Myopia management and Orthokeratology

If you are wearing glasses you must remember your first visit to your eye doctor. Many of you might have been prescribed spectacles or contact lenses as a remedy to the refractive correction (Glass Prescription). As a small kid, I remember my eye care professional prescribing me a -0.75 refractive correction (lens power) when I was around 11 years old. By the time I was 20 years old my refractive correction was -2.75. I always used to wonder and ask myself why my refractive correction was increasing even though I was wearing spectacles as prescribed by my eye care professional. Could this -2.00 Diopter of increase in power have been controlled? Is there any way we can help children of 4 to 5 years already having -1.00 Diopter of correction and stop them from becoming high Myopic(>-6.00 D) when they grow? Should we really worry about Myopia Control in Children? What are the risk factors that come after having a high Myopia?

We have to be asking all these questions now and try getting the answers. One of the reasons for Myopia progression is due to the elongation of the eyeball with its increase in axial length. Myopia Control Wizards (Optometrists) has been trying their best to control this phenomenon of increasing the axial length of the eyeball to control the Myopia progression. Controlling Myopia does not just improve the patient’s quality of life but also prevents vision-threatening conditions like Retinal detachments and Retinal Maculopathy. Now, the question arises how do we control this normal phenomenon of the elongation of the eyeball? Luckily for us, many researchers have already found a way to control this phenomenon by various methods.

Sounds simple yet very effective if you want your child, brothers or sisters to be less vulnerable to refractive error send them outside to play. Though the exact reason for this is not known yet known many researchers have found out that spending just about 10 to 12 hours a week outside the room and indulging in outdoor activities helps to reduce Myopia progression in Children.1Hence, taking kids out of their digital gadgets and spending time outdoors can be beneficial in reducing Myopia progression.

Low dose atropine of 0.01% is considered to be really helpful in controlling the progression of Myopia. The ATOM& LAMP trials study has shown that low dose atropine of 0.01% & 0.05% is more effective than 1% atropine with much fewer side effects and rebound effect. 2, 3

The use of centre distance design Multifocal Contact Lenses helps to reduce the elongation of the eyeball by creating a myopic defocus in the periphery of the retina. With normal spectacle and contact lenses, hyperopic defocus is created in the peripheral retina which makes the peripheral retina elongate in order to focus the light rays into the retina. The centre distance multifocal lenses have high add in the periphery which corrects this hyperopic defocus and pushes the light rays in front of the retina creating a myopic defocus which helps to control the elongation of the axial length of the eyeball.

 

Example:  Multifocal Contact lens of SEED which is available in Nepal

 

The OrthoK lenses correct the Myopia by flattening the centre of the cornea without the need for surgery. As in LASIK surgery, the OrthoK lenses helps to flatten the central corneal area which corrects Myopia. The peripheral cornea creates a myopic defocus that helps to control the Myopia progression as well. The OrthoK lenses are the gold standard treatment for Myopia Control and also is one of the options for Myopia correction.

Myopia progression today has become a topic of discussion for many of the eye health care practitioners. It is estimated that by the year 2050 about half of the world’s population will become Myopic. So, if something is not done to control this progression we will be seeing a rise in more and more Myopic Patients in the days to come. But why should we actually worry about Myopia Progression?

With this digital age children, today spend most of their time in their electronic devices which is turning them into an early Myopes. We are now getting Myopic cases more than ever. It is common to find more than -1 Diopter of Myopia in children of 5 to 6 years. If this is not corrected and controlled these children are bound to become high Myopic at the age of 18. With high Myopia comes the high risk of many eye health conditions like Cataract, Glaucoma, Retinal Detachment & Maculopathy.

The only goal of Myopia Control & Orthokeratology is to stop these children from progressing from -1 Diopter to -6 or -7 Diopters. If we can start Myopia Control now the Myopia progression can be controlled by more than 50% and these children can be saved from the risk factors of high Myopia.

We are treating Myopia as a refractive error but now let’s take Myopia as a disease and start treating it and let’s help those children from progressing their myopia to become high Myopic. If you are parents, brother or sisters of a young Myopic child, start talking about Myopia Control with your eye health care professionals. Pediatric Ophthalmologists along with Optometrists who practices Myopia Control can help the child from progressing their Myopia. Refractions and Ophthalmic Assistants can help you find if your children have any refractive errors and will refer you to the Myopia Control practitioner.

References:
1. Wu PC, Chen CT, Lin KK, et al. Myopia Prevention and Outdoor Light Intensity in a School-Based Cluster Randomized Trial.Available from:https://www.ncbi.nlm.nih.gov/pubmed/29371008
2. Li FF, Yam JC. Low-Concentration Atropine Eye Drops for Myopia Progression. Available from: https://www.ncbi.nlm.nih.gov/pubmed/31478936
3. Yam JC, Jiang Y, et al. Low-Concentration Atropine for Myopia Progression (LAMP) Study: A Randomized, Double-Blinded, Placebo-Controlled Trial of 0.05%, 0.025%, and 0.01% Atropine Eye Drops in Myopia Control. Available from: https://www.ncbi.nlm.nih.gov/pubmed/30514630