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Vista Eye Care’s Myopia Management Clinic

Rather than just prescribing stronger and stronger glasses each year to nearsighted patients, we are now able to identify, characterize, and slow the progression of myopia.  This management of myopia has a host of positive effects which last for the lifetime of the patient.  Myopia Management is very much in line with Vista Eye Care’s Mission Statement of preventative eye care and we are proud to offer this service to our patients.  Please learn more about how we can help your child live a better, healthier life by reducing their endpoint myopia.

What is Myopia?

Myopia is the lengthening of the eye resulting in blurred vision (“nearsightedness”). Historically, myopia has been corrected with glasses, contact lenses, and refractive surgeries such as LASIK and PRK. Myopia typically progresses each year, resulting in a stronger and stronger glasses or contact lens prescription. In the United States, the prevalence of myopia has nearly doubled from 25% to 42% over the last two generations.1 New treatments and techniques in Myopia Management allow for prevention of unnecessary myopic development in children.

Myopia ImpactHow Does Myopia Impact a Patient’s Life?

With the exceptions of childhood blindness and genetic eye disease, the age of onset of myopia is several decades earlier than most other eye diseases including diabetic retinopathy, glaucoma, cataracts, and macular degeneration. Considering the recurring expenses for refractive correction, treatment of complications and visual rehabilitation, the lifetime financial burden of myopia for each patient is substantial. In addition, blurry vision and dependence on optical correction at a young age may have a profound impact on self-esteem as well as the lifestyle and career choices of myopic patients.2

What Are the Risks for Myopic Development?

  • Family History – A child has a three times greater risk of developing myopia if one parent is myopic. Two myopic parents doubles this risk again.3 Children with two myopic parents have been shown to be the fastest progressors. Children with one myopic parent progress faster than children with no myopic parents.4, 5
  • Visual Environment – Spending less than 90 minutes per day outdoors increases the risk of myopic development. This is especially pronounced when combined with more than three hours a day of close-range activities.6
  • Refraction – If the child exhibits 0.50 diopters or less of hyperopia or “farsightedness” at age 6 to 7.7
  • Age – In short, the sooner Myopia Management can be started, the better. The younger a child is when he or she becomes myopic, the faster the myopia will progress.8
  • Ethnicity – Asian ethnicity has been linked to faster myopia progression.8, 9
  • Binocular Vision – Esophoria (where the eyes have a tendency to turn in) and intermittent exophoria (where the eyes have a tendency to turn out) are risks for progression.10

How Does Myopia Affect Eye Health?

Myopia is caused by an elongation of the eye and has been associated with vision-threatening conditions such as cataracts, primary open angle glaucoma, retinal detachment, and vitreous detachment.11, 12, 13, 14, 15, 16

how does myopia affect eye health

By How Much Does Myopia Create a Risk for Eye Disease?

The following table shows the risk of development of disease by the number of times (“X”) that the risk increases compared to someone without myopia.15, 17

 -2.00 D-4.00 D-6.00 D-8.00 D
Myopia Maculopathy2.2x9.7x40.6x126.8x
Retinal Detachment3.1x9.0x21.5x44.2x
Glaucoma2.3x3.3x3.3xNot studied

 

What is Myopia Management?

Myopia Management, also known as “myopia control,” is the process of reducing the amount of myopic development in a young patient. While some myopia is attributed to genetics, it is believed that at least half of a patient’s potential myopic progression is influenced by the environment. Through the use of special vision correction and/or topical medication, a child’s end-point myopia can be reduced. This reduction in myopia can help prevent numerous diseases, improve quality of life, and help assure a lifetime of healthy eyes and great vision. Patients in a Myopia Management program will typically continue to get more myopic, though at a rate less so than those not undergoing treatment.

myopia management

How is Myopia Management Different From Prescribing Regular Glasses and Contact Lenses?

Prescribing single-vision glasses for children with myopia doesn’t appear to slow the progression of myopia. Glasses are necessary as a back-up to Myopia Management efforts, but wearing distance vision correction will only temporarily result in clear vision, and will not slow the progression of myopia. Myopia Management involves the active measurement of both glasses prescription and length of the eye (“axial length”) in order to best optimize the treatment modalities being used.

Is a Small Amount of Myopia Prevention Worth Striving For?

Even a small amount of reduced myopia is well worth the effort. A recent study found that reducing a patient’s final level of myopia by 1.00 D reduces the lifelong risk of myopic maculopathy by 40% regardless of the final level of myopia.18

 

Myopia Management Treatment Modalities

While there is absolutely nothing wrong with using traditional glasses or contact lenses, the following options give us the power to help reduce the amount of prescription your child will ultimately have: 21

 

Ortho K LensOrthokeratology

Orthokeratology (Ortho-K) treatment uses retainer contact lenses that are similar in material to gas permeable contacts. These lenses have custom designs that temporarily reshape the front surface of the eye. There are two huge advantages to Ortho-K. First, the retainer lenses are worn only while sleeping, and typically no glasses or other contacts are used during the day. That’s right, no vision correction is needed during the day when the retainer lenses are worn at night! Secondly, Ortho-K is the most effective treatment for controlling myopia. Studies show a decrease in the progression of nearsightedness by 60-100% with this treatment. This treatment involves multiple visits with our doctors and specialty custom-made retainer lenses.

 

Atropine Eye Drops

Atropine Eye DropsThis is a prescription eye drop that is used every night to reduce the development of myopia and it has been shown to reduce the progression of myopia by about 50%. There are reliable studies showing that topical atropine is well tolerated and effective in slowing the progression of myopia in children.19, 20 Low dose atropine must be compounded by a pharmacist and has limited availability, but we have a mail-order pharmacy that can make this drop for your child. Your child would still wear their normal glasses or contact lenses with this type of treatment.

 

Soft Multifocal Contact Lenses

Myopia Management

These lenses work by creating peripheral retinal blur that slows the stimulus for eye elongation. Research has shown a 30% decrease in the rate of myopia progression for children using these lenses. These daily disposable, soft multifocal lenses are worn during the day and discarded at the end of the day. No contact lens solutions are required. Because these lenses are disposable, they are ideal for patients with allergies and dry eye.

 

Progressive Addition Lenses

Progressive Addition LensesBased on the mean results of 9 studies, wearing progressive addition lenses reduced myopic development by about 24%. Progressive additional lenses are designed to relax the eye’s near focus. This has a substantial effect on reducing myopic progression, though this is the least effective method of Myopia Management. Progressive additional lenses account for multiple distances include phone, tablet, homework, testing-taking, computer screen, and far away distances. When a patient wears their distance-only correction, their eye focuses to see close objects. The idea behind a progressive addition lens is that the patient’s focus will be constantly relaxed and thus reduce the stimulus for the eye to increase in nearsightedness over time. Progressive addition lenses are frequently used in addition to other treatment methods.

 

Myopia ManagementThe Great Outdoors

As time spent using electronic devices has increased in the last 20 years, interest in spending time outdoors has waned for a large segment of the population. Early on, adults were spending all day at the computer resulting in Computer Vision Syndrome, but now, even toddlers may spend up to two hours of screen time per day. Increased screen time inherently means less time is being spent outside in natural sunlight. The Sydney Myopia Study of 4,000 children, 6 to 12 years old, found that those who had more reading or screen time, and less outdoor time, were more myopic than those who spent more time outside.6 The general consensus is that 60 to 90 minutes of outdoor time every day is beneficial for preventing myopia.

Can Multiple Treatment Modalities Be Used in a Myopia Management Program?

When it comes to Myopia Management, every child progresses differently. For the majority of our Myopia Management patients, a single treatment is adequate to slow their myopic progression. If the patient’s myopia is still increasing at a substantial rate, a second treatment method may be introduced. For example, a patient may use atropine and soft multifocal contact lenses.

Why is Every Treatment Program Different?

Every patient’s Myopia Management program is unique because every patient is unique! There are many examples of unique patient scenarios when it comes to designing a Myopia Management program:

  • A patient may not be able to wear soft contact lenses, so Ortho-K lenses are more practical.
  • A patient may have too much astigmatism for any contact lens modality to be practical.
  • A patient may have a sport they participate in that they can’t wear their glasses for, so contact lens modalities may be more useful.
  • A patient may not tolerate contact lenses so atropine treatment may be easiest to implement.
  • A patient may have too high of a prescription for Ortho-K, so soft multifocal lenses may work best.

Every treatment program is customized to what your child needs in order to assure great vision and a successful Myopia Management program!

Does Insurance Cover Myopia Management?

There is currently no insurance or vision plan coverage for Myopia Management services. However, some plans may contribute to devices and medication used in a Myopia Management program, such as progressive addition eyeglasses and atropine medication. Ortho-K lenses are not covered by any vision plans at this time.

What Should We Expect at a Myopia Management Visit?

Our technicians and doctors will perform a variety of testing to establish baseline information about the shape of your child’s eyes, and to monitor the efficacy of our Myopia Management efforts as we go forward. These tests may include:

  • Corneal topography
  • Visual acuities
  • Cycloplegic refraction
  • Axial length measurement (ultrasound)
  • Contact lens fitting
    (for those patients wearing contact lenses)
  • Instructions on the use of low-dose atropine
    (for those patients undergoing atropine treatment)
  • Patient and parent education

What is Included in Vista Eye Care’s Myopia Management Program?

Vista Eye Care’s Myopia Management program incorporates everything your child needs to start down a healthier, less myopic path and includes:

  • Initial consultation visit
  • 3-month follow-up visit
  • 6-month follow-up visit
  • Supply of contacts (720 daily disposable soft multifocal lenses, or one pair of retainer Ortho-K lenses if contact lenses are used in your child’s Myopia Management program)
  • If atropine is used as the primary method of Myopia Management, a credit will be issued towards the yearly cost of the Myopia Management program

How Long Does My Child Need to Adhere to a Myopia Management Program?

We recommend your child stay in our Myopia Management program until there is no risk of their eyes continuing to elongate. Since everyone’s eyes are unique, the length of time your child will benefit from staying in a Myopia Management is variable. We will monitor your child’s eyes closely and give you yearly updates.

What is My Next Step to Learn More and to Start a Myopia Management Program For My Child?

Call us today at (303) 450-2020 to schedule a Myopia Management consultation for your child.  At this 60-minute appointment, you and your child’s doctor can discuss the various modalities of Myopia Management in more detail and they can answer any questions that you may have. This visit is typically one hour in length.

 

 

References

  1. Vitale S, Sperduto RD, Ferris FL. Increased Prevalence of Myopia in the United States Between 1971-1972 and 1999-2004. Arch Ophthalmol. 2009; 127(12):1632-1639.
  2. Chinese Red Cross Foundation. A research report on the Eye Health of Chinese Teenagers.
  3. Jones LA, Sinnott LT, Mutti DO, et al. Parental history of myopia, sports and outdoor activities, and future myopia. Invest ophthalmol Vis Sci. 2007 Aug;48:3524-3532.
  4. Kurtz D, Hyman L, Gwiazda JE, et al; COMET Group. Role of parental myopia in the progression of myopia and its interaction with treatment in COMTE children. Invest Ophthalmol Vis Sci. 2007 Feb;48:562-570.
  5. Loh KL, Lu Q, Tan D, Chia A. Risk factors for progressive myopia in the atropine therapy for myopia study. Am J Ophthalmol. 2015 May; 159:945-949.
  6. Rose KA, Morgan IG, Ip J, et al. outdoor activity reduces the prevalence of myopia in children. Ophthalmology. 2008 Aug;115:1279-1285.
  7. Zadnik K, Sinnott LT, Cotter SA, et al; Collaborative Longitudinal Evaluation of Ethnicity and Refractive Error (CLEERE) Study Group. Prediction of juvenile-onset myopia. JAMA Ophthalmol. 2015 Jun;1233:683-689.
  8. Donovan L, Sankaridurg P, Ho A, et al. Myopia progression rates in urban children wearing single-vision spectacles. Optom Vis Sci. 2012 Jan;89:27-32.
  9. Hyman L, Gwiazda J, Hussein M, et al. Relationship of age, sex, and ethnicity with myopia progression and axial elongation in the correction of myopia evaluation trial. Arch Ophthalmol. 2005 Jul; 123:977-987.
  10. Yang Z, Lan W, Ge J, et al. The effectiveness of progressive addition lenses on the progression of myopia in Chinese children. Ophthalmic Physiol Opt. 2009 Jan; 29:41-48.
  11. Lim R, Mitchell P, Cumming RG. Refractive associations with cataract: the Blue Mountains Eye Study. Invest Ophthalmol Vis Sci 1999;40:3021-3026.
  12. Younan C, Mitchell P, Cumming RG, Rochtchina E, Wang JJ. Myopia and incident cataract and cataract surgery: the blue mountains eye study. Invest Ophthalmol Vis Sci 2002;43:3625-3632.
  13. Chang MA, Congdon NG, Bykhovskaya I, Munoz B, West SK. The association between myopia and various subtypes of lens opaci- ty: SEE (Salisbury Eye Evaluation) project. Ophthalmology 2005;112:1395-1401.
  14. Marcus MW, de Vries MM, Junoy Montolio FG, Jansonius NM. Myopia as a risk factor for open-angle glaucoma: a systematic re- view and meta-analysis. Ophthalmology 2011;118:1989-1994 e1982.
  15. Ogawa A, Tanaka M. The relationship between refractive errors and retinal detachment–analysis of 1,166 retinal detachment cases. Jpn J Ophthalmol 1988;32:310-315.
  16. Risk factors for idiopathic rhegmatogenous retinal detachment. The Eye Disease Case-Control Study Group. Am J Epidemiol 1993;137:749-757.
  17. Blue Mountain Eye Study. Five-year incidence of age-related maculopathy lesions. Mitchell, Paul et al. Ophthalmology, Volume 109, Issue 6, 1092 – 1097.
  18. Bullimore MA, Brennan NA. Myopia control: why each diopter matters. Optom Vis Sci. 2019 Jun;96(6):463-465.
  19. Chua WH, Balakrishnan V, Chan YH, et al. Atropine for the treatment of childhood myopia. Ophthalmology. 2006 Dec; 113:2285-2291
  20. Chia A, Chua WH, Cheung YB, et al. Atropine for the treatment of childhood myopia: safety and efficacy of 0.5%, 0.1%, and 0.01% doses  (Atropine for the treatment of childhood myopia. Ophthalmology. 2012 Feb; 119:347-354.
  21. Wildsoet CF, Chia A, Cho P, et al. IMI – Interventions for Controlling Myopia Onset and Progression Report. Invest Ophthalmol Vis Sci. 2019;60: M106–M131.
 

 

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Vista Eye Care

13695 Colorado Blvd. Thornton, CO 80602
Phone: (303) 450-2020
Fax: (303) 920-1440

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