Myopia management encompasses a range of strategies aimed at controlling the progression of nearsightedness, a common vision problem affecting millions worldwide. With an increasing prevalence particularly in younger populations, effective myopia management approaches have become crucial in minimizing its impact on vision and overall eye health. Proactive and early detection with tailored intervention plans is crucial in addressing this growing health concern.
We currently have several effective strategies for myopia management. Lifestyle modifications and proper spectacles are the first line of defense and are often the easiest to implement. In addition, low-dose atropine eye drop therapy has been shown to reduce the rate of myopia progression. Perhaps the most effective and popular form of myopia management is orthokeratology (aka “ortho-k”) which is a hard contact lens worn at night allowing the vision to be corrected the following day without contacts or glasses. Lastly, Mi-Sight daily disposable soft contact lenses became available in 2019 and are currently the only product that has been FDA-approved for myopia control.
To see which option is best suited for each patient, each patient is scheduled for a Myopia Management consultation with Dr Christine Choi. At this appointment, she will be able to assess which option(s) would be suitable for the patient. The consultation is $100 and not billable to insurance. If patients proceed with a Myopia Management service, this $100 fee will be applied to this service fee.
Atropine eye drops
Studies have shown that low-concentration topical atropine is effective in slowing the rate of progression of nearsightedness in children. Atropine remains an off-label treatment for myopia management, which means the medication is being used in a manner not specified by the FDA. A doctor may legally prescribe a drug for off-label use at their discretion if medically appropriate for their patient.
Instructions for Atropine are 1 drop into each eye nightly before bedtime. During the Atropine therapy program, side effects may include (but are not limited to): blurry vision at near, sensitivity to light, pupil dilation, stinging, and burning.
Orthokeratology (AKA Ortho-K)
Orthokeratology, also known as Ortho-K, is a custom-fit rigid gas permeable lens that is worn at night to gently re-shape the cornea overnight. The result is fully corrected vision during the day without contact lenses or spectacles. There is evidence to show that Ortho-K can reduce the rate of progression of nearsightedness.
Ortho-k is a great option for those patients who do not wish to wear contact lenses during the daytime and is an ideal option for athletes. Ortho-k does have a small risk of infection but the risk can be mitigated by proper hygiene and cleaning techniques.
MiSight 1-day contact lenses
MiSight 1-day contact lenses are the first product to be FDA-approved for myopia control in 2019 and are indicated in children ages 8 to 12. MiSight lenses are soft, daily disposable lenses that are worn during the day. They are very comfortable and well-tolerated by children. The daily replacement of contact lenses eliminates the need to clean lenses daily and reduces the risk of eye infection.
Multifocal soft contact lenses
Multifocal contact lenses have added “reading” power and is traditionally used by an adult who has presbyopia (low focusing power due to the hardening of the lens). There’s evidence to show that certain multifocal contact lenses can slow down the progression of nearsightedness. Multifocal contact lenses are typically replaced every 2-4 weeks and as such do require daily cleaning and maintenance.
Bifocal/Progressive spectacles
Bifocal and/or progressive spectacles have reading power and are typically used by a more mature adult with presbyopia (focus deficiency due to hardening of the lens). Bifocals and/or progressive spectacles have been shown, in some cases, to slow the rate of progression of myopia.
ATOM studies
The ATOM1 study (Atropine in the Treatment of Myopia) found that 1% topic atropine was effective at slowing the progression of nearsightedness and axial elongation. However, in this study, the patients experienced side effects such as blurry near vision, light sensitivity, and a higher chance of rebound upon discontinuation. This prompted researchers to do the ATOM2 study in which it was discovered that lower concentrations of atropine (specifically 0.01%) can have lower side effects while still controlling nearsightedness. The last study worth mentioning is the LAMP study (Low-Concentration Atropine for Myopia), the first randomized placebo-controlled study. In the LAMP study, we discovered that 0.05% atropine was the most efficacious of the different formulations that were studied.