Myopia Control
Myopia Management at Roman Wagner in Schweich
Actively counteract myopia in children.
| In thirty years, it is estimated that half of the world’s population will be myopic [1]. |
| In parts of Asia, up to 80% of the younger generation are already affected by this vision defect [2,3]. |
Myopia, also known as nearsightedness, occurs when the eye has grown too long in relation to the refractive power of the eye lens. A visual object is therefore not focused on, but in front of, the retina [4]. This can be corrected with diverging lenses in glasses or contact lenses. The problem, however, is that especially in children and adolescents, myopia often continues to increase, meaning the eyeball continues to lengthen. This also increases the risk of serious eye diseases such as cataracts (3.1-fold increased 1 [5]), glaucoma (3.3-fold increased 2 [6]), retinal detachment (9.9-fold increased 3 [7]), or damage to the macula (macular degeneration; 9.7-fold increased4 [8]) [9,10]. Therefore, it is important to intervene early in the process and prevent myopia from reaching higher levels.
For decades, methods for myopia control have been researched worldwide. For example, increased time spent outdoors shows a protective effect against the onset of myopia [11,12]. Whether the progression of myopia can also be reduced in this way is currently still being investigated [13-15]. However, it is already recommended that even myopic children spend more time outdoors and take breaks during prolonged near work to look at distant objects instead of near ones. In addition to these easy-to-implement measures, there are currently several options for myopia control whose effectiveness has been studied [16].
Eye drops with the active ingredient of deadly nightshade
In ophthalmology, a preparation containing the active ingredient of deadly nightshade is used to dilate the pupil, e.g., for examining the fundus. This active ingredient also paralyzes the ciliary muscle in the eye, which enables sharp vision at various distances, known as accommodation. Studies in myopic children showed that regular administration of low-dose (0.01%) eye drops, resulting in fewer side effects, slowed the progression of myopia [19]. With the low dose, the spectacle prescriptions of treated children changed significantly less than those of the untreated control group. However, the axial length growth of the eye was not significantly reduced [20,21]. The mechanism of action of the active ingredient is not yet fully understood [22].
Bifocal and Progressive Lenses
These lenses are typically used for individuals over approximately 45 years of age to correct presbyopia. Due to the positive power (so-called addition) incorporated into the spectacle lens, both distant and near objects can be seen sharply. As a method for myopia control, bifocal lenses showed an inhibitory effect on axial length growth, particularly in children who accommodate too little during reading or other near work, i.e., do not precisely adjust the refractive power of the eye lens to the viewing distance [23].
Soft Multifocal Contact Lenses (simultaneous near and distance correction)
Further studies showed that axial length growth is influenced by where a visual object is imaged in the eye relative to the retina, and that this mechanism is primarily controlled by the peripheral retina. The retina detects the image plane in the eye and adjusts the eye’s growth rate accordingly: If the peripheral retinal image is located further forward in the eye, this signals reduced eye growth.
With multifocal contact lenses, the optical power changes gradually, similar to progressive lenses, allowing for sharp vision at both distance and near. In myopic children, the additional plus power is used to shift the image in the peripheral retina forward, thereby inhibiting further eye growth. Studies in children showed that myopia progression, both in terms of refractive values and axial length growth, slowed by approximately 38% on average [16]. Meanwhile, soft contact lenses specifically developed for myopia control have also been approved in the German ophthalmic optics market. Children who wore these special lenses for over three years showed 52% less axial length growth compared to the control group [24].
Orthokeratology (rigid gas permeable contact lenses for overnight wear)
Special rigid gas permeable contact lenses are worn overnight and thus change the shape of the cornea. Up to a certain degree of myopia, this eliminates the need for vision correction during the day [26–28]. The visual impression created by the corneal reshaping also causes myopia to progress less [29,30]: Axial length growth in clinical studies was reduced by 43% over a two-year treatment period [29] and by 33% over seven years compared to the control group wearing conventional glasses or soft contact lenses [30].
MiYOSMART® (spectacle lenses with simultaneous near and distance correction)
The MiYOSMART® spectacle lens is an effective and non-invasive means to correct myopia while simultaneously curbing its progression. It features a special power distribution and is based on the same principle of action as multifocal contact lenses. The central area of the lens corrects myopia like conventional glasses: a visual object is sharply imaged on the retina by the diverging lens. Around the central zone, many small converging lenses are distributed within the glass. These create a second image plane in front of the retina, which has an inhibitory effect on myopia progression: In a two-year observation period, this slowed the progression of myopia in children by 62 percent [17].
At the CENTER FOR GOOD VISION in Schweich, we offer the methods described here in cooperation with ophthalmologists. Since myopia must always be corrected, the optical correction device should also be used directly to counteract the further progression of myopia. MiYOSMART® spectacle lenses are an effective and easy-to-implement form of care that also poses no risk to eye health. We therefore recommend the innovative MiYOSMART® spectacle lens as the primary method.
Book a consultation appointment now
Schedule your individual consultation appointment in good time at the CENTER FOR GOOD VISION in Brunnenzentrum, Steinerbaum 2 in Schweich
We are here for you
Mon-Fri 8:45 AM - 6:00 PM
Sat 9:00 AM - 2:00 PM
Tel.: 06502 91410
Information on increased risk applies to: 1 -3.5 to -6 dpt [5]; 2 <-3 dpt [6]; 3 <-3 dpt [7]; 4 -3 to -5 dpt [8]
References
[1] Holden BA et al. Global prevalence of myopia and high myopia and temporal trends from 2000 through 2050. Ophthalmology. 2016;123(5):1036–42.
[2] Lin LLK et al. Prevalence of myopia in Taiwanese schoolchildren: 1983 to 2000. Ann Acad Med Singap. 2004;33(1):27–33.
[3] Dolgin E. The myopia boom. Nature. 2015;519(7543):276–8.
[4] Flitcroft DI et al. IMI – Defining and classifying myopia: a proposed set of standards for clinical and epidemiologic studies. Invest Ophthalmol Vis Sci. 2019;60(3):M20–30.
[5] Lim R, Mitchell P, Cumming RG. Refractive associations with cataract: the Blue Mountains Eye Study. Invest Ophthalmol Vis Sci. 1999;40(12):3021–6.
[6] Mitchell P et al. The relationship between glaucoma and myopia: the Blue Mountains Eye Study. Ophthalmology. 1999;106(10):2010–5.
[7] Eye Disease Case-Control Study Group. Risk factors for idiopathic rhegmatogenous retinal detachment. Am J Epidemiol. 1993;137(7):749–57.
[8] Vongphanit J, Mitchell P, Wang JJ. Prevalence and progression of myopic retinopathy in an older population. Ophthalmology. 2002;109(4):704–11.
[9] Flitcroft DI. The complex interactions of retinal, optical and environmental factors in myopia aetiology. Prog Retin Eye Res. 2012;31(6):622–60.
[10] Saw S-M et al. Myopia and associated pathological complications. Ophthalmic Physiol Opt. 2005;25(5):381–91.
[11] Rose KA et al. Outdoor activity reduces the prevalence of myopia in children. Ophthalmology. 2008;115(8):1279–85.
[12] Rose KA et al. Myopia, lifestyle, and schooling in students of Chinese ethnicity in Singapore and Sydney. Arch Ophthalmol. 2008;126(4):527–30.
[13] Wu P-C et al. Myopia prevention and outdoor light intensity in a school-based cluster randomized trial. Ophthalmology. 2018;125(8):1239–50.
[14] Wu P-C. The role of time outdoors in myopia onset and progression in schoolchildren from ROCT study. Invest Ophthalmol Vis Sci. 2019;60(9):3297–3297.
[15] Xiong S et al. Time spent in outdoor activities in relation to myopia prevention and control: a meta-analysis and systematic review. Acta Ophthalmol. 2017;95(6):551–66.
[16] Wildsoet CF et al. IMI – Interventions for controlling myopia onset and progression report. Invest Ophthalmol Vis Sci. 2019;60(3):M106–31.
[17] Lam CSY et al. Defocus Incorporated Multiple Segments (DIMS) spectacle lenses slow myopia progression: a 2-year randomised clinical trial. Br J Ophthalmol. 2020;104(3):363–8.
[19] Chia A, Lu Q-S, Tan D. Five-year clinical trial on atropine for the treatment of myopia 2: myopia control with atropine 0.01% eyedrops. Ophthalmology. 2016;123(2):391–9.
[20] Chia A et al. Atropine for the treatment of childhood myopia: safety and efficacy of 0.5%, 0.1%, and 0.01% doses (Atropine for the Treatment of Myopia 2). Ophthalmology. 2012;119(2):347–54.
[21] Yam JC 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. Ophthalmology. 2019;126(1):113–24.
[22] Tran HDM et al. A review of myopia control with atropine. J Ocul Pharmacol Ther. 2018;34(5):374–9.
[23] Cheng D et al. Effect of bifocal and prismatic bifocal spectacles on myopia progression in children: three-year results of a randomized clinical trial. JAMA Ophthalmol. 2014;132(3):258–64.
[24] Chamberlain P et al. A 3-year randomized clinical trial of MiSight lenses for myopia control. Optom Vis Sci. 2019;96(8):556–67.
[26] Swarbrick HA, Wong G, O’Leary DJ. Corneal response to orthokeratology. Optom Vis Sci. 1998;75(11):791–9.
[27] Charman WN et al. Peripheral refraction in orthokeratology patients. Optom Vis Sci. 2006;83(9):641–8.
[28] Kang P, Swarbrick H. Peripheral refraction in myopic children wearing orthokeratology and gas-permeable lenses. Optom Vis Sci. 2011;88(4):476–82.
[29] Cho P, Cheung S-W. Retardation of Myopia in Orthokeratology (ROMIO) study: a 2-year randomized clinical trial. Invest Ophthalmol Vis Sci. 2012;53(11):7077–85.
[30] Santodomingo-Rubido J et al. Long-term efficacy of orthokeratology contact lens wear in controlling the progression of childhood myopia. Curr Eye Res. 2017;42(5):713–20.
Photo: HOYA Lens Deutschland GmbH