What is myopia?
Myopia is the medical term for nearsightedness. Nearsightedness is where the eyeball elongates resulting in blurry distance vision. It begins in childhood and usually gets worse as children grow and stabilizes around age 16.
Some children have severe progression of their myopia that develops into “high myopia” and causes degenerative changes in the retina. High myopia is one of the primary causes of blindness.
What is High Myopia?
There are degrees of myopia. It is measured in diopters that describe the power of correction needed. Low myopia is – 3.00 diopters or less. Moderate myopia is described as -3.00 to -5.00 diopters.
High myopia is defined as nearsightedness requiring correction of -6.00 diopters or higher which means uncorrected vision is worse than 20/400. It also creates an increased risk of sight-threatening problems like retinal detachment, cataracts, glaucoma, and myopic macular degeneration. Most children and young adults with this condition can live a normal life with good corrected vision. This abnormal growth thins the retina which increases the likelihood of retinal tears and detachments, which in turn increases the risk of blindness.
What causes high myopia?
High myopia is believed to be an inherited condition that causes the eyeball to stretch and grow abnormally long from front to back, stretching all the tissues in the eyeball. This abnormal growth thins the retina leading to tears and detachment and increases the risk of blindness from an injury or trauma.
How is high myopia diagnosed?
It is diagnosed with regular eye exams and some special tests. Most cases of high myopia are diagnosed by age 13. While there is no cure, the eye doctors at Union Square Eye Care can offer your child a few well-studied treatments that have been shown to slow progression.
What is the myopia control?
To be clinically meaningful myopia control strategies must slow progression by about 50%. Many myopia control strategies have been tried but have not been proven effective. However, new strategies are being evaluated constantly. Currently, the most effective methods are orthokeratology contact lenses, soft multifocal contact lenses and the topical drug atropine.
Ortho-K is the use of fitted, specially designed gas permeable contact lenses that are worn at night to gently reshape the cornea temporarily to slow progression and improve vision without the need for daytime correction. Improvements in vision are temporary but can be maintained when the lenses are worn regularly. It is similar to the new orthodontic technique to realign teeth without braces. These lenses are ideal to allow for waking hour activities without glasses or with only minimal correction.
Clinical studies report that FDA approved Ortho- K lenses can provide significant vision improvement of 20/40 or better. A series of three lenses with progressive correction may be necessary to reach the desired correction. Once the desired correction is reached, wearing the lenses regularly at night can maintain the correction. The most important risk is infection, common in contact lenses wearers.
Soft multifocal contact lenses
Soft multifocal lenses are dual focus similar to those worn by older people. These also slow progression but are worn during the day. Studies report that this approach can slow progression of myopia in children by almost 50%.
According to a 2019 study*, Atropine is the only medication that has been demonstrated to be consistently effective in slowing myopic progression. The current dose that reports efficacy is 0.01% atropine. Recent studies have shown low dose atropine can retard progression in some children. Talk with your Union Square Eye ophthalmologist for a complete discussion about how atropine may be beneficial for your child. It does avoid the need for the child to wear contact lenses but will require conventional correction.
At Union Square Eye Care in New York City our board-certified ophthalmologists and internationally renowned specialists offer compassionate, comprehensive eye and vision care for children and adults.
Our leader H. Jay Wisnicki MD is affiliated with Mount Sinai Medical Center, and The New York EYE and Ear Infirmary of Mount Sinai and mount Sinai Beth Israel. We continually adopt the most advanced technologies and treatments to address the needs of our patients. Contact Union Square Eye to schedule a consultation.
*Pei-Chang Wu, et al. “Update in myopia and treatment strategy of atropine use in myopia control” EYE Volume 33, PP3-13 (2019)