At Zacks London Eye Clinic our optometrists can provide advice on Myopia Control and the best options for treatment.
‘Since starting treatment my sons prescription has hardly changed in 4 years’
Myopia (short sight) is the most common, progressive ocular abnormality. There are now proven methods of myopia control to minimise myopia progression. The concern among eye care practitioners is that myopia is increasing rapidly throughout the world. Myopia prevalence has more than doubled among UK children since the 1960’s and currently affects 30% of the adult UK population. A recent Swedish study found that 50% of 12 year-old’s are myopic, expected to rise to 70% by age 18, with over 80% in parts of Asia. (See post)
Myopia typically develops between six and thirteen years of age and progresses fastest in younger years before stabilising in early adulthood.
Several factors play a role in the development of myopia including binocular vision status, family history, ethnicity and environment. The chances of developing myopia are 3x higher when one parent is myopic and 7x higher when both parents are myopic. Light exposure is also thought to have a profound impact. Myopia progression increases in winter months and has much higher prevalence in urban settings, especially in children who spend more time indoors and perform more near work.
The prevalence of visual impairment rapidly rises with increasing myopia, especially in old age. Even low myopia significantly increases the risks of cataract, glaucoma, retinal detachment and macular degeneration. Myopia greater than -6.00D is termed pathological myopia because at that level the odds of developing several eye diseases are greatly increased.
Slowing down the progression of myopia will significantly reduce the chance of developing high myopia and therefore greatly reduce the risk of visual impairment in later life.
Before commencing myopia control a thorough eye examination is essential paying careful attention to how the eyes focus at near. A cycloplegic refraction and binocular vision assessment are also often required along with scans of the front of the eyes to consider suitability for orthokeratology and contact lens wear. Our optometrists will then be able to guide you through the best myopia control options. Please note myopia control treatment is elective and there is currently no government approved formula for treatment.
Time Outdoors & Reduced Near Work
Increased outdoor activity, regardless of the type of activity, has been shown to be protective against development of myopia, along with low to moderate levels of near work. Children should of course be encouraged to read and do their school work, but to balance this by reducing other leisure activities involving near tasks, and ensure more time is spent outdoors (ideally 3 hours per day).
MiyoSmart lenses developed by Hoya have proven to curb myopia progression in children (aged 8-13) by 60% using its award-winning D.I.M.S. technology. Stellest lenses from Essilor have a similar design to the Hoya lens but claim to reduce myopia progression by 67% when worn 12 hours per day.
Progressive spectacle lenses including bifocals and multifocals (often called varifocals) are beneficial in certain circumstances, when myopia progression is accompanied by difficulty focussing and aligning the eyes for near tasks. In these cases myopia progression may be reduced by up to 50% whereas in other cases they have little benefit.
Orthokeratology treatment, also known as overnight vision correction involves wearing specially designed rigid gas permeable contact lenses to gently alter the shape of the cornea to correct myopia. The aim is to be free of both glasses and contact lenses during the day. Orthokeratology is very effective for myopia control and several studies indicate a reduction in myopia progression of 50%.
Multifocal Contact Lenses
Monthly disposable multifocal soft contact lenses are available in a wide range of prescriptions and can be tailor made to almost any size and shape. Recent studies show that certain lens designs, although not designed for myopia control, can reduce myopia progression by 30-50%.
1 Day Disposable Contact Lenses
We currently offer two types of daily disposable contact lenses for myopia control, both have excellent proven results. The MiSight randomised clinical trial showed 59% reduction in myopia progression over a 3 year period and NaturalVue Multifocal, showed an incredible 90% control in their five-year practitioner studies.
Repeated Low-Level Red-light therapy (RLRL)
RLRL is a new method for treating myopia. Clinical trials conducted among Chinese children showed that RLRL can reduce myopia progression by around 87.7% providing they have good compliance. Some children can also experience axial length shortening with a reduction in their prescription. The process is thought to increase the rate of blood flow in blood vessels and re-thicken the choroid tissue at the back of the eyes.
Low dose atropine is prescribed in other parts of the world for myopia control, but it is not licenced for use in Europe.
Low dose atropine drops have been shown to be safe and effective in slowing myopia progression in some children. However, when used as a single therapy they are usually less effective than the more traditional methods of myopia control that we can provide with glasses or contact lenses. In extreme cases, where high myopia continues to progress rapidly and after exhausting other means, we can refer to a Paediatric Ophthalmologist who may chose to prescribe low dose atropine, in combination with traditional therapy. The prescription can only be dispensed in a hospital pharmacy as a special order.
For more detailed information for eye care professionals, there is an excellent article here, written for Optometrists on the Association of Optometrists Website.