London Ontario Optometrist Dr. Michael J. Fenn came upon treatments to stem the growing epidemic of nearsightedness, properly known as myopia, out of concern for his patients after over 15 years of seeing desperate patients and their parents looking for options to help stop the sometimes visually devastating effects of myopic progression. "I have a family member who has had two retinal detachments due to very high myopia. “I've also had a gentleman in my practice become blind as a result of his myopia and found it frustrating not being able to offer my patients options to help them." "I felt I had to do something to help these patients and as a result I began studying the growing science behind myopia control."
Myopia is a common condition due to a progressive lengthening of the eye that causes blurry vision when viewing objects that are far away. Its prevalence appears to be increasing and varies throughout the world.1-5It is much more prevalent in industrialized countries and in cities compared to rural areas.6-10,5 In the United States, the prevalence rate has increased from 25% between 1971-1972 to 41.6% between 1999-2004.11,12,5Some countries in Asia are seeing prevalence rates as high as 80% or more.13,14,5This rapid increase in prevalence raises some public health concerns.5For many people, low levels of myopia are a nuisance and just may mean you are dependent on glasses or contact lenses to see things at distance. However, with high levels of myopia the consequences can be sight threatening due to induced anatomical changes that involve a progressive lengthening of the eye. Persons with higher degrees of myopia have a greater risk of visual impairment or blindness from myopic macular degeneration, cataract, glaucoma, retinal holes and tears, and retinal detachments.13,14,15,16,5 Thus, finding ways to slow the progression of myopia is important in decreasing the associated ocular consequences and increasing peoples quality of life.
“I came to dread the conversation with patients and their parents when a child’s myopia would progressively increase without being able to offer them any options other than hope things don’t change at the next appointment.” This often is never the case as most myopia progresses approximately -0.50D per year until a persons 21st birthday, however some patients can progress well into their 20’s.17“Imagine any other medical condition that we would watch get worse and not do anything to help prevent or slow its course. “
The biggest risk factor for children developing myopia unfortunately is one they can’t change: their parents. Children of parents who are myopic are at higher risk of developing myopia.19 However increasingly studies have found environment may play an important role. Primarily, the amount of time spent outside in the development and progression of myopia.18,20-22“The first thing I recommend to parents, especially to those who are myopic themselves and worry about their children is to ensure their children have lots of play time outdoors.” “Studies have shown that children are less likely to become myopic if they spend close to 14 hours a week playing outside and progress at a slower rate if they already are myopic.”18-21 This appears to be independent of the amount of time spent reading.18-21
Once the child becomes myopic, interventions may include orthokeratology, which involves the use of a specially designed rigid gas permeable lens which moulds the cornea while the patient sleeps so when they wake up and remove the lens they don’t require contact lenses or glasses to see for the day. Children and adults like the procedure as it frees them from daytime visual correction, plus studies show that it has the added benefit of slowing the growth of the eye by 30-57% in children. 23-27
Another option is the use of a soft contact lens multifocal lens that is usually prescribed to older patients who want to wear contact lenses and have age related problems with reading that is used off label in children to slow the progression of myopia. Studies show it appears to slow the progression of myopia similar to that of orthokeratology.28-30
The last treatment Dr. Fenn has available is atropine eye drops. Atropine is normally used when treating inflammation of the eye. However, it does appear to also decrease the progression of myopia. When used at its pharmacologically available dosage it appears to decrease myopia progression by 77% over a two year period.31The drop at this concentration can be difficult to tolerate for children as their pupils are constantly dilated and they can’t focus for near tasks and are very light sensitive. Much more tolerable for a patient is having the drug diluted to one 100th of its dosage by a compounding pharmacy. “I have yet to prescribe the 1% concentration of atropine because of the risks of adverse events and side effects even though it appears quite effective.” The 0.01% concentration does not require any special lenses, studies show it slows the progression of myopia by 50% over a two year period, and the minimal concentration and dosage makes the likelihood of any adverse events very low.32In my experience patients tolerate it very well. My major concern which I communicate to patients and parents is the lack of long-term studies on the effects of atropine especially in children, and as a result, it is not the first line of treatment I recommend. Other treatments that have been tried include bifocal and multifocal glasses but have proven to be less effective and only work on children with specific ocular characteristics.33,34
For more information please feel free to visit Dr Fenn’s website at: www.orthoklondon.ca
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