Myopia (Nearsightedness)
The prevalence of myopia is increasing rapidly in US and worldwide. It is approaching 40% of school age children in this country and exceeds 80% in some asian countries. These numbers continue to increase. Myopia is frequently considered a nuisance condition, treatable with glasses, contact lenses and refractive surgery. It is important to recognize that myopia can have serious consequences, being associated with eye conditions later in life such as retinal detachment and glaucoma.
Family history is a very important factor in myopia development. If both parents are myopic, a child has more than a 50% chance of being nearsighted. The chance is 33% if one parent is myopic and 25% if neither parent is myopic.
It is becoming increasingly recognized that environmental factors also play an important role. It has been shown in multiple studies that increased outdoor time is associated with less progression of myopia. It is also becoming clear that increased near work activities and screen time are associated with worsening myopia.
A recent study in China showed that during Covid home confinement that myopia in children ages 6-8 years increased by 1.4-3.0 times the rate compared to 5 years prior.
Chance Of Child Being Nearsighted
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Options for trying to reduce the progression of myopia
Behavioral
Spending more time outdoors
Trying to limit or reduce screen time / near work activities
Atropine
Of treatment options available, low concentration atropine has been found to be the most effective modality of trying to decrease the progression of myopia. The mechanism for this is not completely known, but atropine eye drops are felt to interact with certain muscarinic receptors to decrease the elongation of the eye, which causes myopia.
Low concentration atropine is not currently FDA approved for myopia control. Atropine has been used in medicine for hundreds of years and is approved as an eye drop at a much higher concentration for use in ophthalmology. Numerous studies have been done showing atropine to be both safe and effective for use in myopia control. Eye Physicians of Central Florida is participating in a large multicenter trial that may lead to possible FDA approval. It is currently available from compounding pharmacies at the low concentrations typically used for this purpose. It is not currently covered by insurance for this use. Hopefully, there will soon be an FDA approved product available at commercial pharmacies that will be covered by insurance. Until that time, we will prescribe drops from compounding pharmacies when felt to be medically appropriate.
There is some debate over the most advantageous concentration used for low concentration atropine. Results from the ATOM studies in Singapore more than a decade ago suggested that 0.01% atropine may be the most favorable. Recently released results from the 3 year data of the LAMP study indicate that 0.05% may be the best choice for most individuals longer term. The higher the concentration the more side effects there may be related to difficulty focusing at near and light sensitivity. These side effects are uncommon with any of the concentrations typically used and would be expected to resolve once the drop is stopped.
Your pediatric ophthalmologist at Eye Physicians will help determine which is the best concentration for your child.
MiSight® Contact Lenses
Another treatment option that is available and offered at Eye Physicians of Central Florida are peripheral defocus contact lenses called MiSight® 1 day.
This is an exciting and new approach which has been shown in studies to decrease myopia progression. This is a soft contact lens, worn daytime, similar to other contact lenses. These lenses are not currently available to correct larger amount of astigmatism.
Other contact lenses and glasses may become available in the future based on similar treatment principles. These can be used alone or in combination with atropine.
Learn about the benefits of MiSight® 1 day at https://vimeo.com/475557939.
Orthokeratology
Orthokeratology involves wearing a more rigid contact lens during sleep. It compresses the cornea, temporarily reversing myopia. It has also been shown to have some effect on decreasing progression of myopia, although to with a lesser effect than atropine. There is some risk of infection of the cornea, as can occur with any contact lens.
We do not do orthokeratology treatment at Eye Physicians of Central Florida.
This is offered by some optometrists in Central Florida.
If you would like to learn more about Myopia Control,
contact Eye Physicians of Central Florida to schedule your appointment.