Myopia Control Options and Our Choice

Wish I Knew Before

Updated 10/18/23

It’s been about four years since I first published the post below and five since I started my 7 year old on multifocal soft lenses. The myopia control options have not changed much. If you’re curious, the multifocal soft contact lenses option has kept my child’s vision at the same RX for the last five years. At this point, I would not hesitate to recommend trying a myopia control option for a child if it’s something you can afford.

It’s great to try and prevent myopia, but what if your child is already myopic? Or what if your child becomes myopic in spite of all your attempts to prevent it? Did you know that there are now ways that you can try to slow down your child’s myopia? Below I summarize the options that I researched and what we decided to try for myopia control.

When I was growing up, anyone who became nearsighted just got glasses and were told that there was nothing to be done to either improve or slow down their myopia. However, now, although it’s not widely practiced, many optometrists and ophthalmologists are offering their pediatric patients some options for myopia control.

These options don’t guarantee that your child’s vision will no longer deteriorate, but in very many cases, it slows down the progression by about 50% per year. Let’s say your child’s vision worsens by about -1.00 diopter per year and they are only 8-9 years old.  They may be highly myopic by the time they reach college (when vision changes typically stabilizes). You might even be able to cut that in half! It’s a win even if they end up at -3.00 diopters instead of -6.00.

There are a lot of eye health risks (such as higher risks of retinal detachment, among others) that come with high myopia, in addition to the inconvenience of not being able to do anything without your glasses.  That is significant considering that your child still has a lot of growing and potential deterioration of the vision.

Current Options

First of all, regular glasses or contact lenses (basically single vision lenses) are not an option because they won’t do anything to slow down your progression. 

In my research, I found the following options, first explained in my layman understanding and my opinion of the pros and cons of each. In the Resources section below, you can find great articles on all the more clinical and detailed explanations of each.

Atropine Eye Drops

Atropine eye drops are an eye medicine that you put in your child’s eye nightly. For myopia control, a very low dose is used. They relax your child’s eye-focusing muscle so that they don’t over focus. 

  • Pros: 1-2 eye drops are fairly easy to learn to put in your child’s eyes nightly and children probably get used to this pretty quickly. 
  • Cons: Although they seem to have a high rate of effectiveness (slowing progression at ~77%), the studies for long-term use of these eye drops aren’t available. Our own optometrist wouldn’t recommend these drops for longer than 5 years, citing lack of studies and side effects such as light sensitivity and blurred near vision.

Ortho K

Ortho K (corneal refractive therapy) are gas permeable contact lenses, which are small and firm compared to the multifocal soft lenses (next option). You put them on at night and during your sleep, it will shape your cornea according to your prescription. When you wake up, you remove them with a tiny plunger (not as scary as it sounds), and your vision is corrected. The correction is only temporary though, which is why you have to do it every night. 

Researcher believe that ortho-k also slows myopic progression in a way that is similar to multifocals. They shape the cornea in a way that keeps the axial length of the eye from growing as much. (Myopia worsens when the eye continues to grow.) Effective rates are ~50%.

  • Pros: The lenses are small and probably easier to get on a young child. You don’t have to worry about anything happening to the lenses during the day. Corrected vision wouldn’t have any potentially blur spots as with the multifocals.
  • Cons: They can take a couple of weeks to take effect and get used to as the eye undergoes reshaping. You have to clean them everyday. This option felt invasive to me in the sense that the eye was undergoing a physical reshaping.
size of an ortho-k lense (L) vs a soft lense (R)

Multifocal Soft Lenses

Multifocal soft lenses (MFSL) are soft contact lenses with two or more powers that were originally made for nearsighted adults who started having presbyopia (needing reading glasses). These apparently help stem myopic progression by providing some amount of myopic blur which slows down the rate of retina growth. 

I didn’t understand how a kid could see well through essentially a reading glasses prescription. An optometrist friend explained that when the eye looks through the lenses they will pick out the clearest parts of the image for a particular distance, so it doesn’t matter that the powers are different in some areas of their vision. The effective rates for this option are 30-50% in recent research.

  • Pros: These come in dailies, so you don’t have to worry about cleaning. They’re worn during the day and can be removed easily without any discomfort. They’re not as physically invasive as atropine drops or ortho-k which shapes your cornea.
  • Cons: They’re larger lenses (than the ortho k lenses) so can be more difficult to put in a child. Some children complain of some blurred distance vision (due to the add powers in the lens). Some studies found they decrease the speed of accommodation when worn.

Bifocal or Progressive Lens Glasses

Bifocal glasses / Progressive lens glasses are your regular glasses with the added reading glass portion on the bottom half or a progression of powers through the lens. They are also available in progressive format so that the power transitions without an obvious, unsightly line in the lens. You correct your child’s distance vision with the top half. The bottom half will be a reading glass prescription that helps their eyes to not focus so hard on the near work such as reading, computer, writing. The ranges I saw in effective rate of these glasses is around 10-30%.

  • Pros: No need to worry about contacts or eye drops
  • Cons: Glasses can be cumbersome for kids to wear and some children have difficulty with seeing comfortably with the different powers in the glasses.  Low efficacy rate.

SightGlass Vision Diffusion Optic Technology Lenses

Coming soon – SightGlass Vision Diffusion Optic Technology (DOT) lenses are new special lenses designed specifically for myopia control and to be worn as eyeglasses. The idea behind the lenses is that they diffuse contrast for the child (in a way that mimics outdoor light setting) under the theory that high contrast environments such as reading, and other near-work cause the eye to grow longer and progress myopia. It sounds like the most promising eyeglass solution available yet. Studies have touted up to 74% reduction in myopic progression and up to 50% reduction in axial length growth. They’ve been approved for sale in Canada, but not yet in the US.

  • Pros: No need to worry about contacts or eye drops. Efficacy rate may be comparable to contact lens or atropine options
  • Cons: Glasses can be cumbersome for kids to wear, not yet available

Finally, some parents also choose to do both atropine drops in conjunction with one of the options above for maximum effect. If you just can’t get your child to put on contacts, for example, then glasses plus atropine drops may be your best bet.

Our Choice for Myopia Control

None of the options seemed perfect to me. Generally speaking, it seems that ortho-k has the most studies demonstrating its ability to slow progression. In the end, we chose multifocal soft lenses for our child because I felt it was the least invasive of the options that had high efficacy rates (ortho-k, atropine drops, MFSL). I haven’t ruled out the other options yet, but this is the one we are starting with. We also are incorporating as many healthy lifestyle and eye habits as possible. Since no one seems to know for sure, it doesn’t hurt to try everything that’s probably good for us anyway!

Considerations in choosing can include the health of your child’s eyes, their willingness to use contacts/drops, and their RX. Remember that the effective rates are just averages and your own results may be different.

A lot of studies and research continue to be done in these areas. Unfortunately, results are sometimes conflicting or inconclusive. Nevertheless, there are a lot of helpful articles on these topics that describe the different theories on what causes myopia and the different myopia control options that we have now to help you decide what to do for your child.

Resources

The BEST overview of the options from an optometrist’s perspective that I have ever read. This article also contains an interesting part on the predictor of myopia in children. He lists cutoff points of cyclopegic refraction that tell you the likelihood of your child developing myopia. It also includes a table showing the different types of health risks associated with myopia as it worsens:

Other links with good overviews of the myopia control options:

This blog by an Australian optometrist, compares Ortho-K and MFSL very clearly and even explains the theory behind the lenses and how they work. Be sure to read part 1 and 2.

Apparently, time outdoors doesn’t have the same protective effective if myopia has already begun:

Unclear if outdoor time or near work actually affect myopia progression:

List of research about environmental impact (near work, outdoor time, lighting, etc.) on myopia with comments by the website’s OD:

Myopia experts around the world discuss the state of myopia control efforts:

Slowing progression of myopia must include reduction of near work activities, and increase of natural light and outdoor activity:

Information on the progress of SightGlass glasses and how they work:

Recent media coverage of myopia and increasing popularity of myopia control programs:

2 thoughts on “Myopia Control Options and Our Choice”

  1. Carla Clothnappyco May 5, 2022 / 4:54 am

    Did you continue with the multifocal lenses and if so how is it going?

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    • Wish I Knew Before May 5, 2022 / 9:35 am

      Yes, we’re still satisfied with the choice so far. It’s been almost 3 years, and my child’s vision doesn’t seem to have changed much. The contact RX (-.5, -1.25) has been the same since 2019.

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