The American Academy of Ophthalmology's recently updated Refractive Errors Preferred Practice Pattern now includes a recommendation for low-dose atropine as a preventative measure against myopia in young children at risk. Discover various strategies to protect your child's eye health and reduce their risk of developing myopia.
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At the end of last year, the American Academy of Ophthalmology updated its Refractive Errors Preferred Practice Pattern to recommend low-dose atropine eye drops for myopia prevention in young children at risk. This is an important update for parents who are worried about their children may develop myopia, a common vision condition with a significant genetic component that often runs in the family.Â
In this article, we will discuss various strategies to prevent myopia, including identifying risk factors and taking proactive steps to protect your children's eye health and vision in the future.
Myopia risk factors and onset
Myopia, also known as nearsightedness, is a prevalent vision condition that affects millions of people worldwide. Myopia occurs when the eye is elongated, or the shape of the cornea or lenses is abnormal, resulting in light rays bending inaccurately. This leads to light signals translated by photoreceptor cells to the brain being perceived as blurry.
Presently, approximately 23% of the global population is affected by myopia, and it is projected to increase to 50% by 2050. In the United States, about one-third of the population has myopia, and this number is expected to rise to nearly 60% by 2050.Â
As a parent, it's crucial to be aware of the various risk factors that can increase your child's likelihood of developing myopia. These risk factors include:
- Family history: If you or your spouse have myopia, your child may be at a higher risk of developing it too, with an even higher risk if both of you have it.
- Outdoor time: Research suggests that spending less time outdoors or being exposed to less daylight may increase the risk of developing myopia.Â
- Prolonged close-up activities: Activities such as reading, using computers or smartphones for extended periods, and other close-up activities have been associated with an increased risk of developing myopia.Â
- Late sleep habits: Studies have shown that sleeping late, especially after 9:30 pm, may be associated with a higher risk of developing myopia in children.Â
It's essential to realize that myopia can lead to serious, sight-threatening complications, such as myopic macular degeneration, retinal detachment, cataracts, and glaucoma. And, the higher the degree of refractive error, the higher the risks of these complications.
While eye doctors can prescribe treatments to help stop and slow down the progression of myopia after it has developed, myopia prevention is often overlooked. As a parent, taking steps to reduce your child's risk of developing myopia, especially if they have a higher risk due to genetics or other factors, may go a long way in safeguarding their vision in the long run.
New data and recommendation on low-dose atropine for myopia prevention
Recently, low-dose atropine has emerged as a potential option for myopia prevention in young children. Let's explore the research and what it means for your child.
Atropine is an antimuscarinic agent that was once thought to work by blocking the eye's ability to focus. However, recent research suggests it may work by affecting neurotransmission in the retina and increasing dopamine release, which controls eye growth.
In a study published in JAMA, researchers looked at 474 children between the ages of 4 and 9 who did not have myopia. The children were randomly assigned to receive either 0.05% atropine, 0.01% atropine, or a placebo eye drops. The eye drops were put into both eyes once every night for two years.
After two years, the study found that the children who received the 0.05% atropine eye drops had a lower chance of developing myopia than those who received the placebo eye drops. However, this effect was not observed in children who received the 0.01% atropine eye drops or those who received the placebo eye drops.
Further, the American Academy of Ophthalmology also has updated its Refractive Errors Preferred Practice Pattern to include a recommendation of considering low-dose atropine for myopia prevention in young children at risk. However, it's important to note that the preventative use of low-dose atropine is not FDA-approved.
Outdoor activities and myopia prevention
Increasing your child’s time spent outdoors may be a simple yet effective way to prevent myopia. Studies show that exposure to natural sunlight can release dopamine, a hormone that controls eye growth. In fact, every extra hour spent outdoors per week can reduce the risk of myopia by 2%, and increasing outdoor time from 0 - 5 hours to 14 hours per week can lower the chance of becoming myopic by up to one-third.
To achieve meaningful protection from myopia, children should aim for a minimum of 8 to 15 hours of outdoor activity per week. This can include a variety of activities like sports, gardening, or taking a walk around the neighborhood. Even a picnic on the front patio with sufficient daylight can help.
It's also important to note that myopic children tend to have lower daily light exposure than their non-myopic peers, suggesting that exposure to bright outdoor light is the key factor in preventing myopia rather than physical activity alone.
Lastly, the American Academy of Ophthalmology’s Refractive Errors Preferred Practice Pattern also made a recommendation to consider increased outdoor time for myopia prevention in young children at risk.
Indoor lighting and near-vision work in myopia development
Studies have found that near-vision work and poor lighting can contribute to the development of myopia. Spending more time on near-vision work is associated with a higher risk of becoming myopic, with every additional hour spent on such work per week leading to a 2% increase in the risk of developing myopia. Additionally, being within a working distance of less than 20 cm is also a risk factor for myopia.
The number of years of education or time spent performing near-vision work was also found to carry a greater risk for myopia prevalence. Activities such as prolonged reading or studying, extended computer or smart device use, or other close-up activities were associated with an increased risk of nearsightedness.
Furthermore, the type of lighting used for near work may also play a role in myopia. A study found that using LED lamps was associated with more myopic refractive error in young teenagers. The European Society of Ophthalmology, in the Guidance on Management of Myopia, also recommended the use of incandescent light bulbs instead of fluorescent or LED lighting to maximize indoor lighting and prevent myopia.
Parents should encourage their children to take regular breaks from near-vision work, limit optional near-vision activities, adjust the lighting, and engage in outdoor activities to reduce their child's risk of developing myopia.
Importance of sleep for myopia prevention
Getting enough sleep is important for good health, and it may also help prevent myopia. Studies have found that sleeping late and having shorter sleep duration are linked to a higher risk of developing myopia, which may be influenced by factors such as your sleep-wake cycle (circadian rhythm), indoor environment, and near-vision work.
In one study of over 3,600 adolescents, researchers discovered that for every extra hour of sleep, there was a 0.10 D decrease in refractive error. The study also revealed that those who slept for over nine hours had a lower risk of developing myopia compared to those who slept for less than five hours.
Another research trial with over 6,200 school-age children found that sleeping late (after 9:30 p.m.) was associated with a higher prevalence and incidence of myopia.
Taken together, these studies suggest that getting enough sleep and maintaining a regular sleep schedule before 9:30 pm may help prevent myopia. Parents should encourage their children to establish a consistent sleep routine and make sure they get enough sleep each night.
Conclusion
It's clear that having regular eye examinations and taking steps to prevent myopia in young children is essential for their eye health in the long run. From increasing outdoor time to managing screen time and ensuring adequate sleep, there are many ways parents can help reduce their child's likelihood of developing myopia. And with the recent low-dose atropine recommendation by the American Academy of Ophthalmology, you may want to discuss with your doctor proactively if you believe your child has a higher risk. Remember, a little prevention goes a long way in ensuring a brighter future for your child's eyesight.
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