Myopia in children: Expert advice and new advances in vision care

MYOPIA, commonly referred to as nearsightedness, is a significant and growing concern in pediatric eye health. This refractive error, characterized by the inability to see distant objects clearly, has seen a dramatic increase in prevalence among children worldwide. As their eyes develop, many children experience a progression of myopia, which can lead to serious long-term complications such as retinal detachment, glaucoma, and myopic maculopathy.

In this article, we will delve into the impact of myopia on children's vision and overall well-being. We will also examine the latest advancements in myopia control interventions, drawing insights from leading experts in the field.

Professor Nicola Logan, Professor of Optometry and Director of Research for Optometry and Vision Science Research Group, School of Optometry, Aston University, Birmingham, UK; Tan Thok Chuan, an optometrist and Director at TC Tan Optometrist and Tan & Ho Child Clinic; along with Elizabeth Lumb, Director of Global Professional Affairs for Myopia Management at CooperVision, provides valuable perspectives on the causes, risk factors, and strategies for managing myopia in children. Leveraging their expertise, we aim to shed light on this pressing public health issue and explore effective measures to mitigate its impact on future generations.

Insights from Professor Nicola Logan on the progression of myopia in children

1. How does myopia affect children’s overall vision and eye health, and what are the long-

term implications of this condition for their daily lives?

Myopia can significantly impact children’s vision and overall eye health. As myopia progresses, it increases the likelihood of developing severe eye conditions such as retinal detachment, glaucoma, and myopic maculopathy later in life. Even a modest increase of 1.00 diopter in myopia can elevate the risk of myopic maculopathy by 67%.

For children, high myopia can affect daily activities, including school performance and participation in sports, due to dependence on corrective lenses and potential vision limitations. As they age, high myopia can lead to more pronounced visual impairment and an increased risk of complications that might hinder daily tasks. Early and effective management of myopia is crucial in reducing the risk of these complications, thereby enhancing eye health in the long-term and improving quality of life as they transition into adulthood.

At what age is myopia typically diagnosed in children, and how does its progression

usually unfold as they grow?

Myopia is often first diagnosed in children between the ages of 6 and 12, with its progression commonly occurring during the school years as the child’s eyes continue to grow. Early signs of myopia may appear as children begin to struggle with distance vision, such as difficulty seeing the board at school or problems during sports activities.

The progression of myopia can vary, but it often worsens as children grow. In Asia, the myopia epidemic is particularly severe, with prevalence rates reaching up to 80 – 90% among young adults. As myopia progresses, it can lead to more severe forms, such as high myopia, which increases the risk of significant eye health issues later in life, including retinal detachment, glaucoma, and myopic maculopathy.

Managing myopia effectively from an early age is critical to slowing its progression and preventing severe complications. Early intervention strategies, such as specialized lenses and behavioral adjustments, can help control the rate of disease progression and mitigate the risks associated with high myopia.

Can you elaborate on your recent clinical studies and research findings on myopia

progression and interventions for children?

Recent clinical studies have provided valuable insights into myopia control. For example, a seven-year multicenter clinical trial, in which I participated, demonstrated that early intervention with dual-focus soft contact lenses slowed the progression of myopia by half in children.

The study showed that children who started treatment between the ages of 8 and 12 experienced more substantial reductions in myopia progression compared to those who began treatment later, although children starting treatment at an older age also had beneficial slowing of myopia progression. This research underscores the importance of early intervention and the potential benefits of extending treatment into the teenage years.

Additionally, I conducted a separate study on the long-term impact of daily disposable hydrogel soft contact lens wear on the central corneal endothelium in children. After 10 years of full-time wear, it was determined that when compared to an age-matched group of non-contact lens wearers, long-term, full-time wear of daily disposable contact lenses had no impact on the corneal endothelium. This highlights the safety of daily disposable, hydrogel, dual-focus contact lenses, providing reassurance for their use in managing myopia progression in children.

Perspectives from Mr. Tan Thok Chuan on myopia in Malaysia

1. How have myopia control soft contact lenses helped children in your practice manage

and slow the progression of myopia?

Myopia control soft contact lenses have proven to be effective in slowing down the progression of myopia among children. By mitigating the elongation of the eyeball, these lenses help reduce the risk of developing high myopia-related complications, such as myopic macular degeneration and glaucoma, in the future. Additionally, they allow children to engage in outdoor activities with greater freedom, which can be particularly beneficial for their overall quality of life and development.

We’ve worked with several young patients who have benefited from myopia control soft

contact lenses. For example, we have a 10-year-old boy who had been wearing normal

glasses for 2 years, but his prescription kept increasing. I proposed myopia control soft

contact lenses to both the parents and the patient. They were convinced after I explained the

benefits and the risks associated with high myopia. After 19 months of wearing the lenses, his

myopia and eyeball elongation are under control. One bonus is that the boy can now enjoy

basketball with his contact lenses.

What are the main challenges and opportunities in managing myopia among children

in Malaysia?

The main challenges in managing myopia among children in Malaysia include:

a) Lack of Information: Many parents are not adequately informed or educated about the

benefits and importance of myopia management.

b) Public Misconceptions: There is a prevalent misconception that contact lenses are unsafe

or unsuitable for children, which can deter parents from considering this option.

c) Reluctance Among ECPs: Some eye care practitioners are hesitant to promote myopia

control soft contact lenses due to concerns about longer chair time and higher costs,

which can affect the adoption of these effective treatments.

We have encountered several cases where parents initially held misconceptions about

myopia management with soft contact lenses. For instance, one parent initially refused to

allow his daughter to wear contact lenses, fearing they might cause eye infections and

complications. After I clarified that most problems arise from improper use of monthly

replacement lenses, which require daily cleaning and disinfecting, he changed his mind. His

daughter started using myopia control soft contact lenses, and with our continued education

and support, we effectively addressed these concerns. This approach has helped many

parents overcome their initial skepticism and embrace myopia management solutions for their

children.

How have myopia control soft contact lenses helped children in your practice manage

and slow the progression of myopia?

Myopia control soft contact lenses have been gaining popularity and acceptance among both

parents and children as awareness grows about the dangers associated with high myopia.

These lenses not only help slow myopia progression but also offer improved comfort and convenience compared to conventional contact lenses, contributing to better adherence and

overall management of the condition.

Insights from Elizabeth Lumb on understanding interventions for myopia control

1. How do myopia control soft contact lenses work compared to traditional single-vision

glasses in managing myopia progression in children?

Myopia, or nearsightedness, causes distant objects to appear blurry because the eye is too long or the cornea is too curved. As children grow, their myopia often worsens, meaning a child with a small prescription may develop a high prescription by adulthood. While glasses correct vision and help children see clearly, such as the board in school, myopia-controlling contact lenses not only correct vision but also slow down the changes in prescription.

This helps ensure that a young myopic child won’t experience big changes in prescription between eye examinations and can maintain good vision at school. A myopic eye is effectively too long, and this places the eye’s delicate internal structures at risk of issues, such as retinal

detachment and myopic maculopathy which have the potential to be sight-threatening.

At what age should myopia control interventions be initiated, and how does the

effectiveness vary based on the age of the child?

Myopia control interventions should be initiated as soon as a child is diagnosed with myopia. Since children diagnosed at a young age have a longer path of myopia progression ahead of

them, it’s crucial to start treatment early. This has been demonstrated in a 7-year study—the

longest of its kind on soft contact lens interventions for myopia—which showed that children

who began treatment at a younger age experienced more significant reductions in myopia

progression compared to those who started at a later age.

Given that any amount of slowing provides a significant reduction in the risk of myopia-related

eye health problems, older children can also benefit from myopia control interventions. While

it’s important to start treatment as soon as myopia is diagnosed, it’s never too late to begin.

What are the key benefits of using myopia control soft contact lenses over other

myopia management treatment modalities?

Myopia control soft contact lenses offer several advantages over other treatment modalities.

Once a child puts in their contact lenses in the morning, they stay in place all day. This

consistent wear is crucial, as optimal myopia control depends on full-time wear as

recommended by the manufacturer. In contrast, children using myopia-controlling glasses,

especially younger ones with low levels of myopia, might be tempted to remove them and

forget to put them back on. Studies with spectacle lenses emphasize the importance of

wearing glasses for at least 12 hours a day, which can be challenging due to children’s active

lifestyles.

Myopia-controlling soft contact lenses are available in a daily disposable modality, providing a

fresh lens each day with no need for cleaning solutions—an ideal feature for children. Overall,

these lenses offer a user-friendly approach that integrates well with children’s dynamic

activities and daily schedules, making them a valuable option for managing myopia

progression.

By understanding the complexities of myopia progression and the potential long-term implications, we

can empower parents, eye care professionals, and policymakers to prioritize eye health. Myopia

control soft contact lenses have emerged as a promising solution, offering significant benefits in

slowing the progression of the condition.

Early detection and appropriate management are key to safeguarding children's vision. It is

encouraged that parents schedule regular eye exams for their children and consult with an eye care

professional to discuss myopia control options. Together, we can protect the vision of future

generations.