What is myopia management?
General Information on Short –Sightedness or Myopia
Images should be focused on the retina in a normal eye. In myopia the image is focused in front of the retina causing blurred vision. This can be as a result of a growth in the length of the eyeball.
Prevention is better than cure
It is better to try and prevent a child becoming short-sighted (myopic) as myopia can not be reversed. It is more difficult to slow the progression of short-sightedness (myopia) than to prevent myopia occurring in the first place. It is predicted that 50% of our children will be myopic by the year 2050.
Risks of a Child becoming Myopic
A. 1 parent shortsighted then child 3 times more likely to be myopic
B. 2 Parents shortsighted then child 6 times more likely to be myopic
C. Little time spent outdoors
D. Excessive time spent indoors on near tasks
Time Outdoors Per day
Spending more time outdoors can reduce the risk of developing myopia by 50% due to the effect of natural daylight. Spending less than 1.5 hours per day outdoors is regarded a low amount of outdoor time, 1.5 to 2.5 hours is a moderate amount of time, and more than 2.5 hours is a high amount.
Time Spent on close work
Excessive time spent indoors on near tasks (for example tablet use, reading, jigsaws) increase the risk of developing myopia. With near work in leisure time, we regard less than 1.5 hrs as a low amount of near work, 1.5 to 2.5 hrs as a moderate amount and more than 2.5 hrs as a high amount.
Frequent break from near work is recommended. Engage in distant focused activities and spend more time outdoors.
Problems Associated with higher levels of Myopia
| Condition | Risk at -4.50 | Risk at -6.50 |
|---|---|---|
| Myopic Macular Degeneration | 9.7 times more likely | 40.6 times more likely |
| Retinal Detachment | 9.0 times more likely | 21.5 times more likely |
| Cataract | 3.1 times more likely | 5.5 times more likely |
| Glaucoma | 2.3 times more likely | 3.3 times more likely |
Risk Factors for Myopia Progression
| Age | 9 years old or younger |
| Refractive Error | Less long sighted than normal for age |
| Parental Myopia | 1 or both parents short-sighted |
| Time spent outdoors | 1.5 hrs or less per day |
| Time spent on near Work | 2.5 or more hrs per day |
| Myopia increase | An increase of – 0.75 or more per year |
World Health Organisation (WHO)
In 2019 the WHO issued guidance on how much screen time young children should have. It says children under five years old should not spend more than one hour a day watching devices with screes and those under one should have no exposure at all.
New Thinking on Managing Myopia
Ideally when glasses are worn the whole image would be in focus across the entire retina. Unfortunately, with myopia the spectacle lenses only focus the image on the centre of the retina and the periphery is out of focus (peripheral hyperopic defocus). This peripheral hyperopic defocus seems to stimulate eye growth resulting in more myopia. The new thinking on controlling myopia is to discourage eye growth by correcting this peripheral hyperopic defocus.
Managing Myopia
Once a child is -0.50 myopic and is at high risk, we can consider intervening to use some control strategy. By Myopia control we not mean that the child will not develop more myopia, but rather reduce the progression by up to 50%.
Types of myopia management
1. Glasses
A. MiYOSMART lenses. These revolutionary lenses were developed in Asia and launched within Europe in February 2021.They use D.I.M.S. technology which can effectively manage myopia. The lenses work by simultaneously providing clear vision to the central retina and myopic defocus to the peripheral retina. In case studies children wearing these lenses had myopia progression reduced by an average of 60%.
B. Bifocals: The bigger the segment in the lens the better, but the bigger segments are more visible. They provide between 39-51% control for the biggest segment .
2. Contact lenses
A. Daily disposable Myopia Control Contact Lenses: Mysight Lenses can provide approx. 40% control. There is a low infection risk as contact lenses are thrown out at end of each day.
B. Monthly Disposable Multifocal Contact Lenses: can provide up to 40% control. Small risk of infection as same contacts are used for a month. Lenses are cleaned and stored each night.
C. Ortho K -Overnight wear of hard Gas permeable contact to mould the shape of the front of the eye. Generally no glasses are needed during the day .Can provide up to 41% control. Generally, no glasses are needed during the day.
When do we stop treating myopia?
When your child’s vision is stable for 2 years or more we can revert back to straight forward glasses and/ or contact lenses.
Will Laser surgery reduce the risks?
No. Even if your child has laser eye surgery when they are older the risks associated with high myopia will still be the same. While the laser surgery corrects the front of the eye the retina has already been stretched and hence the risk of Myopic Macular Degeneration, Retinal Detachment etc. are still increased.
Costs
Full Eye Examination & Cycloplegic Examination: €60
Miyosmart lenses: Frame + €224
Bifocals: Frame + €70
Myopia Control Soft Contact Lenses:
Assessment & fitting including 3 & 6 month check-ups: €100
Daily disposable contact lenses- 90 pairs: €160
Orthokeratology Contact Lenses:
Assessment and fitting: €200
Annual fee including all aftercare visits and one pair of lenses every 6 months: €600
Myopia Management at Elliott Opticians
Our optometrists & Dispensing Opticians have a keen interest in Myopia management and will be delighted to discuss the options that are best for your child. Please call the office on 09064 76111 to make an appointment.
Further information available at https://www.mykidsvision.org/en-us https://www.allaboutvision.com/conditions/myopia.htm
http://myopiaprevention.org/ https://myopiainstitute.org/