The dramatically increasing global prevalence of childhood myopia is well established, with half of the world’s population expected to be myopic by the year 2050. Due to the serious
clinical and economic consequences of myopia, the World Health Organisation has declared myopia to be a major public health concern. Advances in knowledge from animal models along with growing body of evidence from human clinical trials has led to a number of optical management interventions to become available in the market.
Why is myopia management needed?
Additional to the inconvenience of needing optical correction, having myopia carries a
multitude of consequences. Research has shown myopia to increase the risk of various
ocular pathologies, the most common being myopic maculopathy; myopia of 5D or more
carries a 60-fold increased risk of developing myopic maculopathy. Through progressive
stretching of blood vessels, geographic atrophy, choroidal neovascularisation, posterior
staphyloma, and other pathological changes, this irreversible and often bilateral macular
disease can have devastating effects on a person’s eyesight. Similarly, glaucomatous optic
neuropathy has a strong association with myopia, where its prevalence among myopes with refractive error of 8D or more can be as high as 50%. Additionally, compared to a non
myopic eye, the risk of retinal detachment increases four-fold in an eye with spherical
equivalent of -1.00 to -3.00D, and 10-fold in levels greater than -3.00D. The likelihood of
developing cataracts also correlates with increasing degrees of Myopia, with posterior
subcapsular opacities having the strongest association. It is important to note there is no
safe level of myopia; although high myopia carries the greatest risk, lower levels also
significantly increase the likelihood of ocular complications.
Globally, uncorrected refractive error constitutes the leading cause of visual impairment and the second worldwide cause after cataract.
Research suggests that slowing a patient myopia progression by 1D reduces the likelihood
of them developing macular maculopathy by 40%, independent of their level of myopia or
race. Despite six-year data being relatively sparse, existing research suggests a reduction of at least 1D of myopia progression may be possible over this time.
It is well established that the sooner we intervene in a child’s myopia progression, the better the outcome.
Your optometrist can evaluate when identifying children at risk, some of which are
identifiable through a child’s history and lifestyle. Measuring a child’s refractive error and eye growth offers vital information when identifying children who would benefit from myopia management.
How do I choose the right myopia management method?
Evidence suggests increased time outdoors is mostly effective in slowing the myopic shift in refractive error and onset of myopia in pre-myopic patients. In myopic eyes, epidemiology reports have shown conflicting results with some concluding that time outdoors does not reduce refractive progression, whereas others suggest it does. Nevertheless, children must be encouraged to make such lifestyle changes; however, the likelihood of strict compliance to 90 minutes of daily outdoor time and taking regular breaks from near work is unlikely to be maintained over several years throughout childhood and adolescence. Therefore, taking into account scope of practice and treatment availability, additional intervention options should be explored.
Available myopia management options
A range of optical and pharmacological myopia control strategies have been developed are widely being used to slow the progression of myopia.
- Atropine
Although not yet licensed for myopia management in the UK, low dose atropine is a popular myopia control method across the world.
- Contact lenses
MiSight 1 day contact lenses (Cooper Vision) are a commonly adopted intervention in the UK for myopia management. These dual focus contact lenses are designed to impose peripheral myopic defocus, which is understood to provide a signal to slow axial growth.
- Orthokeratology contact lenses
Orthokeratology contact lenses are also efficacious in slowing the progression of childhood myopia compared to single vision spectacles.
- Spectacle lenses for myopia control
More recently, new spectacle lens Miyosmart (Hoya) technology has been developed
comprising of a central optical zone to correct distance refractive error and a peripheral zone with multiple segments of relatively positive power (+3.50D) which simultaneously induce peripheral myopic defocus. Likewise novel Stellest lenses (Essilor) are reported to significantly slow myopia progression through incorporation of multiple aspheric peripheral lenslets. Also, Captain Vision lenses (Lesa France) with similar principle are available for myopia control in the European and UK market as well. Captain Vision lenses are highly aspheric lenses that maintain perfect correction in central vision and correct the hyperopic effect of the lens in lateral vision (reduce myopic defocus) and slow myopia progression. Three defocusing options are available: The Captain Vision 350 has a defocus of +3.50D, making it ideal for younger children (up to 10 years old). The Captain Vision 250 has a defocus of +2.50D and is suitable for children aged 10 to 12. The Captain Vision 150 has a defocus of +1.50D and is suitable for children over 12.
- Repeated low-level red-light therapy
Repeated low-level red-light therapy has been used for treating childhood amblyopia in
China for several decades, where anecdotal reports of changes in choroidal thickness and
stabilisation of axial growth led to the application of this therapy for myopia control. These
findings resulted in the development of a specific repeated low-level red-light device for
myopia management. The device has been approved by medical regulators in over 30
countries across Europe and Australia and is currently the only commercially available
instrument for this purpose in the UK.
Myopia management cannot have a one-size-fits-all approach. Your optometrist will help you to choose management which will be tailored to each child’s prescription, lifestyle,
compliance with spectacle or contact lens wear, financial budget and patient/parent
preference. In any case interventions which are licensed for myopia control will be an
optometrist first choice. Although licensed for general use in the UK, standard multifocal
contact lenses and orthokeratology lenses which are not specifically marketed for myopia
management would be considered off-label interventions. If an on-label approach doesn’t
meet a patient’s clinical needs, off-label options can be offered if supported by sufficient
evidence of their benefit to young myopes. Your optometrist will consider their scope of
practice when forming the management plan or if not accessible will refer a patient to a
practitioner who can offer alternative options.
Efalcon store offers standard myopia management with Captain Vision spectacle lenses of Lesa France manufacturer and MiSight 1 day contact lenses from Cooper Vision. Both options offer highly effective myopia management solutions for children, with robust and quality evidence to support it. To learn more about available treatment follow the following links: