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MYOPIA (NEAR-SIGHTEDNESS) CONTROL

Benefits of Myopia Control

Lifestyle – less dependence on glasses and contact lenses, stable prescription

Long-term Ocular Health – high myopes are more likely to be diagnosed with retinal breaks and detachments, glaucoma, macular neovascularization, and choroidal atrophy later in life

Increasing Prevalence of Myopia Worldwide

United States (Age 12-54)
1971-1972 –
25% of population myopic
1999-2004 – 41.6% of population myopic
Increase of 62% over 30 years

5,060 Chinese University Students (Shanghai) – 2012
95.5% myopic, 19.9% greater than -6.00 D (high myopia)

South Korean Military Candidates – 19 year olds – 2012
96.5% myopic

Reasons for Progression

Genetics (30%) – ethnicity, family inheritance

Environment (70%) – time outdoors, lack of blue light, near work, peripheral defocus

Modifiable Environmental Factors

Time Outdoors/Blue Light – 2 hours/day outdoors

Children that spend more time outdoors (exposed to entire visible spectrum of light – including blue light) are less likely to become myopic, and myopic children progress less rapidly with more time outdoors

Diet – Metabolic Syndrome

The increase in processed foods/added sugars in our diets has resulted in increased insulin in the blood stream, which affects growth receptors in the sclera

Peripheral Defocus

Visual Correction Options to control the way light is focused at the back of the eye

Management Options

1. Accelerated Orthokeratology (AOK)

Gentle re-shaping of the cornea (front surface of the eye) to provide clear vision – an AOK lens is inserted before bed, worn overnight and removed in the morning. Achieves peripheral defocus, while providing clear vision throughout the day.

50%+ slowing of progression

Recent modifications to the size of treatment zone of the lens have shown that the rate of slowing can be improved even further (50%+ slowing)

2. Soft 1-Day Contact Lens

A soft, daily contact lens is worn during the day to provide clear vision and peripheral defocus.

~45-50% slowing of progression

3. Atropine Therapy (0.01%) – Eye Drop

Small dosage of atropine used before bed every night.

Mechanism of action and effect on axial length not greatly understood at this time, more studies ongoing at this time.

~45-50% slowing of progression

4. MyoVision Lens – Specialty Lens for Spectacles

A spectacle (glasses) lens that achieves peripheral defocus.

~30% slowing of progression (scientific evidence not strong – limited studies)

5. Executive Bifocal

Peripheral defocus achieved by a large bifocal segment in glasses.

~40% slowing

6. Undercorrection or No Glasses

Does not slow myopia – not a viable option.

References

Walline, Jeffrey J. “Myopia control: a review.” Eye & contact lens 42.1 (2016): 3-8.

Holden, Brien A., et al. “Global prevalence of myopia and high myopia and temporal trends from 2000 through 2050.” Ophthalmology 123.5 (2016): 1036-1042.

Jung, Su-Kyung, et al. “Prevalence of Myopia and its association with body stature and educational level in 19-year-old male conscripts in Seoul, South Korea prevalence on myopia in young males in Korea.” Investigative ophthalmology & visual science53.9 (2012): 5579-5583.

Sun, Jing, et al. “High prevalence of myopia and high myopia in 5060 Chinese university students in Shanghai.” Invest Ophthalmol Vis Sci 53.12 (2012): 7504-7509.

Vitale, Susan, Robert D. Sperduto, and Frederick L. Ferris. “Increased prevalence of myopia in the United States between 1971-1972 and 1999-2004.” Archives of ophthalmology 127.12 (2009): 1632-1639.

Read, Scott A., Michael J. Collins, and Stephen J. Vincent. “Light exposure and physical activity in myopic and emmetropic children.” Optometry and Vision Science 91.3 (2014): 330-341.

Chia, Audrey, Qing-Shu Lu, and Donald Tan. “Five-year clinical trial on atropine for the treatment of myopia 2: myopia control with atropine 0.01% eyedrops.” Ophthalmology 123.2 (2016): 391-399.

Berntsen, David A., et al. “Accommodative lag and juvenile-onset myopia progression in children wearing refractive correction.” Vision research 51.9 (2011): 1039-1046

Liu, Yue M., and Peiying Xie. “The safety of orthokeratology—a systematic review.” Eye & contact lens 42.1 (2016): 35..

Websites

www.myopiaprevention.org
www.brienholdenvision.org