Cases of childhood myopia, or nearsightedness, are on the rise. About 42% of Americans now have myopia.
This condition develops when the eyeball grows too long or when the cornea has an odd shape, known as astigmatism. Light rays aren’t able to focus directly on the retina’s surface, so distant scenes like classroom whiteboards appear blurry.
Single-vision lenses — eyeglasses with a single prescription across the entire lens — can restore far vision. But they can’t stall the progression of myopia. That’s unfortunate because myopia can eventually lead to more serious eye problems such as early cataracts, macular degeneration, glaucoma and retinal detachment. And there's another drawback to these lenses: They must be replaced often. Most children swap out their glasses for increasingly stronger prescriptions until they reach their early 20s. That’s the age when myopia usually stops progressing.
Four potential alternatives to glasses aim to restore vision while also preventing the eye from growing too long as the child ages. These options, in no particular order — low-dose atropine drops, MiSight contact lenses, multifocal contact lenses and orthokeratology — could potentially go a long way towards protecting a child’s vision for life. Here are the pros and cons of these potential myopia treatments.
Atropine is an FDA-approved treatment for lazy eye, but doctors can prescribe it “off label” for an unapproved condition such as myopia when they think it might help.
Clinical trials have explored whether low-dose atropine eye drops can slow myopia progression. But the results have been mixed. A clinical trial of children in the United States found that low-dose (0.01%) atropine eye drops were not effective. A larger trial of children in Europe and North America found that 0.01% atropine drops were slightly helpful, but 0.02% drops were not. Two clinical trials in Asia have suggested that low-dose atropine drops do slow myopia progression, but a small clinical trial in Western Australia found no benefit. At this time, experts consider low-dose atropine a reasonable treatment for myopia. But research is ongoing to determine the most effective concentration of the drug.
Low-dose atropine drops need to be used every day for years to continue curbing the progression of myopia; otherwise, the condition can come back. Eyedrops don’t carry the same risk of infection as contact lenses, but they do have some drawbacks. The drops must be prepared by compounding pharmacies and can cause blurred vision, light sensitivity, enlarged pupils and itchiness.
MiSight lenses are the first FDA-approved contact lenses for controlling myopia progression in children. These soft, disposable lenses can be prescribed to children as young as 8 years old. The lenses are worn during the day and discarded at night.
MiSight lenses have concentric rings to redirect how light hits the retina, which tricks the eye into not growing too long. The lenses can restore far vision, but they can’t reshape the cornea to fix astigmatism.
To get the full benefit, children must wear their MiSight lenses six days a week, for 10 hours a day, until they are teenagers. The lenses are hard to handle, though, and young children with small eyes can sometimes find it difficult to insert and remove them.
Like all contact lenses, MiSight lenses pose a risk for infection. Good contact lens hygiene can lower this risk.
Multifocal contact lenses
Multifocal soft contact lenses combine multiple prescriptions into a single lens to improve near, intermediate and distance vision.
Researchers have found that multifocal lenses with a so-called “center-distance design” can also help slow myopia progression. When these lenses are worn for at least five hours a day, over a period of years, they may slow the elongation of the eye.
Like MiSight, these lenses carry a small risk of corneal infection.
Like orthodontics for your eyes, orthokeratology — dubbed “ortho-k” — uses a series of custom-fitted hard contact lenses to temporarily reshape a child’s cornea. This corrects myopia when it’s caused by astigmatism.
When the lenses are worn nightly, children with myopia can see clearly the next day without needing glasses or contacts. But when a child stops using the lenses, their cornea goes back to its original shape and myopia returns.
Multiple studies suggest that Ortho-K lenses may also slow the eye’s growth. That’s why they are frequently prescribed off-label for pausing myopia’s progression. Larger clinical trials are underway to gain FDA approval for this use.
There are some drawbacks to ortho-k. Some children have trouble adjusting to the hard lenses because they can seem uncomfortable at first. Also, wearing any lenses overnight carries a much higher risk than daytime wear of an infection called infectious keratitis, which can cause blindness. Since the lenses are reused, they require thorough cleaning and extra hygiene steps compared with disposable lenses.
Choosing the right treatment
Your ophthalmologist or optometrist will evaluate your child’s vision and help you choose the right treatment for your child.
Treatment options will depend on a number of factors including safety concerns, such as the increased risk of infections with Ortho-K, prescription level, eye sensitivity, personal compliance, hygiene, lifestyle and cost. Ortho-K and MiSight are the most expensive choices, costing between $1,000 to $4,000 per year. Low-dose atropine drops and multifocal contacts cost less than $1,000 for the entire duration of treatment.
In some cases, doctors may combine lenses and drops to enhance the efficacy of treatment.
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