How to stop short sightedness getting worse? Childhood myopia treatment is being looked at more and more closely by parents. The rate of childhood myopia is increasing to epidemic levels in some countries and researchers are working hard to look for solutions.
There have been a number of ideas over the years that suggest the worsening of myopia in children is down to prolonged close work, reading in the dark or using digital devices. There are a number of other theories but one thing appears certain is that the causes are many and varied.
As a parent, what is more important is to look at practical solutions instead of trying to find the cause. The cause may never be fully known due to its complexity. If the researchers cant get there heads round it, how can we! Having said all that, there is growing consensus on the effect of sunlight or the lack thereof, on the worsening of myopia in children. So more time outdoors is needed! We will talk about risk factors later in this article.
This is where the potential therapies and the facts around how well they might work is more useful to parents. So lets look at these options and see which work best for kids. For any therapy to be effective your child needs to be fully engaged. We find this with patching therapy for kids who have amblyopia. Getting a child to be enthusiastic about wearing a patch on there stronger eye is no easy task. Parents of these children will tell you the strategies from imaginative play to bribes they have to use for their kids. The solutions for myopia control are chosen based on the age of your child, their compentance level and cooperation.
Why myopia control?
Childhood myopia treatment and myopia control are the same thing for me. Why myopia control? Because we cannot stop it but instead aim to provide solutioons to slow it down. And why can’t we stop it? Because, as explained above the many different varaibles that are working tother to cause myopia to progress cannot be eradicated with the therapies on offer.
If, for example, your child has a growth spurt, it can induce a jump in their eye power. Not only has the child’s body grown, so have the different organs in the body, like the eyes.
Contact Lenses as Childhood Myopia Treatment
Multifocal soft contact lenses
In one study, myopia progression and eye elongation were reduced significantly with the use of bifocal contact lenses.16 Forty children, age 11 to 14, wore a dual-focus lens in one randomly assigned eye and a single vision distance lens in the fellow eye for 10 months. The lenses were then swapped between eyes and worn for another 10 months.
Researchers found that for 70% of the children, myopia progression was reduced by 30% or more in the eye wearing the bifocal lens compared to the single vision lens.16 The data suggest that with bifocal lenses, the sustained myopic defocus can slow myopia progression without compromising visual function—even when presented to the retina simultaneously with a clear image.16
Ortho K or Overnight Vision Correction
Orthokeratology or orthok for short has been around for a while, just not for childhood myopia treatment. They are the most invasive of all the myopia control options available. This is because they physically reshape the eye sing a hard contact lens. Yikes! That must hurt, right? You might think so but actually they are similar to hard lenses worn by many contact lenses wearers today. They take some getting used to and thats because the eyes find foreign objects strange at first. So long as the fitting is good, they should feel managable.
OrthoK is also termed “overnight vision correction”. Did I mention you sleep in them? A big no-no for all other contact lenses, but these are specially designed for sleeping in. This is where all the magic happens and the cornea is reshaped over a period of a week of nightly wear. The vision is then corrected during the day and the wearer then reinserts them nightly to maintain the corneal shape.
Unlike, laser vision correction, orthoK is reversible, meaning that if the wearer stops wearing the lenses, the cornea will go back to its normal shape and the wearer will then go back to wearing glasses.
There have been a number of studies in the use of orthok for myopia control and the results have been pretty good. Hence, this option is one of the primary options for myopia control that we recommend for your child .
Soft spherical lenses
This is in the list as they are better than spectacle for myopia control. As the mimic not needing any glasses due to the lens sitting on the eye.
Spectacles as Childhood Myopia Treatment
Bifocals / Multifocals
Not just for the over 40s anymore! The affect of accommodation or using near focusing when your child is reading has been investigated over the years and there have been shown to be advantages over single vision lenses.
In 2000, researchers randomized 82 myopic children with esophoria to bifocals or single vision lenses. They found that bifocals reduced the progression of myopia by 0.25D over 30 months compared to single vision lenses.
Is that enough to warrant this as a potential solution . If contact lenses are not an option then these can be a potential alternative. They take some time to get used to for children in the same way they do for adults.
Single Vision Glasses
This is the “Gold Standard” childhood myopia treatment and has been the option of choice by the majority of Optometrists in and out of the hospital setting. Wearing glasses is the minimum you should do for your child as poor vision can effect learning and “drives” the myopia. Parents often ask for glasses that are not as strong as whats needed. This comes under the category of under-correction. It has been shown that under-correction actually enhances myopia rather than slowing it down. It could be argued from here that if your childs vision gets worse before their next sight test is due – they are in a state of “under-correction” and this will make things even worse. There may be some ground for this thought and hence we always recommend a) that parents stay up to date with their child’s eye examinations and b) they bring them sooner if needed and your child will also be explained the importance of asking for an eye examination if the board is no longer as clear to look at compared to when they first picked up their new glasses.
A 2006 study looked at myopic children between ages six and 15 years old over a period of 18 months.5 Twenty-three of the participants were fully corrected, while 25 were under-corrected by +0.50. Although statistically insignificant, there was a slight progression of myopia (0.17D) in the children who were under-corrected.
A 2002 study showed similar results of increased myopia progression (0.23D) over a two-year period.6 Although the increase was not significant, both studies suggest that under-correcting myopes has a negative effect on the progression of myopia.5-6 Ergo, under-corrected single vision lenses should not be used for slowing the progression of myopia.
Risk Factors for Myopia
A northern Irish Study in 2005 called the NICER study found that regular physical activity was associated with a lower amount of myopia. Does look like they looked at whether the physical activity was outdoor or indoors, but it does mean more time away from close work.
They also found 2.5x higher risk for kids in academically selective schools. Does that mean these children spend more time studying compared to their non-selective school counterparts?
The biggest effect was having parents who are myopic. 7.79x chance of the child having myopia. So if this applies to you child, consider lifestyle changes.
Providing Eyecare to children from schools in Ealing and Harrow tells us that most schools in West London at least provide computer based work to do at home as well as what is already being done in school. So the use of digital devices has become integral to adults as well as children. Parents often blame the use of screen, whether they be small or large on the shortsightedness in their children. I would argue that all the computer related activities should be put in the same box as any other near activities. So reading, crochet, knitting, computer games on the Nintendo 3DS etc all come under the same bracket.
The Avon Longitudinal Study of Parents and Children showed that children who spend long hours outside are less likely to develop shortsightedness by the time they are 15 year old. This has been backed up by other studies in the US and Australia.
So the evidence tells us that lack of sunlight seems to be the most probable link to progressing myopia in children.
Consider this, children that spend time on digital devices are more likely to be indoors. Children who spend time doing prolonged close work tend to be indoors.
The school day is composed of an hour for lunch and a break with the majority of time being spent indoors under artificial lights.
The research shows that a 2 hour spell outside counteracts 8 hours spent indoors.
In the end, we know the following, have your kids spend time outside, the equivalent to 2 hours a day. We dont get enough sun as it is and for half the year the weather doesn’t help either. There has been a big change in the lifestyle of our kids compared to that a few decades ago. Saying indoors
Come and book your child in for a sight test and we can then discuss with you the options suitable for your child. You can read more on Myopia Control Options page.
Salman Siddiqui is the principal Optometrist at Oldfields Opticians. With over 15 years of experience and works as a part-time hospital Optometrist in Paediatric Ophthalmology.