Paediatric Assessment: All about Myopia Control

Do your children’s prescriptions (“eye power”) keep increasing, or do they need to change their glasses often? These could be signs of progressive myopia (short-sightedness), a condition that often worsens during childhood and can lead to serious complications like retinal detachment, maculopathy, and glaucoma if not managed. Early intervention is crucial in controlling its progression.

How Does Myopia Control Work?

It has been proven that reducing the elongation rate of the eyeball (axial length) can slow down myopia progression. Various treatment options are available:

  • Atropine eye drops: A low dose of atropine (0.01%) is used to relax the ciliary muscle in the eye and reduce the stimulus that elongates the eyeball. The drops are applied before bedtime.
  • Ortho-K lenses: Ortho-K lenses are worn overnight to reshape the cornea, providing clear daytime vision without glasses while helping to control myopia progression.
  • Myopia control glasses: These glasses create peripheral defocus, helping to slow down the elongation of the eyeball.

Young_boy_undergoing_an_eye_examination_with_a_trial_frame_conducted_by _an_eye_specialist_smiling confidently.

What is a Myopia Clinic?

A myopia clinic specializes in managing and monitoring myopia. Key services include:

  • Refraction: Your child’s prescription will be checked to update the current status of myopia.
  • Cycloplegic refraction: Also known as dilated refraction, this test uses eye drops to temporarily relax the eye muscles for a more accurate prescription reading.
  • Axial length measurements: Axial length refers to the length of the eyeball, and its measurement helps track the progression of myopia. For example, Aladdin, a non-invasive optical biometry device, is used in OasisEye Specialists to measure axial length. This allows us to compare the length of the eyeball from time to time to assess the effectiveness of myopia control treatments like orthokeratology, atropine eye drops, and myopia control lenses.

Optical_biometry_device_used_for_precise_axial_length_measurements_in _myopia_control_clinics.

Treatment recommendations: Based on these assessments, treatment options like atropine, Ortho-K, or myopia control glasses may be suggested. A separate fitting session is conducted for Ortho-K lenses to ensure proper fit.

When to Consider a Myopia Clinic Visit?

Consider visiting the myopia clinic if any of the following apply:

  • Myopia progresses by 0.50 D or more per year
  • Frequent changes in glasses or prescription within a year
  • Interested in exploring alternative treatments to control myopia progression

Lifestyle Modification for Myopia Control:

Lifestyle changes can significantly impact the progression of myopia, especially in children. Implementing these habits early can reduce the risk of developing high myopia.

  1. Increased Outdoor Time:
    • Spending at least 2 hours outdoors daily can reduce myopia onset and progression.
    • Sunlight exposure is believed to stimulate dopamine release in the retina, which may inhibit excessive eye growth.
  2. Reduced Screen Time and Near Work:
    • Prolonged near-work activities (e.g., reading, using smartphones, tablets, or computers) can strain the eyes and contribute to myopia progression.
    • The “20-20-20 Rule” can help: Every 20 minutes, take a 20-second break to look at something 20 feet away.
  3. Proper Lighting and Ergonomics:
    • Ensure adequate lighting while reading or working on screens to prevent eye strain.
    • Maintain a proper reading distance (at least 30-40 cm from books and screens).
  4. Encouraging Visual Breaks:
    • Encourage children to take regular breaks from screens and engage in physical activities.
    • Balancing indoor and outdoor activities can reduce the risk of eye strain and myopia progression.

Two_children_wearing_prescription_glasses_smiling_in_an_optometry_clinic_with _a_wide_range_of_eyewear_displayed_in_the_background.

Importance of Myopia Control:

Myopia control is essential for both eye health and quality of life. Uncontrolled myopia can lead to long-term complications and impact overall well-being.

Health Benefits:

  • Prevention of High Myopia: Slowing myopia progression can reduce the risk of developing high myopia (typically defined as -6.00D or worse).
  • Reduced Risk of Eye Diseases:
    • Retinal Detachment: High myopia can stretch the retina, making it thinner and prone to tears or detachment.
    • Myopic Maculopathy: Degenerative changes in the retina due to excessive eye elongation can lead to vision loss.
    • Glaucoma: Increased eye pressure in highly myopic eyes can raise the risk of optic nerve damage.
    • Cataracts: People with high myopia may develop cataracts earlier.

Before starting treatment, it is recommended to consult with a paediatric ophthalmologist. The myopia clinic is led by Dr. Sunder Ramasamy, Dr. Norhafizah Hamzah, Dr. Norazah Abdul Rahman, and the team of optometrists at OasisEye Specialists in Bangsar South (Kuala Lumpur). A consultation can guide you in managing your child’s myopia and recommend the most effective course of action.

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Excessive Blinking in Children

excessive_blinking
Why do we blink?

Blinking is a normal response that protects the eye from foreign body entering. It also helps to regulate tears which clean the surface of the eye. Eye blinking may also increase as a reaction to pain, intense light, fluctuations in temperature and humidity, and during conversations.

excessive_blinking
What causes excessive blinking in children?
 
Allergic conjunctivitis (eye allergy)

Your child may experience signs and symptoms of red, itchy or watery eyes accompanied with frequent eye rubbing, and he/she might blink more to relieve the itchiness. 

Epiblepharon (folded eyelid)

Epiblepharon is an eye condition in which there is a fold of eyelid. It causes the eyelashes to turn inward and irritate the eye, resulting in excessive blinking. 

Refractive error (need for glasses)

Your child may be blinking a lot as he/she is seeing blur. Common refractive errors include:

  • Myopia (short-sightedness)
  • Hyperopia (long-sightedness)
  • Astigmatism 
Strabismus (crossed eyes) 

Strabismus, also known as squint, or tropia, refers to the misalignment of the eye. Some children with intermittent exotropia (turning out of the eye) tend to blink more to correct their eyes straight.

Foreign body

A foreign body is an object on your eye that shouldn’t be there, such as dust, wood chips, pieces of metal or rust. It might cause corneal abrasion (scratch of the front surface of the eye) and triggers blinking.

Environment

Sometimes, changes in temperature or humidity will affect blinking rate. Forced blinking might also be triggered by bright lights. 

Habitual tics

Tics result from rapid and repetitive muscle movements. These movements could be triggered by stress, fatigue or boredom. In many cases, tics tend to improve without intervention, and often resolve within weeks or months.

What should I do?

If you think persistent or excessive blinking is troubling your child, you may need to consult an ophthalmologist who will assess and monitor your child’s vision and eye health. After the assessment, your ophthalmologist will advise you on how to manage the excessive blinking, depending on the cases. For example, eye drops may be prescribed if an abrasion or conjunctivitis is diagnosed. In addition, if blurry vision is the reason for the excessive blinking, glasses may be prescribed.

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Can Preterm Birth Cause Myopia?

Implications of preterm birth on a baby’s eyesight

There are frequent worries regarding the consequences of prematurity when a baby is born prematurely. Medical and ocular complications may arise from preterm babies’ incomplete development. Premature birth weight is linked to a higher risk of myopia of prematurity (MOP) and retinopathy of prematurity (ROP).

What is myopia of prematurity (MOP)?

If a baby is born before 37 weeks of pregnancy, it is deemed preterm. The likelihood of medical issues increases with the time a baby is born before the 37-week mark. Babies born before their due date are immature at birth. Preterm babies may therefore not have the same progression of eye development and growth as a full-term baby. The first year of a baby’s life is when the eye grows at its fastest rate. Premature babies are more likely to acquire myopia during the first year of life.

How is MOP different from common myopia?

Changes to the cornea, lens and anterior chamber in preterm babies result in myopia. It is linked to severe ROP, low birth weight, and adverse reactions to ROP treatments. On the other hand, axial myopia is the most prevalent type of myopia when it comes to children in their first and second decades of life. An increase in the eyeball’s length leads to axial myopia. 

MOP and ROP

There is a substantial correlation between severe ROP and MOP, even though MOP can occur without ROP. In premature infants born before 31 weeks, ROP causes abnormalities to the retina. The retinas of the infants develop leaky, abnormal blood vessels as a result of it. Loss of vision due to retinal detachment may arise from these leaky blood vessels. In premature babies, alterations to the front of the eye cause MOP. A highly steep cornea, a thick natural lens and a smaller anterior chamber are some of these changes. Myopia is the outcome of these alterations combined together.

MOP and ROP treatments

Most premature infants only develop mild to moderate ROP. In fact, in the absence of treatment, the ROP may regress or disappear on its own. However, some infants develop advanced ROP and need medical attention. Advanced ROP can be treated with cryotherapy, which freezes abnormal blood vessels, laser therapy which burns abnormal blood vessels, or an injection into the eye that prevents new abnormal blood vessels fr5om growing in the retina. Treatments with lasers and cryotherapy are applied to the abnormal blood vessels located on the retina’s periphery. While these treatments lessen peripheral vision, they aid to maintain central vision. Treatments for ROP are also associated with the development of MOP as a side effect.

Diagram_of_Retinopathy_of_Prematurity_(ROP)_showing_abnormal_blood_vessel_growth_in_the_retina_alongside_a_young_child_wearing_corrective_glasses,_illustrating_the_effects_of_ROP_and_the_importance_of_early_vision_care.

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Myopia and vision issues in preterm babies

Infants born prematurely may be susceptible to myopia. Severe ROP and low birth weight are linked to MOP. Anisometropia and astigmatism are two other eye conditions that might affect a child born prematurely. A young child’s vision may deteriorate as a result of any of these conditions. Amblyopia, or irreversible vision loss, can result from poor vision problems in young children if they are not identified and treated early. Monitoring the vision and eye health of children born prematurely is crucial. Comprehensive eye exams can ensure that visual issues are identified early and managed properly as a preterm baby grows.

Illustration_of_Myopia_of_Prematurity_stages,_showing_progression_from_only_prematurity_to_myopia_associated_with_Retinopathy_of_Prematurity_(ROP)_and_adult_ROP,_highlighting_the_impact_of_early_intervention_and_treatment.

Hyperopia in Children

Children are usually farsighted at birth and childhood because they have smaller eyes. As children get older, their eyeballs will lengthen and the optical focus is shifted from behind the retina onto the retina. In some cases, children can progress from being hyperopic to myopia.

Mild degrees of hyperopia may not show any symptoms of blurred vision as young children have a strong focusing ability which is known as accommodation, to focus close-up prints or objects. Children with low or moderate hyperopia tend to be able to compensate for farsightedness with good accommodation, therefore not experiencing any blur or difficulty reading. In comparison, high degrees of hyperopia can give rise to symptoms.

Hyperopia diagnosed through a thorough eye examination. However, there are common signs and symptoms to look out for. They include the following:

  • Not achieving their potential at school or reluctant to read and learn
  • attention difficulties
  • Frequent headaches or fatigue after near activities such as reading, writing or computer use.
  • Eye squinting to or turns inwards
  • Eye strain or fatigue
  • Images/vision are blur at near but clear in the distance

Dilated Eye Examination for Children

A cycloplegic refraction is a procedure often performed on children which uses eye drops to relax the eyes’ iris muscles. The cycloplegic eye drop will dilate the pupil to prevent over-focusing during eye examination. This is an important diagnostic step, to obtain accurate results in the child’s refraction. It also can identify early signs of serious eye conditions such as lazy eye or misalignment of the eyes.

Treatment

Most children with mild to moderate degree of hyperopia do not require treatment. In high degrees of hyperopia, children are treated with spectacles. Parents are advised to seek a proper consult from a paediatric ophthalmologist for diagnosis and management of the condition.

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Myopia Control Treatment

Children with myopia, also known as short sightedness or near sightedness tend to show regular progression or worsening of their vision over time. The increase in myopia prevalence has led to new development of new standards of care. There are several effective treatment to slow down its progression.

Atropine Eye Drops

Atropine eye drops are given to slow down myopia progression in children. A 0.01% concentration of atropine is usually advised to be used at night. This eye drop works by relaxing the ciliary muscle in the eye which gives an effect to the brain to increase the release of dopamine. Dopamine prevents elongation of the eye and thus reducing the progression of myopia. Low-dose atropine for myopia is used for children between 5 and 18 years old. The drops are put in the eye each night at bedtime. Side effects may include redness or itchiness around the eye.

Ortho-K Lenses

Orthokeratatology are special contact lenses that a child wears overnight to correct blurry vision during the day. It is used to flatten or steepen the curvature while sleeping, reshaping the cornea to get clearer vision during the day. Ortho-K lenses only improves your vision for a short time. Once a child stops wearing the lenses, the cornea goes back to its normal shape and myopia recurs. However, it does provide reduction in myopia progression.

Myopia Control Glasses

Bifocal or multifocal glasses are also prescribed to young children to prevent myopia progression. The top portion of the glasses allows for clear distant vision while the bottom portion contains reading power by reducing or eliminating the accommodative effort associated with myopia. Special spectacle lens design has also been developed which work similarly as Ortho-K lenses by causing peripheral blur and reducing the overgrowth of the eyeball. These spectacle design has shown to be more effective than bifocal or multifocal lens design in controlling childhood myopia progression.

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