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Reducing the progression of myopia (shortsight) in children

Myopia (shortsight) is where the eyeball is slightly too large and distance vision is blurred. This is corrected by the use of glasses or contact lenses. If a child is myopic from an early age, as they grow they will become increasingly more myopic; requiring stronger and stronger glasses. Those people who end up very myopic (more than 6 units) are classed as high myopes. High myopes are more prone to serious visual problems such as retinal detachment and macular degeneration.

The incidence of myopia worldwide is increasing, especially in the Far East. In Singapore over 80% of people are myopic!  There are probably a number of reasons for this.  These include lots of close up work (especially if from an early age), poor lighting, not being outside enough and genetics.

Because of the potential problems associated with high myopia, preventing its progression in children has been an active area of research over the last decade. In China children are encouraged to spend more time outside, avoid reading close up and ensure their classrooms are well lit. Some experts also suggest that children should not be taught to read until they are older, thus reducing close up work at an early age.

Roger Holden Eye Surgeon

Trying to prevent children reading close up

More active interventions have also been tried. Contact lenses have been used to try and mechanically alter the shape of the cornea and somehow reduce eye growth. This does seem to work but only to a point and long term contact lens wear in children can be associated with severe infections of the cornea.

Another treatment gaining in popularity is the use of dilute atropine drops. Atropine is a drug that paralyses the internal eye muscles and stops the eye focusing close up. It also dilates the pupil. The idea is that the child cannot use the eye muscles to focus and this prevents excessive growth of the eye.

The atropine has to be put in both eyes every day for a period of at least two years. The child has to wear reading glasses when he or she wants to look close up (or wear varifocals). Also the child often needs to wear sunglasses when outside because of the dilated pupils.  Dilute atropine drops are used (0.001%) because the normal full strength atropine drops can have general side effects such as changes in heart rate. Dilute atropine seems to be the most promising way of preventing myopia progression especially in younger children. It does however require a great deal of commitment from the parents and the long term results are not known.

Whilst this treatment has become popular in the Far East and the USA the problem is that 0.001% atropine is not available in the UK. However this may change in the future.

 

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