Myopia should be treated timely, and the earlier, the better. Learn about my son's treatment options and how we landed on his treatment choice.
Since my son was confirmed to have myopia, our journey didn’t have a smooth start. My wife and I had some hiccups trying to find a doctor to start managing my son’s myopia.
Our initial experience with a local clinic was not great. We were offered the “Classic Ford Model T” options: we could have any options as long as it is MiSight. As a result, I moved on.
The second clinic demonstrated its experience in myopia management. But the interaction with the clinic was bumpy.
Although we had already made an appointment three weeks in advance, we were told the doctor had become unavailable that morning. We had to settle for another doctor in the clinic, or we had to reschedule. The new time would have conflicted with the family vacation that was planned months ago. So we agreed to see the new doctor.
That wasn’t the end of the story. Once we arrived at the clinic, we were politely switched to another doctor or had to wait longer.
It felt like we were in a queue, and the next available bank teller would help with our transaction as soon as they were free.
That didn’t go well with my wife and me. We were looking for someone to entrust our son’s eyes - a partner to work with.
Long story short, my wife and I decided to seek help and see if we could start my son’s myopia control treatment in Taiwan since it was known for its myopia control research globally. And we will be there for an extended vacation.
Several days after arriving in Taiwan, we went to a well-recognized ophthalmology clinic that specialized in myopia control. After assessing my son's situation, the doctor told us that his condition was relatively early. And doing something about it now could drastically slow down his risk of progressing to high myopia.
Lifestyle modifications
The doctor explained that there are two important aspects to lifestyle modifications: mitigating risk factors that contribute to progression – inappropriate screen use and reading distance, and enhancing others that slow down the worsening of myopia – outdoor activities and periodic eye breaks.
Further, he also recommended after 30 min of near-work activities, my son should take a break for 10 min looking at something at a distance – a similar recommendation since I was young but with an emphasis on looking at objects at a distance.
It made sense. Since looking at objects far away relaxes the ciliary muscle and minimizes accommodation strain, it may be more effective than simply closing one's eyes to relax than I originally thought.
The other recommendation was to spend two hours outside each day, and that includes overcast days and under a tree in the shade. The doctor also touched on the rationales, which were similar to what I posted previously.
Treatment options
Based on my son’s age, axial length, refractive errors, and family history, the treatment strategy is to implement combination therapy initially.
Since myopia could progress rapidly at his age, if we could halt it now – ideally, it could lead to a better treatment outcome in the long run. Further, his treatment could be dialed down when he is older and when his eyes are no longer fast progressing.
Understanding that we would return to the US later, he recommended atropine, Ortho K, MiSight contact lens, Myosight lens, or an atropine-based combination.
As an interesting note, he only recommended the Myosight lens with atropine and explained from his clinical experience the lens is effective when used together. Due to lack of time, I didn’t probe what could be the reason.
Our treatment choice
Of the different options and combinations, we decided on the atropine plus Ortho-K combination therapy option for the following reasons:
- The combination has a strong effect on reducing the risk of myopia progression. The homework that we have done indicated this approach demonstrated a well-tolerated and proven safety profile.
- My son loves swimming. Soft contact lenses or glasses may not be ideal. Furthermore, as a high myope, I used to swim but stopped because of the inconvenience and insecurity of being unable to see things clearly. I hope that it won’t be the case for my son too.
- My son has dry eye. As a soft contact lens wearer, I suspect it may exacerbate the condition. I worry about the different things that could happen if his dry eye gets bad in school.
- Myosight lens is not available in the US. If my son’s prescription changes, it will be difficult to get a new one.
- We will be around when my son wears or removes Ortho-K in the morning and evening. My wife and I can help him ensure good hygiene.
Furthermore, the doctor recommended using a 0.05% dosage for the atropine and explained that studies demonstrated it offered a better efficacy than the 0.01% option but still had a reasonably slow level of side effects.
Ortho-K fitting
After deciding on the treatment options, we were brought to a room for an Ortho-K fitting. It was one of the best experiences I had.
The optician was super patient and experienced with kids. He completed the measurement for the fitting with grace and in no time. He showed me how to put on the lenses on my son like a breeze – with me doing it once after too. He went through how to care for the hard contact lenses thoroughly, as well as reminded the importance of lifestyle modifications. Even though it took about one and a half hours, it was a delightful experience that went by quickly for my son and me. And I felt empowered and hopeful.
The eye doctor did one last check on the fitting and provided us with the atropine prescription (as well as reminded us of the side effects to watch out for). We were scheduled to come back for a check-up one week after.
Our experience and our current routines
From my post earlier, my initial experience with Ortho-K at home was more than what I expected. However, after two weeks, it is now down to a four min routine before bed and three min in the morning, mostly for prepping or ensuring cleanness.
The once-daily atropine was convenient and quick. And my son only had a slightly increased light sensitivity, which didn’t bother him. When going out, his sunglasses helped. He didn’t experience any other side effects or adverse events.
Our evening routine:
- A drop of atropine in each eye 20 min before bed. He would sit by his bed and wait for five to ten minutes while I got his lenses prepared.
- Wipe down and clean the countertop.
- [A new step] Clean his face. [Oily skin may sting the eyes]
- Apply an eye-numbing eyedrop, Lacrimin. The eye drop was very helpful in stopping my son from his involuntary blinking for a couple of minutes. (I anticipate that he will not need this after one month)
- Rinse the first lens with saline.
- Put the lens on the index finger and add one drop of artificial tear to the lens.
- After reminding my son to stare straight and don’t blink. Place the lenses precisely on his eyes with the lens’ edge aligned to the edge of the iris. (Tips: It will be easier to see with the area brightly lit)
- Once placed and I ask my son to feel if he is comfortable and if he feels it is correctly placed.
- Then, I open his eyelids wide to observe if the lens is still in the right position. (Tips: It seemed easier if he looked downward. I would gently push his bottom eyelid to displace the lens slightly. Good lighting also helped.)
- Repeat step 4 for the other lens.
- After finishing with both eyes, I would ask him to lay down for 10 min for the lenses to adhere to the eyes more firmly. Then, he would go to bed directly.
Our morning routine:
- When my son wakes up, he cleans his face. [Oily skin may sting the eyes]
- I would apply artificial tears in both eyes to lubricate the contact eyes for easier removal.
- Wipe down and clean the countertop.
- Clean the mini-plunger with saline solution.
- After reminding my son to stare straight and don’t blink, I place the mini-plunger at the side of his lenses at the edge of the iris and remove the lenses one at a time, leveraging the suction action of the mini-plunger.
- The lenses are cleaned with some multi-purpose solution and then placed in a case that is also filled with the multi-purpose solution.
- Clean the plugger with some multi-purpose solution, raise it with saline, dry it with some tissue paper, then place it back into its container.
Note: I have also received a protein remover set, which I haven’t used yet.
My thoughts after two weeks
Since the beginning, we returned to the clinic every week to check how my son was responding to the treatments and ensuring no adverse events from the atropine.
We picked up his special-ordered lenses with an additional backup pair the following week; I was fascinated at how fast they were able to deliver so quickly.
I was excited at the initial treatment response. And my son at the fact that he could see clearly without glasses and knowing that he has a lower risk of the awful complications.
Yes. He could tell you, if asked, that high myopia could increase the risk of glaucoma, cataract, macular degeneration, and retina detachment.
The initial frustration with wearing Ortho-K lenses went away, and I found its attractiveness renewed.
This is the beginning of a journey that didn’t go as I expected initially, but it is an opportunity to set sail timely - the earlier, the better.
Even though we prefer to find a local navigator, a specialist in myopia, to travel the journey with us from the very beginning, I am confident and hopeful we could partner with one soon.
Meanwhile, we will double and triple-check for a year-long journey, plan out the possible resupply routes, and ways to communicate status to our remote navigator.
Time to turn into the wind to fill the sails. Talk to you later but see you next year Doc.
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