Myopia Management

What is myopia?

Myopia is a common condition that tends to begin in childhood or teenage years, where the eyeball is longer than normal and leads to the image being focussed in front of the retina. The retina is the film lining the back of the eye and is where the image should normally be focussed.

What does my child see?

A child with myopia tends to see blur in the distance. This can make distance tasks more difficult, including seeing the board at school, playing sports and watching TV.

Why does my child have myopia?

There are many factors that can lead to myopia. Research currently suggests that myopia is largely associated with environmental or behavioural factors such as reduced time outdoors and increased near work. Family history of myopia can also increase the likelihood of developing myopia.

Do near electronic devices cause myopia?

There have not yet been any trials looking specifically at the effect of near electronic devices on myopia. What we do know is that increased amounts of near work, and reduced time outdoors is associated with myopia.

Does myopia get worse?

When children develop myopia, the myopia tends to increase over time until their mid to late teens. This increase in myopia can eventually become high myopia, which is when the myopia reaches a prescription of -5.00 D or worse. When the myopia reaches this level, the risk of developing potentially sight-threatening complications increases exponentially. The sight-threatening complications include but are not limited to:

Retinal detachment

• where the retina detaches from the eyeball.

Myopic macular degeneration

• leads to degeneration of the macular area (the area of the eye responsible for sharp vision).

Glaucoma

• leads to degeneration of the optic nerve which is responsible for transmitting signals from the eye to the brain and is thought to be due changes in the pressure of the eyeball.

Cataract

• the lens in the eye responsible for focussing the image becomes cloudy.

It’s important to note that these complications will occur later in life, usually in the 40s or later and they can often be treated. But there can also be permanent vision loss.

Why is higher myopia a problem?

When children develop myopia, the myopia tends to increase over time until their mid to late teens. This increase in myopia can eventually become high myopia, which is when the myopia reaches a prescription of -5.00 D or worse. When the myopia reaches this level, the eye is too long and stretched, and the risk of developing potentially sight-threatening complications increases exponentially.

What can be done about it?

New research has shown that we can slow the increase in myopia in children safely and effectively using optical treatments.

These include:

• multifocal soft contact lenses (worn daily)

• executive bifocal spectacles

• progressive additional lenses (PALs) and peripheral defocus spectacles like the Stellest lens.

• orthokeratology lenses (rigid gas permeable lenses worn overnight to reshape the eye)

Some children may also benefit from use of therapeutic eye drops such as low dose atropine.

These treatments will not stop the myopia from increasing (as the eye of a child still needs to grow naturally) but will slow the increase in myopia. The average effect of treatment has been shown to be 40 to 50% in many studies, however some children will progress more or less than this. It is possible that the strategy used in your child’s eyes, will not slow the rate of progression.

Slowing myopia is important as high levels of myopia can increase the risk of sight-threatening complication in future (discussed above). Preventing higher myopia will also mean that your child will not have to wear thick spectacle lenses, which can be heavier and reduce cosmesis.