The recent visit to the eye clinic with my younger boy left me shocked and confused. The results revealed that his left eye had a staggering 800-degree myopia, while his right eye had 675 degrees. It was a significant increase from the previous examination, just six months ago, where the doctor assured us that his myopia was stable. The sudden jump in degree left me with a whirlwind of emotions—concern, worry, and a sense of urgency to understand what might have contributed to this drastic change.
As a mother, I couldn't help but question what steps I could take to address this issue and ensure the best possible outcome for my child's vision health.
As we discussed the options with the eye clinic, I couldn't help but feel limited in the choices presented to us. The doctor advised us to either switch to special myopia glasses or increase the concentration of atropine to the highest level of 1%. I found it perplexing that these suggestions were only brought up now, when my child's degree had significantly increased. It left me questioning why these options weren't discussed earlier when his myopia was at a lower level. Additionally, I couldn't ignore the potential side effects of using 1% atropine, such as increased sensitivity to light, and the need for transition glasses. Furthermore, the special myopia glasses had their own limitations, with Stellest supporting up to 800 degrees and Myosmart up to 1000 degrees. I found myself grappling with the decision, searching for more information, and seeking alternatives that could provide the best solution for my child's vision health.
Child Myopia
1. Atropine. Atropine eye drops have shown promising results in managing myopia (nearsightedness) in children. When prescribed by an ophthalmologist, Atropine eye drops are used to dilate the pupils and temporarily relax the focusing mechanism of the eye, which helps to slow down the progression of myopia. By inhibiting the eye's ability to accommodate, Atropine eye drops reduce the strain on the eye and limit the elongation of the eyeball, a major contributing factor to myopia development. It is essential to follow the prescribed dosage and usage instructions carefully to ensure its effectiveness and safety. Regular monitoring by an eye care professional is recommended to assess the child's progress and adjust the treatment plan as necessary. Atropine eye drops offer a potential non-invasive approach to managing myopia in children, improving their visual health and potentially reducing the risk of high myopia-related complications in the future.
Child myopia, also known as nearsightedness, is a prevalent concern in Singapore. The city-state has one of the highest rates of myopia globally, with an alarming number of children affected. This condition, characterized by blurry distance vision, can have significant implications on a child's quality of life and academic performance. Factors such as excessive near-work activities, lack of outdoor time, and genetic predisposition contribute to the high prevalence. Recognizing the importance of addressing this issue, Singapore has implemented various strategies to combat myopia, including promoting outdoor activities, reducing screen time, and implementing vision screenings in schools. Additionally, innovative technologies and interventions, such as orthokeratology and specialized eyewear, are being utilized to slow down the progression of myopia.
Options Treatments for Child Myopia
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Side effects Using 1% Atropine. The treatment typically begins with the lowest percentage of Atropine and gradually increases the dosage to achieve stabilization of myopia progression. The highest dosage used is 1%, which has been associated with certain side effects. One common side effect is photophobia, which is increased sensitivity to light, causing discomfort and excessive squinting when exposed to bright light. Additionally, some individuals may experience glare, where bright lights appear excessively intense and may hinder their ability to see clearly. Pupil dilation caused by Atropine can also result in blurred vision and difficulties in focusing on nearby objects, leading to near vision disturbances. While these side effects are generally mild and temporary, they can affect daily activities and might necessitate adjusting the dosage or using the drops at specific times of the day.
Therefore, a step-wise approach is adopted, starting with a milder concentration and carefully monitoring the child's response before considering higher doses to strike the right balance between effectively managing myopia and minimizing potential side effects.
2. Myopia Specialized Glasses. Stellest and Myosmart glasses, are the two popular brands, offer a promising solution for children with high degrees of myopia. Designed specifically to address the progression of nearsightedness, these innovative glasses provide a range of benefits. With advanced lens technology and specialized coatings, they aim to reduce eye strain, control the elongation of the eyeball, and slow down the progression of myopia. These eyewear options are carefully crafted to provide clear vision while maintaining a comfortable fit for long-term wear. The lenses are specifically designed to correct the refractive error associated with myopia and minimize aberrations. By opting for myopia specialized eyewear, parents can have peace of mind knowing that they are taking proactive measures to safeguard their child's eyesight and potentially reduce the need for stronger prescriptions in the future.
| Essilor Stellest | Hoya MiYOSMART |
Clinical available data | 4 years2 | 6 years1 |
Effectiveness | 67% | 59% |
Lens material | Polycarbonate | Polycarbonate |
Coating | UV protection | UV protection |
Blue light protection | Available with a top up (Crizal Prevencia) | Not available |
Method used to control myopia progression | Myopic defocus | Myopic defocus |
Lens Design | A constellation of aspherical lenslets on 11 rings | Hundreds of small segments of constant myopic defocus evenly distributed (honeycomb structure) |
Technology used | H.A.L.T Technology | D.I.M.S Technology |
Central clear zone | 9mm | 9.4mm |
Power available | sph 0 to -10.00 cyl -4.00 | 0 to -10.00 cyl -4.00 |
Adaptation | Minimum | Minimum |
Safety | Safe and non-invasive | Safe and non-invasive |
Aesthetics | Good | Good |
Price | $490 | $530 |
3. Orthokerathology (Hard lense). 
Orthokeratology, also known as Ortho-K, is a non-surgical treatment option for myopia (nearsightedness). It involves the use of specially designed rigid gas-permeable contact lenses that are worn overnight while sleeping. These lenses gently reshape the cornea temporarily, providing clear vision during the day without the need for glasses or contact lenses.
Orthokeratology, also known as Ortho-K, is a non-surgical treatment option for myopia (nearsightedness). It involves the use of specially designed rigid gas-permeable contact lenses that are worn overnight while sleeping. These lenses gently reshape the cornea temporarily, providing clear vision during the day without the need for glasses or contact lenses.
It’s effectiveness can be up to 59% which is similar to MiYOSMART or Stellest.3 With cost ranging from $1500 - $2000 per year, your child will not need to bear the weight of the spectacle throughout the day and will be able to have a wider field of vision as compared to wearing spectacles with MiYOSMART or Stellest. There were two types of Ortho-K: Standard and Custom.
Standard Ortho K is like buying a ready-made suit from a department store — pre-made in set sizes, simply select the closest size to fit and off you go. It might fit well enough but it's not perfect.
Custom Ortho K is like having a tailored suit made just for you — each one is made individually based on precise measurements of you. That means the perfect fit.
Why Ortho-K is uncommon to be recommended as treatment to control child myopia?
a. Wearing contact lenses can bring a higher risk of eye infection for your child. However, the risk can be lowered by having good hygiene and proper maintenance of the lens.
b. Limitation in prescription range: in the range of +2.00 to -6.00 with no more than -1.75 diopters of surface astigmatism. Ortho-K may not be as effective in children with high levels of myopia. There are some optometrists claimed they are able to correct up to -10 diopters which I am not comfortable. Clinical trial of using ortho-K in children with high levels of myopia is ongoing (click here if you want more information about partial correction of high myopia with ortho-K lenses).
c. Compliance Issues: Ortho-K requires strict adherence to wearing schedules and proper lens care. Children who are unable to comply with these requirements may not achieve the desired myopia control.
Conclusion. After conducting thorough research and consulting with an eye specialist, my options for controlling my child's myopia were limited. Considering all relevant information, it was determined that Myosmart lenses were the most suitable choice for my child's condition. Although I regret not being presented with this option earlier, I now understand the importance of seeking second opinions and early intervention. To other parents facing a similar situation, I highly advise seeking suitable myopia control treatments at an early stage and obtaining second opinions if necessary. Early intervention can make a significant difference in managing myopia progression and ensuring the best possible visual health for our children in the long term. Regular follow-ups with eye care professionals will help monitor the effectiveness of the chosen treatment and make any adjustments as needed.
Adding in more info recently found (Updated Aug 2023):
Soft lenses.
a. MiSight® 1 day - Child-friendly daily disposable contact lenses proven to slow the progression of short-sightedness in children. MiSight® 1 day with ActivControl® Technology not only correct short-sightedness – they’re also the first soft contact lenses proven to significantly reduce the progression of myopia in children. Prescription available in the range of +2.00 to -6.00. It reduced myopia progression on average by 59% compared to a single vision contact lens.4
b. ACUVUE® Abiliti™ 1-Day - A new myopia control soft contact lens released by Johnson&Johnson. Instead of using a traditional concentric ring presbyopic lens design, it is designed with novel ring focus technology to slow down myopia progression in children.5 Prescription available in the range of -0.75D and -4.50D and 1.00D or less astigmatism.
Reference:
1. Lam CSY, Tang WC, Zhang A, Tse D, To CH. Myopia control in children wearing DIMS spectacle lens: 6 years results. The Association for Research in Vision and Ophthalmology (ARVO) 2022 Annual Meeting, May 1-4, Denver, US
2. Li X, Huang Y, Yin Z, Liu C, Zhang S, Yang A, Drobe B, Chen H, Bao J. Myopia Control Efficacy of Spectacle Lenses with Aspherical Lenslets: Results of a 3-year Follow-up Study. Am J Ophthalmol. 2023 Apr 9: S0002-9394(23)00147-2.
3. Jakobsen TM & Møller F. Control of Myopia Using Orthokeratology Lenses in Scandinavian Children Aged 6 to 12 Years. Eighteen-Month Data from the Danish Randomized Study: Clinical study Of Near-sightedness; Treatment with Orthokeratology Lenses (CONTROL study). Acta Ophthalmol. 2022 Mar;100(2):175-182
4. Sulley A, et al. Wearer experience and subjective responses with dual focus compared to spherical, single vision soft contact lenses in children during a 3-year clinical trial. Poster presented at AAO 2019, San Francisco, Calif.
5. www.clinicaltrials.gov is a website maintained by the NIH. The 4 clinical studies evaluated subjective comfort as a primary or secondary endpoint for ACUVUE® OASYS Brand daily disposable family. Review conducted as of April 25, 2021.
JJV Data on file, 2021. Development of Optical Design of ACUVUE® Abiliti™ 1-Day Soft Therapeutic Lenses for Myopia Management.
JJV Data on file 2021. Stand-alone Performance Claims; ACUVUE® Abiliti™ 1-Day Soft Therapeutic Lenses for Myopia Management.
JJV Data on File 2021. Mechanical Design of ACUVUE® Abiliti™ 1-Day Soft Therapeutic Lenses for Myopia Management- Effect on Fit and Handling.
JJV Data on file, 2021. Efficacy of ACUVUE® Abiliti™ 1-Day Soft Therapeutic Lenses for Myopia Management: Comparative Claims vs. Single Vision and Dual Focus Lenses.
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