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Myopia (or nearsightedness) is the inability to see distant objects clearly. Nearsighted individuals see better near than far. Myopia is often the result of an elongated eye, or longer axial length on average, that inaccurately focuses light in front of, rather than, on the retina. The retina is the photographic film at the back of the eye. So why is myopia a problem, besides having to wear vision correction? Higher levels of myopia are associated with a higher risk of eye disease. Longer eyes are more susceptible to the following diseases that can cause vision loss:
So what are the options for reducing the natural progression of myopia that occurs as a child ages? There are now plenty of treatment choices, which I will briefly go into here. Before I do, as a clinician, I just want you to know some of the factors that go into deciding which is best. First, we look at the age of the child – the younger the myopia starts, the worse it gets. Their current prescription – the higher it is, the higher it is likely to go. The rate of change – if we have a history of change, we act on it accordingly. Family history (genetics) of myopia – if both parents are myopic and/or older siblings have myopia, the risks of progression are much higher. The activity level and hobbies of your child – lots of reading and lack of outdoor activity is associated with greater risk. The ease of instituting these treatments, both from a cost and adaptation will be considered for the purposes of compliance success. Once a plan has been devised, our office can provide the necessary training/counseling and furnishing of the vision correction aids. Progress visits will be scheduled at intervals of 3 to 6 months typically to monitor and modify treatment as necessary. What we don’t want to do: go longer than recommended between eye assessments, under-correct for myopia or fail to take any action.
Parental myopia, myopic siblings, Asian ancestry, myopia that appears before the age of 7, rigorous academic pursuits (high near visual demands) particularly at younger ages, and limited outdoor activity all can be used to predict myopia and its progression to high myopia. Patients with high degrees of myopia experience a poorer quality of life than those with low to moderate myopia. Refractive surgery can also be affected, with outcomes generally better in patients with lower prescriptions. Myopia control therapy can help change the future of your child’s myopia progression and significantly reduce the risk of future visual impairment.
These are best in certain cases of myopia that are accompanied by convergence excess/esophoria (bifocal lenses) or focusing/accommodation lag (bifocals with prism). A full binocular vision function assessment is performed to determine the best option for your child.
MiyoSmart® is an innovative spectacle lens for myopia control developed by Hoya together with its research partner, The Hong Kong Polytechnic University. Based on a two-year clinical trial results, MiyoSmart® is proven to curb myopia progression by up to 59% and halt myopia progression by 21.5% 3 with its award-winning D.I.M.S. (Defocus Incorporated Multiple Segments) technology.
These are compounded eye drops taken once nightly (not covered by Ontario Drug Benefit or most private insurance). They have shown excellent (60% and above) success at slowing myopia and axial lengthening. Side effects such as light sensitivity and difficulty focusing at near must be monitored. These are the same medications we use to perform dilated eye exams, but at a fraction of the dosage.
Available in monthly or daily disposable formats, both are well-tolerated. The MiSight lens in particular is revolutionary in that it is the first successful daily disposable contact lens aimed at reducing myopia progression, and also well-tolerated in children.
Hard contact lenses worn at night to reversibly shape the cornea to reduce both eye lengthening and myopic progression, while mostly eliminating day-time dependence on vision aids.