Myopia Management

Myopia Management

What is myopia?

Myopia means short-sightedness. If your child is myopic (short-sighted), this is usually because their eye is slightly longer than usual (from the front to the back). This means that light focuses in front of their retina at the back of their eye, rather than focusing directly on it

Who is affected by myopia?

Around a third of people in the UK are myopic. The condition usually starts in childhood (between six and 13 years of age) and tends to get worse until the eye has stopped growing. Myopia can also develop in younger children and adults. People are more likely to become myopic if their parents are also myopic.

What are the symptoms of myopia?

If your child is myopic, they will have problems seeing things in the distance clearly without glasses or contact lenses, but will be able to see things that are close to them. There are varying degrees of myopia.

How is myopia treated?

Myopia is usually easy to correct with glasses or contact lenses (or both). Some adults with myopia have laser surgery to correct it. There are some treatments that may slow down myopia during childhood. This is called myopia management.

Misight

How myopic may my child become?

The exact causes of myopia are not fully understood, so it is difficult to predict accurately how myopic any child may become in the future. Researchers know that the following things may make it more likely that a child will eventually become myopic:

  • having one or both parents with myopia
  • being of east-Asian ethnic origin
  • spending limited time outdoors

Becoming myopic before nine years old may increase the risk of developing a high level of myopia. If a person has a high level of myopia, they will be at a slightly greater risk of losing their sight later in life due to conditions such as retinal detachments, glaucoma and myopic retinal degeneration.

You can access a "myopia calculator" at the Brien Holden Vision Institute in Australia. This may help you work out what prescription your child's eyes may become and also what the effect of the differing treatment options below would be.

Can I reduce how myopic my child will become?

Trying to slow down how quickly myopia gets worse is called myopia management. A number of treatments have been developed for this, including specially designed contact lenses or glasses, and atropine eye drops, but not all are commonly available in the UK. Current evidence suggests that using special contact lenses glasses or atropine eye drops may reduce the progression of myopia by 40% to 60% after one to two years.

If myopia management is successful, this may mean your child grows up with a lower level of myopia than they would have had without treatment. This means that they may not depend on their glasses as much as they would otherwise have had to, and the prescription for their glasses will be lower, so their glasses will be thinner and lighter. Being less myopic may mean your child is less likely to be affected by conditions such as retinal detachment and myopic retinal degeneration.

Although a lot of research has already taken place, it will take many more years before we fully understand how successful myopia management can be. Much of the current research is based on children from east-Asian ethnic backgrounds, and we need more research to understand how myopia management will affect children with European ethnic backgrounds and whether it will be more or less successful in the UK.

The reduction in progression will vary from person to person - while some may have a 100% reduction in progression (their prescription stops increasing) , others may find that their myopia still progresses.  MiYOSMART research identified an average 60% reduction and our own Ortho-Keratology results have helped stop any increase in myopia in over 80% of our young patients fitted in the last 10 years - some starting at age 7. There are no long term studies as yet to determine how much myopia may appear or progress when the treatments are stopped in the future (myopia progression normally reduces in adulthood). 

Myopia management may therefore reduce the risk of your child developing myopia-related sight loss in adulthood, but it will not take away this risk altogether.

We will try to give you advice on the best treatment plan for you or your child based on the current evidence. Eye examinations will be scheduled every six months to review any increase in myopia/ short-sightedness. 

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What are the options for myopia management?

There are four main treatments to try to reduce the progression of myopia:

  • wearing glasses with special lenses in them eg MiYOSMART (Hoya)
  • Speciality daytime soft contact lenses eg MiSight (Coopervision)
  • Speciality overnight Ortho-Keratology contact lenses eg Nocturnal (Night Lenses) or Wave
  • using eye drops - not currently available in UK except as part of trial. 

None of these treatments are available on the NHS. Costs vary but start from £300 initially - we can offer payment options for future annual/replacement fees. Please ask us for further details.

Glasses

These are specially designed glasses. They look the same as traditional glasses but change the focus in the peripheral vision. Visit our MiYOSMART page for more information.

Contact lenses

There are two types of contact lenses which may be used to manage myopia:

• soft daily disposable contact lenses which have been designed to change the focus of light in the peripheral vision. Your child would wear these in a similar way to standard daily disposable contact lenses. Their vision may be slightly less clear with these than with traditional contact lenses.

• orthokeratology (Ortho-K) or corneal-reshaping lenses. Your child would be fitted with specially designed rigid gas permeable (RGP) lenses, which they would wear overnight. These lenses help to alter the shape of the cornea while your child sleeps, in order to temporarily reduce or correct mild myopia and reduce the progression of myopia. Visit our Ortho-Keratology page for more information.

Eye drops

A very low dose of a drug called atropine has been shown to slow down the progression of myopia. The drops are put into the eyes every day. Currently this medicine is not licensed in the UK for treating myopia. More research is being done in the UK (including Belfast) to find out whether it is safe and how well it works

Other methods

In addition to these treatments, children should be advised on the importance of time outside and restricting time on computers and tablets. With children who look at risk of becoming short-sighted, vision therapy with exercises and bifocal or progressive lens spectacles may help to stop or reduce myopia progression. However there is limited research in this area and once myopia has become established, such treatment methods have been found to be limited in effect compared to those listed above. It is therefore very important for such children and especially children where there is a family history of myopia to have regular eye examinations throughout their school career. 

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Choosing no myopia management treatment

Your child will be prescribed traditional glasses or contact lenses if they are diagnosed with myopia. The glasses or contact lenses will improve how well your child can see, but will not slow myopia progression.

The College Optometrists states that as the evidence does not currently tell us whether the long-term benefits of myopia management outweigh the costs, side effects and risks, you might choose to continue to use traditional glasses or contact lenses until there is more evidence about how well myopia management may work. 

However, the World Council of Optometry has recently recommended that myopia management should be the new standard of care for myopic children rather than the traditional approach of simple corrective myopic spectacles or contact lenses. Optometrists should regularly and consistently offer scientifically proven myopia interventions within their practices. It is important that parents and children are given as much information as possible about myopia management and Mackey Opticians will try and offer as much advice as currently available about the different options. 

The side effects and risks of contact lens wear includes microbial keratitis which is increased with over-night wear of contact lenses. Microbial keratitis is a serious and potentially sight threatening complication, There have been very few studies of the incidence of MK since the early 2000's and materials and fitting techniques have improved since then. In general contact lens wear, MK incidence is approx 2-4/10000 wearers per year. This is increased by 500% in those that purchase their contact lenses online. Its avoidance requires Optometrists to form an alliance with their patients and parents to ensure safe and effective lens wear. Compliance and hygiene are very important.

Some researchers have proposed however that the risk of increased eye disease through myopia - retinal detachment, glaucoma and macula disease - is much greater than the side effects or risk of MK in myopic management.

 Your Next Step

Book an eye examination with your local Mackey Opticians Optometrist and we will be able to explain the different options to you and give you advice on myopia management.

 

Mackey Opticians

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   422 Newtownards Road, BELFAST, Co. Antrim, BT4 1HJ

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