The Dangers of Myopia
There is not a day that goes by in our clinic that a parent doesn’t ask us why their child’s eyes are getting worse and is there anything we can do about it. It used to be that our answer was unfortunately that nothing could be done and we would write the next higher prescription for their nearsightedness. As doctors we would lament how this constant increase in myopia would place these patients at a greater risk for blinding conditions like retinal detachment, glaucoma, cataract and chorioretinal degenerations. Parents and children alike would express concern about the thickness and weight of their glasses. But now amazing new research shows that there may be ways to keep the children in the Reno/Sparks area from getting more nearsighted. Myopia is becoming an epidemic, with over 40% of the children in the United States being diagnosed with nearsightedness and this rate is climbing.
Options For the Nearsighted Patient
Several studies have shown the incredible capability of atropine to slow the progression of nearsightedness. Some studies have shown over a 90% reduction in progression rate with Atropine 1% which is remarkable and the most effective treatment studied to date. Atropine isn’t without its drawbacks though. This medication will cause blurred near vision and sensitivity to light as it is a stong dilation agent, and requires the use of photochromic progressive lenses during treatment. Fortunately, concentrations below 0.025% can be made at a compounding pharmacy and still show a meaningful reduction in progression rate without the side effects from dilation. This treatment option may be combined with other prevention methods, though there are no studies demonstrating increased effectiveness of multiple therapies. Atropine has not been approved by the FDA to treat myopic progression, but the medication has been approved for other medical uses and has a long track record of safety. A similar method to diluted atropine therapy is pirenzepine, though this medication is unfortunately not available in the United States. The advantage of pirenzepine is that is does not dilate the pupil or incapacitate the focusing system, the disadvantage being a reduction in myopic progression of only 44%.
This popular alternative to glasses, conventional contact lenses and LASIK turns out to have a hidden beneficial side effect of reducing myopia progression by roughly half. A great alternative for the child that does not wish to wear a correction during the day, this is a safe and effective means of vision correction. Using corneal molds worn overnight the corneal is reshaped to correct vision during the day without glasses or contact lenses. Click here to visit our orthokeratology page to learn more.
Soft Multifocal Contacts
Soft multifocal contact lenses are often a parents first choice for their child as the lenses used are no different than the soft lenses they themselves are used to wearing. Published studies have shown around a 40% reduction in myopic progression. CooperVision currently manufactures the only commercially available soft lens designed specifically for myopia prevention called the MiSight. It is currently unavailable for purchase in the United States.
Rigid Gas Permeable Lenses
Rigid gas permeable (RGP) lenses have long been thought to slow progression of myopia. Studies have confirmed this, but the effect is mild at best. This lens type is still a great option for patients looking for the best visual clarity.
Research shows that wearing full correction single vision glasses do not seem to have any slowing effect, but that wearing progressives (4%) and lined bifocals (16%) had a small but insignificant effect on myopia progression rates. Promotional materials for MyoVision lenses by Zeiss claim a 30% reduction rate, but this has not been seen in any published journal studies as of yet.
Surprisingly, one of the most cost effective ways to slow progression is sending kids outdoors. It has been noted that children that spend 14 hours or more outdoors in a week have a reduced rate of myopic progression. Don’t forget your sunglasses!
There are no current studies to guide us on nutritional advice to slow progression of nearsightedness. Our general advice in this arena tends to follow common sense, eat your vegetables and get regular exercise for a happy healthy life.
There are many websites and books claiming that you can exercise your eyes out of myopic glasses, but this actually only seems to produce an effect in patients with a focusing issue known as accommodative hysteresis. These exercises do not reduce the rate of myopic progression, but rather increase the flexibility of the focusing system for those with “cramped” focusing muscles. These patient are typically not truly nearsighted but rather only suffer from a focusing issue.
Near Work and Reading
The image of the bookworm with glasses is an iconic one. Many scientific studies have looked at the rate of myopic progression in children that read a lot and they have found that reading by itself is not likely to make your child more nearsighted. In patients that have a lag of accommodation it is suggested that a pair of reading glasses may help slow their progression.
Undercorrecting and Not Wearing Glasses
Occasionally we are confronted by parents that believe that undercorrecting their child or by having their child not wear glasses that they will learn to strengthen their eyes and not need glasses. This couldn’t be further from the truth as research has shown that not providing an appropriate correction will actually speed up the progression of nearsightedness. While although patients that don’t wear glasses may learn to interpret blurry letters on a chart better, making them seem like they have better vision, axial length and where light focuses is how nearsightedness is truly measured. By those measures these methods do not work.