VIDEO: Effective methods for myopia management

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We’ve suddenly started to think about ways that we could not just correct the blurry distance vision in children with myopia — we’ve been doing that for ages. That is, somebody could wear single-vision eyeglasses that clear their vision for distance. They could wear contact lenses that do the same thing, or when they’re older and eligible for it, they could have refractive surgery. But all of those things simply treat the symptoms of myopia, that is, distance blur, and they don’t treat the abnormal growth of the eye that is the underlying optical cause of myopia.

We know that that longer eyeball can lead to problems. When somebody’s as old as I am, they might start to develop retinal detachment or glaucoma or even myopic maculopathy. So they might even get profound visual impairment late in life because they’ve got this long eyeball. Myopia control or treatment, which of course has to be applied when the eye is growing in a child, to prevent something that might happen to somebody near the end of life, is an interesting therapeutic dilemma.

Options include multifocal contact lenses — that’s the only, in the U.S., FDA-approved method of treating myopia. It could include orthokeratology, where the child actually sleeps in a small, rigid lens overnight, and that both gives them distance vision that’s clear in the daytime and looks like it also limits that abnormal growth. There are peripheral defocus spectacle lenses that are just coming on the market. And then there’s also pharmaceutical treatment in the form of low dosages of a topical drop atropine, which has been approved for a long time in a higher dosage for use in children with amblyopia, but it’s got a lot of side effects at its higher dosage.

And so, what we’re seeing people do now is, they are using unapproved off-label, low-dose atropine that’s made by compounding pharmacies to try to slow the progression of myopia, and therefore end up with kids who have shorter eyeballs that are less prone to those long-term adverse outcomes.