Myopia Management - Resources

Short-sightedness is a global public health problem. Most people think of myopia (the medical term for short-sightedness) as an inconvenience because the blurred vision it causes is easily corrected with glasses or contact lenses. The problem is that a myopic eye is a longer eye and so the light sensitive part at the back of the eye is stretched. This can lead to a number of eye diseases in later life, such as glaucoma, maculopathy and retinal detachment. Higher levels of myopia (stronger glasses) correlates to greater problems.

Experts are also concerned because the number of people with myopia is increasing. Research suggests that by 2050 it will affect half the world’s population. Myopia normally develops in children and increases in prevalence and amount during the teenage years. We know that about 30% of teenagers in the UK have myopia, and in some East Asian countries around 80% of teenagers have myopia.

Here are the predictions: 

• 5 billion myopes by the year 2050; up from 1.4 billion in 2000
• 1 billion high myopes by 2050; a five-fold increase from 2000
• Number with vision loss from high myopia to increase seven-fold from 2000 to 2050; myopia to become a leading cause of permanent blindness worldwide.

The impact of these levels of myopia on all areas of society is enormous due to the cost of eye examinations, glasses and treatment of eye disease. The reasons why myopia develops are not fully understood; the prevalence has increased too quickly to be explained solely by genetics.

We know that our visual environment also has a role in myopia development. Our lifestyle has changed significantly over the last 50 years, with greater time being spent indoors on computers, tablets and smartphones. It is the lack of time that children spend outdoors that seems to trigger myopia development.

Globally there are many people actively looking for ways to prevent myopia, or, if it has started, at ways to slow its progression. It has challenged our traditional approach to myopia, test vision and make up stronger glasses as needed. Now we are actively helping people consider alternatives which may help reduce progression, and increasing understanding of this phenomenom.

Here are some resources:

Australian Optometrist Dr Kate Gifford has developed an online tool for families to work out the risk of children becoming myopic - My Kid's Vision

Myopia Prevention is a good overview.

Nature published this great article about the Myopia Boom.

Please contact us if you would like to discuss myopia. 

Myopia Management - Ortho-K

Managing Myopia

Myopia  (short sightedness) occurs when the eyeball is too long or too powerful resulting in blurred distance vision. People with myopia are unable to read the board at school, or need glasses for driving. Vision for near objects is clear, within a close range.  Once someone becomes myopic their vision tends to get worse over time and glasses and contact lenses become stronger. The greatest change is usually in childhood and teen years.

Why do we need to control myopia?
High levels of myopia are associated with increased risk of eye diseases such as glaucoma, cataracts, retinal detachment and macular degeneration later in life.

Can you (really) slow or stop myopia?
Yes! Most people can slow down or stop their eyes from becoming more myopic. This is exciting news which resonates with all parents who are short sighted.

What causes myopia development and progression? 
Genetics, individual characteristics and environment. 

In the last 10 years, there has been considerable research into finding the environmental factors which cause myopia progression. Much has been learned from work in animal models. Current understanding is the stimulus to axial elongation—and hence to myopia progression—is defocus not in the central retina but in the mid-periphery. In experimental models, peripheral focus has emerged as very important.

Optometrists can help reduce progression of myopia. We evaluate the whole clinical picture, measuring vision and prescription, recording family history, understanding reading habits and outdoor activity. There are different options to correct vision. Research shows us how each option will influence myopia development. We can intervene and hopefully stabilize vision changes

Techniques include progressive/bifocal glasses with reading power, multifocal soft contact lens, prescription eye drops and Ortho-K contact lenses to reshape the eye. When we have completed an eye examination we can discuss each of these options in full.

Orthokeratology (Ortho-K)

Ortho-K is the use of specially designed rigid contact lenses worn overnight. The contact lens gently reshapes the cornea giving clear vision the following day without contact lenses or glasses. The effect of the lenses is temporary, giving  a day of clear vision and lenses need to be worn every night. (If the lenses are not worn at night, vision will be blurred again the next day).

Overnight Ortho-K lenses produce a corneal shape that seems to be ideal for preventing axial length progression. Ortho-K makes use of “reverse geometry” lenses that are relatively flat in the center. Wearing these lenses at night causes the cornea to become temporarily flat centrally and a little steeper in the mid-periphery. As a result, the Ortho-K produces focused central and mid-peripheral images, which is useful for myopia control.

Although RGP lenses are not known for being comfortable, Ortho-K lenses are worn only at night when sleeping, so there is no discomfort from lens-lid interaction. These are large lenses that don’t move on the eye and provoke sensation. In addition, the materials used are highly oxygen permeable.

Ortho-K is very satisfying for the practitioner. For many children, getting out of glasses gives a big boost to self-esteem; and their parents are thankful to be doing something positive for their children by reducing their myopic progression. Among kids who are active, Ortho-K is safer than glasses for contact sports and safer than ordinary contact lenses for swimmers. Myopia control is just one of many positive benefits of Ortho-K.

Behavioural Optometry Update

In July Sally attended the Australiasian College of Behavioural Optometrist Annual Conference. It was two days full of new research and updates and she came back full of enthusiasm for her Vision Therapy work.

One speaker was Dr Sue Cotter,  Professor of Optometry at the Southern California College of Optometry. Dr Cotter gave an update on eye patching to treat 'lazy' eyes. Lazy eye is the common term for amblyopia, poor vision which occurs in childhood. Amblyopia is often due to a difference in focus between the eyes, when one eye has clearer vision. Vision in the good eye develops normally while the poor eye lags behind. 
 
Many people are familiar with amblyopia treatment, an eye patch covering the good eye. In the past patches were recommended for long periods each day. New research has shown a different approach which can give better results, especially for binocular 3D vision development.

Now we start with prescription glasses alone and closely monitor vision. We are watching for an improvement in the size of letters the weak eye is able to read on our chart. Research has shown glasses alone can be as effective as patching the good eye for 2 hours each day. This is very positive; a young child is more receptive to wearing glasses than an eye patch. If glasses alone do not improve vision enough, then eye patching is still recommended. But by this time the weak eye has improved clarity, which helps children accept wearing a patch.

Newer treatments aim to stop the good eye dominating, and allowing binocular vision to develop as fully as possible. Patching does not help this process but we can enhance binocular vision with Vision Therapy. Other options include Virtual Reality games.

Dr Cotter also spoke about treating amblyopia in children older than 7 years of age. It was previously thought that after this age intervention would not have any positive effect. Evidence has shown there is still time to have a positive effect. Improvements in vision may be slower in older children so we still want to detect problems early.

If you have any questions about children's vision development, or would like to know more about Behavioural Optometry please contact us.

Optometry on the Chathams

In May Sally headed across to the Chatham Islands to check the eyes of a batch of new sailors. For the second time, Mahurangi Technical Institute (MTI) ran their training program on the Chathams for this isolated group. MTI runs courses from introductory level through to enabling someone to skipper ocean-going super yachts up to 24m long. Part of the requirement is good vision and that is why Sally went across too. She tested 14 students on the course, making sure their vision was seaworthy. During her visit she also saw a number of local people, making their eye care easier than a 3 hour flight across. As a visiting optometrist Sally worked from the local hospital and health centre.
 

Low Vision Essentials

For people with low vision glasses are not always the solution. We can help match you with the best tools to help achieve your goal, for example reading mail. There are other suggestions too, to help those less able to see.

Bigger

• Use magnifiers, hand held or stand for reading, sewing etc
• Use large simple labels in the pantry and other storage places
• Use larger print in diaries, address and phone books
• Enlarge recipes, music etc with a photocopier
• Move closer

Bolder 

• Black-on-white or white-on-black gives the best contrast. Use black marking pens to improve your ability to read
• Put white strips on the edge of steps
• Pour dark liquids into white cups and light liquids into dark cups
• Use plain dark tablecloths or mats with white crockery

Brighter

• Improved general and focused task lighting to make things easier to see

Using other senses

• Touch, add tactile marking to appliances
• Be organised
• Eliminate clutter around the home
• Keep things in their place

Myopia Control

Myopia, or shortsightedness, means distance objects appear blurred and out of focus. In everyday language we use ‘myopic’ to describe a person with a short range focus. Myopia is a growing problem throughout the world. Uncorrected myopia is the second most common cause of blindness globally. Estimates show 22.9% of the world suffers from myopia. Of particular concern are the group with very high prescriptions, or high myopia.

Myopia is not just the need for glasses and high myopia is not simply thicker lenses. With myopia comes increased risk of eye conditions like glaucoma, retinal detachment and macular degeneration. These risks increase with higher prescriptions. 

It is understood there is a genetic component to myopia. Having one parent who is myopic doubles the risk of becoming short sighted. Two parents increase the risk by 8 times. Environmental factors also seem to influence the development of myopia. These include time spent indoors versus outdoors. More time outdoors seems to result in less myopia. Spending a lot of time on close range work, reading and screens, is also associated with more myopia.  

If a child is myopic, the likelihood is this will progress as they grow; while some children have slow rates of progression, for others vision changes rapidly. 

How to control myopia in children has become a hot topic for optometrists. Fortunately there are effective ways to intervene and slow myopia progression. These include Ortho-Keratology (hard contact lenses), multifocal contact lenses, atropine eye drops and progressive or bifocal glasses. Talk to us about the best options for you or your children.

For more information see our resource page, or contact us directly.