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Myopia Management

Myopia

What is Myopia?

Myopia is the refractive error of the eye that results in blurred distance vision.  It is the result of the length of the eye (axial length) being longer than it should be, the power of the internal lens of the eye (crystalline lens), the power of the cornea (clear part of the front of the eye), or a combination of all of them.  In a myopic eye, the point in which the distance image if focused falls short of the retina, resulting in a blurred image reaching the retina.  Myopia is sometimes referred to as “near sightedness”  because when an object is brought closer to the eye, there is a specific distance (depending on the amount of myopia) in which that object will be clearly seen. This is because the near object “pushes” the focus point to the retina, and the vision is clear (near sight) without any effort from the focusing muscles.

What Causes Myopia Progression?

A child’s risk of developing myopia is influenced by genetics.  If one or both parents are myopic, the child’s risk of becoming myopic (nearsighted) is three times and six times more likely, respectively, to become myopic as well.

Environment also plays a role in a child developing myopia.  A child who spends a significant amount of time working at a near distance (phone, tablet, reading, computer, etc.) and a limited amount of time outdoors is at a three times greater risk of developing myopia when compared to a child with limited near work and higher outdoor time.  Outdoor light has a different spectral composition than indoor light, and is up to 100 times greater than indoor illumination. It is theorized that both of these may play a role in developing myopia. However, while it has been determined that outdoor time increases risk of developing myopia, it is unclear if outdoor time helps slow myopia progression.

As children grow, their eyes can become longer and larger, in fact, retinal blur influences eye growth.  This is a term called emmetropization. Ideally at birth, the eye will start hyperopic (far sighted), with a prescription of about +1.25D by the time a child is 6 years old.  As the child grows the eye elongates and the amount of hyperopia decreases. If everything works out exactly right, when the child has finished growing (late teens to early twenties) the prescription will end up at zero prescription, called emmetropia. If the eye starts at a lower hyperopic prescription, or even myopic, as the child grows, the eye’s axial length will eventually become longer than it should be and become myopic. It’s interesting to note that the central retina (fovea) is not the key area in determining eye length (axial length) growth, rather the peripheral retina is responsible for the stimulus for the eye to elongate.  What that means is that with extensive time spent looking at near objects, the peripheral retina is constantly receives a near object target. The eye “monitors” its status and it “knows” if it defocuses continually (extensive near focus) it can alter its axial length by growing to reach the refractive error necessary to match the target it is exposed to.

            Expected Refractive Error Based on Age

·         Age     6                                  Refractive Error                    +0.75D or less

Myopia

·         Age     7                                                                                  +0.50D or less

·         Age     8                                                                                  +0.50D or less

·         Age     9                                                                                  +0.25D or less

·         Age     10                                                                                +0.25D or less

·         Age     11                                                                                +0.00D or less

What is Myopia Management?

Myopia Management is a term used to describe various treatment methods used to slow down the progressive loss of distance vision. These treatment methods can be either creating optical defocus or by biochemical influence.  These methods include Corneal Refractive Therapy (CRT) which uses specially designed RGP contact lenses to gently reshape the cornea while sleeping, to provide clear vision during waking hours without glasses or contact lenses. Multifocal Soft Contact lenses, which are used to create peripheral defocus, which has been shown to slow myopia progression. Low Dose Atropine (0.01%) drops which have been one of the more effective ways to slow progression. And Executive Bifocal Spectacle Lenses, which can also have a benefit in slowing myopia progression for those patients who aren’t candidates for CRT or multifocal contact lenses, or are not interested in using Atropine drops.

Why is Myopia Management Important?

Myopia is becoming an epidemic throughout the world.  There is no “safe” level of myopia. The prevalence of myopia in the United States is estimated to between 33-42% of the population (almost 100 million Americans), which has doubled since 1972.  In China the prevalence is higher, estimated to be 65% of the population and in other eastern Asian countries the prevalence is even greater than that.  In Taiwan, 81% of the population is myopic, and in South Korea, 97% of their population is myopic.  The World Health Organization has estimated that by 2050, 50% of the world’s population will by myopic, and of those, 10% (1 billion people) will have severe myopia; defined as greater than or equal to -5.00D of myopia.

Besides the progressive loss of clear distance vision there are health risks that can result from increased levels of myopia. The higher the amount of myopia the greater the risk of developing cataracts, glaucoma, posterior vitreous detachment, myopic macular degeneration, posterior staphyloma and retinal tears and detachments, to mention a few.

·         The risk of glaucoma is 14.4 times higher for a person with -6.00D of myopia when compared to a person with no myopia (emmetropia).

·         The risk of retinal detachment is 7.8 times higher for a person with -8.00D of myopia when compared to a person with emmetropia

·         The risk of cataracts are 3.3 times higher for a person with -6.00 D of myopia compared to a person with emmetropia.

·         The risk of myopic macular degeneration is an alarming 40 times greater risk for a person over -5.00D of myopia compared to a person with emmetropia.

As more and more studies show the efficacy and safety of myopia management treatments, controlling myopia has come to be viewed as more of a necessity than an elective luxury by eye care professionals, educators and parents.

Why Haven’t I Heard of Myopia Management Before?

In many instances, eye care has become a version of “fast-food” commercial optical retail stores, whose main concern is how many “customers” can be seen in the shortest amount of time possible and how many glasses can be sold.  As the results of the studies looking at the effectiveness of Myopia Management are becoming more readily available, it is possible that many of these doctors haven’t had an opportunity to learn about these new treatment options, or perhaps their practice organization doesn’t allow for this type of treatment option to be utilized. The evidence is very clear that myopia progression can be slowed, and with the potential health risks of severe myopia, we feel that treating myopia early is very important.

Benefits of Myopia Management Treatments

Unfortunately, myopia cannot be “cured” or reversed.  However, with current Myopia Management Treatment methods, the risk of myopia progression can be reduced, and the rate of myopia progression slowed. The benefit of initiating Myopia Management is reducing the amount of myopia a child would have developed if nothing were done.  The World Health Organization has indicated that a myopic prescription of -5.00D or higher is considered severe myopia.  Severe myopic eyes are at a dramatically greater risk for myopia related ocular diseases.  If by employing the various Myopic Management Treatment methods, a child’s myopia can be kept below -5.00D, the risk of these related ocular diseases can be dramatically reduced. Treatment should continued as long as myopia progression occurs, and can be stopped once myopia is stable for 2 years or more.

Candidates for Myopia Management Treatment

It is recommended that Myopia Management Treatment methods be initiated as soon as a child has developed -0.50D of myopia.  The different treatment options each have different criteria that make a child a better candidate for one treatment option or another.  These differences will be discussed during a Myopia Management evaluation.

What are Risk Factors for the Development of Myopia?

The myopic risk profile can be helpful to determine if a child is at a greater risk for developing myopia.

  • Age – Myopia develops during early to middle childhood ages and progresses before stabilizing (usually) in late adolescence.  Myopia also seems to progress faster at a younger age.
  • Refractive Error – If a child’s refractive error (prescription) is lower than would be expected for their age.
  • Ethnicity – Highest prevalence of myopia is in children of eastern and southern Asian descent.  65% of the population in China, 81% in Taiwan and 97% in South Korea.  Incidence of myopia is lower in the rest of the world.  35% of the population of Europe is myopic and only 6% of the population of Ethiopia and Tanzania.
  • Parental Myopia – If one parent is myopic, the child is at a 3 times greater risk of developing myopia. If two parents are myopic, the child is at a 6 times greater risk of developing myopia.
  • Time Spent Outdoors – The highest associated environmental risk is low outdoor time; less than 1.5 hours per day outside. Moderate risk with 1.5-2.5 hours per day, and lowest risk with more than 2.5 hours per day.
  • Time Spent with Near Work – The highest associated risk long hours spent with close work (smart phones, tablets, reading, computer, homework, etc) of longer than 2.5 hours per day. Moderate risk is 1.5-2.5 hours per day, and lowest risk with less than 1.5 hours per day.

If a child has 5 or 6 of these risk factors, there is a high risk of developing myopia.

If a child has 3 or 4 of these risk factors, there is a medium risk of developing myopia.

If a child has 0 to 2 of these risk factors, there is a low risk of developing myopia.

What are Risk Factors for Myopic Progression?

If a child has developed myopia, these risk factors can help determine the risk of myopia progression.

·         Age – Myopia progresses faster at younger ages. 

·         Age           7                                  Average Annual Progression         -0.89D

·         Age           8                                                                                              -0.80D

·         Age           9                                                                                              -0.71D

·         Age           10                                                                                            -0.63D

·         Age           11                                                                                            -0.54D

·         Age           12                                                                                            -0.45D

·         Age           13                                                                                            -0.37D

·         Age           14                                                                                            -0.28D

·         Age           15                                                                                            -0.19D

·         Age           16                                                                                            -0.11D

·         Ethnicity – Myopia Progression rate is faster in children of Asian descent.

·         Parental Myopia – Myopia Progression is faster with family history.

0 parent                            Average Annual Progression         -0.36D

1 parent                                                                                        -0.64D

2 parent                                                                                        -0.66D

·         Time Outdoors – There is not a lot of strong evidence to show that outdoor time helps to slow myopia progression

·         Time with Near Work – There is a lot of strong evidence to show that reducing the amount of near work will help slow myopia progression.

References

 Holden BA, Fricke TR, Wilson DA, et al. Global prevalence of myopia and high myopia and temporal trends from 2000 to 2050. Ophthalmology. 2016; 123 (5): 1036-42.

 Saw SM, Gazzard G, Shih-Yen EC, Chua WH. Myopia and associated pathological complications. Ophthalmic Physiol Opt. 2005; 25(5): 381-91.

 Holden BA, Wilson DA, Jong M, et al. Myopia, an underrated global problem with sight-threatening complications. Community Eye Health. 2015; 28 (90):35

 Flitcroft DI. The complex interactions of retinal, optical and environmental factors in myopia etiology. Prog Retin Eye Res. 2012; 31:622-60.

 Zadnik K, Sinnott LT, Cotter SA, et al. Prediction of juvenile onset myopia. JAMA Ophthalmol. 2015; 133(6): 683-9.

 Xiong S, Sankaraidurg P, Naduvilath T, et al.  Time spend in outdoor activities in relation to myopic prevention and control: a meta analysis and systemic review.  Acta Ophthalmol. 2017; 95(6): 551-66.

 Saw SM, Chua WH, Hong CY, et al.  Near work in early-onset myopia. Invest Ophthalmol Vis Sci. 2002; 43(2):332-9.

 Walline JJ. Myopia Control: A Review. Eye Contact Lens 2016; 42:3-8

 Eiden SB, David RL, Bennett ES, DeKinder JO. The SMART study: Background, Rationale, and baseline results. Contact Lens Spectrum. October 2009

 Walline JJ, Lindsley K, Vedula SS, et al.  Interventions to slow progression of myopia in children. Cochrane Database Syst Rev. 2011 Dec 7; (12): CD004916. Doi:10.1002/14651858.CD004916.pub3

 Audrey Chia, Qing-Shu Lu, Donald Tran. (2015) Five year Clinical Trial on Atropine for the Treatment of Myopia 2.  (Abstract) Ophthalmology Publishes Online August 11, 2015.

 Leo SW. Current approaches to myopia control. Curr Oin Ophthalmol 2017; Publish ahead of print

 Anderson RL, Aller T, Walline JJ. Controlling myopia, changing lives. Review of Cornea and Contact Lenses. September 2014.

 Smith MJ, Walline JJ.  Controlling myopia progression in children and adolescents. Adolesc Health Med Ther 2015; 6:133-40

 Chi A, 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(2): 347-54

 Luu CD, Lau AM, Koh AH, Tan D. Multifocal electroretinogram in children on atropine treatment for myopia. BR J Ophthalmol. 2005; 89(2): 151-3

 Sankaridug P. Fitting Multifocal Contact Lenses for Myopia Control. A Review of Cornea and Contact Lens, February 2017

 American Optometric Association. Multifocal contact lens effective in treating myopia in kids.  April 15, 2016. Available at https://www.aoa.org/news/clinical-eye-care/multifocal-contact-lens-effective-at-treating-myopia-in-kids

 Smith, MJ, Walline JJ. Controlling myopia progression in children and adolescents. Adolesc Health Med Ther 2015;6:133.40

 Sankaridurg P. Fitting Multifocal Contact Lenses for Myopia Control.  Review of Cornea and Contact Lenses, February 2017

 Bullimore MA. The Safety of Soft Contact Lenses in Children.  Optometry and Vision  Science. Vol. 94, No. 6, June 2017

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

 Li SM, Kang MT, Wu SS, et al.  Studies using concentric ring bifocal and peripheral add multifocal contact lenses to slow myopia progression in school-aged children; a meta-analysis. Ophthalmic Physiol Opt. 2017;37(1):51-9

 Eiden SB, David RL, Bennett ES, DeKinder JO. The SMART study: Background, Rationale, and baseline results. Contact Lens Spectrum. October 2009

 Smith, MJ, Walline JJ. Controlling myopia progression in children and adolescents. Adolesc Health Med Ther 2015;6:133.40

Eiden SB, David RL, Bennett ES, DeKinder JO. The SMART study: Background, Rationale, and baseline results. Contact Lens Spectrum. October 2009

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

 Walline JJ, Rah MJ, Jones LA. The Children’s Overnight Orthokeratology Investigation (COOKI) pilot study.  Optom Vis Sci. 2004 Jun; 81(6): 407-13

 Kakita T, Hiraoka T, Oshika T. Influence of overnight orthokeratology on axial elongation in childhood myopia. Invest Ophthalmol Vis Sci. 2011 Apr 6; 52(5): 2170-4

 Davis RL, Eiden SB, Bennett E, et al. Stabilizing Myopia by Accelerating Reshaping Technique (SMART) study three year outcomes and overview. Adv Ophalmol Vis Syst 2015; 2(3): 00046

 Sun Y, Xu F, Zhang T, et al. Orthokeratology to control myopia progression: a meta analysis. PLoS One.  2015; 10(4): e0124535

 Liu Y, Xie P. The safety of Orthokeratology – a systemic review. Eye Contact Lens. 2016; 42(1): 35-42

Eiden SB, David RL, Bennett ES, DeKinder JO. The SMART study: Background, Rationale, and baseline results. Contact Lens Spectrum. October 2009

 Walline JJ, Lindsley K, Vedula SS, et al. Interventions to slow progression of myopia in children.  Cochrane Database Syst Rev. 2011 Dec 7; (12): CD004916. Doi:10.1002/14651858.CD004916.pub3

 Sun Y-Y, Li S-M, Li S-Y, Kang M-T, Liu L-R, Meng B, Zhang F-J, Millodot M, Wang N. Effect of under correction versus full correction on myopia progression in 12-year old children.  Graefes Arch Clin Exp Ophthalmol 2017; 255: 189-95.

 Gwiazda J, Hyman L, Hussein M, Everett D, Norton TT, Kurtz D, Leske MD, Manny R, Marsh-Tootle W, Scheiman M. A randomized clinical trial of progressive addition lenses versus single vision lenses on the progression of myopia in children. Invest Ophthalmol Vis Sci 2003; 44:1492-500.

 Smith EL, 3rd. Optical treatment strategies to slow myopia progression: effects of the visual extent of the optical treatment zone. Exp Eye Res, 2013. 114:77-88.

 Leo SW. Current approaches to myopia control.  Curr Opin Ophthalmol  2017; Publish ahead of print

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