Myopia Management

Understanding Myopia

What is Myopia?

Myopia is a common eye condition. Its most frequent symptom is nearsightedness, or the inability to see objects at a distance. This occurs when the eye grows longer than the natural focus point provided by the eye’s lens.

What Causes Myopia?

Myopia is on the rise in both frequency and severity. In the 1970’s, 25% of Americans were myopic. In the 2010’s, the percentage had grown to 42%. By 2050, it is projected that 58% of Americans will be myopic.

This escalation is linked to two factors:
Genetics – Kids with one or two myopic parents are more likely to be myopic.

Lifestyle – Spending more time on activities like reading or using digital devices instead of spending time outdoors increases the likelihood of becoming myopic.

What can be done about it?

Over the last decade, there has been a tremendous amount of research on ways to prevent or limit the march of myopia for children as they grow. This research has led to several clinically backed methods of myopia management:

Go Outside!
The research clearly shows that children who spend a minimum of a 90 minutes per day playing outside are much less likely to become myopic. The reason for this is unknown, but the effect is profound. Drs. Scott & Staci strongly recommend that all kids (and adults too!) take advantage of this effect. However, once a child does become nearsighted, additional action is needed to prevent progression.

MiSight 1-Day Contact Lenses
The first and only contact lens FDA-approved to slow the progression of myopia in children 8-12 at initiation of treatment. MiSight lenses correct a child’s vision while preventing axial growth of the eye using a specific type of bifocal technology. On average, a child’s myopia progression can be reduced 59% with MiSight contact lenses. Drs. Scott & Staci consider this to be the best choice for most children with advancing myopia.

Low Dose Atropine
Daily use of this dilating drop can also prevent the eye from elongating, which is the source of myopia progression. This method may be used in cases where use of MiSight contact lenses is not feasible or desired. Side effects may include light sensitivity, near blur or fatigue, and dry mouth. Another method of vision correction, such as glasses or “regular” contact lenses, is still required.

Orthokeratology
Using Rigid Gas Permeable (Hard) contact lenses fit flat to hold the cornea in place (like a retainer) can also reduce myopia progression. Drs. Scott & Staci feel this method is less advantageous for several reasons and do not prescribe it. We are more than happy to assess your child’s candidacy for them and refer you to a practitioner who uses this method if you feel it is the best option for your child.

Ecenbarger Eye Care’s Response to this Crisis

Dr. Scott & Dr. Staci have a passion for helping children succeed. We have been early adopters for fitting children in contact lenses our whole careers. Contact lenses accommodate a more active lifestyle and children who wear contact lenses generally have a better quality of life than children wearing glasses, especially regarding athletics and appearance. Now, the MiSight lens can provide those benefits AND prevent myopia progression. This is critical for several factors. Of course, the lower the prescription, the more functional the child will be while uncorrected. This can be tremendously important for quality of life and safety in certain situations. What most parents do not realize is that the higher the prescription, the more risk for disease. It is estimated that for every diopter of myopia, the risk for ocular disease (especially glaucoma and retinal detachment) increases 40%. We have a short window of time to act because once that axial elongation of the eye has occurred, there is no going back.

So, we recommend every child be evaluated through the InfantSEE program between 6-12 months old. This comprehensive evaluation is provided at no cost. We establish the refractive baseline, check for normal development of muscle coordination, and perform a complete ocular health check. In most situations for a normal child, the next exams should be at 3 and 5 years old. After that, annual exams are recommended throughout school age. This allows us to chart refractive change. Most kids are born hyperopic (farsighted) and this decreases as they grow. If they pass plano (no refractive error) too soon, they start to become myopic. In that case, the sooner we can institute one of the myopia management measures, the more successful we will be. This is often around age 7 or 8, which is much younger than most parents begin to consider contact lenses for their children. Don’t worry! We have a lot of experience in teaching kids to insert, remove, and care for contact lenses properly. We usually find they are often much better at following our instructions than the parents!

As with all eye care topics, we strive to be your experts and advocates in the field. We are happy to discuss all concerns and further explain this complex topic. Please contact us for more information.

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What is Perfect Vision?

It’s generally assumed that “20/20” is perfect vision, but what does this mean?

Visual acuity is the term used to describe the sharpness of your vision. When doctors do a visual acuity test, they have you view something (usually the Snellen eye chart of letters) from a standard distance and tell them what you see.

One of the lines on the typical eye chart has letters that are a size which has been deemed “20/20 visual acuity,” meaning that at 20 feet, most people can accurately read those characters. This is the standard, so at 20 feet, you read them as well as someone at 20 feet should be able to. It is possible for some people to read smaller letters that fall on lines below. This would be 20/15 or 20/10 visual acuity, meaning at 20 feet, you read letters that most people can only read at 10 or 15 feet. Great!

For people who have less visual acuity, they may be 20/40 or 20/60. The largest letter on the chart (an E on most Snellen charts) corresponds to 20/200 vision. If someone cannot distinguish that letter without assistance, they are considered legally blind.

Did you know the 20-foot measurement isn’t used everywhere? In some countries, they use 6 meters as the standard viewing distance.

Visual acuity of 20/20 is considered “perfect vision” because no aids are required to see better, but people can have better than 20/20 vision. Many young people are able to see letters smaller than the general “20/20” size. Even people who know that they see 20/20 or better, but feel that other aspects of their vision are lacking have options for improvement.

Some people who can pass a visual acuity test sufficiently may still have what we refer to as “high-order aberrations.” Low-order aberrations are familiar to most people as nearsightedness, farsightedness, and astigmatism, but high-order aberrations are less well-known. The eye doctor may find that you have coma, spherical aberration, or trefoil. These can produce symptoms including bad night vision, double vision, starbursts or halos, glare, or blurring.

Options exist for people with high-order aberrations who would like sharper vision. Gas permeable (GP) contact lenses are rigid lenses that may improve your vision better than glasses or soft contacts can. There are also laser vision correction surgeries that can address some eye irregularities leading to various types of eyesight problems.

Of course, if you want to know your visual acuity, a comprehensive eye exam is the best way to assess your vision. You can speak to the doctor about how well you’re seeing now, and what options are available to help you get 20/20 vision!