Myopia in children: how to care so that vision does not worsen?

Myopia is a visual abnormality that is found increasingly commonly in the present era. People with myopia can see objects that are near clearly, but objects that are far are seen unclearly. This is caused by the eyeball being too long or the cornea being too curved, causing light from objects to refract and fall in front of the retina, similar to an image projected from a projector falling in front of the screen, whereas the appropriate position should fall exactly on the screen.

Causes of myopia in children

Myopia in children often occurs in school-age children and adolescents. Most children begin to have myopia after the age of 7 years onwards. The exact cause is not clearly known, but it often results from genetic and environmental factors. The main causes include:

• Genetic factors: If one or both parents of the patient have myopia, the chance that the child will have myopia increases accordingly.

• Near-vision activities: Activities that use near vision at a distance of less than 20–30 centimeters, such as reading or writing, including prolonged use of electronic devices, all contribute to increasing myopia.

Symptoms of myopia in children

• Blurred vision for distant objects

• Squinting to see more clearly

• Eye strain, headache, inability to see the board in the classroom clearly

• Needing to sit close to the television or screen

Other eye diseases caused by myopia

• Amblyopia

• Limitations in certain occupations such as military, police, pilot

• Increased risk of cataract before old age

• Increased risk of glaucoma

• Increased risk of macular degeneration

• Increased risk of retinal tear and retinal detachment

• Increased risk of strabismus from myopia

• There may be limitations in refractive surgery in the future in cases where the patient has high myopia

The risk of all eye diseases related to myopia increases according to the level of the patient’s myopia.

Correction of myopia

• Wearing eyeglasses is the safest method to correct myopia and has no side effects, suitable for people with myopia at all ages.

• Wearing contact lenses is recommended only in older children who are responsible and able to take good care of contact lens hygiene by themselves, because wearing contact lenses has many complications which may affect vision in the long term.

• Refractive surgery is recommended in people with myopia aged 20 years and older (refractive surgery only reduces the necessity of wearing eyeglasses or contact lenses; the risk of eye diseases mentioned above still remains in all respects).

Slowing the progression of myopia

Myopia is a condition that, once it occurs, cannot be cured and tends to increase continuously according to the growth of the child. Currently, there are treatments to slow the progression of myopia so that it does not progress rapidly, with the following methods:

1. Reduce the use of eyes for near-vision activities at distances less than 20–30 centimeters as much as possible.
2. Increase time spent on outdoor activities as much as possible, with a recommendation of more than 14 hours/week or more than 2 hours/day.
3. Wearing rigid contact lenses (OK/Lens) involves wearing rigid lenses at night during sleep and removing them after waking (not popular in Thailand due to severe complications from lens wear such as eye infection, corneal abrasion, dry eye).
4. Wearing myopia control spectacle lenses
5. Using myopia control eye drops

Reducing near-vision use and increasing outdoor activity time is recommended for all pediatric patients with myopia because it is easy to do, safe, and has no cost.

As for wearing myopia control spectacle lenses and using myopia control eye drops, it requires joint decision-making among the ophthalmologist, parents, and the patient in planning long-term treatment. Each method has different advantages and disadvantages as follows:

Using myopia control eye drops

This involves instilling Atropine at concentrations ranging from 0.01%–0.05%. The choice of concentration depends on the physician’s judgment together with the rate of increase of the patient’s myopia. It usually requires cooperation from both parents and the patient to instill the drops regularly every day continuously for many years, and side effects may be found such as allergic conjunctivitis, photophobia, and problems with near vision.

Advantages

• Lower cost compared with myopia control lenses

• Multiple concentrations available, adjustable according to severity of myopia

• Does not require care by the child

Disadvantages

• Requires cooperation from parents to instill drops for the child every day

• Has side effects from the medication such as allergic conjunctivitis, photophobia, and near-vision problems

• There is a chance of rapid increase in myopia if the medication is stopped abruptly without tapering under ophthalmologist supervision

Wearing myopia control spectacle lenses

These are specially designed lenses that help slow myopia. From the outside, these special lenses look like regular lenses, making the wearer appear as if wearing normal eyeglasses. However, wearing myopia control lenses is recommended for as long as possible, generally more than 10–12 hours/day depending on the lens design. It is recommended to remove the lenses only when sleeping, bathing, or swimming. Myopia control spectacles can be worn for sports as usual.

Advantages

• No side effects because it is not a medication

• No rapid increase in myopia when stopped abruptly

• Does not require parental cooperation to instill drops daily

Disadvantages

• Higher cost than regular eyeglasses

• Not suitable for children who do not wear glasses all the time

• Requires care of the glasses by the child, which are expensive

Control of myopia is a long-term treatment that requires regular follow-up with an ophthalmologist and cooperation from both the patient and parents to achieve effective outcomes in slowing myopia.

All methods of slowing myopia are supported by research for effective outcomes, and multiple methods can be used together for better treatment results. There is no fixed standard treatment; each patient may have limitations and lifestyles suitable for different methods of treatment.