Myopia management | What are my options?
Myopia management is an exciting and fast-moving area of optometry. As I write this in February 2021, we have just had another myopia control option, MiyoSmart spectacle lenses, added to our ever-growing list of therapies to help us slow the progression of myopia in children. There has never been a better time to have your child assessed for myopia, progression of myopia and to explore to the options available to you as a parent within our myopia management clinic to help slow down myopia progression and thus reduce potential future eye health problems for your child.
Myopia management options fall into 5 categories:
- Avoidance strategies
- Contact lenses
- Spectacle lenses
- Pharmaceutical options
- Vision therapies
Myopia management options: Avoidance strategies
There are genetic aspects to myopia. If both parents are myopia (short-sighted) your child has a 1 in 2 chance of developing myopia. If one parent is myopic your child’s risk is 1 in 3, and if neither parent is myopic your child’s risk is 1 in 4. Genetic aspects we cannot avoid. However, there are few simple things we can do reduce your child’s risk of becoming myopic. These are particularly important at present as I am writing these whilst working from home during the COVID-19 pandemic whilst trying to keep my 3-year-old son entertained. These are some basic steps we can take as parents to help reduce our child’s risk of developing myopia.
Let us split these into indoor and outdoor rules:
Indoor rules for a healthy visual environment:
- The 20/20/20 rule – try to encourage your child to take a 20 second break every 20 minutes and look at 20 metres to allow the eyes to relax. If using a tablet or laptop to complete a home-schooling task, ask your child to look outside the window for 20 seconds. We try to make a game of this with our son by playing eye-spy.
- Limit screen time – limit screen time to one-two hours per day depending on your child’s age. 1 hour for pre-schoolers and 2 hours for school age. Set a screen time limit for the day.
- The elbow rule – Encourage your child to hold devices further away using the elbow to write distance and the minimum distance between eyes and the screen.
Outdoor rules for a healthy visual system:
- Spent at least 90 minutes per day outdoors – there is evidence to suggest that outdoor playtime can be protective against your child becoming myopic
- Ensure your child I physically active for at least 60 minutes per day – sedentary posture has been suggested as a potential risk factor in myopia progression. Keep those little ones active.
- Sun protection –encourage your child to wear sunglass, a hat and seek shade in the summer months where the UV is at its strongest.
If you would like to read more detailed advice about avoidance of myopia, where I go in to much more detail about the information covered above then please CLICK HERE.
Myopia management options: Contact Lenses
I have been using contact lenses to help slow the progression of myopia in children since 2010. Back in 2010 my options were limited to off-label use of multifocal contact lenses originally designed to help people over the age of 45 see at both distance and for reading. But as we had no viable alternatives or any approved or licensed products at that point in time for treating myopia, we had no choice but to use these products. There was evidence that such lenses would be beneficial in slowing myopia and thankfully my own personal experience with them seconded this. We later introduced orthokeratology as another method of both correcting a child’s myopia to allow them to see clearly at school but also to help slow down myopia progression.
More recently we have had a load of exciting new lenses added to list of options. Back in 2016 we were amongst the first 10 practices in the UK to be able to offer MiSight contact lenses. The first daily disposable contact lens approved for use in myopia management. Since then, we have been fortunate to again be amongst the first in the UK to offer Naturalvue, Mylo and SEED 1dayPure EDOF. These are all excellent options of slowing the progression of myopia in children.
Contact lenses we use often in myopia management:
- SEED 1dayPure EDOF
If you wish to read more about the contact lens options for myopia control, then please CLICK HERE.
Myopia management options: Spectacle lenses
We know that under-correcting or not correcting myopia can worsen and speed up myopia in children. We know that regular spectacles used to correct myopia and allow your child to see clearly have little effect on slowing myopia progression. Previous studies have shown that progressive addition lenses (PALS or varifocals) and bifocals have only little effect on slowing myopia progression.
Several novel designs have been studied more recently with very promising results in the studies. However, they are largely unavailable in the UK. We were delighted to announce at the end of January 2021 that we were amongst the first practices in the UK to be accredited to offer Hoya’s MiyoSmart spectacle lenses. Studies of this lens show it to be very effective at slowing both myopia progression and axial length – slowing both by approximately 60%. If you wish to read more about MiyoSmart spectacle lenses please CLICK HERE.
Myopia management options: Pharmaceutical options
Unfortunately, these options are not currently licensed for use in treating myopia in children in the UK. Unless your child is enrolled in a clinical trial or study with a university or hospital clinic you will find pharmaceutical interventions hard to come by.
Many studies have been conducted on the use of pharmaceuticals in reducing myopia progression with the vast majority testing the use of Atropine in various concentrations. Whilst initial studies looked to be very promising the rebound effect once the treatment is stopped and the side-effects of atropine use are our main concerns in atropine use. More recent studies suggest that atropine may be a good treatment if used in addition to optical interventions such as contact lenses or spectacles. Atropine remains a watch this space topic in the UK.
Myopia management 0ptions: Vision therapies
These simply do not work. Therapies such as the Bates Method are nothing more than snake oil and should not be used in the treatment of myopia. We unfortunately cannot train the eye to resolve myopia. If your child has a problematic accommodative lag, esophoria or another binocular vision anomaly coupled with their progressing myopia then vision therapy coupled with optimal optical correction may be suggested, but should only be done so by an optometrist, orthoptist or ophthalmologist.
Myopia management – booking an appointment within the myopia clinic
If you wish to book your child an appointment within our myopia management clinic please call 0141 943 3300 or CLICK HERE to book online using our online diary.
Myopia Management – Ask the expert
Please feel free to email me at email@example.com if you have any questions about myopia or myopia management. I would be delighted to help.
About the author
Craig McArthur is an optometrist director of Peter Ivins Eye Care and has a special interest in myopia management in children. Craig launched Scotland’s first dedicated Myopia Management Clinic within Peter Ivins Eye Care in 2013.
Craig has published numerous articles on the subject of myopia management and lectures extensively throughout the UK, Europe and the Far East on the subject.