Myopia

‘Myopia’ or ‘short-sightedness is a condition where your child sees close-up objects clearly, but cannot see distant objects (such as the blackboard) clearly.  Many children with myopia also have astigmatism (another type of focusing abnormality). 

Myopia commonly develops during school age and progresses slowly (that means your child needs ever-stronger glasses to see clearly for distance) until it often stabilises in mid- late teens. It would be nice to lessen and even stop this progression. In this pamphlet I discuss techniques that slow the progression of ‘school myopia’, techniques that slow down the growth of the eye (slow the progression of axial length).A lot of the recent research on reducing myopia progression has been done in Oriental children. The results probably also apply to Caucasian children (but we do not really know).One important point to note when you read about myopia treatments: you can probably ignore all research that does NOT measure ‘axial length’ (eye ball size) as this seems to be THE important factor to measure and modify.

 

This pamphlet IS for the parents who say:

  1. I hate the idea of my child growing up increasingly dependent on ever-stronger glasses. Can’t you do anything to make it better?

  2. …. I’ve read that with bad myopia you’re more prone to get retinal detachment and go blind in one eye.  Can we prevent that? 

This pamphlet is NOT for the parents who say:

  1. That’s nature. I’m also short-sighted and wear glasses or contacts – they were fine for me.

  2. …and anyhow, when s/he’s 20 s/he can have laser and that’s the end of it.

  3. I’m 46 now. When I take my glasses off I can read and use the computer, better than my partner or friends.  

Techniques that have been studied and have little or no effect on myopia progression

  • Altering the patterns of spectacle wear.

    Some people have believed that correcting myopia with full-time wear & full strength glasses may result in myopia getting worse. This happens in chickens but probably does NOT happen in humans.

    Varieties of less-than-full-time glasses wear and less-than-full-strength glasses wear have been studied. Some studies show no effect, some show a tiny positive effect, and some show a tiny negative effect. For your child, there is NO expectation of a useful benefit.

  • Bifocals and Multifocals.

    Optometrists have been using bifocal lenses [and more recently multifocals] as a possible treatment for myopia since the 1940’s, because they ‘make sense’ to those who believe that excessive near focusing contributes to myopia progression.

    Several well-designed clinical trials of bifocal and multifocal lenses conducted in children in the United States, Finland, and Denmark showed NO significant differences in the myopia progression rates, including the new “MYOVISION” lens.

  • Drops to lower eye pressure.

    Drops normally used to treat glaucoma have been shown to have little or no effect on the progression of myopia.

  • Biofeedback Visual Training

    (including the Bates methods)

    There is no conclusive evidence that biofeedback visual training is effective in retarding myopia.

Techniques that have or may have some effect on myopia progression

  • Traditional Chinese medicine treatments.

    Facial "Qi Qong" eye exercises were created in the 1950s in China, and are part of the school routine in many parts of China. It was postulated that massaging the various acupuncture pressure points around the eye improves venous blood circulation, relaxes the muscles, and reduces eyestrain. The evidence from two studies conducted in Singapore and Taiwan were inconclusive.

    In another study of 242 adolescent eyes in Beijing, small pieces of adhesive pressure plaster grains of Semen impatiens were evaluated. Significant treatment effects were claimed for myopia progression.

  • Contact lenses

    There is some data suggesting that hard contact lenses as used in ‘Orthokeratology’ and a Dual-Focus soft contact lens (Cooper Proclear ‘D’ and similar) might slow myopia progression in children.

  • 'Revialvision'

    (formerly called Neuro Vision)

    This technique was developed in Singapore and is based on computer-generated vision exercises [and not to be confused with the technique of the same name which tries to expand the field of vision in patients with field loss]. Some success is claimed for low myopia. Many studies seem to have been performed by investigators with a commercial interest in the technique. Further studies are necessary.

Techniques that usually have some effect on myopia progression

  • Spend time out-of-doors.

    Oriental and Caucasian children who spend more time outside have less myopia progression. This seems to be independent of any effect of the time spent on close work indoors.

  • Atropine eye drops.

    Atropine 1% has been used in ophthalmology for over a century. There have been more than 20 studies over 30-40 years that show this to be effective for reducing the rate of myopia progression in most Oriental and Caucasian children in whom it is tried.

    In a Mayo Clinic study, normal myopia progression was at the rate of 1 unit change in 3 years in normals, and a rate of 1 unit change in 20 years in those using atropine.

More Information About Atropine Eye Drops

Atropine 1% relaxes the pupil and focusing muscles of the eye causing blurred vision for near and a dilated pupil; this large pupil causes sensitivity to light. Some of the real and potential long-term side effects of atropine 1% eye drops in chidren are of concern and that is why it never received wide acceptance.

Atropine 0.01% seems to be nearly as effective as Atropine 1% in reducing myopia progression in Oriental children. In one recent 2 year study it seemed to have NO side effects. When stopped after 2 years, the improvement seems to persist [the improvement may not persist if higher %s have been used].

A respected colleague from Singapore writes of her experience: Singapore has one of the highest myopia rates in the world, and 7 year olds in our schools have 20% myopia prevalence rates, increasing to some 40 percent by 12 years old. [Dr Kowal’s note: The rate is about 15% in 15 year olds in predominantly Caucasian populations]. The rate in University is around 85 to 90 %, and it seems related to educational status.

I usually offer kids and parents the option of starting Atropine when I see a rapid increase in the myopia rate. In Singapore the average increase for 7 year olds is -1D per year at 7 years, between 8 and 11 years between 1-1.5 Ds a year, and after 12 years 0.5D a year …. much higher than in Western studies. So, if they are even faster than this rate, or even at this rate, I discuss this option with them ….?I review after 6 months, and if it does not work, then they discontinue. If it works, (and the results are sometimes very impressive!) and parents are agreeable, we continue till age 12years, (since in middle school the increase is slower), but parents/ child can discontinue anytime.

Dr Kowal’s recommendations: The only treatments that reliably slow down the rate of myopia progression are:

1. Spending more time out- of- doors

2. Atropine eye drops

If you want to try Atropine in your child:

1. You should commit to daily drops of 0.01% Atropine in both eyes for at least 6 months.

2. You can stop at any time

3. Come back to see me (or an interested optometrist) every 6 months for vision, refraction tests (without and with dilating drops) and axial length measurements (special equipment required).

4. 0.01% Atropine eye drops are commercially available in some Asian countries. In Australia they need to be prepared by a compounding pharmacist.

Two pharmacies that we know of are:

1. Slade’s pharmacy @ Epworth Richmond

2. Pharmacy Smart Compounding. Shop 1, 190 Belmore Road Balwyn