Optician India

Introduction to Myopia

Myopia, commonly known as nearsightedness, is a refractive error that makes distant objects appear blurry while close objects remain clear. This condition occurs when the eye’s length is too long or when the cornea is too curved, causing light to focus in front of the retina instead of directly on it. Myopia affects people of all ages, but it’s becoming especially common among children and young adults due to lifestyle and environmental factors, such as increased screen time and limited time outdoors. Left unchecked, myopia can lead to serious eye health issues later in life, including retinal detachment, glaucoma, and myopic maculopathy.

Why Myopia Control is Important???

As myopia progresses, it not only worsens vision but also increases the risk of severe ocular conditions. Myopia control refers to methods aimed at slowing down the progression of myopia in children and young adults. While myopia correction (such as glasses or contact lenses) simply improves vision temporarily, myopia control techniques work on preventing or reducing the extent of myopia over time, thereby potentially lowering the risk of future complications.

Prevalence of myopia in the world

The global prevalence of myopia has reached epidemic proportions, with rates continuing to rise across all age groups and regions. The projected rates of myopia by 2050 paint a concerning picture. Nearly half of the world’s population is expected to be myopic, and a significant portion is at risk of permanent vision impairment due to high myopia.

Where To Start???-Myopia Management Courses

1. Brien Holden Vision Institute (BHVI) Myopia Management Program- BHVI offers a structured, evidence-based online myopia management course designed for optometrists and ophthalmologists. It covers both foundational and advanced myopia control concepts.

2. CooperVision Myopia Management Specialist Training- CooperVision is known for its specialty lenses, including MiSight, a soft contact lens FDA- approved for myopia control. Their training is geared toward practitioners looking to use this product in their practice.

3.  International Myopia Institute (IMI) Resources- IMI provides guidelines and clinical resources for practitioners around the world. While not a formal course, the IMI has published extensively on standards and best practices in myopia control.

4. The World Council of Optometry (WCO)- Myopia Management Standard of Care Initiative- WCO’s initiative aims to make myopia management a standard part of optometric practice globally. They offer a variety of training resources through webinars, articles, and online modules.

5. American Academy of Orthokeratology and Myopia Control (AAOMC) – Myopia Control Programs-AAOMC focuses on orthokeratology (Ortho-K) and myopia management and offers specialized training for practitioners interested in overnight lenses to reduce myopia progression.

Complication due to Myopia Progrssion

1. Myopic Macular Degeneration (MMD): This condition affects the macula, the central part of the retina, and can lead to significant vision loss.
2. Retinal Detachment: High myopia increases the risk of the retina detaching from the back of the eye, which can cause severe vision loss if not treated promptly
3. Cataracts: Myopia can lead to the development of cataracts at an earlier age, requiring surgical intervention to restore vision
4. Glaucoma: The increased pressure within the eye associated with myopia can  lead to glaucoma, damaging the optic nerve and potentially causing blindness
5. Posterior Subcapsular Cataracts: These cataracts form at the back of the lens and can significantly impair vision
6. Nuclear Cataracts: These cataracts form in the central part of the lens and can also lead to vision impairment

Myopia Progression Calculators

1.The Brien Holden Myopia Calculator -is typically accessible on the Brien Holden Vision Institute website. Eye care professionals can also use it in clinical settings as part of a comprehensive myopia management plan.

2.LVPEI Myopia Calculator-You can access the Myopia Calculator on the LVPEI website or consult with an LVPEI-affiliated eye care professional to use the calculator as part of a myopia management plan.

3.MyKids Vision Risk Assessment Tool-parents determine their child’s myopia risk based on their child’s:Family History of Myopia,Outdoor Activity Levels andScreen Time and Near Work.

Suggested Treatment Option for Myopia Control

M.Orthokeratology (Ortho-K) Lenses-Ortho-K involves specially designed rigid contact lenses worn overnight to reshape the cornea temporarily. This reshaping allows the user to see clearly without corrective lenses during the day.

ACUVUE ®  Abiliti ™  Overnight lenses- FDA approved orthokeratology lenses worn during sleep. They temporarily reshape the cornea, allowing clear vision during the day typically without the need for vision correction.

Y. Atropine Eye Drops-Low-dose atropine (typically 0.01% to 0.05%) is used in the form of eye drops applied nightly to slow myopia progression. Atropine reduces the eye’s tendency to grow too quickly, which contributes to myopia progression.

O. Soft Contact Lenses- Multifocal soft contact lenses have different focal zones within the lens, which help reduce the stimulus for eye elongation that contributes to myopia. Specific designs, such as dual-focus or center-distance lenses, have shown promise for myopia control.

MiSight ®  1 day-FDA-approved* soft contact lens proven to slow the progression of myopia (nearsightedness) in children, aged 8-12 at the initiation of treatment.

P. Multifocal or Myopia Control Spectacles-Specialized myopia control spectacles use multiple optical zones to reduce myopia progression. The lenses include near and peripheral defocus zones, which help slow down eye elongation.

1. Hoya MiYOSMART- is the innovative solution for slowing down myopia progression in an easy, safe, effective non-invasive way, so your child can race full-steam ahead.

2. Essilor Stellest lenses-are glasses lenses that are designed to correct vision and slow the progression of myopia, or short-sightedness, in children.

3.The ZEISS MyoCare lens is the age-related design released for myopia management in children.

4.Nova Myosafe- Speciality Lens For Myopia Management.

P.Red Light Therapy-Red light therapy is emerging as a promising approach for controlling myopia (nearsightedness) in children and young adults. Recent studies suggest that low-level red light therapy may help slow the progression of myopia, which typically worsens during childhood and adolescence.The therapy involves exposing the eyes to low-level red light, often around 650 nm, for brief sessions daily.

I. Lifestyle and Environmental Modifications- recommends increasing outdoor activity  and managing screen time or other near work activities as preventive measures.

1. Outdoor Time: Spending more time outdoors can help reduce the risk of myopia in children. Aim for at least 2 hours of outdoor activity each day.

2. Limit Screen Time: Reduce the amount of time spent on digital devices and encourage regular breaks. Follow the 20/20/20 rule: every 20 minutes, take a 20-second break and look at something 20 feet away.

3. Corrective Lenses: Use specially designed myopia control lenses, such as multifocal or orthokeratology (Ortho-K) lenses, which have been shown to slow myopia progression.

4. Atropine Eye Drops: Low-dose atropine eye drops can be prescribed by an eye care professional to slow down the progression of myopia.

5. Balanced Diet: Ensure a diet rich in nutrients that support eye health, including vitamins A, C, and E, as well as omega-3 fatty acids.

6. Proper Lighting: Ensure adequate lighting while reading or working on tasks that require focus. Avoid reading in dim light or direct sunlight.

7. Regular Eye Exams: Schedule regular eye check-ups to monitor myopia progression and adjust prescriptions as needed.

8.Encourage Visual Activities: Engage in activities that stimulate visual skills, such as sports and games that involve eye-hand coordination.

9. Educational Resources: Educate parents and children about the importance of eye health and the factors that contribute to myopia.

A.Binocular vision therapy (BVT)-is another approach to controlling myopia, focusing on improving coordination between the eyes and addressing visual issues related to eye alignment, accommodation (focusing), and convergence (eye movement inward). This type of therapy aims to address underlying binocular vision issues that may contribute to myopia progression, especially in children.

Parental Education

M.Awareness: Parents need to be aware of the risk factors and symptoms of myopia. This includes understanding the importance of regular eye check-ups and early detection

Y.Behavioral Changes: Educating parents about healthy eye habits can make a significant difference.This includes encouraging outdoor activities, limiting screen time, and ensuring proper lighting while reading or doing homework.

O.Myopia Management: Parents should be informed about various myopia management strategies, such as corrective lenses, orthokeratology (special contact lenses), and atropine eye drops

P.Role Modeling: Parents can set a good example by practicing healthy eye habits themselves, such as taking breaks from screens and spending time outdoors.

I.Resources: There are various resources available, such as online websites and educational campaigns, that provide valuable information and tools for parents to help manage their children's eye health

A.Understanding:Parents should be informed about the signs of myopia, such as squinting, sitting too close to the TV, or having difficulty seeing distant objects. Regular eye examinations are crucial for early detection and treatment.

Ensuring informed consent is vital for understanding the benefits, risks, and responsibilities associated with myopia control treatments

Myopia control is a critical area of focus in eye care due to the rising prevalence of myopia worldwide, especially among children and adolescents. Uncontrolled myopia not only impairs vision but also increases the risk of serious eye health issues, such as retinal detachment, glaucoma, and myopic maculopathy, later in life. Fortunately, various interventions have proven effective in slowing myopia progression.In conclusion, myopia control is achievable through a combination of treatments tailored to the individual, regular monitoring, and preventive lifestyle changes. Early intervention is vital to minimizing the impact of myopia on long-term eye health and quality of life.

References

1.Burton MJ, Ramke J, Marques AP, Bourne RR, Congdon N, Jones I, et al. The Lancet Global Health commission on Global Eye Health: vision beyond 2020. Lancet Glob Health. 2021; 9(4):e489–e551.

2.https://www.who.int/news-room/fact-sheets/detail/blindness-and-visual-impairment

3.https://bhvi.org/news/how-to-use-the-myopia-calculator-with-your-patients/

4.https://missionmyopia.lvpei.org/

5.https://myopia.worldcouncilofoptometry.info/

7.https://www.essilor.com/uk-en/products/stellest/

8.https://www.hoyavision.com/vision-products/miyosmart/

9.https://www.zeiss.com/vision-care/en/eye-care-professionals/lenses/lenses-for-every-need/lenses-to-manage-myopia-progression-in-children.html