As an optometrist, it is likely you are asked about myopia progression from concerned parents every day.
Is there anything we can do to stop his eyes from getting worse?
According to a study conducted in the United States between 1999-2004, one-third of the population is affected by myopia.
In Eastern Asian countries, it is estimated that 90% of the population are myopic.1
Studies have shown the best options for treatment include: orthokeratology, pharmacological agents, and soft bifocal contact lenses.3
Factors Contributing to Myopia Progression:
The factors influencing the progression of myopia are not fully understood, but are believed to be a combination of 2 main factors.
In recent studies conducted of twins, results support a heritability index of 77%.
However, these same studies concluded,
“it is hard to show anything but a modest effect on their etiologies. Thus we are still left with the impression that the influence of environment exerts a greater effect than does the concerted action of several genes.” 4
2. Near Work vs. Time Outdoors
It has long been thought that the accommodative efforts required in near work contribute to the progression of myopia because the prevalence is much higher in developed countries.
Recent studies have not correlated with this theory.
The Collaborative Longitudinal Evaluation of Ethnicity and Refractive Error Study (CLEERE Study) was conducted to study the effects of certain activities on myopia progression during a 1-year period.
The study found that the amount of hours spent reading for pleasure, other near work activities, or outdoor sports activity had a clinically insignificant effect on annual myopia progression.
An additional 10 hours of reading for pleasure only correlated with an average increase of -0.08. 5
Orthokeratology slows the progression of myopia by correcting central refractive error and maintaining peripheral blur.
The lenses essentially act to decrease axial length, and have been shown to be more effective than single vision soft contacts, RGP lenses or spectacles.2
Ortho-K has been shown to decrease progression by more than 40%! 3
2. Pharmacologic Treatment – Atropine or Pirenzepine
0.01% Atropine has also been proven to slow progression of myopia. The ATOM study showed a decline in progression over a 2-year period.1
Atropine given at night decreases accommodation, and fortunately there are no significant side effects resulting from Atropine use.3
Interestingly, trials were also successful in mitigating concerns that these children would be unable to perform near vision tasks while on this treatment. Only 6% of children on 0.01% atropine felt the need to request near vision spectacles to help with accommodation.2
Atropine use is considered “off-label” in the U.S. so your patient needs to sign an “informed consent” for off-label treatment.
The action of Pirenzepine is thought to be on the sclera, and is a gel that is applied daily.
The agent does not dilate the pupil and has less of an effect on decreasing accommodation.1
Studies show Atropine can decrease myopia progression from 54% to 21%.2
3. Soft Contact Lens Options
Soft bifocal contact lenses have gained popularity in the last several years. The theory is that bifocal lenses work by improving near comfort and relaxing accommodation.
In 2014, the DISC study showed that multifocal contacts with the full distance prescription combined with a +2.50 add was able to slow myopia progression by a small amount.
Patients who were not using multifocal lenses progressed at .47 diopters compared to those using the lens at .33 diopters a year.1
As far as the type of multifocal contact lens to use and what add power, more research is needed. One study conducted with identical twins found that a distance center lens resulted in better success.3
In order to be considered clinically significant, treatment options must decrease myopia progression by 50%.
Under correction of refractive error, gas permeable lenses, and nutritional factors have been ineffective in slowing progression according to recent studies.
Trials investigating the effect of spending more time outdoors on slowing the progression of myopia have been mixed.2
A very important thing to be aware of is that many studies have shown that under correction actually causes progressive myopia!4
At this time, Orthokeratology is considered to be the most effective treatment in myopia progression.
For a great video to educate your patient’s on myopia and treatment visit Dr. Richard Anderson’s website.
1. “Myopia Prevention and Control.” Contact Lens References Related to Myopia Prevention. N.p., 2012. Web. 17 Jan. 2016. <http://www.myopiaprevention.org/references_contact_lenses.html>.
2. Smith, Molly J., and Jeffrey J. Walline. “Controlling Myopia Progression in Children and Adolescents.” Adolescent Health, Medicine and Therapeutics. Dove Medical Press, 13 Aug. 2015. Web. 17 Jan. 2016. <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4542412/>.
3. Anderson, Richard, OD, Thomas Aller, OD, and Jeffrey J. Walline, OD. “Controlling Myopia, Changing Lives.” Review of Cornea and Contact Lenses. Review of Cornea and Contact Lens, 15 Sept. 2014. Web. 17 Jan. 2016. <http://reviewofcontactlenses.com/content/c/50427/>.
4. Myrowitz, Elliott H. “Juvenile Myopia Progression, Risk Factors and Interventions.” Saudi Journal of Ophthalmology. Elsevier, 13 Aug. 2015. Web. 17 Jan. 2016. <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3729802/#b0075>.
5.Jones-Jordan, Lisa A., Loraine T. Sinnott, Susan A. Cotter, Robert N. Kleinstein, Ruth E. Manny, Donald O. Mutti, Daniel J. Twelker, and Karla Zadnik. “Time Outdoors, Visual Activity, and Myopia Progression in Juvenile-Onset Myopes.” Investigative Ophthalmology & Visual Science. The Association for Research in Vision and Ophthalmology, 17 Nov. 2015. Web. 17 Jan. 2016. <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3474591/figure/i1552-5783-53-11-7169-f01/>.