Myopia control Is there a cure for nearsightedness?- Evidence based Practice

Myopia control Is there a cure for nearsightedness?- Evidence based Practice

If your child has myopia (nearsightedness), you are probably wondering if there is a cure or at least something that can be done to slow its progression so your child doesn't need stronger glasses year after year.

For years, eye care practitioners and researchers have been wondering the same thing. And there's good news: A number of recent studies suggest it may indeed be possible to at least control myopia by slowing its progression during childhood and among teenagers.

What Is Myopia Control?

Although an outright cure for nearsightedness has not been discovered, your optometrist can now offer a number of treatments that may be able to slow the progression of myopia. These treatments can induce changes in the structure and focusing of the eye to reduce stress and fatigue associated with the development and progression of nearsightedness.

Why should you be interested in myopia control?

Because slowing the progression of myopia may keep your child from developing high levels of nearsightedness that require thick, corrective eyeglasses and have been associated with serious eye problems later in life, such as early cataracts or even a detached retina.

Currently, four types of treatment are showing promise for controlling myopia:

• Atropine eye drops
• Orthokeratology ("ortho-k")
• Multifocal contact lenses
• Multifocal eyeglasses

Here is a summary of each of these treatments and of recent myopia control research:

1. Atropine Eye Drops 

Atropine eye drops have been used for myopia control for many years, with effective short-term results. But use of these eye drops also has some drawbacks. Topical atropine is a medicine used to dilate the pupil and temporarily paralyze accommodation and completely relax the eyes’ focusing mechanism. Atropine typically is not used for routine dilated eye exams because its actions are long-lasting and can take a week or longer to wear off. (The dilating drops your eye doctor uses during your eye exam typically wear off within a couple hours.) A common use for atropine these days is to reduce eye pain associated with certain types of uveitis. Because research has suggested nearsightedness in children may be linked to focusing fatigue, investigators have looked into using atropine to disable the eye's focusing mechanism to control myopia.

Interestingly, one study found that when atropine drops were discontinued after two years of use for myopia control, children who were using drops with the lowest concentration of atropine (0.01 percent) had more sustained control of their nearsightedness than children who were treated with stronger atropine drops (0.1 percent or 0.5 percent). They also had less "rebound" myopia progression one year after treatment. 

2. Orthokeratology

Orthokeratology is the use of specially designed gas permeable contact lenses that are worn during sleep at nightto temporarily correct nearsightedness and other vision problems so glasses and contact lenses are not needed during waking hours. But some eye doctors use "ortho-k" lenses to also control myopia progression in children. Evidence suggests nearsighted kids who undergo several years of orthokeratology may end up with less myopia as adults, compared with children who wear eyeglasses or regular contact lenses during the peak years for myopia progression. Many eye care practitioners refer to these lenses as "corneal reshaping lenses" or "corneal refractive therapy (CRT)" lenses rather than ortho-k lenses, though the lens designs may be similar. Kids do look cute in glasses! But with the proliferation of ortho-k and other myopia control techniques, fewer kids may need eyeglasses for myopia in the future. Children who wore ortho-k lenses had a slower increase in axial length of their eyes by 43 percent, compared with kids who wore eyeglasses. Also, the younger children fitted with the corneal reshaping GP lenses had a greater reduction of myopia progression than the older children.

3. Multifocal Contact Lenses

Multifocal contacts are special lenses that have different powers in different zones of the lens to correct presbyopia as well as nearsightedness or farsightedness (with or without astigmatism). But researchers and eye doctors are finding that conventional or modified multifocal soft contact lenses also are effective tools for myopia control. The good news is, there are ways to protect your children from landing on the wrong side of this statistic. One key may be to encourage them to turn off their electronic
devices and head outdoors. 

4. Multifocal Eyeglasses

Multifocal eyeglasses also have been tested for myopia control in children, but results have been less impressive than those produced with multifocal contacts.A number of studies published between 2000 and 2011 found that wearing multifocal eyeglasses does not provide a significant reduction in progressive myopia for most children. The best way to take advantage of methods to control myopia is to detect nearsightedness early. Even if your child is not complaining of vision problems (nearsighted kids often are excellent students and have no visual complaints when reading or doing other schoolwork), it's important to schedule routine eye exams for your children, starting before they enter preschool. Early childhood eye exams are especially important if you or your spouse are nearsighted or your child's older siblings have myopia or other vision problems

What About Myopia Control In Adults?

Myopia typically develops during the early school years and tends to progress more rapidly in pre-teens than in older teenagers. This is why myopia control studies usually involve relatively young children. While it is true that myopia also can develop and progress in young adults, this is less common. In addition, it is possible that an adult's eyes will not respond to myopia control treatments the same way a child's eyes do. For these reasons, it is likely that most research on controlling myopia progression will continue to focus on nearsighted children rather than adults. 

Can Eye Exercises Cure Myopia?

You no doubt have seen or heard advertisements on television and the Internet that claim eye exercisescan reverse myopia and correct your eyesight"naturally." Some of these eye exercise programs recommend you ask your eye doctor to write you an eyeglasses prescription that intentionally under-corrects your nearsightedness for full-time wear as an adjunct treatment to performing the exercises. The claim is that the exercises and under correction of your myopia will reduce your nearsightedness, so you will need less vision correction as time goes on. It's worth noting here that research has shown under correction of myopia is ineffective at slowing myopia progression and may in fact increase the risk of nearsightedness getting worse. Also, intentional under correction of myopia causes blurred distance vision, which may put your child at a disadvantage in the classroom or in sports and affect their safety. My opinion (and the opinion shared by most optometrist and vision researchers) is that eye exercises do not cure myopia, are highly suspect, and are not supported by well-designed independent research. Buyer beware! Optom. Ankit S. Varshney M.optom, FIACLE, FASCO, Ph.D. (pursuing)

Optom. Mr. Ankit S. Varshney (M.optom, FIACLE, FASCO, Ph.D. [pursuing] )
Assistant Professor