Myopia Management
The prevalence of myopia, or nearsightedness, has greatly increased since COVID-19 as children have been spending more time on screens and less time outdoors. If you missed my previous post, myopia is associated with an eyeball length, or axial length, that is longer than average. As the eyeball grows longer the tissue and structures within the eye gets stretched and potentially compromised; therefore patients with myopia not only have a hard time seeing clearly faraway but also have a greater risk of developing different ocular complications. The onset of myopia typically occurs during childhood and can quickly progress as the eye continues to grow. Myopia progression depends on numerous factors including family ocular history/genetics, systemic conditions, screen time, near work, and overall lifestyle. For this reason, we strongly encourage routine check ups with an optometrist to track the rate of myopia progression and start myopia management if an abnormal rate of progression is observed. The different forms of myopia management include Atropine eye drops, multifocal soft contact lenses, and rigid gas permeable/ortho-k contact lenses.
1. Low-dose Atropine eye drops: Low-dose Atropine is a common choice of myopia management for our younger patients who may not be ready for contact lenses just yet. The eye drop is to be administered into the eyes nightly. In conjunction with the nightly eye drop, the patient will still need to wear their glasses and/or contact lenses during the day to see clearly. The biomechanics of Atropine helps slow down growth and elongation of the eyes. Potential side effects of Atropine include light-sensitivity, headaches, or slight blurry vision up-close. However, our optometrists will work closely with our patients to minimize any side effects that may occur.
2. Multifocal Soft Contact Lenses: MiSight contact lenses are soft contact lenses with a multifocal design that is FDA approved for myopia management. If a patient’s prescription is outside of MiSight’s parameters there are alternative multifocal soft contact lens brands that can be used off-label. The multifocal lens design provides clear central vision and peripheral “myopic defocus” which signals the eyes to slow its elongation down. These lenses are to be worn throughout the day and then taken off before bedtime. Potential adverse effects of multifocal soft contact lenses include lens awareness (which should resolve with time) and risk of ocular infections if the lenses are not handled properly. Our optometrists and staff ensure that our patients and/or their parents are properly trained on how to insert, remove, and take care of the contact lenses.
3. Rigid Gas Permeable Lenses/Ortho-K Lenses: Orthokeratology, or Ortho-K, lenses are custom designed rigid lenses that are worn overnight. The lenses work by temporarily reshaping the cornea, or clear dome-shaped structure in the front of the eye, in a way that provides clear central vision and peripheral “myopic defocus” similar to multifocal soft contact lenses. Unlike multifocal soft contact lenses, Ortho-K lenses are worn overnight and removed in the morning. The temporary reshaping of the cornea provides clear vision throughout the day without the need of glasses or contacts lenses. We like to describe Ortho-K lenses as retainers for the eyes. If lens wear is discontinued the cornea will eventually revert back to its original shape and the myopia will return. For this reason we have our patients continue with Ortho-K wear until their early-mid 20s when their prescription has usually stabilized. Similar to soft contact lenses, the potential adverse effects are lens awareness and increased risk of ocular infections. Again, our team works closely with our patients to ensure they are properly trained on how to handle and care for their lenses.
All three forms of treatment have comparable efficacies but recent literature suggests that Atropine eye drops should be viewed more as a stepping stone until the patient is ready to wear contact lenses. Our optometrists will take the time to learn our patient’s lifestyles, understand parents’ concerns, and obtain necessary measurements to find the myopia management program that works best! The goal of myopia management is to reduce the strength of future eyeglasses or contact lenses needed to correct vision and to decrease the risk of certain sight threatening eye disease. Schedule an appointment now for a comprehensive eye exam or for a myopia consultation for further information!