Epidemic is a word that has been overused in recent years. However when we look at the statistics coming from Seoul, South Korea 96.5% of 19 year old college students are myopic the word is more than suitable. Unfortunately this is not just happening in Seoul, the trend is global.
The biggest single issue being highlighted by current research is the increasing percentage of time children are spending indoors. “Based on epidemiological studies, Ian Morgan, a myopia researcher at the Australian National University in Canberra, estimates that children need to spend around three hours per day under light levels of at least 10,000 lux to be protected against myopia. This is about the level experienced by someone under a shady tree, wearing sunglasses, on a bright summer day. (An overcast day can provide less than 10,000 lux and a well-lit office or classroom is usually no more than 500 lux.) Three or more hours of daily outdoor time is already the norm for children in Morgan's native Australia, where only around 30% of 17-year-olds are myopic. But in many parts of the world — including the United States, Europe and East Asia — children are often outside for only one or two hours.” http://www.nature.com/news/the-myopia-boom-1.17120
Myopia Control - A Cure for Nearsightedness?
There is increasing evidence that talking to children and teenagers about lifestyle changes, specifically spending more time outside and less time on smart devices is a great place to start.
Research also shows that good optical prescribing techniques for both spectacles and contact lenses are necessary to slow down and perhaps even stop myopic progression. Eye drops such as Atropine can also slow down myopic progression.
It is David’s prescribing objective that myopia should be kept to an absolute minimum. There is absolutely NO advantage in allowing myopia to progress, in fact there are many ocular health risks associated with increased levels of myopia.
David has been practising myopia control focused optometry for over ten years. In which time he has developed a strategy to slow myopia in order of importance:
- Lifestyle changes and advice (Three hours a day outside, minimum)
- Orthokeratology (Ortho-k)
- Soft multifocal contact lenses
- Low dose, Atropine eye drops (higher dose if required)
- Multifocal/bifocal eyeglasses
Ortho-K contact lenses
Ten years ago, when David started practising myopia control, there wasn’t a lot of research based evidence to support him but, his attitude was, why should we prescribe glasses that do nothing to slow myopia and may even contribute to its progression? Why not look at better alternatives? After some thorough research the most promising alternative was Orthokeratology (Ortho-K) contact lenses. Ortho-K contact lenses are rigid, gas permeable lenses which are worn at night and then removed in the morning. The contact lenses reshape the cornea during sleep allowing clear vision during the day without the need for glasses or contact lenses. Three years ago research from Hong Kong indicated OrthoK slows down myopic progression by 42%. Then in October this year at an OrthoK conference in Queensland, Russell Lowe, from Melbourne presented results showing that figure could be as high as 67%! New designs and ideas presented at the conference suggest further advances are also possible.
Soft, multifocal contact lenses
These are a good alternative to Ortho-K lenses. They are easier to get used to, and more comfortable to wear. The main disadvantage is that current designs don’t have the same long-term success in slowing down myopia as Ortho-K lenses. Research shows they have equivalent benefit to Ortho-K but only for six months to a year. So, soft, multifocal lenses can be good to start with but we recommend switching over to Ortho-K after a year at most. Designs and research are progressing constantly so don't be afraid to ask if there have been any advances in soft, multifocal designs!
Atropine Eye Drops
A recent study published in Nature this year looks at the effect of a 0.5% Atropine solution in slowing myopia in Europeans.The results found Atropine to be both successful and sustainable at slowing down myopic progression. However there were a relatively high number of adverse side effects.
“Atropine is the standard of care for myopia progression in Taiwan. The reasons for not prescribing Atropine for progressive myopia in western countries are as yet unclear. One reason may be the report of a higher efficacy of treatment in Asians than in Europeans. Although our power to study differences herein was low, our study could not confirm any differences between ethnicities. Another reason may be fear for serious and irreversible complications after prolonged use, but this is not substantiated by literature. Long-term effects of atropine treatment have been investigated in both animal as well as human studies” (Nature)
Atropine is being studied for its effectiveness at lower doses such as 0.02% and 0.01% and even at these low levels it has been found to have beneficial effect. For rapidly progressing myopia or myopia not responding to other control techniques 0.5% Atropine needs to be considered.
Multifocal or bifocal glasses
Spectacles still play a role in the speed of mypic progression. Contrary to common opinion single vision lenses have been shown to have no effect in slowing down myopia. However, research shows bifocal or multifocal glasses slow down the progression of myopia between 20 to 30%. Care needs to be taken by the optometrist not over or under prescribe- (make the glasses too strong or too weak.)