My child is nearsighted (myopic) and his/her prescription keeps going up every year, can anything be done to prevent that?

The short answer to this question is YES. There are several options that are available nowadays to try and slow down the progression of myopia. This blog entry will explain what myopia is, why we should want to slow its progression, and what medical advances have become available in recent years that are of benefit.


What is myopia?

Nearsightedness (myopia) is a common vision problem worldwide and is typically first detected during childhood. In myopia the eyeball length is typically too long, resulting in a failure to properly focus light rays that are coming from a distance. Symptoms include blurry vision at a distance (seeing the board in the classroom for example), squinting to see, and headaches. Unfortunately, myopia is becoming more and more common worldwide.  The normal course of myopia is that the prescription will continue to worsen throughout childhood, the teenage years, and into the early 20’s. Sometime parents are alarmed by how quickly myopia can progress and it often means changing glasses lenses every year (or sometimes sooner!). Because most of the progression often occurs in childhood it is important to intervene early – to prevent the prescription from getting worse in the first place.


Why is this important?

Since nearsighted (myopic) kids will require glasses or contact lenses anyway, why do we care about slowing its progression? In addition to requiring thicker and heavier glasses there are also medical reasons for why higher amounts of myopia is bad. For example, higher amounts of myopia are associated with a greater risk of retinal detachment later in life, and this is something that can cause blindness. Because of this, optometrists have a vested interest in intervening, when possible, to slow the progression of a child’s myopic prescription. The approach we take early on will determine the outcome that will affect someone for the rest of their life.


What options are available for controlling the progression of myopia?

There are basically three categories for treatment options. Special contact lenses, special glasses lenses, and eye drops. Regardless of which option you are interested in, it is important to discuss with your optometrist prior to beginning any of the treatment options outlined below. Comprehensive eye examinations for children are covered by Alberta Health Care and I would be happy to discuss any of these options in more detail during your child’s examination.

In the case of contact lenses, there is a daily disposable soft contact lens now approved by Health Canada with an indication for myopia control. This contact lens is intended to be used specifically by young children and is safe and relatively easy to use, but it does require having the child learn how to insert, remove, and care for the contact lenses. These soft lenses are only used in the daytime and not overnight, and from the patient’s standpoint are used exactly the same as any other daily disposable soft contact lens. There is also an older technology called ortho-K where a rigid contact lens is left in the eye overnight to change the shape of the eye. Though this method can also be effective, it is also more complicated and requires the patient to wear rigid contact lenses overnight.

Special glasses lenses are also available nowadays that have been shown to effectively slow the progression of myopia. The nice thing about this approach is that it is very straightforward. The child needs glasses anyway so if we just use this specific lens design, we can get the benefits of myopia control without any change to day-to-day habits. There are different lens manufacturers that make different lenses that are designed for myopia control. Speak to your optometrist to learn more.

The final option is eye drops. Atropine is a medication that is available in eye drop form and can be used to dilate the pupil. Normally Atropine eye drops are commercially available in a 1% concentration that will dilate the pupil, but in myopia control this is not what we use. Studies have shown that daily application of low dose atropine drops (concentration ranging from 0.01 to 0.05%) are effective in slowing the progression of myopia without a strong dilating effect. Some side effects that could come up include blur at near and light sensitivity, but these side effects are typically not severe and can usually be avoided if they occur by choosing a lower concentration of atropine. One drawback to this method is that low-dose atropine eye drops are not commercially available in the required concentrations and must be prepared by a special compounding pharmacy (there are options for this in Edmonton). Speak to your optometrist to learn more.

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