myopia control

Can Axial Length Be Reduced?

Wish I Knew Before2 Comments

Updated 4/14/22

Image credit: myopiaprofile.com (a very helpful site, btw!)

This is a niche post for those of us trying to explore the causes and cures for myopia. Since the causes of myopia are not fully understood, the treatments are still under discovery and experimentation. If you search online, you probably won’t find much evidence that the axial length of the human eye can be reduced – this is a key measurement that folks are using as an objective way to determine if axial length myopia can be reversed. However, I suspect that there exists some evidence – it just hasn’t reached Google’s top search results. I discovered that the axial length of my child’s eye was reduced over a 3 month period, leading me to think some researchers out there may have similar data on children.

So my current answer to “can the axial length of an eye be reduced?” Yes, based purely on numbers and measurements for a single child data point – more on this below, along with the caveats. All in all, it’s still encouraging information. (Update as of 11/17/22: In absence of a new post on axial length, I wanted to share that our optometrist once described a case of one teenage patient whose axial length dropped significantly for an unknown reason and the patient’s RX correspondingly dropped about 2 diopters! So YES, axial length absolutely can change, but IF and HOW it will happen is not understood.)

Here are the axial length measurements on my 8 yr old child who has an RX of OD: plano, OS: -1.25:

DateLifestyle habits leading up to the measurement dateAxial length (on Carl Zeiss IOLMaster)
Start of June 201920-20-20 near work rule, outdoor time ~1.5-2 hrs/day, “active focus” 2-3x/wk for a few minutes at a timeOD: 24.37mm
OS: 24.65mm
End of June 201920-20-20 near work rule, outdoor time ~2-3 hrs/day, “active focus” 2-3x/wk for a few minutes at a timeOD: 24.36mm
OS: 24.66mm
End of August 201920-20-20 near work rule, outdoor time ~3-4 hrs/day, “active focus” 2-3x/wk for a few minutes at a time, plus lenses when readingOD: 24.43mm
OS: 24.75mm
Beginning of Dec 201920-20-20 near work rule, outdoor time ~1.5-2 hrs/day, “active focus” 1-2x/wk for a few minutes at a time, regular wear of multifocal soft contact lensesOD: 24.38mm
OS: 24.67mm

Things to note on the data

  • In a 3 month period, there was a .05mm reduction in the right eye and a .07mm reduction in the left eye. The practitioner wasn’t surprised by the positive change and said this was known to happen with the initial wearing of multifocal soft contact lenses, from which I inferred that more reduction isn’t to be expected. 
  • .07mm is estimated to be the equivalent of 0.25 diopters, according to our optometrist.
  • .12mm is the average growth/year in the axial length of non-myopic children, according to our optometrist.
  • Although we incorporated many good vision habits, the reduction in axial length did not occur until my child was able to wear multifocal soft contact lenses. 
  • Even though the right eye is not myopic, we decided to wear multifocals in both eyes to try and help prevent the right eye from becoming myopic. After one eye becomes myopic, it is common for the other eye to become myopic as well. 
  • The increase in axial length came during the summer at a time when we were able to spend a lot of time outdoors in a lot of sunshine, we no longer had school (less near work time), and when we had added the use of plus lenses for reading. 
  • I checked my child’s vision with an eye chart a few times a week, and it seemed to me like his eyes were getting better during the 3 months that there was an increase in the axial length.
  • Our attempts at “active focus” were so few per week that it’s not a significant factor for consideration. 
  • My child gets almost zero screen time. He reads books a lot but will only occasionally read as much as 45 minute blocks which are then peppered with a 20-20-20 rule.

Thoughts on the effect of the multifocal soft contact lenses

Since I’m sitting around with my single child data point, I’m wondering if the axial length reduction is more easily induced in children. Typically the younger you are, the more likely your body is able to recover or have positive changes. I’ve noticed those patterns generally with how quickly children can recover from the same cold that knocks adults out. Similarly, oral immunotherapy on preschool age children can cure their allergies vs older children and adults are more likely to become desensitized (which is not a cure). 

Multifocal soft contact lenses were originally created for adults with presbyopia, but many adults have trouble adapting to the vision that they get with multifocals because the contact provides center distance vision and essentially places patches of plus power throughout the lens. I guess adult eyes don’t accommodate as well as children’s eyes and they tend to see both the blurry and the clear images at the same time. Children, on the other hand, are known to adapt to multifocal soft contact lenses rather easily. It would be interesting to see if adults who have progressing myopia would benefit from wearing multifocal lenses to slow or halt their myopia.

Multifocal soft contact lenses and “active focus” – Since seeing that the contact lenses seemed to make the most difference in my child’s axial length, I’ve been thinking about how they work and how it might compare to the concept of active focus which I read about on endmyopia.org. According to endmyopia, active focus is the activity you need to do to stimulate your vision to improve – you look at something that’s just very slightly blurry and then focus on it to see if you can clear the blur. When you wear multifocals, your eyes also have to do something similar on a constant basis. Because there are patches of less clear vision, your eyes have to learn to adapt to pick out the parts that are clear to create the focused image that you finally see. I could be totally off-track, but just throwing it out there. Thoughts, anyone?

If you have any axial length measurements or similar experiences, please do share! Anyway, we’ll be measuring axial length again in another few months. Stay tuned.

Resources

This is a very helpful post in providing more numbers for understanding axial length, and understanding of possible ethnic differences, and growth differences in myopic and non-myopic children:

Here are other posts that are helpful for trying to understand how practitioners use axial length in managing your child’s myopia:

Can You Control or Reverse Your Myopia?

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In my quest to quell my child’s myopia, I discovered the myopia reversal community online. It seems there are many adults who are trying to improve their vision naturally. Yet while the medical eyecare community has not reached the point where they will even consider that myopia reversal is possible, myopia control for children is a growing sub-specialty and reaching mainstream eyecare practices in the US. In Asian countries where myopia is unusually high, myopia control is already a common practice. Considering that myopia control didn’t exist when I was growing up, (and yet here it is), I’m wary of dismissing the possibility of myopia reversal too quickly.

My takeaway

Researching and comparing these two “fields” was helpful for me in deciding how to manage my child’s myopia and also in convincing me that it was worth trying to reverse some of my own myopia. Below are some of the similar ideas that I found between the two areas .

Single vision lenses (SVL) will likely progress your myopia – This is not yet a commonly known fact, especially among adults. On the plus side, as I mentioned earlier, myopia control is definitely a growing sub-specialty and I think it’s only a matter of time before it will become common practice:

  • Myopia control view: Optometrists who provide myopia control options to children know that the traditional single vision glass lenses or contact lenses will mostly likely cause your prescription to get worse and worse. (Yes, that’s the lenses that you and I grew up wearing.) The current thought is that myopia stabilizes in adulthood, but the eye is particularly susceptible to growth in childhood and teenage years since those are “growing” years for the body. SVL are known to cause peripheral light to focus behind the retina, which is thought to stimulate the axial growth of the eye and therefore increase myopia.
  • Myopia reversal view:  In the philosophy of two popular myopia reversal methods, Jake Steiner’s endmyopia.org and Todd Becker’s gettingstronger.com, it is also believed that the cycle of progressively stronger RXes are due to wearing SVL that perfectly correct or overcorrect your vision. If your myopia is worsening as an adult, it seems that perfectly corrected or overcorrected SVL could also be a contributing factor. They call it “lens-induced” myopia

Reducing near work strain is important in treating myopia – Giving your eyes a break from reading a book or the computer screen is common wisdom (that many of us probably have trouble following). However, myopia treatment takes this a step further.

  • Myopia control view – Multifocal or bifocal glasses and multifocals contacts give the child different corrections for distance viewing and near viewing. The theory here is that the near viewing through an add power reduces the strain of close work. Although studies haven’t found much clinical benefit from bifocal glasses as from the multifocal contacts, researchers think it may be due to children not being able to use the bifocal lenses correctly (looking thru the right part for the particular activity at hand).
  • Myopia reversal view – Similarly, many myopia reversal methods also include wearing either a reduced RX or plus lenses for near work to reduce strain. 

Outdoor time affects myopia – Spending time outdoors is believed to play a central role in vision.

  • Myopia control view – Research in myopia control is full of studies on the possible link between myopia and time spent outdoors. It is believed that spending more time outdoors (3 hours/day) can help prevent myopia in children (although studies find that it’s not helpful once myopia has begun). Although there are many theories (i.e., the eye needs vitamin D, outdoor time replaces screen/reading time, being outdoors skews the eyes towards using distance vision, etc.), it’s also not clear why the outdoor time may prevent the eye from growing too much.
  • Myopia reversal view – Jake Steiner’s endmyopia.org frequently posts about the importance of incorporating outdoor time into part of the rehabilitation. While myopia control researchers still don’t feel that they have found the reason that outdoor time is beneficial, Mr. Steiner believes that outdoor time spent actively trying to see things more clearly is the reason that outdoor time can improve vision.

The effects of both treatments are variable in individuals – both research and anecdotal evidence show that neither myopia control nor reversal methods are guaranteed to work. Researchers don’t know why myopia control works for some children but not so much in others. I haven’t found any formal myopia reversal studies on adults – perhaps I just haven’t logged enough hours in the search. Nevertheless, the treatments do seem to work  for many adults anecdotally and definitely for many children.

Resources

This Medium post by an Australian optometrist describes how the traditional approach of glasses for children is becoming outdated and that myopia is becoming recognized as a condition that can be treated:

Two of the most popular myopia reversal techniques seem to be Jake Steiner’s endmyopia.org and Todd Becker’s gettingstronger.org:

Lens-induced myopia was reversible in a study of chicks

Thoughts? More info? Better info? I’m all ears. Email me at:  wishiknewbefore20@gmail.com or leave a comment below.

Myopia Control Options and Our Choice

Wish I Knew Before2 Comments

Updated 5/7/21

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:

6 Habits to Fight Myopia

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I’ve been nearsighted since I was eight and I’ve always hated that. Contacts or glasses – it’s just one extra thing you have to do. Plus, I can hardly do anything without them. Ever read “Lord of the Flies”? Remember Piggy and how useless he becomes without his glasses? Don’t worry if you’ve never read it, but if you have, then you can know that I have recurring nightmares about becoming Piggy.

Children’s vision at highest risk 

habits to prevent myopia
Myopia is on the rise, but there are ways to fight it

Kids are usually born with perfect vision and we should help them preserve their vision for as long as possible! Our eyes are in growth and development mode from infancy through adulthood. Vision tends to stabilize in adulthood, but during the long prior developmental period, children’s eyes are more vulnerable to positive or negative factors that can affect their growth. (Enter coronavirus and distance learning for the kids – yikes, what is going to be the impact?!!)

Eye health declining globally

Generally, there’s two reasons that experts say are responsible for myopia or other eye problems. One, genetics (not much you can do about that currently) and two, environmental factors such as exposure to outdoor light, eye strain, near work, and fatigue. 

There appears to be a worldwide rise in myopia possibly due to environmental factors, but the research isn’t definitive yet. About half the young adults in the US and Europe have myopia (double the number from 50 years ago) and in China 90% of young adults and teenagers are nearsighted compared to 10%-20% just 60 years ago. In fact, researchers estimate that one third of the world population will be nearsighted by 2020. Freaky, right!? 

The truth is that researchers are still not sure what may be causing the surge of myopia. They just have a lot of theories with various data to support. However, there is a lot of data that often points to the following culprits: 

  • Rise in close work: any activities that focus your eyes on nearby objects such as crafts, reading, electronic devices, even Legos!
  • Lots of screen time. It has even caused dry eye in children, a condition typically found in middle-aged adults 
  • Too much time indoors! The less time you spent outdoors the likelier you are to be myopic, apparently exposure to bright, natural light (outdoors) is necessary for natural eye development

What can be done?

If you want to reduce the likelihood for eye problems, research results suggest the following: 

  1. Most importantly, raise your awareness of eye-straining activities (you gotta realize it’s a problem if you are ever going to remember to do anything about it – don’t wait until you have symptoms!)
  2. Make sure you do near work such as reading, homework, legos, puzzles in good lighting and even better, if it is in natural lighting
  3. Build habits for regular breaks and reasonable usage for devices and other near work, like the 20-20-20 rule (For every 20 minutes of close work, look at something 20 ft away for 20 seconds).
  4. Ensure that you maintain a good reading and writing distance – this is often overlooked especially in children, but very important. The links below will help you ensure that you do close work with the right distances:
  5. Getting sufficient sleep to reduce eye fatigue and strain when doing close tasks 
  6. Replace indoor time with more time outdoors. According to Ian Morgan, a myopia researcher at the Australian National University in Canberra, children need about 3 hours of outdoor time daily to be protected against myopia. I researched this topic further here.
  7. Check your vision regularly. These free, eye chart printables can be helpful for checking regularly at home.

Resources

Global rise of myopia: 

A look at the possible causes of myopia:

More on children’s screen time, and tips for healthier viewing: 

Dry eyes caused by screen time:

Outdoor light has protective effect on vision:

How much outdoor light you need to protect against myopia: