MYOPIA (NEAR-SIGHTEDNESS) AND HOW TO CONTROL IT
Myopia, also known as near-sightedness, occurs when a person’s eye is too strong, or more commonly, too long.
This results in the inability to see things clearly at a distance. Kids with at least one parent with a myopic
refractive error are more likely to develop myopia. Spending time doing a lot of near work is associated with
increased myopic refractive error. One of the biggest predictors of myopia progression is having a myopic
refractive error of at least -1.25D between 6 to 7 years old. 1 As children grow, so do their eyes, meaning that the
younger a child is when they develop myopia, the more myopic they will become as they age. Because children’s
eyes continue to grow as they grow, their myopic refractive error also increases. Therefore, delaying initiation of
myopia control increases the chance of higher refractive error once the child’s prescription stabilizes. Increased
myopia can significantly impact people’s lives. Moderate to high myopia can increase risk of developing
glaucoma. 2 Cataracts were found to be more prevalent in people with moderate or high myopia. 3 Retinal
detachments also occur more frequently in people with high myopia because the long eye can cause the retina
to stretch and form breaks, leading to a detachment. 4 High myopia can also lead to maculopathy, which can
result loss of central vision. 5 Many people choose to get LASIK when their refractive error stabilizes. If a person’s
myopia is too high, LASIK may not be able to fully correct their refractive error.
Thankfully, there is hope. Several methods have been shown to be helpful in reducing the rate of myopia
progression. These options include soft or hard contact lenses worn during the day, hard contact lenses worn at
night, and eye drops used at bedtime. In our office, we specifically offer the options of using eye drops or soft
contact lenses.
Atropine
Atropine is an eye drop that reduces the eye’s ability to focus well and increases sensitivity to light by making
the pupil bigger. It is FDA approved for treatment of conditions such as amblyopia. In lower concentrations,
however, it has been shown to slow the progression of myopia with few side effects in most children. A recent
trial from my Low-concentration Atropine for Myopia Progression (LAMP) study found that 0.05% was more
effective at reducing progression of myopia than lower concentrations that had been used in the past. Vision
was unaffected in most children. After cessation of treatment with atropine, a rebound effect, meaning
increased myopia, has been observed. 6 It is important to note that this method of myopia management is not
FDA approved.
Treatment with low-dose atropine involves instilling an eye drop into each eye at bedtime. If near vision is
affected, glasses with a reading prescription may need to be used. Sunglasses can help reduce light sensitivity.
After initiation of treatment, the child will be scheduled for a 1-month follow-up, and then a 6 month follow-up.
The child will then be monitored every 6 months until it is determined that it is reasonable to stop treatment.
Soft Contact Lenses
The type of contact lenses used in myopia management focus light on the retina in such a way that it helps to
keep the eye from growing quickly. Because of the design of the lens, some children may experience that their
vision at near is not quite as clear as it is with distance only contact lenses. This is perfectly normal and not
unexpected. Some parents are concerned about the risks associated with contact lens wear in kids. However,
research has shown that children are at no greater risk for infection than adults. In fact, younger kids, ages 8-11,
have been shown to have an even lower incidence of corneal infiltrates than adults. 7
Our office has two options for soft contacts for myopia control. The first is MiSight contact lenses, which are the
only FDA-approved management for myopia. This lens is indicated for use in children between 8 and 12 years of
age with a refractive error of -0.75D to -4.00D. 8 MiSight lenses have been used off-label in children younger than
8 years old and older than 12 years old. Because this is a daily lens, it is safer and easier to care for than a
monthly replacement lens. However, since more contact lenses are needed, the cost of the lenses is higher per
year than that of a monthly.
The second option is a Biofinity Multifocal contact lens with center distance correction and a high add power.
This type of lens is FDA approved for the correction of refractive error and presbyopia. In children, this lens can
be used off-label for myopia control. It helps to focus light on the retina in a way similar to MiSight, to help keep
the eye from elongating quickly.
If soft contact lenses are used, the child will be given a set of trial lenses and taught how to insert and remove
the lenses, as well as how to care for them. It is recommended that the contact lenses be worn for at least 10
hours per day, 6 days per week. The patient should also have a pair of updated glasses that can be worn if there
is a problem with the contact lenses. After the initial fitting, the patient will be seen for a 1-week follow-up, at
which time the prescription will be finalized if the patient is doing well with them. Then, there will be a 1 month
and 6-month follow-up to assess stability of refractive error and the child’s ocular health with the contact lenses.
Following that, the patient will be seen every 6 months.
Please click on the Forms button below and fill out the consent form and bring it to your local office.
References
1. 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;123(7):977–987.
doi:10.1001/archopht.123.7.977 https://jamanetwork.com/journals/jamaophthalmology/article-abstract/417134
2. Marcus MW, de Vries MM, Junoy Montolio FG, Jansonius NM. Myopia as a risk factor for open-angle glaucoma: a
systematic review and meta-analysis. Ophthalmology. 2011 Oct;118(10):1989-1994.e2. doi:
10.1016/j.ophtha.2011.03.012. PMID: 21684603. https://pubmed.ncbi.nlm.nih.gov/21684603/
3. 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 Dec;43(12):3625-32. PMID: 12454028.
https://pubmed.ncbi.nlm.nih.gov/12454028/
4. Williams K, Hammond C. High myopia and its risks. Community Eye Health. 2019;32(105):5-6. PMID: 31409941; PMCID:
PMC6688422. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6688422/
5. Ohno-Matsui K, Kawasaki R, Jonas JB, Cheung CM, Saw SM, Verhoeven VJ, Klaver CC, Moriyama M, Shinohara K,
Kawasaki Y, Yamazaki M, Meuer S, Ishibashi T, Yasuda M, Yamashita H, Sugano A, Wang JJ, Mitchell P, Wong TY; META-
analysis for Pathologic Myopia (META-PM) Study Group. International photographic classification and grading system
for myopic maculopathy. Am J Ophthalmol. 2015 May;159(5):877-83.e7. doi: 10.1016/j.ajo.2015.01.022. Epub 2015 Jan
26. PMID: 25634530. https://pubmed.ncbi.nlm.nih.gov/25634530/
6. Yam JC, Li FF, Zhang X, Tang SM, Yip BHK, Kam KW, Ko ST, Young AL, Tham CC, Chen LJ, Pang CP. Two-Year Clinical Trial
of the Low-Concentration Atropine for Myopia Progression (LAMP) Study: Phase 2 Report. Ophthalmology. 2020
Jul;127(7):910-919. doi: 10.1016/j.ophtha.2019.12.011. Epub 2019 Dec 21. PMID: 32019700.
https://pubmed.ncbi.nlm.nih.gov/32019700/
7. imore MA. The Safety of Soft Contact Lenses in Children. Optom Vis Sci. 2017 Jun;94(6):638-646. doi:
10.1097/OPX.0000000000001078. PMID: 28514244; PMCID: PMC5457812.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5457812/
8. “MiSight® 1 Day.” CooperVision, https://coopervision.com/practitioner/our-products/misight-1-day/misight-1-day.