Myopia Control for Children

Myopia Control for Children and Teens using Ortho-K

What is Myopia?

Myopia is the refractive error that results when an imbalance of the eye structures responsible for creating an accurately positioned focal point of a faraway object (corneal power, lens power, and eyeball length) causes this point to be focused in front of the retina instead of on the retina. Myopia is also known as “near sight”, because when an object is brought nearer to the eye, the focal point moves back toward the retina until at some point (depending on the amount of myopia) the near object becomes focused on the retina without any effort from the focusing muscles, and the person has “near sight”.

What Causes Myopia Progression?

As children grow, their eyeballs can become larger and longer. This causes the focal point of a far object to become located further and further in front of the retina, creating the need for stronger and stronger eyeglass prescriptions.

What is Myopia Control?

Myopia Control is the term describing the treatment methods used to slow down or stop the progressive loss of far vision in children by preventing the eyeball from growing too long.

Why Are More and More Parents Having Their Children Undergo Myopia Control Treatment?

Myopia has become an epidemic throughout the world. Besides the loss of far vision, there are increased eye health risks as a result of having eyeballs that are too long. As more and more studies show the efficacy and safety of myopia control treatment, it has come to be viewed as more of a necessity than an elective luxury by eye care professionals and educators and parents.

Why Haven’t I Heard of This Before?

Unfortunately, most eye care has turned into “fast-food” national commercial optical retail stores, whose main concern is how many “customers” can be crammed in and how many pairs of eyeglasses can be sold. The optometrists who work there do not have the specialized training or time to perform Myopia Control. Neither do ophthalmologists, whose specialty is eye disease and surgery. Almost all Myopia Control throughout the world is performed by orthokeratologists who have dedicated themselves to making a huge difference in the lives of their patients. Dr. Jeruss has been performing and lecturing on Ortho-K and Myopia Control since 1983. He is a Fellow of the International Academy of Orthokeratology and American Academy of Ortho-K and Myopia Control, and is world renowned for his work in the area of astigmatism and creative lens design.

Myopia Has Become a Worldwide Epidemic

Incidence of Myopia in Different Countries:

• USA = 42% of the population in 2010 (doubled from 1972)
• Europe = 35% of the population in 2010
• China and other Asian countries = 80%, and increasing rapidly.
• Worldwide = 1.45 billion (25% of population) in 2010 with estimated 2.5 billion (33% of population) by 2020.

Predictive Factors in Myopia Progression

• Myopic parents have more myopic children than do non-myopic parents, but genetics play far less of a role than previously thought.
• Excessive reading or near work is NOT a predictor of myopia! (Surprise!)
• There is more myopia in urban environments than in rural or primitive societies.
• Lack of time outdoors in bright natural light is a predictor for myopia progression.
• Peripheral hyperopia is a STRONG predictor of myopia progression.

What is Peripheral Hyperopia and How Does It Cause Eyeball Elongation?

Why Should We Care if Our Children’s Myopia Worsens Each Year?

“They can just keep getting stronger glasses and contact lenses, right?” “Sure, their lenses will keep getting thicker and thicker, but they’ll still be able to see OK with a stronger Rx, right?” “So, what’s the big deal?”

Myopia is a Risk Factor for Cataracts, Retinal Detachment, Macular Degeneration, and Glaucoma

At -3.00D of myopia, the risk of posterior subscapular cataract is 3X that of an emmetrope, and the risk of retinal detachment and myopic maculopathy is 9X that of an emmetrope. Once children reach -5.00D of myopia, they have a 5X greater risk of cataracts, a 21X greater risk of retinal detachment, and a 40X greater risk of myopic maculopathy. These ratio risks demonstrate that there is no physiological level of myopia that could be considered “safe” in comparison to emmetropia.

Myopes have a 2-3X higher risk of developing glaucoma.

What Can Be Done to Prevent My Child’s Vision from Worsening?

Current Treatment Options for Myopia Control

1. Low concentration 0.01% atropine eye drops (currently considered an “off-label” use by FDA)
2. More time spent outdoors in bright natural light
3. Bifocal (soft or rigid gas permeable) contact lenses (far-center/near-periphery)
4. NaturalVue® small aperture, aspheric progressive multifocal soft daily disposable contact lenses
5. Ortho-K

Each of the above treatment options are explained in detail below:

1. Atropine eye drops
   These are normally used to dilate the pupil and temporarily paralyze the focusing muscles to reduce the eye pain from uveitis (inflammation of the middle layer of the eye, which includes the choroid, ciliary body, and iris). Because research suggests that focusing fatigue is linked to nearsightedness in children, investigators have tried using topical atropine to disable the eye’s focusing mechanism to try to control myopia. Studies have shown atropine eye drops to produce a large reduction in myopia progression in the first year, but after that the myopia control effect wears off. Also, when the drops are discontinued there is a fast rebound effect which leaves children considerably more nearsighted than when they started the drops.

• More time spent outdoors
  Many studies have shown the benefits of bright outdoor light in developing normal vision (emmetropia) as well as decreasing myopia progression. Send your kids outside to play at least 1-2 hours per day!

• Soft bifocal contact lenses (center = far / periphery = near)
  Studies have shown that a center-far, periphery-near concentric soft bifocal contact lens can achieve some degree of myopia control. However, due to the relatively low amounts of bifocal “ADD” powers available (up to +2.50), and the even lower amounts that can usually be tolerated before the patient’s distance vision is severely compromised (typically +1.00 to +1.50), there is typically not sufficient peripheral myopia created to counteract the peripheral hyperopia that causes eyeball elongation and myopia progression.

• NaturalVue® multifocal daily disposable contact lenses
  Due to the unique aspheric optics, very large amounts of “ADD” power create the peripheral myopia needed to counteract the peripheral hyperopia, thereby preventing the eyeball from growing longer and becoming more myopic. This lens can even provide satisfactory visual acuity when there is 1.0 D of astigmatism present. Because of the large amounts of “ADD” power created, even with low amounts of myopia, we have begun sometimes using the NaturalVue® lens as first choice for our youngest kids who are just starting to become myopic.

• Ortho-K night wear retainer contact lenses
  Ortho-K is the controlled re-shaping of the cornea to eliminate refractive error by using specially designed rigid gas permeable contact lenses worn overnight and removed upon waking, providing clear unaided visual acuity for all waking hours. When used for myopia control, Ortho-K lenses are specifically designed with a central smaller optic (treatment) zone so that the emphasis is on creating a larger area of peripheral myopia to counteract the peripheral hyperopia, thereby preventing the eyeball from growing longer and becoming more myopic. Ortho-K lenses for myopia control have been shown over and over and over again in study after study after study for many years to be the best method for reducing the long-term progression of nearsight in children. WAVE lenses, in particular, because of their incredible customizability, can be designed to maximize the reduction in myopia progression.

WAVE Custom Designed Lenses Offer Unrivaled Advantages:

There are a number of different Ortho-K lenses available, but Dr. Jeruss has preferred to use WAVE lenses since 2004. WAVE lenses are the only ones that can be custom designed with:

1. any overall lens diameter (to fit different sized corneas), including corneoscleral (larger than cornea).
2. any optic (treatment) zone curvature and diameter (to correct much higher refractive errors than other lenses are capable of, and to adjust for different pupil sizes).
3. a “decentered optic (treatment) zone” (to counteract excessive lens decentration and turn a failing case into a success!). *** In March 2016, Dr. Jeruss was the first person in the world to design a decentered optic zone! This was such an important development for Ortho-K that it was just incorporated into the latest version of the WAVE software!
4. any reverse zone (“pull” zone) curvature and diameter (to create faster treatment)
5. any slope between the treatment zone and the reverse zone (to create different amounts of peripheral myopic defocus for stopping myopia progression)
6. any alignment zone width and curvature and slope (to improve lens centration)
7. any edge width and degree of lift (to improve comfort)
8. any overall power (to allow for clear vision with daily wear, if desired)
9. any center and edge thickness (to prevent lens warping and improve comfort)

Other Resources about Myopia, Ortho-K, and Myopia Control:

1. Myopia Prevention and Control myopiaprevention.org/index.html
   (contains HUNDREDS of articles and studies on myopia control)
2. The Ortho-K Network ortho-k.net/
3. WAVE Contact Lenses http://www.wavelenspatient.com/index.html
4. All About Vision allaboutvision.com/parents/myopia.htm
5. Eye to Eye Vision Center Facebook page
   https://www.facebook.com/pages/Eye-to-Eye-Vision-Center
   (click on our Facebook link to see our patient video testimonials on Ortho-K and Myopia Control)