YOUR CHILD HAS MYOPIA
‘Myopia’ or
‘short sightedness’ is a condition where your child sees close-up objects
clearly, but cannot see distance objects (such as the blackboard) clearly.
Many children with myopia also have astigmatism (another type of focusing
abnormality). Myopia commonly develops during school age and progresses
slowly (that means your child needs ever-stronger glasses to see clearly for
distance) until it often stabilises in mid- late teens. It would be nice to
lessen and even stop this progression.
In this pamphlet
I discuss techniques that slow the progression of ‘school myopia’, techniques
that slow down the growth of the eye (slow the progression of axial length).
A lot of the
recent research on reducing myopia progression has been done in Oriental
children. The results probably also apply to Caucasian children (but we do not
really know).
One important point to note
when you read about myopia treatments: you can probably ignore all research that
does NOT measure ‘axial length’ (eye ball size) as this seems to be THE
important factor to measure and modify.
This pamphlet IS
for the parents who say:
1. I hate the idea of my child
growing up increasingly dependent on ever-stronger glasses. Can’t you do
anything to make it better?
2. …. I’ve read that with bad
myopia you’re more prone to get retinal detachment and go blind in one
eye. Can we prevent that?
This pamphlet is
NOT for the parents who say:
1. That’s nature. I’m also
short sighted and wear glasses or contacts – they were fine for me.
2. …and anyhow, when
s/he’s 20 s/he can have laser and that’s the end of it.
3. I’m 46 now. When I take my
glasses off I can read and use the computer, better than my
partner or friends.
A. Techniques
that have been studied and have little or no effect on myopia
progression:
?1. ALTERING THE
PATTERN OF SPECTACLE WEAR ?Some people have
believed that correcting myopia with full time wear & full strength glasses
may result in the myopia getting worse. This happens in chickens, but probably
does NOT happen in humans.
Varieties of
less-than-full-time glasses wear and less-than-full-strength glasses wear have
been studied. Some studies show no effect, some show a tiny positive effect, and
some show a tiny negative effect. For your child, there is NO expectation
of a useful benefit.
2. BIFOCALS AND
MULTIFOCALS ?Optometrists have
been using bifocal lenses [and more recently multifocals] as a possible
treatment for myopia since the 1940’s, because they ‘make sense’ to those who
believe that excessive near focusing contributes to myopia
progression.
Several
well-designed clinical trials of bifocal and multifocal lenses conducted in
children in the United States, Finland, and Denmark showed NO significant
differences in the myopia progression rates, including the new “MYOVISION” lens.
?
3. DROPS TO LOWER
EYE PRESSURE.
Drops normally
used to treat glaucoma have been shown to have little or no effect on the
progression of myopia.
4. BIOFEEDBACK
VISUAL TRAINING (including the Bates
methods)
There is no
conclusive evidence that biofeedback visual training is effective in retarding
myopia.
B. Techniques that have or may have some
effect on myopia progression:
5. TRADITIONAL
CHINESE MEDICINE TREATMENTS ?Facial "Qi Qong"
eye exercises were created in the 1950’s in China, and are part of the school
routine in many parts of China. It was postulated that massaging the various
acupuncture pressure points around the eye improves venous blood circulation,
relaxes the muscles, and reduces eyestrain. The evidence from two studies
conducted in Singapore and Taiwan were inconclusive.
In another study
of 242 adolescent eyes in Beijing, small pieces of adhesive pressure plaster
grains of Semen impatiens were evaluated. Significant treatment effects
were claimed for myopia progression.
6. CONTACT
LENSES
?There
is some data suggesting that hard contact lenses as used in ‘Orthokeratology’
and a Dual-Focus soft contact lens
(Cooper Proclear ‘D’ and similar) might
slow myopia progression in children.
7.
‘REVITALVISION’ (formerly called Neuro Vision)
This technique
was developed in Singapore and is based on computer-generated vision exercises
[and not to be confused with the technique of the same name which tries to
expand field of vision in patients with field loss]. Some success is
claimed for low myopia. Many studies seem to have been performed by
investigators with a commercial interest in the technique. Further studies
are necessary.
C. Techniques that usually have some
effect on myopia progression:
8. SPEND TIME
OUT-OF -DOORS
Oriental and
Caucasian children who spend more time outside have less myopia
progression. This seems to be independent of any effect of the time spent
on close work indoors.
9. ATROPINE EYE
DROPS ?
Atropine
1% has been used in
ophthalmology for over a century. There have been more than 20 studies over
30-40 years that show this to be effective for reducing the rate of myopia
progression in most Oriental and Caucasian children in whom it is tried.
In a Mayo Clinic
study, normal myopia progression was at the rate of 1 unit change in 3 years in
normals, and a rate of 1 unit change in 20 years in those using
atropine.
Atropine 1%
relaxes the pupil and focusing muscles of the eye causing blurred vision for
near and a dilated pupil; this large pupil causes sensitivity to
light. Some of the real and potential long-term side effects of atropine 1%
eye drops in chidren are of concern and that is why it never received wide
acceptance.
ATROPINE
0.01%
Atropine
0.01% seems to be nearly as
effective as Atropine 1% in reducing myopia progression in Oriental
children. In one recent 2 year study it seemed to have NO side
effects. When stopped after 2 years, the improvement seems to persist [the
improvement may not persist if higher %s have been used].
A respected
colleague from Singapore writes of her experience:
?Singapore has one of the
highest myopia rates in the world, and 7 year olds in our schools have 20%
myopia prevalence rates, increasing to some 40 percent by 12 years
old. [Dr Kowal’s note: The rate
is about 15% in 15 year olds in predominantly Caucasian populations]. The rate in University is around 85 to 90 %,
and it seems related to educational status.
?I usually offer
kids and parents the option of starting Atropine when I see a rapid increase in
the myopia rate. In Singapore the average increase for 7 year olds is -1D
per year at 7 years, between 8 and 11 years between 1-1.5 Ds a year, and after
12 years 0.5D a year …. much higher than in Western studies. So, if they
are even faster than this rate, or even at this rate, I discuss this option with
them ….?I review after 6 months, and
if it does not work, then they discontinue. If it works, (and the results
are sometimes very impressive!) and parents are agreeable, we continue till age
12years, (since in middle school the increase is slower), but parents/ child can
discontinue anytime.
Dr
Kowal’s recommendations: The only treatments that reliably
slow down the rate of myopia progression are:
1.
Spending more time out- of- doors
2.
Atropine eye drops
If
you want to try Atropine in your child:
1.
You should commit to daily drops of 0.01% Atropine in both eyes for at least 6
months.
2.
You can stop at any time
3.
Come back to see me (or an interested optometrist) every 6 months for vision,
refraction tests (without and with dilating drops) and axial length measurements
(special equipment required).
4.
0.01%
Atropine eye drops are commercially available in some Asian countries. In
Australia they need to be prepared by a compounding pharmacist.
Two pharmacies that
we know of are:
1. Slade’s pharmacy @ Epworth
Richmond
2. Pharmacy Smart Compounding. Shop 1, 190
Belmore Road Balwyn
If you find another, please let
us know @ <Roberto@privateeyeclinic.com>
YOUR CHILD HAS MYOPIA
‘Myopia’ or
‘short sightedness’ is a condition where your child sees close-up objects
clearly, but cannot see distance objects (such as the blackboard) clearly.
Many children with myopia also have astigmatism (another type of focusing
abnormality). Myopia commonly develops during school age and progresses
slowly (that means your child needs ever-stronger glasses to see clearly for
distance) until it often stabilises in mid- late teens. It would be nice to
lessen and even stop this progression.
In this pamphlet
I discuss techniques that slow the progression of ‘school myopia’, techniques
that slow down the growth of the eye (slow the progression of axial length).
A lot of the
recent research on reducing myopia progression has been done in Oriental
children. The results probably also apply to Caucasian children (but we do not
really know).
One important point to note
when you read about myopia treatments: you can probably ignore all research that
does NOT measure ‘axial length’ (eye ball size) as this seems to be THE
important factor to measure and modify.
This pamphlet IS
for the parents who say:
1. I hate the idea of my child
growing up increasingly dependent on ever-stronger glasses. Can’t you do
anything to make it better?
2. …. I’ve read that with bad
myopia you’re more prone to get retinal detachment and go blind in one
eye. Can we prevent that?
This pamphlet is
NOT for the parents who say:
1. That’s nature. I’m also
short sighted and wear glasses or contacts – they were fine for me.
2. …and anyhow, when
s/he’s 20 s/he can have laser and that’s the end of it.
3. I’m 46 now. When I take my
glasses off I can read and use the computer, better than my
partner or friends.
A. Techniques
that have been studied and have little or no effect on myopia
progression:
?1. ALTERING THE
PATTERN OF SPECTACLE WEAR ?Some people have
believed that correcting myopia with full time wear & full strength glasses
may result in the myopia getting worse. This happens in chickens, but probably
does NOT happen in humans.
Varieties of
less-than-full-time glasses wear and less-than-full-strength glasses wear have
been studied. Some studies show no effect, some show a tiny positive effect, and
some show a tiny negative effect. For your child, there is NO expectation
of a useful benefit.
2. BIFOCALS AND
MULTIFOCALS ?Optometrists have
been using bifocal lenses [and more recently multifocals] as a possible
treatment for myopia since the 1940’s, because they ‘make sense’ to those who
believe that excessive near focusing contributes to myopia
progression.
Several
well-designed clinical trials of bifocal and multifocal lenses conducted in
children in the United States, Finland, and Denmark showed NO significant
differences in the myopia progression rates, including the new “MYOVISION” lens.
?
3. DROPS TO LOWER
EYE PRESSURE.
Drops normally
used to treat glaucoma have been shown to have little or no effect on the
progression of myopia.
4. BIOFEEDBACK
VISUAL TRAINING (including the Bates
methods)
There is no
conclusive evidence that biofeedback visual training is effective in retarding
myopia.
B. Techniques that have or may have some
effect on myopia progression:
5. TRADITIONAL
CHINESE MEDICINE TREATMENTS ?Facial "Qi Qong"
eye exercises were created in the 1950’s in China, and are part of the school
routine in many parts of China. It was postulated that massaging the various
acupuncture pressure points around the eye improves venous blood circulation,
relaxes the muscles, and reduces eyestrain. The evidence from two studies
conducted in Singapore and Taiwan were inconclusive.
In another study
of 242 adolescent eyes in Beijing, small pieces of adhesive pressure plaster
grains of Semen impatiens were evaluated. Significant treatment effects
were claimed for myopia progression.
6. CONTACT
LENSES
?There
is some data suggesting that hard contact lenses as used in ‘Orthokeratology’
and a Dual-Focus soft contact lens
(Cooper Proclear ‘D’ and similar) might
slow myopia progression in children.
7.
‘REVITALVISION’ (formerly called Neuro Vision)
This technique
was developed in Singapore and is based on computer-generated vision exercises
[and not to be confused with the technique of the same name which tries to
expand field of vision in patients with field loss]. Some success is
claimed for low myopia. Many studies seem to have been performed by
investigators with a commercial interest in the technique. Further studies
are necessary.
C. Techniques that usually have some
effect on myopia progression:
8. SPEND TIME
OUT-OF -DOORS
Oriental and
Caucasian children who spend more time outside have less myopia
progression. This seems to be independent of any effect of the time spent
on close work indoors.
9. ATROPINE EYE
DROPS ?
Atropine
1% has been used in
ophthalmology for over a century. There have been more than 20 studies over
30-40 years that show this to be effective for reducing the rate of myopia
progression in most Oriental and Caucasian children in whom it is tried.
In a Mayo Clinic
study, normal myopia progression was at the rate of 1 unit change in 3 years in
normals, and a rate of 1 unit change in 20 years in those using
atropine.
Atropine 1%
relaxes the pupil and focusing muscles of the eye causing blurred vision for
near and a dilated pupil; this large pupil causes sensitivity to
light. Some of the real and potential long-term side effects of atropine 1%
eye drops in chidren are of concern and that is why it never received wide
acceptance.
ATROPINE
0.01%
Atropine
0.01% seems to be nearly as
effective as Atropine 1% in reducing myopia progression in Oriental
children. In one recent 2 year study it seemed to have NO side
effects. When stopped after 2 years, the improvement seems to persist [the
improvement may not persist if higher %s have been used].
A respected
colleague from Singapore writes of her experience:
?Singapore has one of the
highest myopia rates in the world, and 7 year olds in our schools have 20%
myopia prevalence rates, increasing to some 40 percent by 12 years
old. [Dr Kowal’s note: The rate
is about 15% in 15 year olds in predominantly Caucasian populations]. The rate in University is around 85 to 90 %,
and it seems related to educational status.
?I usually offer
kids and parents the option of starting Atropine when I see a rapid increase in
the myopia rate. In Singapore the average increase for 7 year olds is -1D
per year at 7 years, between 8 and 11 years between 1-1.5 Ds a year, and after
12 years 0.5D a year …. much higher than in Western studies. So, if they
are even faster than this rate, or even at this rate, I discuss this option with
them ….?I review after 6 months, and
if it does not work, then they discontinue. If it works, (and the results
are sometimes very impressive!) and parents are agreeable, we continue till age
12years, (since in middle school the increase is slower), but parents/ child can
discontinue anytime.
Dr
Kowal’s recommendations: The only treatments that reliably
slow down the rate of myopia progression are:
1.
Spending more time out- of- doors
2.
Atropine eye drops
If
you want to try Atropine in your child:
1.
You should commit to daily drops of 0.01% Atropine in both eyes for at least 6
months.
2.
You can stop at any time
3.
Come back to see me (or an interested optometrist) every 6 months for vision,
refraction tests (without and with dilating drops) and axial length measurements
(special equipment required).
4.
0.01%
Atropine eye drops are commercially available in some Asian countries. In
Australia they need to be prepared by a compounding pharmacist.
Two pharmacies that
we know of are:
1. Slade’s pharmacy @ Epworth
Richmond
2. Pharmacy Smart Compounding. Shop 1, 190
Belmore Road Balwyn
If you find another, please let
us know @ <Roberto@privateeyeclinic.com>