My question was: How is myopia managed and prevented in kids?

My hypothesis was that if you spend more time reading and being on screens, then you’re more likely to develop myopia because your eyes are fatigued and not getting the breaks they need. Therefore, to prevent and manage myopia, it’s important to spend less time on screens and reading.

I used online resources (news articles, websites, research articles) and interviewed an expert to find my information.

Newspaper Headlines, Research Articles, Websites.

Headlines: 

• Did your kid get glasses post-pandemic? Study says myopia rates are soaring around the world.

           CBC News, January 6, 2025

• 1 in 3 children are now nearsighted globally. What’s behind the rise?

  Globe and Mail, September 26, 2024

• Myopia will affect 740m children and teenagers by 2050, research suggests.

  The Guardian, September 24, 2024

Common Websites used for research:

• Cleveland Clinic
• All about vision
• Mayo Clinic
• My kid's vision
• AAO.org

 

I interviewed Dr. Bunny Virk, lead optometrist at FYidoctors, Calgary, McKenzie Towne.

1. What age do you suggest starting eye exams?

2. At what age does myopia usually start and when do you introduce glasses?

3. Is there a usual age at which myopia stops progressing?

4. How do you decide who may benefit from myopia lenses or atropine drops?

5. What is the difference between myopia and astigmatism? Do they usually occur together?  Do the prevention and treatment strategies work for both?

This is what Dr. Bunny Virk responded:

1. Optometrists recommend babies have their first eye exam between six and nine months

 

2&3. Myopia generally starts in school-age children and progresses until about 20 yrs old.  Glasses are introduced when the patient requires them and vision is affected.

 

4. The best option for myopia control treatment would depend on a few factors, specifically the patient’s age, hobbies/activities, prescription, and ocular health. For example, a teenager may not tolerate the side effects of atropine, therefore would be better suited for myopia control lenses.

 

5. Myopia is simply ‘near-sightedness’, which means images far away appear blurry and light focuses in front of the retina.  Astigmatism is due to improper curvature of the eye, which causes blur at all distances (both far and near) and light focuses on multiple points of the retina. They can occur together or separately. Astigmatism can also occur with farsightedness. 

 

Treatment for astigmatism, similar to myopia, would include glasses, contact lenses, or refractive surgery (like LASIK/PRK), lens exchange depending on the severity.  Prevention has been shown to work more effectively for myopia vs astigmatism.  Techniques include giving your eyes a breaks from screens, playing outside and using myopic control devices. 

 

Other Data:

The eye is a sensory organ through which light enters. The eye sends a signal to your brain through the optic nerve. The brain will then decode the message and build a picture of what is happening.

The anatomy of the eye is complicated. Many parts of the eye work together. The cornea is what protects the inside and bends the light as it enters the eye. The iris is in charge of your eye colour. The pupil is the small black circle inside of your iris and the retina is a layer of light sensitive cells which convert light to electrical signals. 

 Myopia, or nearsightedness, is a common eye focus disorder. It makes far things blurry and about 40% of the United States population has it. Kids can be seen squinting or complain of headaches. 

Common causes of myopia include genetics. If both parents have myopia, the kids are 6 times more likely to have it. Also environment and behaviour plays a huge role. If you spend more time doing near work and less time outdoors, you have an increased risk. 

What happens to your eye when you get myopia is that your eye grows too long front to back causing light to be focused in front of the retina rather than on the retina. 

There are new innovative lenses. The MiYOSMART and the Stellest are myopia design lenses that slow progression. Both consist of lenslets or mini lenses. Stellest in concentric rings and MiYOSMART in honeycomb pattern. Stellest typically 67% effective and MiYOSMART 60%. 

How do myopia control lenses work? With single vision correction, light is focused behind the retina, the eye becomes longer and it doesn’t help with myopia progression. With myopia control lenses light rays are focused in front of the retina and it reduces myopia progression. 

Ortho-K or orthokeratology is a rigid night time lens that reshapes the cornea. You don’t need daytime glasses and it reduces progression by 50%. Myopia control soft control lenses are soft daytime lenses that slow the elongation of the eyeball and reduce progression 40-60%. 

Atropine eye drops are a medication that dilates the pupil which means making the pupil bigger. They cause light sensitivity and are not for children under 3 months of age. They do help with myopia by temporarily freezing eye muscles used to focus. 

Even though 40% of the US population has myopia right now, this number is increasing quite rapidly. COVID 19 had a large impact on myopia especially in kids. When schools shut down, kids were on digital screens more and any near work overall. They spent much less time outdoors. 

You should spend less time doing near work and more time outdoors. Spending time outdoors is the largest prevention factor. A 50% reduced risk. You should be outside more at an early age.

Some common recommendations are to spend two hours per day outside and also follow the 20-20-20 rule of near work which means that every 20 minutes you should look 20 feet away for 20 seconds.

Conclusion

Myopia affects 1 in 3 kids and adolescents and may affect 1 in 2 by 2050. School and public policies and parental education should be put in place reccomending early eye exams and supporting kids in spending more time outdoors and less time doing near work like screens in early childhood.

To prevent myopia, it is important to spend more time outdoors and less time doing near work.

Using a combination of strategies, like atropine drops, outdoor time, and myopia control lenses are better at controlling myopia than a single approach.

My hypothesis was partially correct, but I learned much more doing this project, such as additional strategies and the importance of spending more time outdoors.

Future Considerations

It is important to consider how to encourage more outdoor time in a climate like that in Calgary. 

Myopia treatments are new. More research is needed on the long term use and effects, and on combining strategies versus using one. 

It is also important to study prevention strategies for other eye conditions like astigmatism. 

Global collaborative approach to myopia prevention and treatment is necessary to reduce the global burden of myopia. 

Artificial intelligence may have a role in early diagnosis, personalized treatment and monitoring progression of myopia. 

There are emerging treatments such as red-light therapy which are being studied. The studies are in early stages and safety standards are being determined. 

https://www.allaboutvision.com/en-ca/conditions/myopia/

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

https://www.mayoclinic.org/diseases-conditions/nearsightedness/diagnosis-treatment/drc-20375561  

https://www.mykidsvision.org/knowledge-centre/all-about-eye-glasses-for-myopia-control  

https://my.clevelandclinic.org/health/drugs/20729-atropine-eye-solution

https://www.mayoclinic.org/drugs-supplements/atropine-sulfate-ophthalmic-route/description/drg-20313091

https://www.hoyavision.com/en-ca/for-eyeglass-wearer/miyosmart/

https://pmc.ncbi.nlm.nih.gov/articles/PMC10466414/

https://www.cbc.ca/news/health/myopia-children-shortsightedness-prevalence-outdoor-indoor-1.7399141

https://my.clevelandclinic.org/health/body/21823-eyes

https://my.clevelandclinic.org/health/symptoms/22238-dilated-pupils

https://www.aao.org/young-ophthalmologists/yo-info/article/preventing-myopia-during-the-covid-19-pandemic

https://www.mykidsvision.org/en-US/what-is-myopia?form=MG0AV3  

https://www.myopiaprofile.com/articles/how-outdoor-time-influences-myopia-prevention-and-control-a-meta-analysis?form=MG0AV3 

https://www.mykidsvision.org/knowledge-centre/what-is-ortho-k

https://www.optometrists.org/childrens-vision/guide-to-pediatric-eye-conditions/what-is-myopia/why-is-my-childs-myopia-worsening/#:~:text=Myopia%20typically%20develops%20in%20childhood,the%20clock%20on%20the%20wall

https://www.visionprooptical.com/blog/418105-eye-movement/

https://www.mykidsvision.org/knowledge-centre/how-do-myopia-control-soft-contact-lenses-work

https://www.reviewofoptometry.com/article/myopia-control-experts-advocate-global-strategy-consensus?form=MG

https://www.aao.org/eye-health/news/red-light-therapy-nearsightedness-myopia-children

I would like to acknowledge my teachers, and my parents, who have helped me lot through this process with lots of advice.

I would additionally like to acknowledge Dr. Bunny Virk, lead optometrist at FYidoctors, Calgary, McKenzie Towne for his expert opinion and interview responses.