An adaptive approach increases the likelihood of successfully stopping myopia progression in children. Learn more about a case of reduced lens power and stabilized eye axial length after 8 months.
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If your child has myopia or is undergoing myopia control treatment, rest assured that you are not alone.Â
Eight months ago, I began sharing my personal experience navigating this journey, including the difficulties of finding the right doctor to work with locally.
Since then, we have encountered numerous challenges, adapted to changing circumstances, and now seen promising results - no myopia progression for the past 8 months!
In this post, I would like to share our journey, including the obstacles we faced, how we overcame them, and what we learned along the way.
Can stabilized eye axial length lead to a reduced refractive error in myopia?
It has been eight months since my son began his myopia control treatment with Ortho-K and atropine aboard. When we first started, he had refractive errors of -2.50 D in both eyes, with axial lengths of 23.93mm and 24.14mm in his right and left eyes, respectively. And I am thrilled to report that he has made incredible progress.
After returning to the US, we had a follow-up appointment in September but were not satisfied with the doctor's reactive approach. Given my son's high risk of fast progression, we felt that a more intensive approach was necessary, so we started looking for a more suitable partner.
Fortunately, we found Dr. B, OD, who showed his passion and built a good rapport with my son. After his initial assessment, it was likely that my son's myopia had not progressed. However, to confirm this, we needed to eliminate the effects of Ortho-K by stopping his contact lens wear and continuing with atropine monotherapy once nightly.
At our follow-up visit last week, we were thrilled with the results. My son’s refractive error was at -1.5 D in both eyes, with axial lengths of 23.92mm and 24.11mm for his right and left eyes, respectively. Dr. B initially thought the previous -2.5 D could have been an error, but I had multiple results from 8 to 12 months ago showing a correction of around -2.5 D.
Since my son is entering his growth spurt, I suspect this improvement is due to stabilized axial length. Studies have shown that children's eyes have a natural growth rate of about 0.1-0.2mm each year. Therefore, if there is no change in axial length, a reduction in refractive error may be possible.
Adjusting myopia treatments
Initially, when our son was diagnosed with myopia, my wife and I consulted a myopia specialist abroad to create a treatment plan that would work best for him. After careful consideration, we decided on a more intensive treatment plan that involved a combination of Ortho-K and 0.05% low-concentration atropine. This treatment approach addressed two unique mechanisms of the treatments, peripherical hyperopic defocus and dopamine release, and had been shown to be highly effective for myopia control.
The treatment plan involved using Ortho-K for six nights with one night of rest, combined with atropine once every night. This combination therapy was recommended due to our son's Asian ancestry and family history of high myopia, which puts him at a higher risk. We also wanted to ensure that we had a backup treatment in case we needed to stop one of the treatments.
However, after a few weeks, we had to make the first adjustment. We noticed that our son was experiencing blurred near-vision as a side effect of the atropine. With guidance from his doctor remotely, we changed the atropine dosage to every other night to alleviate these side effects. Additionally, we improved lighting around the house, particularly around his study desk. However, after a week or two, the side effects got better and did not bother our son as much, so we gradually increased the treatment to five nights a week, with two non-consecutive school days as the resting day.
As winter came, we made another adjustment to our son's treatment plan. We increased the atropine dose back to once every night in late December to compensate for the reduced outdoor time, which was only slightly more than one hour every day because of the shorter daytime.
Last month, to confirm and establish a clear baseline for our son's myopia, we paused Ortho-K for three weeks under the supervision of our new doctor while continuing with atropine once every night. We made sure to continue lifestyle modifications, such as outdoor activities and limitations on digital screen time, during this period.
Removing the effect of Ortho-K allowed us to see if there were any changes in his refractive error, which helped us determine if adjustments to his treatment plan were needed. And we were happily surprised with the results of a decrease in refractive error and no myopia progression!
Key takeaways
Some final thoughts, our success in stopping my son's myopia from progressing for the time can be attributed to the intensive combination strategy, timely treatment adjustments, and adherence to healthy eye habits. We've also learned the importance of staying positive, being patient, and providing supportive encouragement.
Remember, myopia control is a team effort between parents, healthcare professionals, and your child. Staying in communication with your doctor, monitoring and adjusting the treatment plan as needed, and encouraging your child to maintain healthy eye habits are key.
By taking an adaptive approach, you can help your child maintain clear sight and reduce the risk of myopia progression.
I wish you and your child all the best in your myopia control journey.
(Off to a local glasses shop now to get a new set of backup glasses for junior)
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