Myopia or short-sightedness

Q: What does it mean to have myopia?

A: If someone has myopia, it means that they can only see up close. Distance vision is blurred.

Q: is it possible to go blind from myopia?

A: Myopia can weaken the eye structure due to excessive stretching which can lead to macular degeneration and retinal detachments. These conditions are more prevalent is worse cases of myopia.

Q: How common is myopia.

A: In Asian countries (like Singapore, China or Hong Kong) myopia occurs in epidemic proportions. It is less common, although increasing every year, in Caucasian populations.

Q:  What causes myopia?

A: We now know that genetic disposition and prolonged close work (reading, using digital screens, etc) precipitates and leads to the progression of myopia

Q: How can myopia be treated?

A: There is a huge amount of research on this very subject. There are four main approaches to slowing the progression of myopia.

First, wearing glasses or contact lenses that provide the clearest distance vision is essential. In years past, it was believed that prescribing “weak” lenses that allowed reduced distance vision was the best. However, several large studies have proven that prescribing weak lenses makes the myopia worse.

Secondly, newly designed soft contact lenses that reduce peripheral retinal blur have been shown to slow myopia progression as have rigid gas permeable contact lenses that the patient sleeps in overnight.

Thirdly, an increasing number of studies have shown that myopia progression can be slowed using very weak atropine eye drops (with no side-effects) once a day can slow the progression of myopia significantly.

Finally, other studies have shown that spending an hour each day outdoors also helps.

Q: How about the eye-exercise methods described on the internet, like the Bates Method? Don’t they work?

A: Unfortunately, a large number of studies have shown that these techniques, while they mostly do no harm, do not reduce the progression of myopia in any way. Not even a little bit.

Q: Is there any way to prevent myopia in my children?

A: There is no known way to prevent myopia if you are genetically disposed to it. However, studies have shown that the rate of progression can be slowed by ensuring children have perfectly clear distance vision at all times, spending at least an hour outdoors daily, using very weak atropine drops daily and the use rigid gas permeable contacts designed to be slept in each night or soft contact lenses that reduce peripheral retinal blur.

Q: I suppose children should have regular eye check-ups then?

A: Yes. We recommend yearly to 2 yearly eye checks for all children. We can catch problems early.

What the current evidence on Myopia Control tells us…

Risk factors for myopia

1. One or both parents are myopic (30% progression in 6-12 year olds)
2. Continuously reading for more 30 minutes without breaks
3. Higher academic achievement
4. Spending less than 1 hour outdoors daily

Refraction risks

1. Less than +0.75 D at 6 years
2. Less than + 0.50 D at 7-8 years
3. Less than +0.25 D at 9-10 years
4. Overcorrection or under correction causes progression

Binocular Vision

Accommodation

1. Myopes show higher lags of accommodation
2. Higher progression rate in myopes with higher lags of accommodation

Accommodative vergence

1. Myopes have higher AC/A raios
2. Begins 4 years prior to myopia onset

Heterophoria

1. Esophoria at near more likely to become myopic cycloplegic refraction at every visit

Spectacle lenses

• Best for low myopes (< 1.50 D), low rate of progression (~ 0.25 D/year)
• Near esophoria
• Accommodative lag > 1.00D

Possible lenses

1. Defocus Incorporated Multiple Segments Technology or ‘D.I.M.S. Technology’ (Hoya)
2. Bifocals (39% reduction in progression)
   1. Add +1.50 if lag is > 1.00D
   2. If lag is < 1.00 D, use BI prism in near seg
3. PALs (14% reduction in progression)
   1. Add +2.00 D
   2. More effective if near esophoria and lag
4. Zeiss Myovision – insignificant effect

Contact Lenses

• Best – Cooper Vision MiSight lenses (40 – 50% reduction in progression)
  1. Must be worn 6-7 days a week
  2. Peripheral vision is slightly blurred
  3. Adaption is needed
  4. Daily disposable options
  5. Doesn’t have to be worn overnight
• Orthokeratology (40 – 50 % reduction in progression)
  1. High cost
  2. Frequent follow ups needed
  3. Adaptation is necessary
  4. Sleep in lenses
  5. No daytime wear

Atropine eye drops (50% reduction in progression)

1. Instill at night – simple
2. No side effects
3. Glasses or contacts still needed
4. Need to compounded (very low dose 0.01%)

What do I recommend?

1. Low dose atropine (0.01%) nightly
2. MiSight Cooper Vision Contact Lenses
3. Defocus Incorporated Multiple Segments Technology or ‘D.I.M.S. Technology’ (Hoya) – when available
4. Bifocal/Progressive Addition Lenses

What is proven to be ineffective?

1. Undercorrection of myopia
2. Overcorrection of myopia
3. Single vision spectacles
4. Single vision contact lenses

Lifestyle Recommendations

1. Spend at least 2 hours a day outdoors (sun protection is STILL important)
2. Have a break of 5 minutes every 30 minutes when doing close work
3. Increase the working distance and lighting (elbow to knuckle distance is the minimum)

When to have check backs

1. Every 3 to 6 months

Thanks to Dr Rohan Hughes, OD, (PhD candidate) for his input into this document