Myopia

The eye is too curved (or too big) to focus distant objects on the retina clearly

Sometimes called being near-sighted, meaning that your vision up close is better than your vision far away

Patients usually first notice problems with far away vision during childhood years at school, sometimes problems begin in young adulthood

We can correct this with eyeglasses, contact lenses or vision (refractive) surgery (for adults) 

American Optometric Association: https://www.aoa.org/healthy-eyes/eye-and-vision-conditions/myopia

Cleveland Clinic: https://my.clevelandclinic.org/health/diseases/8579-myopia-nearsightedness

EyeWiki (American Academy of Ophthalmology): https://eyewiki.org/Myopia

Control of myopia

These are treatments designed to not only allow a person to see clearly far away, but also slow down how much the degree of myopia increases from year to year

Some stats

If a parent has myopia, there is some evidence that we can prevent myopia from developing in children by having the children play outside for 2 hours a day

Maybe looking far away helps to prevent the development of myopia

In children who already have myopia, outdoor activity does not seem to change how much the myopia increases from one year to the next

We expect the eye to grow larger and the myopia to increase in magnitude each year until around 20 years old when most eyes tend to stabilize

There is some evidence that focusing your eyes on close up work constantly for over 45 minutes as well as focusing closer than 8 inches can cause your myopia to increase

Some children have very large increases in myopia each year, setting them on the path to end up with a very high myopia

High myopia carries a higher than normal risk of damage to the health of the eye, increasing risk of 

Retinal detachment (devastating permanent loss of vision) by 6X

Glaucoma (damage to the optic nerve leading to permanent peripheral vision loss) by 50%

Posterior subcapsular cataracts by 5X

What can we do to slow the increase of myopia?

Measure a new eyeglass prescription once a year and update the eyeglasses to get the clearest distance vision possible

Using old eyeglasses, which do not allow clear distance vision, has been shown to increase the rate of myopia change

For more proactive treatment we can do one of four evidence based treatments (only two are FDA approved)

Special eyeglass (spectacle) lenses

This is a new option which gained FDA approval for the treatment of increasing myopia (Essilor Stellest) in Sep 2025

Other lens companies are currently moving through the clinical study phase (Zeiss Myocare) while other companies are in the pre-approval phase (Hoya MiYOSMART)

This is my favorite option because kids just wear the glasses, no special drops or routines beyond that

As with any new product through the FDA approval process, the cost is going to be more, but many insurance plans are starting to cover these specialty spectacle lenses

Orthokeratology

Ortho-K uses a custom hard contact lens to flatten the cornea while you sleep

When you wake up, you remove the contact lens and you can see clearly for a day or so

The range of prescription able to use ortho-K (+2.00 to -6.00, and up to 1.75 astigmatism)

The fitting of these types of lenses can be cost prohibitive and my office does not currently offer this service

This treatment has been shown to decrease the rate at which myopia increases

Multifocal soft contact lens wear

This works about as well as ortho-K

Only one brand of multifocal soft contact lens has been FDA approved for the treatment of increasing myopia (MiSight)

The multifocal contact lenses will not be as clear for far away vision as regular contact lenses

Atropine drops

These can be prescribed in low concentrations and ordered from a compounding pharmacy (OSRX Pharmaceuticals)

These drops have been shown to slow down the rate of change of myopia in some studies, but not others (and another)

The drops are typically put into the eye each night, before bedtime

Eyeglasses still need to be worn and kept updated with clear vision

What these treatments aim to do

The goal with myopia control therapies is to slow down the increase in myopia from year to year

It is not expected to stop the increase in myopia

From my experience, the average amout of change per year is 0.50 DS

Anything less than that would be considered a success