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Myopia Control

Myopia control encompasses various techniques to slow the progression of nearsightedness, particularly in young individuals. These methods can include lifestyle adjustments, specialized optical interventions, and pharmaceutical treatments. Addressing myopia early with these strategies aims to reduce the risk of associated complications and preserve long-term eye health.

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Atropine Eye Drops

Benefits of Low-Dose Atropine:

  • Effective in Slowing Myopia Progression: Studies have shown that low-dose atropine (0.01%, 0.025%, and 0.05%) can slow myopia progression by 50% or more in children without the severe side effects seen with higher concentrations.

  • Minimal Side Effects:

    • Little to no pupil dilation (less light sensitivity).

    • No significant impact on near vision.

    • Fewer complaints of dry eyes or discomfort compared to higher doses.

Why Low Dose?

  • High doses (1%) of atropine cause significant side effects such as blurred near vision and pupil dilation, making it impractical for everyday use.

  • Lower concentrations provide a good balance between efficacy and tolerability, reducing eye elongation while allowing the child to function normally in school and daily activities.

Key Findings from Research:

  • ATOM (Atropine for the Treatment of Myopia) Study: Showed that atropine, even at 0.01%, significantly slows myopia progression.

  • LAMP Study (Low-concentration Atropine for Myopia Progression): Demonstrated that 0.05% atropine was more effective than 0.01% or 0.025% at slowing myopia, but with only a slight increase in side effects.

Takeaway:

Low-dose atropine likely works by interfering with the chemical signals that cause the eyeball to grow longer, reducing the rate of myopia progression. It is widely used for children with progressive myopia as a relatively safe and effective treatment to help prevent severe vision impairment later in life.

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Orthokeratology (Ortho-K) and Myopia Control

Orthokeratology (Ortho-K) is a non-surgical method for temporarily reshaping the cornea using specially designed rigid gas-permeable contact lenses worn overnight. Ortho-K lenses are primarily used to correct myopia (nearsightedness) and control myopia progression in children and young adults.

How Ortho-K Works:

  1. Corneal Reshaping:

    • The Ortho-K lenses gently flatten the central cornea while you sleep, temporarily changing its shape.

    • When the lenses are removed in the morning, the new corneal shape helps focus light directly on the retina, correcting nearsightedness for the rest of the day.

  2. Temporary Effect:

    • The reshaping effect is reversible. If the lenses are not worn consistently, the cornea returns to its original shape in a few days, and vision returns to the previous prescription.

Mechanism for Myopia Control:

  1. Peripheral Defocus:

    • Ortho-K lenses create a focused image in the central retina but induce peripheral myopic defocus—meaning the light rays focus in front of the peripheral retina rather than behind it.

    • This defocus signal may slow the elongation of the eyeball (the main cause of myopia progression).

  2. Reduction of Axial Elongation:

    • Several studies suggest that children wearing Ortho-K lenses show a significantly slower axial elongation rate (lengthening of the eyeball) than children using traditional glasses or standard contact lenses.

Benefits of Ortho-K for Myopia Control:

  • Freedom from daytime glasses or contact lenses: No need to wear corrective lenses during the day.

  • Slows Myopia Progression: Multiple studies show that Ortho-K can slow myopia progression by 40-60%.

  • Improved Sports Participation: This is ideal for children and teens who play sports, as they don’t need to worry about glasses or contact lenses falling out.

Potential Risks and Considerations:

  1. Infection Risk:

    • Since Ortho-K lenses are worn overnight, there's a small risk of developing corneal infections (microbial keratitis). Proper hygiene and lens care can minimize this risk.

  2. Lens Fitting Adjustments:

    • Regular follow-up visits with an optometrist or ophthalmologist are required to ensure the lenses fit correctly and continue to safely reshape the cornea.

  3. Cost:

    • Ortho-K lenses can be more expensive than glasses or daytime contact lenses. They also require yearly updates as the prescription changes.

  4. Temporary Vision Correction:

    • The vision correction only lasts about 1-2 days after the lenses are removed, so they need to be worn consistently every night.

Studies Supporting Ortho-K for Myopia Control:

  • The SMART Study (2015) Found that children using Ortho-K had 50% slower axial eye growth than those wearing glasses.

  • ROMIO Study: Demonstrated that Ortho-K lenses slowed myopia progression in children by up to 43% over a 2-year period.

Who is a Good Candidate for Ortho-K?

  • Children and teens (ages 6–18) with progressive myopia.

  • People with mild to moderate myopia (typically -1.00 to -6.00 diopters).

  • Those who prefer not to wear glasses or daytime contact lenses (e.g., athletes or active children).

Takeaway:

Ortho-K is an effective, non-invasive option for correcting myopia during the day and slowing its progression. While it requires commitment and proper lens care, many studies have shown it to be a valuable tool for managing childhood myopia, especially when combined with lifestyle adjustments like spending more time outdoors.

Special Myopia Control Glasses Lenses

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Special myopia control glasses, such as MiyoSmart, MyoCare, and Stellest lenses, are designed to slow myopia progression while providing clear vision. These lenses use innovative designs based on myopic defocus principles, which have been proven effective in reducing the elongation of the eyeball (a key driver of worsening myopia).

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Key Points Across All Myopia Control Glasses Lenses

  1. Peripheral Myopic Defocus: All these lenses are based on creating a focused image on the central retina and a defocused image in the periphery, which helps signal the eye to slow its elongation.

  2. Safety and Simplicity: Unlike contact lenses or atropine eye drops, these lenses are safe, non-invasive, and easy to use—making them a popular choice for young children.

  3. Compatibility: These lenses are available in different prescriptions, including anti-reflective coatings and photochromic options.

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1. MiyoSmart Lenses (by Hoya)

Technology: DIMS (Defocus Incorporated Multiple Segments)

  • Design: MiyoSmart lenses have a central optical zone for clear vision and a surrounding ring of multiple defocus segments.

  • These segments create peripheral myopic defocus, meaning light focuses in front of the peripheral retina rather than behind it, which helps slow eye elongation.

Effectiveness:

  • Clinical trials showed that MiyoSmart lenses slow myopia progression by around 60% and reduce axial elongation by 50%.

  • The HOYA clinical study (2-year follow-up) demonstrated that children wearing MiyoSmart lenses had significantly less myopia progression than those wearing standard glasses.

Advantages:

  • Easy to use—worn like normal glasses.

  • Non-invasive and maintenance-free.

  • Safe and effective for children as young as 6 years old.

Disadvantages:

  • Some users may experience an initial adjustment period.

  • The lens design may slightly reduce contrast sensitivity in some cases.

2. Stellest Lenses (by Essilor)

Technology: H.A.L.T. (Highly Aspherical Lenslet Target)

  • Design: Stellest lenses have a clear central zone for sharp vision and 1,021 tiny aspherical lenslets arranged in a unique constellation-like pattern around the clear zone.

  • The lenslets create a “volume of myopic defocus,” meaning the peripheral retina receives a consistent defocus signal that discourages axial elongation.

Effectiveness:

  • Studies by Essilor show that Stellest lenses can slow myopia progression by 67% and reduce axial elongation by 60% over a two-year period.

  • The 9-month interim study indicated that 90% of children wearing Stellest lenses experienced no significant myopia progression.

Advantages:

  • Provides consistent defocus across a wide field of vision.

  • Comfortable and highly effective for most children.

Disadvantages:

  • Slightly more expensive compared to MiyoSmart or standard lenses.

  • Requires professional fitting and follow-up to ensure optimal results.

3. MyoCare Lenses (by Zeiss)

Technology: C.A.R.E (Controlled Area of Retina Elongation)

  • Design: MyoCare lenses use a central clear vision zone and a surrounding myopic defocus zone to redirect light to limit eye elongation.

  • The lens ensures that the defocus areas do not interfere with central vision, providing a smooth transition.

Effectiveness:

  • Zeiss reports that MyoCare lenses can slow myopia progression like MiyoSmart and Stellest, with a reduction in axial elongation of up to 50-60%.

Advantages:

  • Comes in different designs, including MyoCare and MyoCare S, to suit varying levels of myopia and prescriptions.

  • Trusted brand with a long history of high-quality lens manufacturing.

Disadvantages:

  • Similar to Stellest, the price can be higher than traditional lenses.

  • May require time for users to adapt to the peripheral defocus.

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