Why have I never heard about myopia control?

Myopia control is a more recent approach to a young, progressing myopic patient.

In years past, the only treatment offered to a progressing myope was to prescribe stronger glasses or contact lenses to allow them to see well, and the eye was allowed to progress until it plateaued once growth was complete, typically in the mid to late teen years.

The past decade has seen an abundance of research, studies and treatment options emerge that are effective and evidence based. Two of the current mainstays of treatment, low-dose atropine and orthokeratology, have long been observed to have beneficial effects in slowing progression.

The commercially available strength of Atropine (1%) had been observed since the 1970’s to slow the progression of myopia. However, it was not widely adopted by clinicians due to side effects experienced by patients - light sensitivity due to pupil dilation and loss of ability to focus at near - which greatly impacted a child’s ability to function.

It was not until ~2015 and the ATOM 1 study that lower doses of Atropine were discovered to be beneficial in slowing progression of myopia. Currently 0.02%-0.05% Atropine drops, used once per day, is a common starting point for treatment with minimal side effects.

A second treatment option that has been observed for many years to be beneficial is orthokeratology. Orthokeratology (latin: ortho - straighten, kerato - cornea) was first described in the 1960’s. However, in the early days of orthokeratology, inconsistent results due to variability in the fit and effect of lenses and poor breathability of lens materials resulted in minimal use.

From the 1980’s onwards such innovations as improved lens design, highly breathable lens materials, consistent lens production and highly accurate corneal measuring devices has allowed orthokeratology to quickly achieve excellent vision and has resulted in increased use by practitioners.

Early use of orthokeratology was aimed at correcting the vision of adults, but it was noted by doctors that children using the overnight lenses had slower rates of progression. The first study that demonstrated this slowing of progression was in 2005 and many peer-reviewed studies have followed demonstrating the myopia controlling effect.

This relatively longer history of use in myopia control and the added benefit of not requiring day-time glasses or contact lenses makes orthokeratology a popular choice for myopia control.

In the last ~10 years there has been an abundance of research and development into myopia treatment options. We have been fortunate in the last 3 years to have had two treatment options enter the Canadian market, the CooperVision MiSight daily contact lens and the Hoya MiyoSmart spectacle lens.

Both of these myopia controlling options were developed specifically for slowing the progression of myopia and involve treatment options more familiar to most parents - a daily contact lens and glasses.

Having multiple effective, evidence-based treatment options has allowed practitioners to confidently prescribe myopia control options and tailor a treatment approach to each child’s individual lifestyle. More treatment options involving pharmaceuticals, glasses and contact lenses are currently in development and the future of myopia control is very promising!

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