In the past, myopia (nearsighted, shortsighted) was considered a simple refractive error which was corrected with glasses or contact lenses. Now, however, myopia is becoming a worldwide epidemic. Approximately 30% of the world’s population is myopic and that percentage is predicted to reach 50% by 2050. In the U.S, the prevalence of myopia has increased from 27% to 44% over the last 30 years. In some Asian countries, the prevalence of myopia approaches 80-85%. Myopia is starting sooner in children, progressing more rapidly, and stopping at a later age than in the past.
What causes myopia?
There are both genetic and environmental components to myopia. Having one myopic parent doubles the chance of a child becoming myopic and having two myopic parents results in a 5X greater chance. In addition, more time spent looking at near (reading, computers, tablets, phones, etc.) and less time spent outdoors have been associated with myopia.
What are the risks associated with higher amounts of myopia?
Myopia is now considered a disease or a risk factor for a disease by many because of its association with myopic retinopathy, glaucoma, and retinal detachment. Of course, there is also a decreased quality of life with not being able to see clearly more than a few feet in the distance.
What more can be done?
Currently, when nearsighted people sense that their distance vision is getting blurry, they visit their eye doctor who makes their prescription stronger. Some people need to see their eye doctor every year or two. Others, especially children, need to make visits shorter than a years time because their vision changes dramatically. There is current and ongoing research that shows there are safe, effective, and evidence-based approaches to reduce the progression of myopia such as overnight wear of hard contact lenses (Orthokeratology), the use of certain types of multifocal contact lenses, and low dose Atropine eye drops taken nightly.
How much can be done?
Once myopia starts, it is not reversible. Ortho-K and soft contact lenses have been shown to decrease myopia progression 40-50%. Atropine, depending on the strength, can reduce progression by about 60-70%.
When should one start with myopia care?
The ideal and simple answer is at the onset of myopia when one is getting their first pair of glasses.
How do you know when it is safe to stop treatment?
Of course, the onset and progression of myopia is different in everyone. The same can be said for when it will slow down or stop. Dr. Wojton will continuously monitor the rate of change of vision as well as the lengthening of the eye and will taper the treatment when it appears that progression is slowing down. It is important to note that myopia care is a long-term and continuous effort and it is recommended to commit at least two years for treatment.
What are the risks?
Risks involved with contact lens wear include giant papillary conjunctivitis, corneal abrasions,and corneal infections and ulcers. However, these complications are rare with proper care. Atropine drops can cause blurred vision at near and sensitivity to bright lights, but this is unlikely because of the low concentration that we will be using.
What are the costs?
Dr. Wojton will be happy to consult with you at no charge and answer any questions that you may have. If you wish to begin Myopia care for your child, a more detailed eye exam and consult will be initiated and a specific treatment plan involving soft contact lenses and/or Atropine eye drops will be discussed and initiated (Dr. Wojton does not fit Orthokeratology contact lenses). There will be a reasonable priced yearly program fee which will include 2-3 office visits per year. Depending on the treatment plan, there will be a cost for the contact lenses and/or the Atropine eye drops.
Is this covered by insurance or vision benefits?
The Myopia Care consult and the progress checks can not be billed to insurance plans, but patients can use their flex spending or health savings accounts. Also, third party healthcare finance companies such as Care Credit can be used as well. Contact lenses may be may be partially or fully covered if you have that benefit with your vision plan. You will be given a prescription for Atropine eye drops to be purchased at a compounding pharmacy recommended by Dr. Wojton.
So now what?
First, If your child’s eyesight gets worse every year, click on the calculator for an estimate on how much worse your child’s vision will be over time. Secondly, If you would like to do more than just “bump up” his/her prescription every year, call Normandy Optical and make an appointment with Dr. Wojton.
Is there anything else I can do?
Multiple studies have shown that that time spent outdoors and sunlight reduces the chances of becoming myopic. However, spending time outdoors after becoming nearsighted has no effect on its progression
Soft contact lenses have been used safely for decades for the treatment of nearsightedness and farsightedness. Also, Atropine is commonly used for the treatment of amblyopia (lazy eye). Although contact lenses and atropine are FDA approved, they do not have FDA approval specifically for myopia care. This means that that they will be used “off-label”. That’s OK; off-label use of medical devices and medications is a common and accepted practice in health care.
***In late November, 2019, CooperVision announced it received FDA approval of its MiSight 1 day contact lens which was clinically proven to slow the progression of myopia (nearsightedness). MiSight 1 day contacts will be available in the U.S. beginning in Spring, 2020.***
One Last Note
Read about how Dr. Wojton successfully slowed down his daughter’s myopia using multifocal contact lenses.
It’s a little embarrassing when you are an optometrist and you get a letter from the school nurse indicating that your child failed her vision screening at school. But that’s what happened to me in 2009. I had always done yearly eye exams on Ally starting when she was 5 years old, and she had always had 20/20 vision and healthy eyes. But in 2009 at the age of 9, after I received the letter from her school, I measured her vision as 20/40 in her right eye and 20/25 in her left. Since she had no complaints about seeing in the distance and she could still see 20/20 using both eyes, I decided to not prescribe glasses for her at this time. Rather, I would monitor her every 6 months or so.
Seven months later in September, 2009, her vision decreased to 20/50 in her right eye and 20/40 in her left. Now it was time for her first pair of glasses. Her prescription was -0.75 right eye and -0.50 left eye. Each year (or less) her distance vision would get worse and her glasses and contact lenses would get stronger. In November of 2013, her prescription was now -3.25 right eye and -2.50 left eye. At that time there was some very early research regarding the use of bifocal contact lenses and their effects of slowing down the progression of myopia. Since she was already wearing contacts, I figured I’d give it a try.
Fast-forward to August of 2019. She is now 19 years old and I am thrilled to report that her prescription has barely changed in the 6 years that she has been wearing the bifocal contacts! Her prescription now is -3.50 in her right eye, -2.75 in her left eye.
Since 2013, there has been much more research done indicating that certain types of multifocal contact lenses can slow the progression of nearsightedness. And since myopia is increasing by a staggering amount, interest in slowing myopia has increased. Although the study that included my daughter only had a sample size of one person, her results are encouraging to many nearsighted children similar to her.
- Myopia Control 2020: Where are we and where are we heading? (Article from the Ophthalmic & Physiological Optics, the journal of The College of Optometrists)
- Myopia control: Is there a cure for nearsightedness? (Information from AllAboutVision.com)
- Why myopia progression is a concern (Information from AllAboutVision.com)
- MyopiaControl.org (Clinical & Research Information for the Eyecare Professional)
- My Kid’s Vision (A free online tool that helps parents assess and manage myopia risks for their kids.)
- Low-Concentration Atropine for Myopia Progression (LAMP) Study (Article from the January 2019 issue of Ophthalmology, the journal of the American Academy of Ophthalmology.)
- Topical Atropine in the Control of Myopia (Article from the Autumn 2016 issue of the Medical Hypothesis, Discovery & Innovation in Ophthalmology journal.)
- ManageMyopia.org (Myopia care information and resources.)
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