It’s a very familiar story for parents. You’re at the eye doctor and your child’s vision is getting worse. They need to get stronger glasses and/or contact lenses. The questions that occur with worsening myopia (nearsightedness) for most parents are: how bad is it getting? will it ever stop changing? how bad will it be when he/she is an adult? is this normal? is there anything we can do to keep it from getting worse? If you’ve had these questions before, this article is definitely written with you in mind.
10 Things for Parents to Consider with Worsening Myopia in Children.
1 Age of the Child
If one focus is the long term trajectory of a child’s prescription, the age of onset of myopia and myopia changes is very important. As an eye doctor, I’m much more concerned about children who are showing worsening myopia at ages 5-7 than children 15-17. There’s a longer runway, so to speak, for the younger child to keep changing. Also, some studies show that children who are myopic at younger ages can change more severely.
2 Amount of Myopia Change
When a child has a big increase in their myopia in a single year, I’m concerned. Even if there’s not necessarily been a history of consistent changes, the big changes concern me as a potential indicator of things to come. The axial length of the eye is increasing in response to something and will that “something” be there over the next several years. While the ATOM-1 and ATOM-2 studies defined myopia progression as an increase of -0.50 Diopters in one year, I think worrisome progression may be a bit more than that. But, there’s a lot of factors here to consider.
3 History of Myopia Progression
One challenge that I have in my clinic is discussing progression of myopia for children that are seeing me for the first time. Maybe the previous doctor didn’t discuss myopia progression or myopia intervention. But, if there is a history of myopia progression–even in small amounts–it’s a concern. This concern is compounded by other considerations mentioned in this article.
4 Amount of Time Spent Outdoors
Studies have shown a correlation between amount of time outdoors and lower risks of myopia. At least one study showed that kids who spent more time indoors were 40% more likely to develop myopia than kids who spent two to three hours a day outside. That’s not to say sending your child outside all day will prevent them from ever becoming nearsighted. But, I do believe, given the research, the amount of time a child spends outdoors is one of the things parents should consider when faced with myopia progression.
5 Whether to give Full Prescription or Under-Prescribe
There was an old school train of thought on worsening myopia that went like this: if the myopia monster was getting bigger and hungrier every year, purposely not giving into it would stop it from getting bigger. For example, if Susie’s prescription increased by 40%, then only putting a 20% increase in her glasses would somehow stop her from getting worse down the road. I still get some parents that ask about this and I understand that perspective. The problem is that one study, which compared 16 different methods of myopia intervention, found that under-prescribing actually increased progression more than if the full prescription was given. Not only that, but the child is going to have blurry vision while trying to read the board at school if they are under-corrected. Consider under-prescribing a lose-lose scenario.
6 Low-Dose Atropine for Myopia Intervention
Myopia intervention methods have gained more traction in the last few years thanks to several outstanding studies. Many of these studies looked at large groups of patients to compare and rank effectiveness in controlling the progression of myopia in children. Right now, the most effective method of myopia intervention is low-dose atropine (0.01% concentration). It’s a prescription eye drop used daily for at least two years. The ATOM-2 study showed that, over a 5 year period, low-dose atropine showed over a 50% reduction of myopia progression. That is very effective over such a long period of time. The eye drop comes with very low risk of side effects and will not blur vision or cause light sensitivity like full dose atropine. Read more about low-dose atropine here.
7 Orthokeratology for Myopia Intervention
The “16 Interventions” Study showed that orthokeratology was highly effective in controlling myopia progression in children–second in effectiveness only to low-dose atropine. Orthokeratology uses a special, custom-made hard contact lens to flatten the cornea. The lenses are FDA approved to be worn in children overnight. The added benefit is that, due the reshaped cornea, glasses and contact lenses are not needed during the daytime to see clearly. The child wears the lenses while sleeping, takes them out in the morning, goes to school and sees great without glasses. While this is a major benefit, the studies show Orthokeratology is very effective at controling the elongation of the eye. It’s this constant elongation of the eye in some children that is resulting in very progressive myopia. Some practices, mine included, refer to this treatment as Corneal Reshaping Technology (CRT).
8 Soft Multi-focal Contact Lenses for Myopia Intervention
The “16 Interventions” Study also showed that soft, multi-focal contact lenses were effective in controlling the progression of myopia in children. While not as effective as low-dose atropine or orthokeratology, they could be very helpful for many situations—especially in those cases where the progression is more moderate. Soft multi-focal contact lenses could also help supplement low-dose atropine to provide even more myopia control in those children that seem to be highly progressive in their worsening myopia.
9 Health Risks associated with Myopia
It’s well known within the medical field that myopia is associated with increased risk of certain eye disease and conditions. Unfortunately, eye doctors have not always done a good job educating the public on this. Many patients do not know there is a strong correlation with myopia and retinal detachments. Studies show that the higher the myopia the greater the risk. This is serious because retinal detachments can cause blindness depending on the location of the detachment and the timeliness of treatment. I think it’s important for all parents of children with worsening myopia to know that this is more than just a vision issue. There are ocular health implications. Check out this post on “5 Reasons why Progressive Myopia is a Health Issue.”
10 Myopia is near Pandemic Proportions
Myopia has almost doubled in the United States over the last 3 decades and it may affect over 40% of the population. In some areas of Asia, it may affect up to 80% of the population. There’s no denying that present generations are more likely to be myopic and to have greater amounts of myopia. There are a lot of debates over the exact reason for this. What’s not up for debate is that we must do something to address myopia and myopia progression as a public health issue. I really believe that starts on an individual basis with parents fully understanding risks for myopia progression, myopia intervention methods available, and the health risks of the myopia. With that knowledge in hand, parents and eye doctors can work together to make the right decisions for the benefit of the child.
As always, please feel free to shoot me any questions or comments. Please share this post with other parents to help increase awareness.