with Drs Luke & Gina Small
Q: What is Myopia? What is the progression?
Myopia is also known as “nearsightedness” and causes distance vision to be blurry. Progression or increase in myopia happens as the eyes grow, which is why myopia often worsens as children get older.
Q: What age does it begin and when does it stop progressing?
It can start quite early in age where we’ve seen in it in infants as young as 6 months of age, however, this is rare. Typically we start to see it in kids at school age (5 years and older). In terms of the progression stopping, we used to say sometime in the early ’20s, but we do see it progressing into the later ’20s depending on that person’s genetic predisposition and their working/school environment.
Q: Why is the progression of Myopia a health concern?
The risk with myopia progression is that as the eye grows, the retinal tissue has to stretch causing some areas of the retina to thin and stretch. This event causes an increased risk for a retinal tear or detachment, a certain type of cataract, and myopic maculopathy (which can mimic macular degeneration). This event can also cause changes to the optic nerve, which puts that patient at higher risk for also developing glaucoma. The more myopic the eye, the higher the risk for these diseases to occur.
Q: At what age should you start managing the progression of Myopia?
Studies show that management options can start as soon as we start to see signs of myopia at the child’s eye exam. We have four main options for management (Atropine drops, multi-focal contact lenses, Ortho-K contact lenses and specific glasses lenses) and each of these options is discussed with the patient’s parents and often comes down to the age of the patient and what they are most comfortable with. Most of the recent studies we are relying on include children up to the age of 15. Currently, we are treating our 12-year-old with Atropine drops and MiyoSmart glasses lenses. We are not currently treating our 15-year-old daughter.
Q: What is Ortho K/Contact Lenses and how does it manage Myopia?
Orthokeratology is the fitting of a specially designed rigid gas permeable (meaning it allows a high amount of oxygen to reach the eye) with the intention of flattening the corneal (front of the eye) surface and creating some peripheral blur. These are worn typically at night while the child sleeps. The analogy is somewhat like an orthodontist fitting a retainer that would be worn at night. We don’t currently fit these specialty lenses at Armstrong & Small Eyecare Centre, but we can refer this procedure out when requested.
Q: My child is too young for Contact lenses, should they wait to begin myopia management?
Studies show that the earlier the treatment is started the better and ideally before the age of 8. Our 12-year old son isn’t a fan of how he looks in contact lenses (loves his glasses!). We, therefore, have opted for myopia management with the use of Atropine drops that are instilled before bed. This could be started at just about any age. The strength of the drops seems to be constantly changing based on the most recent studies as they try to determine which dosage will give the most control with the least amount of side effects. As I mentioned above, we’ve also switched his glasses lenses to a myopia management lens. There haven’t been any studies yet to look at combining different types of management, but we felt that it couldn’t hurt him to do both at this time.
Q: How do these specialty glasses lenses work to manage the progression of myopia?
Currently Armstrong & Small is using Hoya’s MiyoSmart lenses (https://www.hoyavision.com/en-ca/discover-products/for-eye-care-professionals/specialty-lenses/myopia-management/) which creates a ring of defocus or blur in certain parts of the lens. The reason for this is that one of the triggers for myopia is to have a clear image on every part of the retina. The retina then attempts to expand in order to keep each of these areas clear. If there are some areas of defocus purposefully, then there is less demand for the retina to stretch or expand. Our son noticed these areas of blur when he was scootering and in the classroom depending on how he looked through the lenses, but he quickly adapted and hasn’t mentioned anything after his first day of trying them. We suggest caution with any exercise type activity in the first week or so of wearing these lenses.
Q: How do the specialty soft contact lenses work and how often does my child need to replace them?
Currently Armstrong & Small is using Coopervision’s MiSight 1-day contact lenses. These lenses have a central clear zone much like the MiyoSmart glasses lenses and then a ring of peripheral defocus that has been proven to slow the progression of myopia. These lenses are replaced everyday which makes for a much safer profile for kids aged 8-16. Daily disposables contacts reduce the potential for infections and other problems vs. A 2-week or monthly since the child is getting a brand new lens everyday and relied upon to clean and disinfect the lens properly. Coopervision is just in the process of creating an entire myopia management program around the wear of these lenses called Brilliant Futures which should be released soon and will include a parents portal and app with education, notifications, reminders and ways to track progress. Watch for this exciting new program in the near future! https://coopervision.ca/contact-lenses/misight1day
Q: What lifestyle changes can be made to lower the progression of Myopia?
Studies have shown that 2 hours of time spent outdoors per day can slow down the progression of myopia. Obviously, this is tougher to accomplish when it’s -30 degs Celsius outside! It’s also important to take breaks from screen time or near work as this has been shown to also trigger the eye to expand and lengthen causing more myopia progression. For more info on recommended screen time use, please see the following guidelines accepted by the Canadian Association of Optometrists in 2019: https://opto.ca/sites/default/files/resources/documents/childrens_vision_and_screen_time_en_march_2018_0.pdf
Q: I have heard that Myopia is being called an epidemic. Do you think so? And if so why is the prevalence increasing so dramatically?
It is estimated that half of the world’s population will be myopic by the year 2050 (5 billion people). This increase is related to 3 main factors: 1) Genetic Factors (ethnicity, age, parental myopia, family history of eye disease) 2) Environmental Factors (time spent outdoors, amount of near work and working distance) 3) Optical Factors (refractive error, axial length and binocular vision status).