Welcome to the Chang Eye Group Myopia Management program! We are so excited that you have chosen us to accompany you on your myopia management journey.

WHAT IS MYOPIA?

Myopia, also known as nearsightedness, causes distant objects to appear blurry while near objects are clear.  Myopia develops from the eyeball growing too long (increased axial length) or the cornea is too curved.  In the U.S. 40% of kids have myopia, compared to just 20% 30 years ago, according to the American Academy of Ophthalmology. In many Asian countries, as many as 90 percent of children are myopic. It is estimated that nearly 5 billion people worldwide will be myopic by 2050.  Children can be diagnosed with myopia at a young age, sometimes as early as 5 years old.  Myopia is not reversible, but progression can be significantly slowed with modern management methods. 

RISK FACTORS

For progression:

  • Myopia has been found to have a genetic link and runs in families. Having one parent with myopia increases the child’s chance of being myopic compared to parents without myopia.  If both parents have myopia there is an even greater risk of the child becoming myopic.
  • The younger a child (age 5-7) develops myopia, the higher the risk of progression
  • Asian ethnicity may be linked to faster progression of myopia
  • Increased time spent indoors and doing near tasks

Patients with myopia, especially high myopia, have an increased risk of sight-threatening diseases, such as:

  • Glaucoma – 1.5 times greater
  • Cataracts – 17% more likely to need surgery
  • Retinal tears and detachments – 6 times greater
  • Myopic macular degeneration – risk changes with amount of myopia

WHAT CAN I DO?

Until recently, the only treatment for myopia were glasses and contact lenses to make distance objects clear.  However, this does not stop myopia from progressing.  As the child grows, frequent prescription changes are needed as the eye grows and vision becomes worse.  Now, doctors around the world are treating myopia to help slow the progression.  In our program, we utilize one of three treatment methods:  atropine drops, soft multifocal contact lenses, or orthokeratology.  We also prescribe at least two hours of outdoor time a day.

WHAT IS ATROPINE?

Historically, atropine is used in concentrations of 0.50-1.00% for various ocular conditions including inflammation and amblyopia (lazy eye).  It causes the pupils to dilate, or get larger, which makes light seem brighter.  Atropine also reduces the eyes’ ability to focus while viewing near objects.  However, the concentrations used for myopia management are 0.01-0.05%.  Low concentration atropine has been shown to slow the progression of myopia by 50%, or more, without dramatically increasing pupil size or decreasing near focus. The exact mechanism of action of atropine for myopia management is unknown at this time, however robust evidence supports atropine use to slow the progression of myopia.

WHAT ARE MULTIFOCAL CONTACT LENSES?

Soft multifocal contact lenses are routinely worn during the day to help people over age 40 to see clearly at distance and near.  Children may not see quite as clearly with these contact lenses compared to distance vision only contact lenses, but there are no additional risks compared to regular daily contact lens wear.  The doctor may prescribe you daily or monthly disposable contact lenses that are customized to your needs.  The lenses are worn during daytime and need to be removed at night with a proper cleaning regimen. The child will need to have an updated pair of glasses for backup, but the contact lenses serve as both visual correction and therapeutic treatment for myopia.  Preliminary results showed a 35% reduction in the rate of progression of myopia and a reduction of up to 45% in the rate of progression in axial length.

WHAT IS ORTHOKERATOLOGY?

Orthokeratology (also known as Ortho-K, corneal reshaping technology) lenses gently and non-surgically reshape the outer layer of your corneas while you sleep.  A custom-made molding contact lens is inserted before the patient goes to bed, and is removed upon waking.  Vision is improved during the day, decreasing, or in most cases, eliminating the need for glasses and contact lenses during waking hours with proper use.  Use of these lenses lead to a consistent reduction in myopia progression of approximately 45% over a two-year period and 30% over five years, when measured in terms of axial length.

Myopia Management has the potential to slow down the progression of myopia, empower your child to live life without depending on glasses or contact lenses and decrease the risks associated with myopia.

If you’re interested in a Myopia Management Evaluation and want to discuss your options with one of our highly-qualified optometrists, get in touch with Chang Eye Group.

Because better vision is life changing.

Good resource for more information and recent developments

References

  1. Rauch K. Low-Dose Atropine for Kids with Myopia. American Academy of Ophthalmology. https://www.aao.org/eye-health/news/low-dose-atropine-kids-with-myopia. Published January 25, 2018. Accessed April 15, 2021.
  2. Holden BA, Mariotti S, Kocur I, Resnikoff S, He M. The Impact of Myopia and High Myopia. Myopia Report for Web. https://www.who.int/blindness/causes/MyopiaReportforWeb.pdf. Published March 18, 2015. Accessed April 15, 2021.
  3. Holden BA, Fricke TR, Wilson DA, et al. Global Prevalence of Myopia and High Myopia and Temporal Trends from 2000 through 2050. Ophthalmology. 2016;123(5):1036-1042. doi:10.1016/j.ophtha.2016.01.006
  4. Jiang X, Tarczy-Hornoch K, Cotter S, et al. Association of Parental Myopia With Higher Risk of Myopia Among Multiethnic Children Before School Age. JAMA ophthalmology. https://pubmed.ncbi.nlm.nih.gov/32191277/. Published May 1, 2020. Accessed April 15, 2021.
  5. Williams K, Hammond C. High myopia and its risks. Community Eye Health. 2019;32(105):5-6.
  6. YAM J, Li FF, Tang SM, Chen LJ, Tham CCY. Low-concentration atropine for myopia progression (LAMP) study Phase 2: 0.05% atropine remained the best concentration among 0.05%, 0.025%, and 0.01% atropine over 2 years. Investigative Ophthalmology & Visual Science. https://iovs.arvojournals.org/article.aspx?articleid=2747191. Published July 22, 2019. Accessed April 15, 2021.
  7. Chia A, Lu Q-S, Tan D. Five-Year Clinical Trial on Atropine for the Treatment of Myopia 2: Myopia Control with Atropine 0.01% Eyedrops. Ophthalmology. https://pubmed.ncbi.nlm.nih.gov/26271839/. Published August 11, 2015. Accessed April 15, 2021.
  8. Walline JJ. Effect of High vs Medium Add Power vs Single-Vision Contact Lenses on Myopia Progression in Children. JAMA. https://jamanetwork.com/journals/jama/fullarticle/2769263#:~:text=The%20Bifocal%20Lenses%20In%20Nearsighted,myopia%20progression%20and%20whether%20a. Published August 11, 2020. Accessed April 15, 2021.
  9. Si JK, Tang K, Bi HS, Guo DD, Guo JG, Wang XR. Orthokeratology for myopia control: a meta-analysis. Optom Vis Sci. 2015;92:252–7.