Explore options to halt or slow nearsightedness (2023 US perspective): atropine, soft contact lenses, overnight lenses, and glasses. Take action promptly and adhere to treatment.
Does your child squint when watching TV or spotting friends across the playground? Are they struggling with school because they can't see what's on the whiteboard? As the school year begins, some children may experience vision problems—faraway objects appear blurry—and are subsequently diagnosed with nearsightedness.
In this blog, we'll delve into what nearsightedness is, explore various treatment options, and provide insights on considerations for the most suitable approach for your child.
Understanding nearsightedness
Nearsightedness, medically known as myopia, occurs due to changes in the way light enters the eye and focuses on the retina—the light-sensitive tissue situated at the back of the eye. Under normal conditions, light rays traverse the cornea and lens, focusing precisely on the retina. However, in most instances of nearsightedness, a child's eye elongates abnormally, causing light rays to focus in front of the retina instead of directly on it. This misalignment distorts the signals sent to the brain, resulting in blurred vision.1
Vision correction, such as the use of regular glasses or contact lenses, addresses the symptom of distant blurriness but does little to the root cause of abnormal eye growth, which is associated with vision-threatening complications of the condition, including myopic macular degeneration, retinal detachment, cataracts, and glaucoma.1
Myopia control, on the other hand, aims to stop or slow down nearsightedness, preventing both the refractive error and the axial length of the eye from worsening.1
How can we slow nearsightedness?
In the United States, the main myopia control strategies involve atropine eye drops, myopia control soft contact lenses, overnight contact lenses, and myopia control glasses. The efficacy of these treatments varies only slightly. Generally, they can reduce the risk of nearsightedness progression by approximately 45-65%. Interestingly, some children may even experience a complete halt in progression.2,3
Since the effectiveness is comparable across treatments, the choice should be based on individual lifestyles and personal preferences, leading to optimal treatment adherence. Additionally, the sooner treatment starts after diagnosis, the better. Once nearsightedness worsens, it cannot be reversed.1
Atropine eye drops
Atropine eye drops, an antimuscarinic agent, have been extensively studied for their potential to control nearsightedness in children. Initially, it was thought that atropine worked by blocking the eye's accommodative function. However, recent research suggests it may actually work by increasing dopamine release and controlling the growth of the eye's axial length.
Studies have shown that low-concentration atropines, specifically 0.05% atropine, are effective in slowing down the worsening of nearsightedness with fewer side effects compared to higher concentrations.2,3 Recent studies revealed that 0.01% atropine might have an impact on slowing refractive error progression, but not on reducing axial length growth, making 0.05% the preferred starting concentration.4 Common side effects of atropine include dilated pupils, light sensitivity, and difficulty with close-up reading.2,3
Atropine can also be combined with other treatments, such as myopia control glasses, myopia control soft contact lenses, or overnight contact lenses, providing additive effects and is more effective than individual treatment alone.3,5,6
Atropine has been extensively utilized for treating nearsightedness in various Asian countries for several decades. However, it seems due to the absence of patent protection and the significant investment necessary to conduct supplementary studies to fulfil FDA approval requirements, no pharmaceutical company pursued the development of low-concentration atropine for myopia control until recent years. And without FDA approval, some optometrists are hesitant to prescribe atropine off-label, especially the lack of commercially available low-concentration atropine.
In the US, low-concentration atropine can be procured from a compounding pharmacy, typically prepared by diluting high-concentration ophthalmic atropine. The expense for atropine treatments ranges from approximately $40 to $100 per month.7
Additionally, since atropine does not influence vision correction, the continued use of glasses or contact lenses is necessary, especially since uncorrected vision – not wearing glasses or contact lenses – is a risk factor for nearsightedness progression.8
Myopia control glasses
Most myopia control glasses work because of the peripheral myopic defocus effect, PMD. In PMD, the image of an object focuses in front of the peripheral region, sending signals to the brain that halt the growth of the eye.1
Several types of lens designs for myopia control have been explored and developed. Initially, bifocal or progressive additional lenses were found to slow down nearsightedness, though they were somewhat less effective.2,3
Next-generation lenses have since been developed, boasting greater effectiveness. Brands like MiYOSMART (DIMS) or STELLEST (HAL) feature a treatment zone with hundreds of tiny lenslets, enhancing the peripheral myopic defocus effect.1,3,5
Myopia control glasses correct vision and control nearsightedness simultaneously. Clinical trials have shown these glasses can effectively slow down the worsening of nearsightedness with an excellent safety profile.2,3 Although they may initially cause blurred peripheral vision due to PMD, children usually adapt to this effect within a few days. Their convenience and ease of use have made them the most popular treatment option among parents.7
Depending on the brand, these glasses can correct spherical errors --correcting myopia-- ranging from -7.50D to -10.00D and astigmatism up to 4.00D. In the case of both conditions, if astigmatism is 4.00D, then the nearsightedness correction power would be up to -3.50D to -6.00D. (Learn more about reading eyeglasses prescription)
The cost of these lenses starts from US$500-700, not including the frames. While these glasses are not commercially available in the US, parents have been procuring them from Canada and other countries.7
Myopia control soft contact lenses
Myopia control soft contact lenses, commonly also referred to as multi-/dual-focal contact lenses, not only correct refractive errors but also slow down the elongation of the eye through the peripheral myopic defocus effect.1
Among the various soft contact lenses that effectively slowed nearsightedness in studies, one notable option is MiSight. It is the only FDA-approved soft contact lens for myopia control in children. MiSight features peripheral rings that focus light in front of the retina, along with two vision correction zones and two myopic control zones. The vision correction zones are for myopia correction. The control rings generate peripheral myopic defocus, which is important for slowing the elongation of the eye.1,9
Extensive research has demonstrated the effectiveness of MiSight in reducing the progression of nearsightedness across a broad range of different age and ethnic groups in children. Moreover, it has a well-established safety profile; some side effects include dry eyes, blurred vision, eye discomfort, and a low risk of eye inflammation and infection.9
Due to its proven efficacy and safety, as well as its FDA approval, eye doctors in the US seem to prefer MiSight.
When compared to other treatment options, MiSight is more expensive than other treatments, except Orth-K in the US. These contact lenses are usually priced at approximately US$1,200 to US$1,500 per year.7
It is important to note, MiSight offers vision correction power up to -7.00D* and does not offer astigmatism correction for children requiring them.10 Eye doctors may consider off-label use of other multifocal soft contact lenses, such as NaturalVue, Biofinity toric, or Ultra Multifocal, as alternative options. (Learn more about reading contact lens prescription)
* In the US, MiSight is indicated for children of 8-12 years of age and have a refraction of -0.75 to -4.00 diopters (spherical equivalent) with ≤ 0.75 diopters of astigmatism. The range available may vary by country.
Overnight contact lenses
Orthokeratology (Ortho-K) presents a non-surgical and reversible method that utilizes overnight hard contact lenses to reshape the cornea, resulting in improved vision and myopia control. These specialized gas-permeable lenses are worn during sleep, allowing for clear sight during the day. By inducing the peripheral myopic defocus effect, similar to other optical treatments, Ortho-K can halt or slow nearsightedness progression.1
Various meta-analysis studies have shown that Ortho-K has comparable efficacy as with atropine eye drops, myopia control glasses, or myopia control soft contact lenses.2,3 However, it's important to note that similar to soft contact lenses, Ortho-K may have some side effects, including dry eyes, blurred vision, eye discomfort, and a low risk of eye inflammation and infection.1
Despite its benefits, Ortho-K is not often the first choice recommendation by eye doctors due to the required effort and cost. Each pair of lenses is custom-made, contributing to higher prices ranging from $2,000 to $5,000 (not including the daily cleaning supply).7
In general, overnight lenses enable vision correction of up to -6.00D, with the ability to correct astigmatism up to 1.75D.1 Additionally, Ortho-K demands significant involvement from parents and may lead to stress for both the parent and child, especially when handling the lenses.7
More outdoor activities
Increasing your child's time spent outdoors and exposure to sunlight is a simple yet effective way to slow down nearsightedness from progressing.11
Research has shown that sunlight’s brightness and some of its wavelengths are beneficial in regulating eye growth. Hence, we have included it here as it should be a part of any treatment plan.
Furthermore, ~2 hours of outdoor activity per day is as effective as certain treatments and comes at little to no cost.2 Just don’t forget to have appropriate sun protection.
Additionally, since atropine does not influence vision correction, glasses or contact lenses are still necessary, especially since uncorrected vision – not wearing glasses or contact lenses – is a risk factor for nearsightedness progression.
(Learn more about how an outdoor activities tracker can help)
Interventions for myopia control
More outdoor time
Pros:
- No prescription is required
- Can be activated with the "Go out and play" voice command
Cons:
- May be more difficult to keep up in winter or poor weather conditions
- Still need to wear glasses or contact lenses
Approximate Cost:
- Free
Atropine
Pros:
- Easy to apply at night
- Can combine with other treatments
Cons:
- May have drug related side effects: light sensitivity, blurry near vision, and dilated pupil
- Still need to wear glasses or contact lenses
Approximate Cost:
- US$500 to 1200 / year
Myopia control glasses*
Pros:
- Easy and convenient
- Cost effective
Cons:
- Narrower field of vision
- Need to be worn for effectiveness
- Not convenient during sports
Approximate Cost:
- US$500-700 per pair (Frames extra)
* Not available in the US (approved in Canada)
Myopia control soft contact lenses (MiSight)
Pros:
- Well-suited for sports
- Generally perceived as more aesthetically
- Disposable lenses for improved hygiene
Cons:
- A lower risk of eye infection vs OrthoK
- Need to be worn for effectiveness
- Shouldn’t be worn during water-related activities
Approximate Cost:
- US$1500 / year
Overnight contact lenses (Ortho-K)
Pros:
- No visual correction is needed during the day
- Parents can help with the wearing or handling of contact lenses at night
Cons:
- A low risk of eye infection
- Daily cleaning required
- Can’t readily track the actual refractive error change (3-week washout required)
Approximate Cost:
- $2,000 to $5,000 (Cleaning solution extra)
Key takeaways
In this article, we have explored several myopia control options, including atropine eye drops, myopia control soft contact lenses, overnight contact lenses, and myopia control glasses. Each of these options has its own advantages and considerations. To effectively manage nearsightedness and slow down its progression, it is crucial to take prompt action and remain dedicated, as any progression or eye elongation cannot be reversed.
Looking towards the future, it is essential to keep our focus on achieving clear sight. Embracing the myopia control option that best aligns with your and your child’s lifestyle and preferences will lead to better adherence and results.
Together, we can help our children halt or slow nearsightedness until it stabilizes in their late teens to twenties. At that point in time, LASIK can be considered to restore their vision 20/20!
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7. Data on file. ClearSight Health 2023.
10. CooperVision. MiSight Website. https://misight.com/product-specifications
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