WHAT IS MYOPIA?
Generally, a newborn’s eyeball is shorter than ideal, but its length increases with age. Under normal conditions, the length of the globe of the eye will increase to an ideal length by adulthood. With the eyeball at an ideal length, one will see well all the time, both near and also at a distance.
Unfortunately, many eyeballs simply do not grow to an ideal length by the time a child reaches adulthood. Myopia is a condition where the globe of the eye has become elongated from its ideal length. This causes light to focus at the front of the retina instead of on the retina. A person with myopia (nearsightedness) will not be able to see things clearly at a distance without wearing corrective lenses such as glasses or contact lenses.
Generally, a newborn’s eyeball is shorter than ideal, but its length increases with age. Under normal conditions, the length of the globe of the eye will increase to an ideal length by adulthood. With the eyeball at an ideal length, one will see well all the time, both near and also at a distance.
Unfortunately, many eyeballs simply do not grow to an ideal length by the time a child reaches adulthood. Myopia is a condition where the globe of the eye has become elongated from its ideal length. This causes light to focus at the front of the retina instead of on the retina. A person with myopia (nearsightedness) will not be able to see things clearly at a distance without wearing corrective lenses such as glasses or contact lenses.
The globe of the eye overgrows due to both genetics and environmental factors. In the U.S., the prevalence of myopia in adults has increased from 25% in 1979 to nearly 50% in 201610. In China, the prevalence for myopia in the university student population is approximately 90%. The average degree of myopia among these students is over 4.00 D according to one study done in Shanghai(17).
These alarming statistics are even more frightening if you consider the health risks of having myopia. Myopia increases the chance of developing serious eye ailments such as retinal detachment, glaucoma, cataract and other sight-threatening diseases(8). Although any degree of myopia is a risk factor for future vision loss, high myopia of more than 6.00 D is associated with a very high risk of these conditions. For example, persons with more than 6.00 D of myopia have a 14.4 times greater chance of developing glaucoma(2). Those with over 8.00 D of myopia
have a 7.8 times greater risk of having a retinal detachment(8). Myopia is now the second highest leading cause of visual impairment in the world.
The globe of the eye overgrows due to both genetics and environmental factors. In the U.S., the prevalence of myopia in adults has increased from 25% in 1979 to nearly 50% in 201610. In China, the prevalence for myopia in the university student population is approximately 90%. The average degree of myopia among these students is over 4.00 D according to one study done in Shanghai(17).
These alarming statistics are even more frightening if you consider the health risks of having myopia. Myopia increases the chance of developing serious eye ailments such as retinal detachment, glaucoma, cataract and other sight-threatening diseases(8). Although any degree of myopia is a risk factor for future vision loss, high myopia of more than 6.00 D is associated with a very high risk of these conditions. For example, persons with more than 6.00 D of myopia have a 14.4 times greater chance of developing glaucoma(2). Those with over 8.00 D of myopia
have a 7.8 times greater risk of having a retinal detachment(8). Myopia is now the second highest leading cause of visual impairment in the world.
WHO IS AFFECTED BY MYOPIA?
Genetics play an important role in developing myopia. A child where both parents are myopic has a much higher chance of developing high myopia (over 6.00 D) than one with only one or no parent that is myopic(15). Asians also tend to be much more susceptible to developing myopia
early in life. The progression of myopia in Chinese according to many studies averages at an 0.8 D increase per year between the ages of 7-14 years old(4), which is in most cases the fastest growth period in terms of the length of the eyeball. It is not uncommon to see an over 2.00 D increase in a single year in Chinese children. These children who are nearsighted at a young age (10 years old or under) are very likely to become highly myopic(5). Asians also tend to have a higher degree of myopia and the degree of myopia may continue to increase through their early adulthood.
Genetics play an important role in developing myopia. A child where both parents are myopic has a much higher chance of developing high myopia (over 6.00 D) than one with only one or no parent that is myopic(15). Asians also tend to be much more susceptible to developing myopia
early in life. The progression of myopia in Chinese according to many studies averages at an 0.8 D increase per year between the ages of 7-14 years old(4), which is in most cases the fastest growth period in terms of the length of the eyeball. It is not uncommon to see an over 2.00 D increase in a single year in Chinese children. These children who are nearsighted at a young age (10 years old or under) are very likely to become highly myopic(5). Asians also tend to have a higher degree of myopia and the degree of myopia may continue to increase through their early adulthood.
The environment also plays a major role in worsening the degree of myopia. Many studies have linked urbanization and education to myopia(7,14). Long hours of reading, computer use and near work, in general, are believed to be negative environmental factors in developing myopia(20). Nearsightedness is twice as common in middle and higher income provinces in China compared
to the more rural areas of China with less near-work demands and where children experience less school pressure(9).
There are many studies that show outdoor activities with sun exposure helps to slow down increases in myopia(16). A lack of sun exposure can be a contributing factor to the development of myopia in children(6). A rule of thumb for a good amount of outdoor activities to prevent myopia progression is 12 hours a week for children during their growth years.
The environment also plays a major role in worsening the degree of myopia. Many studies have linked urbanization and education to myopia(7,14). Long hours of reading, computer use and near work, in general, are believed to be negative environmental factors in developing myopia(20). Nearsightedness is twice as common in middle and higher income provinces in China compared
to the more rural areas of China with less near-work demands and where children experience less school pressure(9).
There are many studies that show outdoor activities with sun exposure helps to slow down increases in myopia(16). A lack of sun exposure can be a contributing factor to the development of myopia in children(6). A rule of thumb for a good amount of outdoor activities to prevent myopia progression is 12 hours a week for children during their growth years.
CONTROLLING MYOPIA
WHAT IS MYOPIA CONTROL?
Based on data obtained from the various diagnostic tests done during the initial consultation, as well as a relevant lifestyle history, and genetic predisposition, doctors will design a customized myopia prevention program for the myopic patient. The primary purpose of the treatment program is to maximally slow down or stop the progression of myopia.
Slowing down myopia progression by 50% can reduce the chance of developing high myopia by 90%(10). It is also known that the higher the myopic prescription, the higher one’s chance of losing vision later in life. Therefore, slowing down the lengthening of the globe of the eye, so as to keep myopia at the lowest possible degree is of utmost importance to our children.
There are four distinct treatment therapies mentioned (Ortho-k, BT50, atropine .01% and soft dual-focus lenses), Night Wear Ortho-k is by far the most proven and effective in the control of myopia progression. Ortho-k also has the additional benefit of not having to rely on glasses or contacts to see well during all waking hours. Children, especially those who actively participate in sport activities, love the crisp vision afforded without corrective lenses not to mention the added confidence and self-image of not having to wear eyeglasses. Virtually 100% of all night wear Ortho-k patients do not need to use glasses to see well during the day.
The most effective myopic control program is a combination of different treatment modalities as well as maintaining a healthy lifestyle and good visual hygiene. Our doctors often prescribe Gold NW Ortho-k lens users to also apply Atropine 0.01% eye drop and BT50 glasses as extra protections against rapid myopia progression in children and young teens. Our doctors often prescribe Gold NW Ortho-k lens users to also apply Atropine 0.01% eye drop and BT50 glasses as extra protections against rapid myopia progression in children and young teens.
NIGHTWEAR ORTHO-K LENSES
Golden Vision Myopia control clinics’ Gold NW Ortho-k lenses are custom designed nightwear lenses that are made according to one’s corneal shape. A special diagnostic technology called a corneal topographer is utilized to “map” out the exact shape of the front part of the eye called the cornea. Using the data from the mapping of the cornea, the Gold NW Ortho-k lenses will be made to a person’s personal prescription, and also in accordance with the shape of the cornea. By wearing these lenses overnight every night, a patient under treatment will not require any vision correction during all waking hours. These lenses change the refractive surface of the cornea in such a way that the resulting image onto the retina (analogous to the photo plate of a camera) gives you the sharp vision that you want, and importantly, also slows down or stops the increase in the degree of myopia(4,18).
Our Gold NW Ortho-K lenses outperform other commercially available Ortho-k lenses in therapeutic value. The Gold lenses can correct a high degree of myopia exceeding -10.00 D and a moderate to high amount of astigmatism of up to 4.00 D compared to the commercially available CRT Ortho-k lenses that can only correct up to no higher than -6.00 D of myopia and a very minimal amount of astigmatism of 1.75D. The sophisticated 6-curve design of the Gold NW Ortho-k lenses enable many of our patients to have near perfect vision throughout the day with just a few hours of wearing the lenses overnight. Most other Ortho-k lenses require a full 8 hours of sleep time with the lenses in order to produce crisp vision throughout the day. Usually after just one night of wearing the Gold lenses for a few hours, a moderate prescription myopic patient will see close to 20/20 the next day.
The preventive benefit of Gold NW OK lens in terms of myopia control also surpasses other Ortho-k designs. Based on data collected in our clinics, our lenses slow down myopia progression by an average of 75%, whereas other lenses (CRT) provide on average control of about 50%. The Gold NW OK lenses are most suitable for Chinese children who are genetically more prone to high myopia and environmentally more vulnerable due the high demands from school work. Gold NW OK lenses are highly oxygen permeable and are extremely comfortable to wear. They require very minimal time to adapt to, and are safe and effective(13). At our various clinics, more than 5,000 myopic children are now using these lenses to prevent and treat myopia.
Atropine eye drops
Atropine at a 1% concentration has long been known to be the most effective treatment for progressive myopia. This eye drop medication at this concentration has been very popular with children with myopia in Asian countries such as Taiwan, Hong Kong and Singapore for many years. There have been many studies that show a better than 80% effectiveness in slowing down myopia progression using atropine at a 1% concentration(12).
Although atropine 1% is proven to be safe and there are no long-term negative side effects. It has, however, the temporary side effects of light sensitivity and blurry near vision. Even though the side effects invariably go away as soon as the patient stops the drops, very few doctors in the US prescribe atropine at 1% concentration for myopia control.
In 2018, the landmark ATOM(2) study of different concentrations of atropine and effects in myopia control showed that atropine at a 0.01% concentration (diluted 100 times) has 50% effectiveness in curbing myopia progression without the side effects experienced at higher concentrations(3). Thus, atropine 0.01% has become the standard treatment for progressive myopia. Children with myopic parents, those who spend a lot of time reading with lots of school work, and those who have developed myopia at a young age are most indicated for use of this drop once a day. Atropine 0.01% is not commercially available in the USA. It takes strict compounding pharmacy conditions to obtain a stable and effective eyedrop at low concentration. At Golden Vision, we are proud to provide you dependable sources for good quality Atropine 0.01%.
Atropine 0.01% can also be used as adjunct treatment with other myopia control methodologies such as Ortho-k, soft dual-focus lenses, and BT50 glasses. The most recent study showed that atropine 0.01% when used in combination with Ortho-K, increases the effectiveness of myopia control by 20% over Ortho-k lenses alone(11).
BT50 GLASSES and PROPER VISUAL HYGIENE
We cannot change our genetic makeup and those who have “myopic” genes are most prone to negative environmental factors that worsen myopia. A recent study found that children who have the APLP(2) gene and spent a large amount of time reading had an increased disposition toward myopia compared to those without the genetic variance(19). What we can do is to educate our children to practice proper visual hygiene in order to reduce damaging impact caused by these environments.
1. BT50 glasses (+0.50 blue-light filtered reading glasses). For children who are already being treated with Ortho-k and soft multi-focal lenses to control the progression of myopia, they no longer need to wear glasses to see well at any distance. However, to increase the effectiveness of the treatment, BT50 glasses are often prescribed for children that spend a lot of time reading books and viewing digital screens such as a computer and cell phone. BT50 glasses provide two mechanisms that increase protection to the eyes. They reduce eye strain caused by vision fatigue when one does a lot of close-range reading(21) and they also filter out the harmful blue frequency light emitted by digital devices.
2. Good reading habits is good visual hygiene. Do not bring reading material too close to the face. It’s best to maintain a minimum reading distance of 12″ from the face. Take frequent breaks to view objects at a distance of 20 feet away after 20 minutes of continuous reading to relax your eyes. Avoid using a smartphone for an extended period of time. It’s best to use the BT50 glasses every time one finds oneself reading or viewing a digital device for over 30 minutes.
Soft dual-focus lenses
Due to the success of Ortho-k in slowing down the eyeelongation problem in many children, medical researchers have been looking for other alternatives to the treatment of progressive myopia including specially-designed soft contact lenses that can create the “therapeutic” retinal image that in the past was only possible from Ortho-K lenses. Today, several custom-made soft lenses are able to simulate the same therapeutic retinal images of the Ortho-k lenses. It is expected that soft lenses for myopia control will eventually rival Ortho-k lenses in popularity.
Some of the advantages of soft contact lenses are easy adaptation, great comfort, and ability to be made for any prescription and can conform to many eye shapes that are more difficult for night wear Ortho-k lenses. For example, some patients have congenital eye conditions where the eyelashes tend to roll inward causing a constant rubbing of the cornea.
Soft dual-focus lenses can serve as an eye protection against the eyelashes scraping against delicate surface of the eyes. These lenses are also helpful to those who are unable to adapt to wearing Ortho-k lenses overnight. The effectiveness of the soft dual-focus lenses alone are shown to achieve a 30-40% slowdown in growth of the axial length of the eye(1).
REFERENCES
1. Anstice, Nicola S., and John R. Phillips. “Effect of Dual-Focus Soft Contact Lens Wear on Axial Myopia Progression in Children.” Ophthalmology, vol. 118, no. 6, 2011, pp. 1152–1161.
2. Chen, Sheng-Ju, et al. Current Neurology and Neuroscience Reports., U.S. National Library of Medicine, 2012
3. Chia, A., Lu, Q. and Tan, D. (2016). “Five-Year Clinical Trial on Atropine for the Treatment of Myopia 2.” Ophthalmology, 123(2), pp.391-399.
4. Cho, Pauline, et al. “The Longitudinal Orthokeratology Research in Children (LORIC) in Hong Kong: A Pilot Study on Refractive Changes and Myopic Control.” Current Eye Research, vol. 30, no. 1, 2005, pp. 71–80.
5. Chua SYL, Sabanayagam C, Cheung Y-B, et al. “Age of onset of Myopia Predicts Risk of High Myopia in Later Childhood in Myopic Singapore Children” Opthalmic Physiol Opt. 2016;36(4):388-394
6. Cui, D. Trier, K., Ribel-Madsen, S.M. “Effect of Day Length on Eye Growth, Myopia Progression, and Change of Corneal Power in Myopic Children” Ophthalmology. 2013; 120(5),1074-1079
7. Dandona, Rakhi, et al. “Population-Based Assessment of Refractive Error in India: the Andhra Pradesh Eye Disease Study.” Clinical and Experimental Ophthalmology, vol. 30, no. 2, 2002, pp. 84–93.
8. Flitcroft DI. “The Complex Interactions of Retinal, Optical, and Environmental Factors in Myopia Aetiology.” Prog Retin Eye Res. 2012; 31 (6): 622-660
9. He, Mingguang, et al. “Refractive Error and Visual Impairment in Urban Children in Southern China.” Investigative Opthalmology & Visual Science, vol. 45, no. 3, Jan. 2004, p. 793.
10. Holden, Brien. “The Impact of Myopia and High Myopia.” World Health Organization, 16 Mar. 2015.
11. Kinoshita, Nozomi, et al. “Additive Effects of Orthokeratology and Atropine 0.01% Ophthalmic Solution in Slowing Axial Elongation in Children with Myopia: First Year Results.” Japanese Journal of Ophthalmology, vol. 62, no. 5, Apr. 2018, pp. 544–553.
12. Kothari, Mihir, and Vivek Rathod. “Efficacy of 1% Atropine Eye Drops in Retarding Progressive Axial Myopia in Indian Eyes.” Indian Journal of Ophthalmology, vol. 65, no. 11, 2017, p. 1178.
13. Liu, Y M, and P Xie. “The Safety of Orthokeratology–A Systematic Review.” Current Neurology and Neuroscience Reports., U.S. National Library of Medicine, Jan. 2016
14. Murthy et al “The Prevalence of Uncorrected Refractive Error in Urban, Suburban, Exurban and Rural Primary School Children in Indonesian Population.” International Journal of Ophthalmology, 2017
15. Racella R, McLellan J, Grice K, Del Bono EA, Wiggs JL, Gwiazda JE. “Role of Genetic Factors in the Etiology of Juvenile-Onset Myopia on a Longitudinal Study of Refractive Error.” Optom Vis Sci. 1999;76(6):381-386
16. Rose KA, Morgan IG, Smith W, Burlutsky G, Mitchell P, Saw S-M. “Myopia in Children.” Ophthalmology. 2008;115(8): 1279-1285
17. Sun, Jing, et al. “High Prevalence of Myopia and High Myopia in 5060 Chinese University Students in Shanghai.” Investigative Ophthalmology & Visual Science, The Association for Research in Vision and Ophthalmology, 1 Nov. 2012
18. Sun, Yuan, et al. “Correction: Orthokeratology to Control Myopia Progression: A Meta-Analysis.” Plos One, vol. 10, no. 6, Nov. 2015
19. Tkatchenko, Andrei V., et al. “APLP2 Regulates Refractive Error and Myopia Development in Mice and Humans.” PLOS Genetics, vol. 11, no. 8, 2015
20. Vitale, S. (2009). “Increased Prevalence of Myopia in the United States Between 1971-1972 and 1999- 2004.” Archives of Ophthalmology, 127(12), p.1632.
21. Zhao, Hai-Lan, et al “Role of Short-Wavelength Filtering Lenses in Delaying Myopia Progression and Amelioration of Asthenopia in Juveniles.” International Journal of Ophthalmology, 2017
REFERENCES
1. Anstice, Nicola S., and John R. Phillips. “Effect of Dual-Focus Soft Contact Lens Wear on Axial Myopia Progression in Children.” Ophthalmology, vol. 118, no. 6, 2011, pp. 1152–1161.
2. Chen, Sheng-Ju, et al. Current Neurology and Neuroscience Reports., U.S. National Library of Medicine, 2012
3. Chia, A., Lu, Q. and Tan, D. (2016). “Five-Year Clinical Trial on Atropine for the Treatment of Myopia 2.” Ophthalmology, 123(2), pp.391-399.
4. Cho, Pauline, et al. “The Longitudinal Orthokeratology Research in Children (LORIC) in Hong Kong: A Pilot Study on Refractive Changes and Myopic Control.” Current Eye Research, vol. 30, no. 1, 2005, pp. 71–80.
5. Chua SYL, Sabanayagam C, Cheung Y-B, et al. “Age of onset of Myopia Predicts Risk of High Myopia in Later Childhood in Myopic Singapore Children” Opthalmic Physiol Opt. 2016;36(4):388-394
6. Cui, D. Trier, K., Ribel-Madsen, S.M. “Effect of Day Length on Eye Growth, Myopia Progression, and Change of Corneal Power in Myopic Children” Ophthalmology. 2013; 120(5),1074-1079
7. Dandona, Rakhi, et al. “Population-Based Assessment of Refractive Error in India: the Andhra Pradesh Eye Disease Study.” Clinical and Experimental Ophthalmology, vol. 30, no. 2, 2002, pp. 84–93.
8. Flitcroft DI. “The Complex Interactions of Retinal, Optical, and Environmental Factors in Myopia Aetiology.” Prog Retin Eye Res. 2012; 31 (6): 622-660
9. He, Mingguang, et al. “Refractive Error and Visual Impairment in Urban Children in Southern China.” Investigative Opthalmology & Visual Science, vol. 45, no. 3, Jan. 2004, p. 793.
10. Holden, Brien. “The Impact of Myopia and High Myopia.” World Health Organization, 16 Mar. 2015.
11. Kinoshita, Nozomi, et al. “Additive Effects of Orthokeratology and Atropine 0.01% Ophthalmic Solution in Slowing Axial Elongation in Children with Myopia: First Year Results.” Japanese Journal of Ophthalmology, vol. 62, no. 5, Apr. 2018, pp. 544–553.
12. Kothari, Mihir, and Vivek Rathod. “Efficacy of 1% Atropine Eye Drops in Retarding Progressive Axial Myopia in Indian Eyes.” Indian Journal of Ophthalmology, vol. 65, no. 11, 2017, p. 1178.
13. Liu, Y M, and P Xie. “The Safety of Orthokeratology–A Systematic Review.” Current Neurology and Neuroscience Reports., U.S. National Library of Medicine, Jan. 2016
14. Murthy et al “The Prevalence of Uncorrected Refractive Error in Urban, Suburban, Exurban and Rural Primary School Children in Indonesian Population.” International Journal of Ophthalmology, 2017
15. Racella R, McLellan J, Grice K, Del Bono EA, Wiggs JL, Gwiazda JE. “Role of Genetic Factors in the Etiology of Juvenile-Onset Myopia on a Longitudinal Study of Refractive Error.” Optom Vis Sci. 1999;76(6):381-386
16. Rose KA, Morgan IG, Smith W, Burlutsky G, Mitchell P, Saw S-M. “Myopia in Children.” Ophthalmology. 2008;115(8): 1279-1285
17. Sun, Jing, et al. “High Prevalence of Myopia and High Myopia in 5060 Chinese University Students in Shanghai.” Investigative Ophthalmology & Visual Science, The Association for Research in Vision and Ophthalmology, 1 Nov. 2012
18. Sun, Yuan, et al. “Correction: Orthokeratology to Control Myopia Progression: A Meta-Analysis.” Plos One, vol. 10, no. 6, Nov. 2015
19. Tkatchenko, Andrei V., et al. “APLP2 Regulates Refractive Error and Myopia Development in Mice and Humans.” PLOS Genetics, vol. 11, no. 8, 2015
20. Vitale, S. (2009). “Increased Prevalence of Myopia in the United States Between 1971-1972 and 1999- 2004.” Archives of Ophthalmology, 127(12), p.1632.
21. Zhao, Hai-Lan, et al “Role of Short-Wavelength Filtering Lenses in Delaying Myopia Progression and Amelioration of Asthenopia in Juveniles.” International Journal of Ophthalmology, 2017
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