Myopia (short-sightedness) is a common eye problem. Sight difficulties caused by myopia can usually be corrected with prescription glasses or contact lenses, but myopia can also affect people’s eye health in other ways.
There are several options designed to manage the progression of myopia by slowing down eye growth, particularly in children and young people. There are advantages and disadvantages to each of these options.
Research shows us that there are ways of predicting how myopic your child’s eyes might become. We have invested in a new piece of equipment called a MYAH that will enable us to quickly and painlessly measure the length of your child’s eye and so predict their risk of becoming myopic. This will also helps us measure how effective myopia management options are working when used.
This article explains what myopia is, the issues it can cause, and the possible benefits and limitations of options to manage it. Your optometrist will be able to tell you more about myopia and myopia management and advise you on the best options for your child.
What is myopia?
Myopia happens when the eye grows too quickly, meaning that light focuses in front of the retina (the light-sensitive layer at the back of the eyeball), rather than on it. This is a bit like setting up a projector, where the image will be blurred if the screen is positioned too far away. If your child has myopia, objects in the distance will be blurred, but objects that are close to them will be clear. The most common way to correct this is with glasses or contact lenses which focus light back onto the retina. The more myopic (short-sighted) your child is, the poorer their distance vision will be without glasses or contact lenses. Myopia can develop at any age, but it is more likely to begin in childhood. Once myopia begins to develop, it usually continues to get worse until early adulthood but will sometimes stabilise before then. The likelihood of developing myopia has been linked to several different factors, including family history, ethnic background, environment (particularly living in cities and spending a lot of time indoors) and excessive time spent carrying out close-up tasks.
What are the risks of myopia?
Being myopic increases the risk of certain eye conditions, and this risk increases the more myopic you are. If your child is myopic, they are more at risk of developing the following conditions at some point during their life.
- Myopic maculopathy
– This refers to a condition which damages the central vision. If your child has a high level of myopia, they are at greater risk of developing myopic maculopathy. - Retinal detachment
– This is where the retina pulls away from the other layers of the eye. It can lead to permanent sight loss if it is not treated quickly. Higher levels of myopia increase the risk of this happening.
- Cataracts
– This is where the lens of the eye becomes cloudy. Cataracts are very common and mostly develop in older age. There is some evidence that suggests higher levels of myopia mean cataracts may develop at a younger age. Treatment for cataracts is normally straightforward and effective. - Glaucoma
– This is a condition where the optic nerve becomes damaged. It affects the peripheral vision (side vision) first but can lead to severe sight loss. There is some evidence that myopia may slightly increase the risk of developing glaucoma. Early treatment can significantly slow the development of glaucoma and reduce the risk of permanent sight loss.
What is myopia management?
Myopia management is a name for any process that tries to delay or limit how myopic a person becomes. Currently in the UK, the most common approaches to myopia management are to prescribe specially designed glasses or contact lenses and advise people to make simple changes to their lifestyle.
Important: Myopia management does not cure or reduce existing myopia but aims to slow down the growth of the eyeball, and so limit how short-sighted your child becomes.
Typically, the eye grows rapidly in childhood and continues to grow at a slower rate throughout the teenage years, and even into early adulthood, so myopia management might need to be continued until your child is in their late teens. If myopia management is stopped before your child’s eyes have stopped growing, the myopia may start to get worse again.
What are the options for myopia management and how effective are they?
Research shows that different forms of myopia management can work for some people, but not for everyone. Also, most of the evidence has been gathered from a South-East Asian population in countries such as Singapore, and as genetic and environmental factors can affect myopia, we cannot be certain that research in the UK would give the same results. This means we cannot tell beforehand whether myopia management will work for your child.
- Lifestyle changes
– Spending time outdoors during the day can help to delay the onset of myopia. This can limit how myopic your child becomes, and so reduce their risk of developing eye-health complications in later life. If your child is already myopic, spending time outdoors may slow down its progression, but the evidence for this is less certain. Based on current research, you should encourage your child to spend between 80 to 120 minutes (one hour and 20 minutes to two hours) outdoors throughout the day. More time spent in education is known to be a risk for developing myopia, and although the reasons for this remain unclear, it may be due to time spent on near tasks. Current evidence does not strongly suggest that reducing time on near activities prevents myopia from developing or progressing and, of course, learning from screens at school and doing homework is important for children and teenagers. However, it’s a good idea for them to take regular breaks from close work and avoid spending too much leisure time looking at screens. Your child should follow the 20-20-20 rule — after every 20 minutes spent looking at a screen, they should spend 20 seconds looking at something at least 20 feet away.
- Night Lenses
– These are different from standard contact lenses as they are designed to alter the shape of the eye during sleep so that glasses or contact lenses are not needed during the day. Research shows that night lenses can significantly slow down the progression of myopia in some children. (by around 50%). - Standard glasses and contact lenses
– Evidence suggests that while standard glasses and contact lenses will allow your child to see clearly, they have little to no effect on slowing down myopia. If your child’s glasses or contact lenses are not the right strength, this can make myopia develop more quickly, so it is important for your child to visit their optometrist for regular checks. - Myopia-management soft contact lenses
– There is a range of CE-marked or UKCA-marked contact lenses specifically to manage myopia. Research shows that myopia-management contact lenses can significantly slow down the progression of myopia in some children (at an average rate of around 50 %), but they need to be worn for at least 10 hours each day, six days a week, to achieve the best results. If your child is unsuitable for these lenses, their optometrist might recommend soft multifocal contact lenses, which are normally prescribed for older people who need reading glasses. Although these are not designed for myopia management, research shows that they can also significantly slow down the progression of myopia in some children.
What are the risks of wearing contact lenses?
Generally, research shows that contact lenses, including orthokeratology lenses, are considered safe for children, as long as the child carefully follows appropriate advice on using them safely to reduce the risk of infection. Contact lens wearers should always consult an eye care professional if they believe they have an eye infection, but most contact lens complications are minor and will settle without any lasting damage if patients stop wearing the lenses.
It is important to NEVER let your contact lenses come into contact with tap water, including while showering, swimming or bathing..
Myopia-management glasses
As with contact lenses, there are also glasses that are available to specifically manage myopia. These glasses have lenses that are designed to allow clear central vision while stopping the light from focusing clearly around the edges of the vision. Research shows that myopia management glasses can significantly slow down the progression of myopia in some children (at an average rate of around 50-60%).
Other interventions
In various parts of the world, atropine is used to manage myopia, but it is not currently licensed for this purpose in the UK. At high concentrations (1%), atropine is effective at slowing down the progression of myopia, but it has unacceptable side effects, including the eyes becoming sensitive to light, difficulty focusing on near objects and the risk of allergic reaction. Lower doses of atropine (0.01% and 0.05%) have been shown to slow down the progression of myopia in some children and have fewer side effects than high doses, but research is still ongoing to decide the best concentration and length of treatment.
Repeated low-level red light
Repeated low-level red light is a relatively new option for managing the progression of myopia. With this option, your child looks into a small device, which is kept at home, to expose their eye to a specific type of red light. They do this five days a week for three minutes at a time, twice a day (separated by at least four hours). While research shows that this can significantly slow down the progression of myopia in some children, all of the studies so far have been carried out in China and we do not yet know the effect of exposing the eye to red light over the long term, including whether it is safe.
How effective are myopia-management options?
Myopia-management contact lenses, glasses and orthokeratology lenses have a similar effect, with an average reduction in myopia progression and slowing of eye growth of between 40% to 60% over two to three years compared with wearing standard contact lenses or glasses. In real terms, ON AVERAGE: A 10-year-old child with a starting prescription of -1.00D might expect their myopia to progress by -0.50 D per year to approximately -2.50D after wearing myopia-management contact lenses over three years compared with a progression of -1.00 D per year , ending up with a -4.00 prescription if they had worn standard contact lenses. It is important to note that some people respond better to myopia management than others and it is not possible to predict the response for any given child.
