Myopia Control

Dr. Eldon R Repsher
Optometrist

5832 N Main St Joplin, MO 64801
(417) 623-7900 | Email

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What is Myopia?
Myopia is a rising epidemic in the developed world with approximately 50% of people in the United States diagnosed as myopic and almost 90% in parts of Asia [1]. In addition to the social, emotional, and financial effects of myopia, there are anatomical ramifications as well. Highly myopic patients are exposed to unique risks due to their elongated axial length (front to back length of the eye). While refractive surgery may eliminate a patient’s myopic refraction once it stabilizes, it does not eliminate the pathological threat associated with high myopia.

If we suspect an ocular condition or disease,
we will immediately schedule or perform
diagnostic tests to determine our next steps.

What can we do?
1) Get your children outdoors. Many large studies^{[1, 2]} have shown that children who spend more time outside, particularly in the pre-school age group, are less likely to develop myopia or to lesser degrees.

2) Make sure your children always wear the most current glasses prescription. Studies have found that children who are under-corrected become more nearsighted faster^[4]. Children aged 9-11 in particular may need lens power changes more often than once yearly.

3) Practice good visual hygiene. The 20/20/20 rule encourages looking at something 20 feet away, every 20 minutes, for at least 20 seconds. Do not hold near material too close to your eyes.

4) Consider the myopia control options listed below.

Corneal Reshaping/Refractive Therapy (CRT)
CRT lenses are “hard” contact lenses that are worn at night. These lenses reversibly reshape the surface of the eye (cornea) during sleep, providing clear vision during the day. The cornea will return to its original shape if the patient discontinues wearing their “retainer” lenses at night.

These lenses will last approximately one year before they start to lose their shape and need to be replaced. Children wearing CRT lenses will become nearsighted half as fast^[5-7] as children who wear standard glasses or contacts. The best candidates for CRT are those with low to moderate myopia without significant astigmatism

Multifocal Soft Contact Lenses
Multifocal soft contact lenses have been traditionally used for adults over the age of forty who need help with both their distance and near vision. Myopic children with minimal astigmatism become more nearsighted half as fast when they wear a specific type of multifocal soft contact lens, compared to those who wear standard glasses or contacts^{[6, 9-11]}.

Numerous studies support the ability of children to independently care for contact lenses and wear them successfully. Daily disposable contacts eliminate the need for cleaning and disinfecting, which improves compliance, and are the preferred soft contact lens treatment option for children^[12].

Low Strength Atropine Eye Drops
Atropine drops are very effective at slowing the progression of myopia. The specially-made drops must be purchased from a compounding pharmacy and typically cost $45/month minimum. We reserve atropine treatment for patients who have a very strong family history of high myopia, or who are showing very rapid progression early on.

Even at the low concentration of 0.01% there is still some impact on the near focusing system and pupil, and approximately 15% of patients will require a bifocal and/or transition lens to compensate^[13]. These drops will typically need to be used once daily until around 18.

1. Jones-Jordan, L.A., et al., Time outdoors, visual activity, and myopia progression in juvenile-onset myopes. Invest Ophthalmol Vis Sci, 2012. 53(11); p. 7169-75.
2. Wu, P.C., et al., Outdoor activity during class recess reduces myopia onset and progression in school children. Ophthalmology, 2013. 120(5): p. 1080-5.
3. Muhamedagic, L., et al., Relation between physical activity and myopia progression in student population. Med Glas (Zenica), 2013. 10(2): p 385-90.
4. Legerton, J.A.C., Brian, Myopia Regulation: Myth or Megatrend. Review of Optometry, 2009.
5. Santodomingo-Rubido, J., et al., Factors preventing myopia progression with orthokeratology correction. Optom Vis Sci, 2013. 90(11): p. 1225-36
6. Smith, E.L., 3rd, Optical treatment strategies to slow myopia progression: effects of the visual extent of the optical treatment zone. Exp Eye Res, 2013. 114: p. 77-88.
7. Walline, J.J., L.A. Jones, and L.T. Sinnott, Corneal reshaping and myopia progression. Br J Opthalmolol, 2009. 93(9): p. 1181-5.
8. Charm, J. and P. Cho, High Myopia-partial reduction ortho-k: a 2-year randomized study. Optom Vis Sci, 2013. 90(6): p. 530-9.
9. Anstice, N.S. and J.R. Phillips, Effect of dual-focus soft contact lens wear on axial myopia progression in children. Ophthlology, 2011. 118(6): p. 1152-61.
10. Lam, C.S., et al., Defocus Incorporated Soft Contact lens slows myopia progression in Hong Kong Chinese school children: a 2-year randomized clinical trial. Br J Ophthalmol, 2014. 98(1): p. 40-5.
11. Walline, J.J., et al., A randomized trial of the effect of soft contact lenses on myopia progression in children. Invest Ophthalmolo Vis Sci, 2008. 49(11): p. 4702-6.
12. Walline, J.J., et al., Daily disposable contact lens wear in myopic children. Optom Vis Sci, 2004. Apr;81(4):255-9.
13. Cooper, M.D., et al. Current Status on the Development and Treatment of Myopia. Optom Clinical Research. 2012.