Nearsightedness is on the rise!
With our children spending more time in front of screens and less time outdoors, myopia is fast becoming an epidemic. By the year 2050, it is estimated that 50% of the world will suffer from myopia – about 5 billion people.
The consequences of high myopia are more than just thick glasses. Those with myopia have a higher risk of retinal detachment, blindness or vision impairment due to myopic macular degeneration (MMD) and myopic retinopathy. Cases of cataracts and glaucoma also increase with higher severity of myopia.
Thankfully, new advances in myopia control are now actively being researched. Although the literature on this subject is still in its infancy, there are some good studies to draw from.
Soft Bifocal Contact Lenses
These are soft contact lenses that cause blur of the peripheral vision. They work to limit the growth of the eye by focusing light in front of the retina to promote slowing of eye elongation. This method is caused peripheral defocus.
These contact lenses are for daily contact lens wear and should be worn most of the day and taken off while sleeping. Studies show that axial elongation (eye growth) is slowed by 46-87% with this method.
This treatment is considered the optical equivalent of dental “braces”. Treatment involves overnight wear of rigid gas permeable contact lenses that reshape the cornea while sleeping.
Like Soft Bifocal Lenses, the idea is to create peripheral defocus. The advantage to this treatment is that upon waking in the morning, the contact lenses are removed and the cornea retains the molded shape for the rest of the day.
However, unlike braces, this reshaping is not permanent. These retainer lenses must be worn every night to maintain the effect.
Studies show that axial elongation is slowed roughly 43% with this method.
For best results, it is recommended to start when the refractive error is less than 4.00D of myopia, and ideally for patients older than 9-10 years of age. It can be started earlier depending on the maturity level of the patient.
Orthokeratology has been around for decades and has traditionally been used for adults as an alternative to wearing glasses or contacts and for those who want a non-surgical alternative to laser eye surgery.
This is the newest area of myopia control research. Recent studies have found that 0.01% atropine decreases progression of myopia by 50-87% compared to a placebo group. However, we do not know exactly how this medication works to control myopia. At higher concentrations (e.g. 0.5%, 1%), there is a dangerous rebound if treatment is discontinued where refractive error returns quickly to placebo levels. Interestingly, there was no rebound effect found for 0.01% atropine. Some side-effects of atropine include blurred near vision, less accommodation (focusing ability at near distances), and pupil dilation resulting in light sensitivity. However, these effects are minimal for 0.01% atropine. This method is recommended for children who are unable to wear contact lenses.
Your optometrist will discuss the above methods with you and make recommendations depending on the lifestyle of your child and the goals of treatment.
So, how often should you have your child’s eyes checked?
The Alberta Association of Optometrists recommends the first eye exam for children at six months of age, when the child is two years of age, and every year after the age of four. Eye examinations are covered under Alberta Health Care until age 19.
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