It’s that time of the year again… Time to stock up on pencils, wide-ruled notebook paper, and get your kids’ eyes checked. All kids should have their eyes checked at the beginning of each school year, and prior to kindergarten. Many learning disabilities are diagnosed incorrectly and may in fact be vision problems.
Estimates claim 20% of children have refractive errors and require either glasses or contact lenses to improve their vision. Myopia, hyperopia, and astigmatism are the most common refractive conditions. Additionally, lazy eye can be present in children and needs to be treated as soon as possible to prevent permanent vision loss.
During the COVID-19 pandemic, virtual education had a significant impact on childhood myopia due to increased screen time and decreased outdoor time. The incidence of myopia in 2020 photo screenings, conducted by schools in China, was higher than the highest prevalence of myopia between 2015-2019 for children ages 6-8.
We are also seeing the effects of virtual education and long-term digital device use on the eyes of American children.
What is myopia?
Myopia, also called being near-sighted, is the inability to see in the distance. The term seems opposite but is a reference to where the light falls in comparison to the retina. In patients who are unable to see in the distance, the light falls near the retina. Nearsightedness occurs because the eye is a little longer than it should be from front to back. The anatomical stretching of the eye can lead to eye pathologies such as retinal detachment, glaucoma, myopic macular degeneration, and cataracts.
Myopia is the most common ophthalmic condition in the world and is estimated to affect 22.9% of the world’s population.
- By 2050, the percentage of people affected by myopia is expected to grow to 49.8% worldwide with 9.8% of myopes designated as high myopia.
- Recent estimates suggest visual problems among preschool children will increase by 26% by 2060 with uncorrected refractive error comprising 69% of cases. If untreated, it can hinder a child’s performance in school.
What causes myopia?
Myopia is caused by a combination of both genetics and environmental/lifestyle factors. Your genetics are the most important factor associated with myopia. When parents wear glasses for distance, there is a greater chance the children will. Myopia rates are highest in children of East Asian descent regardless of where they live. Researchers have identified many myopia-associated loci and genetic mutations or variants, but more studies are needed in this area.
Studies have demonstrated myopia may be caused by near-work tasks such as studying, reading, and screen time among children. Children aged 7 to 9 years who were exposed to reading were more likely to be myopic. Children with myopia are more likely to spend significantly more time studying, more time reading, and less time playing sports. Those that spend time outdoors are less myopic.
Like anything dietary, moderation is key. It’s important not to discourage children from reading, but to balance it with outdoor time. One study demonstrated to reach a 50% reduction in myopia, 76 minutes per day is needed outdoors. Doctors may recommend two hours of outdoor time per day for your child with myopia.
How can myopia be treated?
Physicians have increased their efforts to reduce myopia progression due to increased incidence worldwide and potential ocular complications. Myopia progression means the child’s prescription worsens over time with age and as the eye’s axial length increases (the eye gets longer from front to back).
The goal of myopia treatment is to target and slow axial length elongation. Myopia can be treated with eye drops called Atropine, Orthokeratology lenses, or soft multifocal contact lenses. Soon, specially designed spectacles will be a method for treating children.
Atropine
Atropine is a topical medication instilled in the eyes of children daily to slow myopia progression. 1% Atropine eye drops showed the most effect on reducing myopia control; however, it causes blurred near vision and light sensitivity. 0.01% Atropine is the optimal concentration prescribed by doctors to effectively control myopia progression with minimal side effects.
Orthokeratology
Orthokeratology uses hard contact lenses to reshape the cornea. Children sleep in contact lenses overnight specifically fit to the cornea to slow progression. Orthokeratology is extremely effective in treating myopia progression and is very safe.
Treatment success requires a combination of proper lens fitting, compliance to lens care regimen, good adherence to follow-up, and quick treatment of complications. Recent research presented by the National Library of Medicine states orthokeratology slows the progression of myopia by 40%.
Soft multifocal contact lenses
Although Myopia control contact lens fittings are still limited to 2–5% of all contact lenses fitted, numbers are expected to grow as studies demonstrate success. For most children, soft multifocal contacts are the preferred treatment by doctors and parents. Only certain contact lens brands have proven effective at slowing progression due to their lens design.
The use of specialty soft contact lenses slowed myopia progression by 40% in children ages 7-12 by slowing eye lengthening when compared to spectacle use.
Spectacles
Essilor Stellest lenses have not been approved in the U.S. yet but are being used in Canada. The lenses slow down myopia progression by 67% on average when compared to single vision lenses, when worn 12 hours a day. This may prove to be a good option for children who are not ready for contact lenses or children under 7 years of age.
There is a circulating myth that if children are under-corrected in glasses, their prescriptions will not worsen. This is untrue.
Who is a candidate for myopia management?
Ideal candidates for myopia control are children from the ages of 7-12 with a prescription that worsens each year. If the child has one or both parents with a high prescription in their glasses, they are a perfect candidate. The child’s prescription for glasses, lifestyle, or the progression in their prescription may suit them for one method of myopia management over another.
Myopia progression is also occurring in young adults due to increased digital device and computer use. More studies are needed in this area to determine the reason for changes and how to stop myopia progression.
