Myopia and Myopia Control Q & A
Super Vision Center
Myopia is the most common refractive eye issue in the world estimated at 1.5 – 1.6 billion people worldwide. Historically Myopia has been referred to as a refractive error but even low amounts increase the risk of serious eye disorders such as retinal detachment, cataract, myopic maculopathy and glaucoma. High myopia is now rapidly becoming the major cause of blindness in some Asian countries. Pathological myopia is considered to be a refractive error greater than 6 diopters and an axial length greater than 26 mm.
The good news is that nowadays, with current technologies, we can treat myopia and slow down or halt its progression. That is referred to as “myopia control (MC).”
The International Academy of Orthokeratology and Myopia Control (IAOMC), of which Dr. Berke is a fellow and lecturer, is an organization dedicated to scientific research and education worldwide. They hold annual conferences with world renowned speakers. We Want To Control Myopia Not Just Manage It.
Prior to your next appointment with Dr. Berke at Super Vision Center in Santa Ana, watch these following videos to learn more about myopia and myopia control and what can be done to stop or slow down the progression.
What is Myopia and its Dangers?
Myopia is a refractive error in your eyeball. When you look at near objects they are clear but distant objects are not in focus and are blurry.
Here is a really cool Vision Simulator to show you what vision looks like when you are myopic to various degrees:
Myopia has become one of the major health issues on the planet. Myopia is now considered as a disease.
In fact, the Centers for Disease Control (CDC) now views progressive myopia as an epidemic disease affecting 1.6 billion children and adults worldwide with expectations that the number will hit 2.5 billion by 2020. 50% of the world’s population will be myopic by 2050. It’s an epidemic. It has gone up 75% in the U.S. since the 1970’s and at current rates there are 400,000 new myopic cases in America per year! Increasing Myopia not only causes blurrier and blurrier distance vision but more importantly it can significantly increase the odds of developing sight threatening conditions like:
Retinal Holes, Tears and Detachments
Here is a table of the risk factor for myopic pathologies depending on the degree of myopia:
For further information see: www.brienholdenvision.org.
The Complications of Myopia – IOVS Meta Analysis 2020
Extensive research has shown that ortho-K can slow the progression of myopia reducing the risk of retinal detachment, cataract, myopic maculopathy and glaucoma as well as the social issues associated with wearing thick, heavy glasses. Ironically, the image focused by glasses and conventional soft lenses may actually contribute to the axial length growth of the eye, increasing myopia. For more information go to: www.orthokacademy.com.
What is the Cause of Myopia?
The causes of myopia is both genetic and environmental/behavioral the latter of which accounts for probably 90%, and is blamed on close range activities such as reading and the extended use of modern day high-tech devices, ie computers, smart phones, tablets and gaming devices. See: D.I. Flitcroft. (2012) The complex interactions of retinal, optical and environmental factors in myopia aetiology. (ABSTRACT)
Early onset of myopia (ages 5 and beyond) notoriously indicates the most rapid increase and is associated with life time eye care and interference with education and normal learning.
Distance vision is blurry because your eyeball is typically too long in measurement from the front to back and the image falling on the retina is not in focus. Uncommonly you could have myopia because your eye’s cornea or lens is too curved. Some people have a combination of these issues that result in their myopia. Other symptoms may include having headaches caused by eye strain as you try to focus on objects in the distance. Near vision is usually great without correction. The landmark study by Earl L. Smith III, OD, showed that peripheral retinal defocus was the cause of myopia progression and that OrthoK lenses bring the peripheral focus back to the plane of the retina thus breaking the feedback loop that tells the eye to stop elongating and stops the myopia progression. Listen to Dr. Earl Smith, OD, PhD as he explains the relationship between refractive error and eye growth: Dr. Earl Smith
Here’s an amazing graphic (MRI) of what selective eye elongation looks like.
Myopia control (MC) – a cure for nearsightedness?
Why should you be interested in myopia control? Because stopping or slowing the progression of myopia may keep your child from developing high levels of nearsightedness that require thick, corrective eyeglasses and have been associated with serious eye problems later in life, such as (with -3.00 Diopters (D) of myopia): cataracts (3X RISK compared to no myopia), glaucoma (4X RISK), maculopathy (9X RISK) or retinal detachment. (10X RISK). Controlling myopia progression by 1 D reduces the risk of myopic maculopathy by 40-67% and the risk of open-angle glaucoma by 20%.
Once -5.00D is reached the risks are: cataracts 5X; myopic maculopathy 40X; retinal detachment 22X.
How can I help my child prevent myopia? Currently, four types of treatments are showing promise for controlling myopia:
- Orthokeratology (“ortho-k”) – Optical
- Atropine eye drops – Pharmaceutical
- Multifocal contact lenses – Optical
- Spending time outdoors especially doing athletic things like playing tennis or volleyball or anything that requires physical action and peripheral vision judgements. And, limiting time on central fixation with electronic devices.
Ortho-K is the gold standard for MC. Evidence suggests nearsighted kids who undergo orthokeratology end up with as much as 85% less myopia compared to children who wear eyeglasses or regular contact lenses during the peak years for myopia progression.
Atropine eye drops have been used for myopia control for many years, with effective results but has significant drawbacks. Three landmark studies, referenced below, ATOM, ATOM2 and the LAMP studies, basically point out the safety and efficacy of various doses. Atropine and ortho-k can be combined very effectively when needed in extreme cases. What is the mechanism of action of atropine in controlling myopia? Read this most recent publication.
Multifocal Contact Lenses afford a similar optical effect as ortho-k but not as precise in controlling myopia and must be worn at all times of waking hours.
INFORMATION & RESOURCES
- BREAKING PRESS RELEASE 11/15/19
The U.S. Food and Drug Administration (FDA) approved the MiSight® 1 day contact lens, indicated to slow the progression of myopia (nearsightedness or short-sightedness) when initially prescribed for children 8-12 years old. See the FDA release.
See 3-year Clinical Study on MiSight®.
“MiSight® is a revolutionary product that can make a meaningful difference in the lives of children needing visual correction.” “Today’s approval is a big step forward for the ophthalmic industry as eye care professionals finally have an approved treatment for slowing the progression of myopia rather than just providing glasses or contact lenses to mask the condition. The increased incidence of myopia is a global epidemic so it’s exciting to see an FDA approved product which can now become the standard-of-care within the ophthalmic industry to treat this crisis.” MiSight® lenses are expected to be available in the U.S. beginning in March of 2020.
Short video on MiSight® that discusses Myopia, what it is; what causes it; how it affects your child; and how to treat it: https://player.vimeo.com/video/398605852
MiSight® has also produced a video interviewing several kids about their experiences with MiSight® Contact Lenses: https://vimeo.com/438868498
- NEWS RELEASE 5/27/20.
Dr. Berke has just successfully completed a professional training workshop and is now certified to prescribe the new CooperVision MiSight® daily wear Myopia Control Contact Lens described above. Dr. Berke is one of the first optometrists to gain certification in Orange County.
- A fantastic paper on the causes and treatments for myopia written by Bruce H. Koffler, MD covers the subject thoroughly. See: “The Case For Myopia Control Now.“ And also view a live interview with Dr. Koffler, MD.
- An excellent article on the current state of Ortho-K and its effectiveness on myopia control is: “Orthokeratology: An Update”
- An awesome review paper (with 257 references) for you to read if you are so inclined is about the etiology and treatment of myopia: “A Review of Current Concepts of the Etiology and Treatment of Myopia”
- The Role of Orthokeratology in Myopia Control: A Review
Michael J. Lipson, O.D., F.A.A.O., F.S.L.S., Moya M. Brooks, M.D., and Bruce H. Koffler, M.D.
- Outstanding book on “Contemporary OrthoKeratology”.
Michael J. Lipson, OD, FAAO, FSLS, Clinical Associate Professor, Ophthalmology and Visual Sciences
University of Michigan’s Kellogg Eye Center.
- Comprehensive review of: Prevention and Management of Myopia and Myopic Pathology.
- Compendium of articles regarding OrthoK to gain insights into the issue of myopia development by comparing many different original research articles.
- Myopia Control in 2019 – Peer Review Literature.
- Calculate the risk factor for your child’s myopia: https://globalmyopiacentre.org/calculator/
1% atropine usage yields 80% less refractive error and 100% axial length control.
0.5%, 0.1%, 0.01% atropine usage was studied. Myopia rebound effect was shown when treatment stopped with the higher doses and poor axial length control with 0.01%.
Combined ATOM 1&2 results and showed 0.05% atropine most effective in controlling refractive error and axial elongation.
- https://www.myopiainstitute.org/ and MUST READ booklet: International Myopia Institute’s: IMI White Papers on latest research.
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