It is estimated that 41% of the population in the United States is myopic, or near-sighted. This is a 66% increase from just 30 years ago, and the incidence continues to rise. This is problematic for both financial and health reasons. The cost of vision correction, especially in those more highly myopic is becoming increasingly expensive. More importantly, individuals who are more myopic have a higher risk of glaucoma, early cataract, retinal detachment and some forms of macular degeneration, regardless of whether or not they correct their myopia with LASIK or some other vision correction surgery.
There are many theories as to why we are becoming increasingly near-sighted. Most parents point to the increased use of electronic devices and overall increase in near-work. But there is no evidence to support that. The most recognized theories have proposed that we are becoming more near-sighted because we are spending more time indoors and not getting outside enough. Our eyes, as they develop, aren't exposed to long distances and therefore continue to elongate making us more near-sighted. The receptors in the eye responsible for this growth regulation are located in the periphery of the eye. Based on this theory, a child would be fine to sit and read a book all day, as long as they sat outside to do it.
We typically develop near-sightedness during our school ages and this is the time that we can do something to slow or stop the progression. There are three options currently available that have shown an impressive ability to halt the worsening of myopia in children.
The first and arguably most effective is orthokeratology, or ortho k. This is a system that utilizes an overnight contact lens device to gently shape the cornea to remove near-sightedness and allow the child to see all day without the need for contacts or glasses. It is safe and easily reversible (simply discontinue the overnight use of the device). Some studies have shown a 100% decrease in the progression of myopia and this treatment is FDA approved for children of all ages. This is the best option because it eliminates the need for daytime glasses or contacts and has the best data to show that it stabilizes myopia
MULTIFOCAL SOFT CONTACT LENSES
The second tool in slowing the progression of myopia is the use of multifocal contact lenses. It is believed that the signal to grow the eye longer, and therefore make it more near-sighted, is triggered by your peripheral vision. As we spend more time indoors, our peripheral vision is exposed to more closed rooms and short distances as opposed to the infinite sight lines of being outside. Wearing certain types of multifocal soft contacts can trick your peripheral vision into thinking its outside while allowing the central vision to function normally.
DROP THERAPY WITH ATROPINE
Atropine drops have proven very effective in slowing or even stopping the progression of
myopia in children and teenagers. This sounds like a perfect solution if not for the side effects seen with atropine use. This medication causes strong dilation of the pupil, making the child light sensitive and subject to glare at night. Atropine also inhibits the eyes ability to focus, making reading and near-work almost impossible. There are studies underway that are examining lower concentrations of atropine that those readily available to see if the side effects can be reduced or eliminated without losing the myopia control effects.
What is myopia? Click the video below for more information.
Andrew Biondo, OD, FSLS is the Primary Medical Director at Kirkwood Eye Associates in Kirkwood, MO. Serving the greater St. Louis area, Dr. Biondo has 12 years of experience as an eye care provider, health educator & consultant to the specialty contact lens industry. His special interests include contact lenses, dry eye disease, glaucoma, macular degeneration, laser eye surgery & preventive vision care.