Myopia Control

Myopia Control

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What is Myopia?

Myopia (or nearsightedness) is the inability to clearly see objects at a distance. Nearsighted individuals see better near than far. Myopia is often the result of a growing eye, that inaccurately focuses light in front of, rather than on, the retina. The retina is the photographic film at the back of the eye. Your child has been diagnosed with myopia or is showing signs of myopic regression. Myopic eyes have a larger axial length on average.

So why is myopia a problem, besides having to wear vision correction?  Higher levels of myopia are associated with a higher risk of eye disease in adulthood. Longer eyes are more susceptible to the following diseases that can cause vision loss:

 

The optics of myopia are seen below. A myopic eye is longer than the focus length of the eye.  Distant objects such as street signs, presentation boards or faces are blurred.

What are the risk factors for myopia?

Parental myopia, myopic siblings, Asian ancestry, myopia that appears before the age of 7, rigorous academic pursuits (high near visual demands) particularly at younger ages and limited outdoor activity all can be used to predict myopia and its progression to high myopia. Patients with high degrees of myopia experience a poorer quality of life than those with low to moderate myopia. Refractive surgery can also be affected, with outcomes generally better in patients with lower prescriptions. Myopia control therapy can help change the future of your child’s myopia progression and significantly reduce the risk of future visual impairment.

Below shows the difference that can be made over time with myopia control tactics.

Myopia Control Therapy with Dr. Sciberras

So what are the options for reducing the natural progression of myopia that occurs as a child ages? There are now plenty of treatment choices, which I will go into briefly here. Before I do, as a clinician, I just want you to know some of the factors that go into deciding which is best.  First we look at the age of the child – the younger the myopia starts, the worse it gets. Their current prescription – the higher it is, the higher it is likely to go. The rate of change – if we have a history of change, we act on it accordingly. Family history (genetics) of myopia – if both parents are myopic and/or older siblings have myopia, the risks of progression are much higher. The activity level and hobbies of your child – lots of reading and lack of outdoor activity is associated with greater risk.  The ease of instituting these treatments, both from a cost and adaptation will be considered for the purposes of compliance success. Once a plan has been devised, our office can provide the necessary training/counseling and furnishing of the vision correction aids. Progress visits will be scheduled at intervals of 3 to 6 months typically to monitor and modify treatment as necessary. What we don’t want to do:  go longer than recommended between eye assessments, under-correct for myopia or fail to take any action.

Treatment Options

Bifocal Glasses

These are best in certain cases of myopia that are accompanied by convergence excess/esophoria (bifocal lenses) or focusing/accommodation lag (bifocals with prism).
 

Atropine Eye Drops

These are compounded eye drops taken once nightly (not covered by Ontario Drug Benefit or most private insurance). They have shown excellent (60% and above) success at slowing myopia and axial lengthening. We use a lower concentration to minimize side effects. These are the same medication we use to perform dilated eye exams, but at a fraction of the dosage.

Contact Lenses

Available in monthly or daily disposable formats, but both are well-tolerated. The MiSight lens in particular is revolutionary in that it is the first successful daily disposable contact lens aimed at reducing myopia progression, and also well-tolerated in children.
 

D.I.M.S. Spectacle Lenses

This spectacle lens type is made up of a central clear optical zone for correcting the myopia, with an outer band of defocus that acts to control myopia progression. The lens makes use of the natural eye adjustment known as “emmetropisation”, where the eyeball shapes to receive focused images as it does for normal vision. The D.I.M.S. lens design, MiyoSmart, distributed in Canada through select eye care professionals by Hoya Canada, was found to have the following statistically significant outcomes:

– Curbs myopia progression on average by 59%

– Slows axial eye growth on average by 60%

– completely halted myopia progression in over 20% of study participants

Below is an image of the D.I.M.S. Lens for Myopia Control.  Each of the small segments seen in the periphery of the lens adds +3.50D of power to create a myopic defocus, image lands in front of the peripheral retina, to help slow elongation of the eye. These lenses have equal adaptation and acceptance to standard single vision lenses, with the benefit of slowing myopia progression in children.

                       

Orthokeratology

Hard contact lenses worn at night to reversibly shape the cornea to reduce both eye lengthening and myopic progression, while mostly eliminating day-time dependence on vision aids.

Our Service Commitment

Myopia Control Therapy is an investment in your child’s future well-being. With increased screen time at the expense of outdoor activities, myopia is growing at epidemic proportions. By 2050, half the world’s population, or 5 billion people, will be myopic. A number of treatment options exist that have been found to diminish the eye’s axial lengthening and the corresponding myopia progression. After conducting a thorough oculo-visual assessment, Dr. Sciberras will determine the modalities best suited for successful compliance and myopia control. At times, more than one viable option exists, and the decision will be made after deliberate consultation between doctor and parents. We are 100 percent committed to providing you with the best value in eye care and eye wear. We strive to provide all patients with clear, comfortable vision in the best lens technology and most convenient modality for your child. We have an obligation to make the science and research available to you to ensure long-term eye health for your child.

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To learn more about children’s vision and its importance to learning, click here.

A Word About Astigmatism

Astigmatism can accompany nearsightedness. It is the result of an eye that is shaped like a football. It causes light to be focused at two distances within the eye, instead of one. The one place light should be focused in order to have clear vision is the retina. Astigmatism can cause blurred vision at near and far distances. This can result in headaches, eyestrain and squinting. Astigmatism can be corrected with either glasses or contact lenses.

The Importance of Regular Eye Exams

Vision is a gift and should never be taken for granted. Dr. Sciberras can detect eye disease in the absence of symptoms and can determine risk factors for future eye disease. Some of the symptoms your child may display in the presence of myopia includes: frequent eye rubbing, squinting, sitting closer than normal for reading and viewing tasks, turning their head to the side, complaints of tired eyes or inability to recognize signs or people from a distance.

Early intervention through regular eye exams and myopia control therapy are the best way to maintain healthy eyes and vision preservation for your child.

To learn more about this topic, and to calculate your child’s future myopia based on their specific risk factors, visit www.MyKidsVision.org

Another useful site is called www.myopia.care

Sign up for the Myopia App – this ingenious digital device app measures how closely the device is being held and darkens the screen if it’s held too close, revealing the screen again when it’s held back at the ideal distance or further. Developed by a partnership of scientists and optometrists, early research on this app has shown it effectively modifies screen time behavior, making a dramatically positive difference to the demand placed on the eyes.

                                 Recommended Screen Time

  • 0-2 years of age should have no screen time. Watching a screen at a young age can limit time for active play and learning, reduce opportunities for language development and inhibit their attention skills.
  • Children aged 2-5 years should have a maximum of 1 hour per day. Infants, toddlers and pre-schoolers should not be inactive or sedentary for more than one hour at a time, except for sleeping. In this age group, excessive screen time is associated with less outdoor, creative and active play time; poorer language skill development; poor social skills and an increased risk of obesity.
  • Children of school age (5-17 years) should be limited to 2 hours of recreational screen time per day. When using screen-based electronics, positive social interaction and experiences are encouraged. Sleep is also so important in this age group. Children aged 5-13 years should have an uninterrupted 9 to 11 hours of sleep per night and 8 to 10 hours per night for those aged 14–17 years. Consistent bed and wake-up times are very helpful, as are restricting screen time 2 hours before bed and removing screens from the bedroom where possible. 
  • Apply the 20-20 Rule:  take a break from reading or screen time every 20 minutes for 20 seconds. He or she should look across the room to relax the focusing muscles in the eyes before commencing near viewing. This can be managed as a break between book chapters, between Netflix episodes for tweens and teens, or timers set for younger children.

Your vision matters to us.