Myopia Management

Myopia is being recognized as a worldwide epidemic with significant health consequences. The rapid increase in myopic development with the enhanced risk for ocular diseases such as glaucoma, earlier onset of cataracts and retinal tears, holes and/or detachments, make myopia a significant health concern. For example, moderate levels of myopia (-0.75 to -3.00 diopters) are associated with 3 to 4 times greater risk of retinal detachment. The risk of retinal detachment jumps to 20 to 80 times that of a non-myope when the myopia is greater than -6.00 diopters. A 2016 study by Holden reports that reducing the rate of myopia progression by 50% (through treatments like orthokeratology, soft multifocal lenses …) would decrease the prevalence of all myopia and reduce high myopia up to 90%.

Genetics play a role in the progression of myopia (continual deterioration of distance vision): If one parent is myopic, the risk is 1.5 times; if both parents are myopic, the risk is three (3) times. Environment plays a role, too: reading too close to the eyes increases myopia progression and playing outside 9 to 10 hours per week reduces the risk of developing myopia, but is not likely to have the same effect once myopia begins. In fact, one study known as CLEERE reports that if a child is less hyperopic than +0.75 by first grade, he/she is at an increased risk to become myopic.

Contributing to myopia development and progression:

• Diet and nutrition
• Time spent outdoors
• Interferences in focusing
• Interferences in binocularity, integration and coordination of the eyes
• Type of visual correction worn
• Habits and behaviors during near vision activities such as reading, writing, typing, computing and texting

Now here is the good news: with our guidance you or your child can MINIMIZE the progression of myopia. Because we constantly update our knowledge of myopia development by reading extensively and attending education seminars, you, your family and friends benefit.

Alternatives for Managing Myopia

1. Do nothing
• The degree of distance vision blur is not interfering with your daily activities. If you decide against preventive and/or therapeutic treatment alternatives, your myopia will increase.
2. Preventive – choosing this alternative provides you with the basic tools to minimize further vision changes. These include:
• Stress-relieving lenses – your prescription glasses, when used appropriately and consistently, reduce the stress caused by sustained focusing and/or sustained convergence during near activities. The prescription of your stress-relieving is carefully determined during your comprehensive vision evaluation. In addition, the prescription may change over time (months); therefore regular, scheduled optometric examinations are important to the success of a preventive approach to myopia management. The goal of prevention means maintaining hyperopia, and this often requires wearing glasses during near vision tasks and holding reading materials at or beyond the Harmon distance (the distance from the elbow to the middle knuckle).
• Outdoor Activities – spending time outdoors 9 to 10 hours per week where the eyes have the opportunity to look at far and distant objects provides several important benefits in the management of myopia progression:
• The eyes can relax their focusing mechanism when looking far away.
• Engaging in movement-oriented activities like walking, running, climbing…provides opportunities to lower stress levels in the eyes and body.
• Recent studies show that vitamin D levels in myopic children are low, in some cases 40%! Sunlight stimulates the body to produce Vitamin D. Since our culture spends excessive time indoors, no wonder Vitamin D levels are so low.
• Time spent outdoors reduces time spent performing visually stressful and potentially myopia-producing near vision activities.
• Visual Hygiene – our handout by this name provides a list of recommendations for minimizing the bad or adverse effects of prolonged visual activities.
• Diet and Nutrition - develop a balanced diet that avoids overcooked proteins and provides an ample intake of fresh fruits and raw or lightly cooked vegetables. If your diet is not balanced, consider vitamins, mineral and other supplementation. One dietary constituent we believe is important to ocular function is essential fatty acids (primarily omega 3). If you want additional advice and guidance, we can provide the name of a nutritionist.
3. Therapeutic
• Orthokeratology (OK) – Ongoing studies of children confirm the effectiveness of orthokeratology in reducing the rate of myopic progression by 40 to 50%. Additionally, studies confirm the safety of orthokeratology: complication rates are the same as other modalities of soft and gas permeable lens wear. Perhaps the best aspect of orthokeratology is that you and your child will see clearly all day WITHOUT glasses or contact lenses: NO broken or lost glasses, good vision without the social stigma of wearing glasses.
• Multifocal contact lenses – Research by Earl Smith, PhD, OD confirms a mechanism that increases myopia development and myopia progression. The way light focuses on the retina can cause the eye to grow longer (axial elongation). Regular glasses and contact lenses, especially single vision corrections, actually make the situation worse! The way distance-only glasses and contact lenses focus light ADDS to the process that increases axial length and ultimately myopia progression. Certain multifocal contact lenses not only counter the adverse effects of distance-only glasses and contact lenses, but they provide the type of retinal focus Smith employed to stop axial elongation in his test subjects (monkeys).
• Bifocal glasses – By prescribing the appropriate distant and near vision glasses, we can provide a means to reduce near visual stress that often triggers or accelerates myopia development and progression.
• Atropine – Low doses of this prescription eyedrop is very effective in slowing myopia progression and can be prescribed as a stand-alone treatment or in conjunction with other therapies.
• Vision Training – Certain problems with the focusing and eye-teaming abilities increase the risk of myopia increases. Incorporating vision training with these therapeutic interventions trains the myopic individual to use the visual system more efficiently and develop a greater capacity to withstand the stresses imposed by near vision activities.