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Myopia Management

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What is myopia?

You may have heard of the term “near-sighted.” Well, this is also known as myopia. This is when your near vision is clear, but your distance vision is blurry. This can happen when your eye is a little too long or a little too powerful. Therefore, the light is not focused directly on your retina (back part of your eye). This results in blurry vision. Myopia is extremely common and can develop gradually over time. It usually presents in childhood. Typically, the most change occurs in childhood and adolescence and can level off as one ages. However, it can also worsen as you age due to systemic conditions or as a result of natural aging. The condition tends to run in families. If one or both parents are nearsighted then the child has an increased risk of becoming nearsighted as well. A few factors such as family history, time spent outdoors, and increased near work increases your risk for myopia. Therefore, it is a mix of both environmental and hereditary factors that can contribute to the development of myopia. Luckily—myopia is easily corrected in order to get you seeing your best. There are multiple options for treatment: glasses, contacts, or refractive surgery. However, keep in mind that myopia is associated with higher risk of retinal detachments, glaucoma, early cataracts and macular disease. Each of these conditions may result in significant vision loss and potentially blindness without proper treatment. Myopia can be prevented with early intervention. Some preventative treatment options include soft multifocal contact lenses, orthokeratology contact lenses, and low dose atropine drops. Speak to your eye doctor to discuss your options for myopia control and treatment.


Symptoms

There are many tell-tale signs of near sightedness, including:

  • Blurry vision looking at far away objects
  • Squinting or closing eyes in order to see in the distance clearly
  • Headaches
  • Eye strain
  • Difficulty seeing road signs while driving which can worsen at night
  • Frequent eye rubbing
  • The need to move closer to signs, televisions, or the front of the room.
  • Holding objects very close to the face

The symptoms associated with near sightedness tend to subside following treatment with glasses or contacts.

Headaches and eye strain can remain for a few weeks while your eyes adjust to treatment. In children, look for poor performance in school as well as shortened attention spans.

Viewing forest through eyeglasses

Keratoconus patient with Intacs

Risk factors

Myopia can be diagnosed at a young age. Most progression in myopia occurs between the ages of 8-12 years old. This is because your eyes are growing along your body, causing your vision to change as well.

  • Long durations of reading
  • Intense close visual work
  • Extended hours of computer work
  • Parents who are near sighted
    • The risk of myopia is greatest if both parents are near sighted. However, having even one parent who is near sighted puts you at higher risk.
  • Outdoor activity
    • Controlled research studies have shown that children that spend more time outside have less progression in their near sightedness than children who spend less time outside. This time was found to be up to 14 hours a week.
  • Increased duration on devices
    • Increased time spent doing near work is associated with a progression in myopia. Monitoring your child’s time spent on computers, iPad, and phones would help minimize the effect on vision.

Preventative measures

  • Orthokeratology
    • Orthokeratology refers to the use of gas permeable contact lenses during sleep in order to temporarily correct vision without the use of glasses or contacts throughout the daytime. Gas permeable contact lenses are made of a rigid material in comparison to soft contact lenses. This contributes to the mild reshaping of the eye that prevents the progression of myopia. Several studies have shown that the use of orthokeratology lenses is associated with slowed progression of myopia.
  • Atropine eye drops
    • Atropine is a drug typically used to dilate the pupil. It results in trouble reading and seeing up close due to effects on the eyes’ lens (focusing system of the eye). Its effects last for an extended duration, typically around 7-12 days until it wears off. Studies have shownthat the use of these eye drops can effectively control short term myopia progression. Myopia progression is associated with eye fatigue and over stimulation. Therefore, the use of atropine is thought to work to prevent progression by inhibiting over stimulation via relaxation of the eye’s focusing system (the lens). Some negative side effects of atropine eye drops include discomfort, light sensitivity, and blurry near vision.
  • Multifocal contact lenses
    • Multifocal contact lenses have multiple powers in different areas of the lens that can be used to correct near and distance vision simultaneously. These are essentially the contact lens version of a progressive or bifocal pair of glasses. Researchers have found that multifocal contact lenses could also be used for myopia control. The use of these lenses prevents over correction and over stimulation of the eye at near distances. Both are known to contribute to an increase in myopia progression, so these lenses help to stop this in its tracks!
  • In order to protect overall vision:
    • Get regular yearly eye exams
    • Wear glasses or contacts prescribed by your eye doctor
    • Take regular breaks from reading or computer work
    • Eat a diet rich in fruits, vegetables, and omega 3 fatty acids
    • Avoid smoking
    • Use protective eye wear
    • Wear sunglasses regularly

Risks associated with myopia

Persons with high myopia (greater than 6 diopters (-6.00D) of myopic prescription) are at higher risk of developing:

  • Retinal detachment
  • Cataracts
  • Macular conditions
  • Glaucoma

Regular visits to your eye doctor can prevent unwanted complications from myopia. New onset of floaters, flashes of light, decrease in vision, shadow like curtains in vision, or any changes in vision should be followed with a comprehensive eye exam to ensure proper treatment and management.

man looking through binoculars

Frequently asked questions about myopia

How do I know my child is near sighted?

Children are often unaware of their difficulty with their vision. They believe that everyone sees the way they see and don’t know what symptoms to look for so they may not report any. Looking for common signs of myopia would be a good way to monitor your child for myopia. Bring your child in for a comprehensive eye exam if you notice they are frequently squinting or rubbing their eyes, moving closer to objects in order to see, or if they seem unaware of distant objects.

Does myopia have any negative side effects?

Myopia puts an individual at greater risk for retinal detachments. This is a rare complication but is possible! If you have been diagnosed with myopia, be on the lookout for the sudden appearance of new floaters, flashes of light, or a curtain like shadow in your vision. Any of these symptoms may indicate a retinal detachment and requires immediate observation. This is a vision threatening condition and the timing of treatment is critical. If you believe you are experiencing any of these symptoms, seek immediate treatment with your eye doctor. In addition, myopia places you at higher risk for glaucoma and macular disease. Regular yearly eye exams will help catch complications earlier and ensure long lasting vision.

I’m having trouble getting the atropine drops into my child's eye. Are there any tips?

Children often find eye drop administration daunting! A good trick would be to have your child close their eyes, tilt their head back or have them laying down, and place a drop into the inner corner of their eye near their nose. This will allow the drop to go onto their eye and avoid missed dosages.

Can myopia go away on its own?

An adult with myopia usually remains nearsighted. Myopia may also increase as you age with the development of cataracts. Systemic conditions such as diabetes can also contribute to an increase in nearsightedness. Trauma or brain injury can cause changes in vision as well.

When does nearsightedness tend to stabilize?

Myopia tends to progress until about the age of 20. The greatest amount of progression is seen in elementary school aged children.

How does myopia limit my child’s quality of life?

Untreated myopia may set your child back in development and learning. Not being able to see the board at school would not allow your child to learn at the same pace as their peers. They may experience emotional distress as a result of their slowed learning.

Can myopia lead to blindness?

There are different levels of myopia in patients, ranging from minor vision problems to progressive and serious degenerations. Degenerative myopia is a rare progressive type of myopia that may lead to blindness. Regular comprehensive eye exams with your eye doctor can help determine what type of myopia you have and what your prognosis is.