Why myopia management matters

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Myopia management matters not just because it’s preferable to have lower numbers in a prescription and thinner glasses. Generally, once a child becomes myopic (also called short-sighted, causing blurred distance vision) it tends to progress, or get worse, every few to several months. The younger a child becomes myopic, the faster they tend to progress, leading to higher levels of myopia. This means we should start a myopia management strategy as soon as possible. Click here to read more about when to start and when to stop myopia management.

Myopia management is the area of children’s eye care dedicated to slowing down childhood myopia progression. It can also be called myopia control, although this term is also used for the area of science researching spectacle lens, contact lens and atropine eye drops to control myopia progression. You can click on the relevant words to learn more about each option.

But what’s the point of all of this fuss? Why do we want to slow down myopia progression? If they have to wear glasses anyway, does it matter if they’re stronger or weaker? Can’t they just get laser surgery as an adult to fix it?

Myopia management is about protecting eye health

Myopia in children may just seem like a pair of glasses. However, as childhood myopia worsens, the eye is growing at an accelerated rate. The eyes are meant to grow in childhood, at a regular rate up until age 10-12. However if they grow too quickly or don’t stop at age 10-12, then a child becomes myopic. This excessive growth of the eye stretches the retina – the light sensitive layer lining the back of the eye – and the stretching increases risk of eye diseases and vision impairment occurring across your child’s lifetime.

A myopic eye is longer, or more stretched, than a normally sighted eye due to excessive eye growth.

A normal eye length is 22 to 24mm. When the eye grows to longer than 26mm, the risk of your child suffering vision impairment in their lifetime is 25%. If the eye grows to more than 30mm, which can occur in very high myopia, the risk skyrockets to 90%. Myopia control is about slowing down this excessive eye growth, ideally to the normal rate expected in childhood. Even at levels of myopia traditionally thought of as quite ‘low’, there are increased risks of eye diseases compared to someone who is not myopic – see the table below.

A table showing the increased risk of eye diseases with higher levels of myopia, from Flitcroft et al 2012 (link). The risk of these eye diseases for someone who is not myopic is ‘1’ – these are odds ratios, indicating the multiple of increased risk for that eye disease by the level of myopia. For example, a -1.00D myope has a 2.1x increased risk of cataract and a 3.1 x increased risk of retinal detachment compared to someone who is not myopic.

Myopia management is about quality of life

Someone with myopia has to wear glasses or contact lenses to correct their blurred distance vision. However if you have lower myopia, you’re more functional in the mornings before you put your glasses or contact lenses on; you can cope a little better without them rather than being disabled without them. Also, if your child does decide to have laser surgery to correct their myopia in early adulthood, a lower prescription means both more likelihood of them being suitable, and better visual outcomes after surgery.

The good news

It’s important to see myopia for what it really is – a condition of the eyes which increases disease risk. It’s not just about a pair of glasses, and it can’t just be ‘fixed’ with laser surgery as even in this case, your child will still have a longer eye than normal and still carry the increased risks of eye disease and vision impairment across their lifetime. But there’s something you can do about it – talk to your eye care practitioner about a myopia management strategy for your child. This could include specific types of spectacle lenses, contact lenses, atropine eye drops and advice about the visual enviroment. Click on the relevant words to learn more about each. The final word?

Every 1 dioptre less of myopia (-1.00, or 4 steps) means a decreased risk of myopic maculopathy of 40% across a lifetime.

Bullimore & Brennan, OVS 2019

Myopic maculopathy is a type of macular degeneration which is associated with myopia, and not so much with age like the typical form of which you may have heard. It is already the leading cause of vision impairment in working aged adults in China and Japan, where levels of myopia are very high. BUT the story can be different for your child, and indeed for this generation, if we implement myopia management.

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When to start and when to stop myopia management