry, but the blurry vision can be

corrected with glasses, contact lenses or refractive surgery. There may

also be ways to control the growth of myopia. 

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Why try to control myopia growth? 

Myopia treatments have been shown to reduce a person’s myopia by

up to 60 percent, which could reduce the need for wearing glasses or

contact lenses.(7-9) Myopia has also been associated with common

vision-threatening conditions like cataracts, primary open angle glaucoma

and retinal detachments.(10-15) The risk of developing these conditions

depends on the severity of the myopia; Therefore, reducing a person’s

myopia could also decrease his or her chances of developing one of

these vision-threatening diseases. 

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What are some of the treatments for controlling myopia? 

Corneal Reshaping Contact Lenses 

Corneal reshaping contact lenses are worn during sleep and are removed in the morning. They temporarily change the shape of the cornea so that a person can see clearly all day long without glasses or contact lenses. They are also thought to slow myopia development because they bend light that enters the eye in a beneficial way. Corneal reshaping contact lenses have been shown to reduce myopia progression on average by about 50 percent.(16-18) 

 

Soft Bifocal Contact Lenses 

Soft bifocal contact lenses are routinely worn to help people aged 40 years and older read clearly as well as see far away. Soft bifocal contact lenses also are thought to slow myopia by bending light that enters the eye in a beneficial way. These lenses have been shown to reduce myopia progression on average by about 50 percent.(19, 20) 

 

Atropine 

Atropine is an eye drop that typically makes light seem bright because it makes the pupil (the black hole in the middle of the eye) bigger; it also blurs near vision because it reduces the eye’s ability to focus while looking at nearby objects. It is not known how this medication slows myopia development. Low concentration (0.01%) atropine has been shown to slow myopia progression by about 60 percent without increasing pupil size or decreasing near vision dramatically.(7-9)

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How long do I need to be treated? 
The scientific community does not yet fully understand how long people should be treated with myopia prevention methods, but the general consensus is that people should be treated until they are at least in their mid-teens or longer.(9) 

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Are myopia treatments safe? 

Contact lenses 

Children (ages 8-12 years) and teens (ages 13-17 years), both of which are age groups that are commonly fitted with contact lenses, are at an equally low risk for developing contact lens-related problems or being noncompliant.(21) Children and teens are able to wear their contact lenses for a similar amount of time each day. In addition, both groups feel that contact lenses improved their social acceptance, appearance, ability to play sports and overall satisfaction with their vision correction.(22, 23)

 

0.01% Atropine 

Low dose atropine is considered to be safe for children.  Low dose atropine has been shown to work without increasing pupil size or decreasing near vision dramatically, like the side effects that are seen with full strength atropine (1%). In fact, only 8 percent of children complained of having problems with low concentration atropine, and glasses can reduce these symptoms if it is harder for the child to read or if the child is more sensitive to lights.(7-9) 

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Are myopia treatments FDA approved?  

Evidence in the scientific literature suggests that some contact lenses and eye drops may slow the growth of nearsightedness in some children. However, the United States Food and Drug Administration (FDA) has not specifically approved any contact lenses or eye drops for this specific purpose. All contact lenses and eye drops used at Heights Optometry and/or North Park Optometry have been approved by the FDA, just not specifically to slow the progression of nearsightedness. 

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References 

  1. Sorsby A, Benjamin B, Davey JB, Sheridan M, Tanner JM. Emmetropia and its aberrations; a study in the correlation of the optical components of the eye. Spec Rep Ser Med Res Counc (G B) 1957;11:1-69. 

  1. Kaufman PL, Alm A, Adler FH. Adler's physiology of the eye : clinical application. 10th ed. St. Louis: Mosby; 2003:xvii, 876 p. 

  1. Remington LA. Clinical anatomy of the visual system. 2nd ed. St. Louis: Butterworth-Heinemann; 2005. 

  1. Jones LA, Sinnott LT, Mutti DO, Mitchell GL, Moeschberger ML, Zadnik K. Parental history of myopia, sports and outdoor activities, and future myopia. Invest Ophthalmol Vis Sci 2007;48:3524-3532. 

  1. Rose KA, Morgan IG, Ip J, et al. Outdoor activity reduces the prevalence of myopia in children. Ophthalmology 2008;115:1279-1285. 

  1. ay MT, Au Eong KG, Ng CY, Lim MK. Myopia and educational attainment in 421,116 young Singaporean males. Ann Acad Med Sin- gapore 1992;21:785-791. 

  1. Chia A, Chua WH, Cheung YB, et al. Atropine for the treatment of childhood myopia: safety and efficacy of 0.5%, 0.1%, and 0.01% doses (Atropine for the Treatment of Myopia 2). Ophthalmology 2012;119:347-354. 

  1. Chia A, Chua WH, Wen L, Fong A, Goon YY, Tan D. Atropine for the treatment of childhood myopia: changes after stopping atropine 0.01%, 0.1% and 0.5%. Am J Ophthalmol 2014;157:451-457 e451. 

  1. Chia A, Lu QS, Tan D. Five-Year Clinical Trial on Atropine for the Treatment of Myopia 2: Myopia Control with Atropine 0.01% Eye- drops. Ophthalmology 2016;123:391-399. 

  1. Lim R, Mitchell P, Cumming RG. Refractive associations with cataract: the Blue Mountains Eye Study. Invest Ophthalmol Vis Sci 1999;40:3021-3026. 

  1. Younan C, Mitchell P, Cumming RG, Rochtchina E, Wang JJ. Myopia and incident cataract and cataract surgery: the blue mountains eye study. Invest Ophthalmol Vis Sci 2002;43:3625-3632. 

  1. Chang MA, Congdon NG, Bykhovskaya I, Munoz B, West SK. The association between myopia and various subtypes of lens opaci- ty: SEE (Salisbury Eye Evaluation) project. Ophthalmology, 2005;112:1395-1401. 

  1. Marcus MW, de Vries MM, Junoy Montolio FG, Jansonius NM. Myopia as a risk factor for open-angle glaucoma: a systematic re- view and meta-analysis. Ophthalmology 2011;118:1989-1994 e1982. 

  1. Ogawa A, Tanaka M. The relationship between refractive errors and retinal detachment--analysis of 1,166 retinal detachment cases. Jpn J Ophthalmol 1988;32:310-315. 

  1. Risk factors for idiopathic rhegmatogenous retinal detachment. The Eye Disease Case-Control Study Group. Am J Epidemiol 1993;137:749-757. 

  1. Aller T, Wildsoet C. Optical control of myopia has come of age: or has it? Optom Vis Sci 2013;90:e135-137. 

  1. Cho P, Cheung SW, Edwards M. The longitudinal orthokeratology research in children (LORIC) in Hong Kong: a pilot study on re- fractive changes and myopic control. Curr Eye Res 2005;30:71-80. 

  1. Walline JJ, Jones LA, Sinnott LT. Corneal reshaping and myopia progression. Br J Ophthalmol 2009;93:1181-1185. 

  1. Walline JJ, Greiner KL, McVey ME, Jones-Jordan LA. Multifocal contact lens myopia control. Optom Vis Sci 2013;90:1207-1214. 

  1. Anstice NS, Phillips JR. Effect of dual-focus soft contact lens wear on axial myopia progression in children. Ophthalmology 2011;118:1152-1161. 

  1. Walline JJ, Lorenz KO, Nichols JJ. Long-term contact lens wear of children and teens. Eye Contact Lens 2013;39:283-289. 

  1. Walline JJ, Gaume A, Jones LA, et al. Benefits of contact lens wear for children and teens. Eye Contact Lens 2007;33:317-321. 

  1. Walline JJ, Jones LA, Sinnott L, et al. Randomized trial of the effect of contact lens wear on self-perception in children. Optom Vis Sci 2009;86:222-232. 

  1. Kleinstein RN, Sinnott LT, Jones-Jordan LA, et al. New cases of myopia in children. Arch Ophthalmol 2012;130:1274-1279. 

  1. Gwiazda J, Hyman L, Hussein M, et al. A randomized clinical trial of progressive addition lenses versus single vision lenses on the progression of myopia in children. Invest Ophthalmol Vis Sci 2003;44:1492-1500. 

  1. Group C. Myopia stabilization and associated factors among participants in the Correction of Myopia Evaluation Trial (COMET). Invest Ophthalmol Vis Sci 2013;54:7871-7884. 

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