What is Myopia Control ?
There are several strategies we can employ to slow the progression of myopia. A customized treatment plan for your specific situation will be discussed. The goal of treatment is to slow or even stop myopia from progressing.
This document is designed to educate you regarding your options, benefits and any potential risks. It is important to understand that it is impossible to perform any treatment without the patient accepting a certain degree of responsibility and risk. Myopia control strategies are elective. Alternatives are: eyeglasses, conventional contact lenses or refractive surgery (adults only). Please read this information in its entirety and feel free to ask any questions you may have.
1. WHAT IS MYOPIA?
Myopia, or nearsightedness, is the condition in which the eye focuses light at a point in front of the retina instead of directly on the retina. Therefore, a blurred or distorted visual image is produced on the retina. This occurs due to a lengthening of the eyeball referred to as axial elongation. The smaller and further away the target from the eye, the more blurry the vision. As most people have experienced, myopic vision typically gets worse with time causing a need for stronger glasses and/or contact lenses. As myopia progresses, so does the risk of developing certain eye diseases such as macular degeneration, glaucoma, cataracts, retinal holes/tears, retinal detachments, vitreous detachments and floaters.
2. WHY DOES MYOPIA GET WORSE?
Fig.1: The image of the corrected myopic eye (left image) shows how light rays which would have fallen at a point in front of the retina are pushed back to land on the center of the retina. This can be done with spectacle or contact lenses. However, peripheral light rays are also pushed backward and fall behind the retina. The eye will then elongate (right image) so that the peripheral focal points will fall on the retina. As this occurs, the central retinal focus will now move in front of the retina causing the patient to require stronger lenses. The stronger lenses will move the focus point back to the central retina, but again push the peripheral focus points behind the retina and the process will repeat itself as myopia progresses. Interestingly, the uncorrected (or undercorrected) myope also often suffers a similar elongation for reasons not yet fully understood.
Fig 2: This image is of the corrected myopic eye for myopia control. The optimized correction pulls peripheral focus points forward so that they fall in front of the retina which will slow or stop the eye from continuing to grow longer.
3. WHAT IS MYOPIA CONTROL?
Myopia control is a multifactorial approach to discourage the eye from elongating which leads to higher degrees of myopia. There are several methods or strategies which can be employed. Not all methods work for all patients. Your doctor will discuss the various options available. These options include:
b. SOFT MiSight® 1 day Contact Lenses
d. Bifocal Spectacle Glasses
e. Increased outdoor time
f. Decreased screen time
a. WHAT IS ORTHOKERATOLOGY?
Orthokeratology or Ortho-k is the science of temporarily changing the curvature or shape of the cornea. This changes how light is focused on the retina at the back of the eye. It works each night while you sleep by using specially designed retainer contact lenses put in prior to bed and removed upon awakening. The result is clear vision throughout the day without glasses or contact lenses on. Ortho-k creates an optimal corneal shape to reduce peripheral light rays from promoting eye growth as described above. Studies show this modality can slow down the progression of myopia by 40-60% compared to controls1, though significantly higher percentages have been reported from clinicians globally (in many cases between 80-100%).
b. WHAT ARE SOFT MiSight® 1 day CONTACT LENSES?
The FDA approved MiSight® 1 day soft contact lenses are meant to be worn daily to correct nearsightedness and slow the progression of myopia in kids with healthy eyes. When placed on the eye, one part of the MiSight contact lens corrects the refractive error to improve distance vision in nearsighted eyes, similar to a standard corrective lens. The lenses worn create a small distance zone surrounded by a near zone. The near zone is thought to reduce peripheral light rays from promoting eye growth as described above. Recent studies show this modality can slow down the progression of myopia by 30-50% compared to controls.2
c. WHAT IS ATROPINE?
Atropine is an eye drop medication historically used to dilate the pupils. Atropine, when used in diluted concentrations, has been shown to be an effective means of slowing down myopia progression. The mechanism of action is unknown at this time. Studies show this modality can slow down the progression of myopia by approximately 40-60% compared to controls. The most common potential side effects of Atropine are light sensitivity, focusing dysfunction, dry mouth and tachycardia. However, these are rare given the diluted nature of the eye drop used. Diluted Atropine does not exist in a “ready-made” prescription bottle and therefore must be compounded by a special compounding pharmacist and will not be covered by insurance.3
d. BIFOCAL SPECTACLE GLASSES:
Bifocal glasses create 2 zones or focal points. The upper portion of the lens is meant for far distance viewing, the lower portion is meant for near viewing and is less strong than the upper segment. Progressive lenses are similar to bifocals, but the junction is invisible and there is also an intermediate zone. Of all the strategies being studied now, bifocal glasses have been shown to be least effective for myopia control. Studies have shown up to 40% reduction in myopic progression, though the efficacy decreases after the first year to statistically insignificant levels.4 However, there are currently spectacle lenses being used in other countries with novel designs not yet available in the US that show good initial results.5
e. INCREASED OUTDOOR TIME:
Children today spend a large amount of time indoors. This has been shown to be a risk factor for myopia. There are several theories about this and research on the subject continues. When indoors, spaces are smaller and more “vertical” as walls surround us. The visual plane is more “horizontal” when outside, thereby creating a much wider field of focus. Additionally, the natural sunlight impacts the chemistry of the retina to decrease signals to grow longer. It is also theorized that indoor activities such as reading, using a computer or hand-held device may lead toward increases in myopia.
f. DECREASED SCREEN TIME:
Cell phones, tablets, computers, televisions and laptops have become pervasive in our society. They create a near point strain which can be a trigger for increasing myopia.
4. PROFESSIONAL FEES:
The fees for Myopia Control depend on the modality chosen as most appropriate for you or your child. Myopia control treatments start at $1800, and require more frequent office visits and more sophisticated testing than simple annual examinations. While insurance coverage for the “routine” components of an annual exam are allowable, follow-up visits and the materials involved will be out-of-pocket expenses.
1. Lipson MJ, Brooks MM, Koffler BH. The Role of Orthokeratology in Myopia Control: A Review. Eye & Contact Lens 2018;44: 224–230. 2. 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):51-59.
3. Yam JC, Jiang Y, Tang SM, et al. Low-Concentration Atropine for Myopia Progression (LAMP) Study: A Randomized, Double-Blinded, Placebo Controlled Trial of 0.05%, 0.025%, and 0.01% Atropine Eye Drops in Myopia Control. Ophthalmology. 2019;126(1):113-124.
4. Gwiazda J, Hyman L, Hussein M, et al. 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(4):1492-1500.
5. Lam CSY, Tang WC, Tse DY, et al. Defocus Incorporated Multiple Segments (DIMS) spectacle lenses slow myopia progression: a 2-year randomised clinical trial. Br J Ophthalmol. 2020;104(3):363-368.