A review of the latest Myopia Management options for your child

If you’re reading this blog, you’ve already been made aware of and discovered the challenges with the current epidemic of myopia. Bhavin Shah, a member of Myopia Focus's advisory board, has given our readers a round-up of the latest treatment options backed by scientific research and evidence.

You may have noticed that more children are myopic than ever before.

Myopia is on the rise around the world. In the UK and the west, the number of myopic children has doubled over the past 2 decades.

In the Far East, over 90% of 18-year-olds are myopic [1], [2]. Since the pandemic, the incidence of myopia also appears to have accelerated [3]. Childhood myopia, especially high myopia, can increase the risk of serious eye conditions later in life, such as retinal damage and glaucoma. [4], [5], [6], [7]

Thankfully there are now some evidence-based, safe and successful options to help delay myopia's onset and slow down the progression rate.

The College of Optometrists (the professional body for all Optometric standards in the UK) advises its members to discuss the options for myopia management for all children who become myopic. If the Optometrist cannot provide management in their practice, they should direct parents to relevant resources such as myopiafocus.org to find an experienced and suitably trained practitioner for myopia management [8].

There are several factors that could induce the onset and progression of myopia, with most playing a part in the increasing number of children developing myopia. They are all explored below.

Hereditary factor

A child with a myopic parent is 3 times more likely to develop myopia. This increases to 6 times more likely when both parents are myopic [9]. This means that the number of children becoming myopic could increase with every generation.

Prolonged reading and close/near work

Holding books very close (especially less than 20cm) and prolonged reading time, especially without regular breaks, is a significant factor in developing myopia and can increase the rate of its progression [10].

Lack of time outdoors

Sunlight has a natural protective effect against the onset of myopia [11]. A National Trust survey showed children spend just over 4 hours outdoors per week; about half the time their parents used to spend outdoors when they were the same age.

So, what evidence-based options are out there to slow down the progression of myopia? There are some exciting and effective ways to impact the condition's progression. They won’t stop the change completely; they will slow the rate of change by about half on average. The treatments work by modifying how the light hits the peripheral parts of the eye and retina (the thin light-sensitive film inside the eye). Over 15 years ago, researchers found that altering the light that hits this part of the retina reduces the progression of myopia.

The best treatment option for your child can vary based on many factors, including: the age of your child, their spectacle prescription, and for contact lens options, their ability to manage contact lens wear.

Contact lenses for children

Children can be very successful contact lens wearers. Kids between 8 to 12 years of age have one of the lowest risks of complications compared to other age groups [12]. Children can respond well to contact lenses and find that the freedom from wearing glasses can improve self-esteem and self-confidence and aid in sports and physical activities.

There are 2 modalities of contact lenses that are proven to work exceptionally well for myopia management. Either option will slow the rate of change by about 50%:

• Daily wear dual-focus soft lenses

• Orthokeratology (also known as OrthoK or Night lenses)

Dual Focus Contact Lenses [13]

Dual-focus daily wear lenses are worn like regular contact lenses during the day and have unique peripheral optical properties that slow the rate of myopic progression. They are usually soft lenses, and, in most cases, they are single-use, daily disposable lenses, reducing the risk of infection. Complication rates are extremely low because each pair is thrown away at the end of the day, and a new fresh sterile pair is applied the next day. A limitation of this modality is that water must be avoided because of the risks of infection. They need to be removed before swimming and going in the shower. The effectiveness of this type of lens for myopia management has been studied since 2010

Orthokeratology [14]

Orthokeratology lenses are bespoke rigid lenses that are only worn overnight. They gently reshape the cornea, the front surface of the eye. On waking, the lenses are removed, and changing the cornea's shape means that the myopia is neutralised for the day, and the child can see clearly throughout the day without lenses. A beneficial side effect of this reshaping is that it changes the cornea's peripheral optical properties. Children will need to wear them again at night; otherwise, the cornea will revert to its natural shape, and myopia will return to the baseline again. There are some limitations with this method; the range of powers of myopia that can be corrected is not as wide as soft lenses, and they can take some time to achieve the optimum fitting and effect. The positive benefits are that a child doesn’t need to wear any contact lenses during the day. Sports such as swimming are much better with orthokeratology because the vision is clear during the day without any contact lenses or glasses. Orthokeratology for myopia management was shown to work over 20 years ago.

New generation spectacle lens options

More recently, in 2014, a research team from Hong Kong created a new generation of spectacle lenses that have similar peripheral optical properties to contact lenses, but they can be worn like regular glasses [15]. They are especially helpful for children who are not suitable or struggle to tolerate contact lenses. Since then, there have been several other companies that have produced similar lens designs.

Atropine eye drops [16]

These eye drops were traditionally used to dilate the pupil of the eye and relax the muscles that focus the eyes when looking close. Over 25 years ago, it was found that low doses of Atropine can slow down the rate of progression of myopia in children. It is extensively used in the Far East. However, there is continuing investigation to determine the most effective dose. In the UK, Atropine is not yet licenced for use in myopia management. A small number of Ophthalmologists and consultants do prescribe it under supervision. Atropine is being researched in hospitals and academic institutions to see if it will be equally effective for the UK population in the same way as they have been used in the Far East. After these trials, Atropine may be licenced for use through registered prescribers.

Please note that Atropine eye drops are not yet fully licenced for myopia management in the UK.

Now that you as a parent are aware of the various options, what should you be doing to help your child?

Speak to an expert in myopia management

There is now lots of scientific research, studies and treatments showing that myopia's progression can be slowed substantially. Speak to a practitioner who has experience in this subject, and they will be able to discuss the best options for your child. Each child is different, so a bespoke plan for your child's individual needs is the best approach. You’ll be able to find a local verified expert in the search function of this site.

The treatment options above provide the most effective and proven value for myopia management. However, there are some additional habits that may also provide incremental benefits.

Get outdoors

Children are spending less time outdoors than before. Being outdoors in sunlight has a protective effect on the eyes against myopia 8. A child should spend at least two hours a day outdoors.

Hold books or devices further away

The research shows that the increased effort of focusing required when books are held too close can increase the progression of myopia. Books should be held further away than 20cm (and more if possible).

Take breaks from close work and device use.

It is essential to take breaks from intense near work by looking into the distance. This will relax the muscles used by the eyes to focus at close distances. These are muscles that turn the eyes in and those that focus the lens inside the eye. The tiredness of these muscles causes eye strain and drives more myopia. The easiest thing to remember is 20/20/20. Focus on an object at least 20 feet away for 20 seconds every 20 minutes. Taking a 10-15-minute break every 50 minutes also helps to improve concentration as well as helping to relax the muscles of the eye.

Sleep

A recent study found that a lack of sleep can increase myopia progression [17]. Children should be getting between 9-11 hours of sleep every night. Using smartphones and tablets before sleep also affects circadian rhythms and further affects sleep patterns.

If you're a parent whose child has been diagnosed with myopia or if they are struggling with their distance vision, we hope you found MyopiaFocus helpful. Please join our community or sign our petition to get the government and NHS to recognise myopia as an ocular disease/severe ocular condition and fund myopia management for children.