What Is Progressive Myopia?

Nearsightedness or myopia is one of the most prevalent eye disorders worldwide and its incidence is increasing. In fact by 2050, myopia is projected to affect half of the world’s population!

Many children diagnosed with nearsightedness (myopia) experience a consistent worsening of their vision as they grow into adolescence. This condition can be so aggressive that for some, each time they take their child to the eye doctor for a vision checkup, their prescription gets higher.

This is called progressive myopia and can be a serious condition for many children now and in the future. Not only is there a financial burden and inconvenience associated with having to replace eyeglasses on a regular basis, but high myopia is a risk factor for many eye diseases later in life such as retinal detachment, early onset cataracts, glaucoma and macular degeneration.

What Causes Progressive Myopia?

Myopia is a refractive error that happens when the eye focuses incoming light in front of the retina, rather than directly on it, resulting in blurred distance vision. While an exact cause of progressive myopia is not known, most research indicates that a combination of environmental and genetic factors trigger the condition.

First of all, there is evidence that a family history of nearsightedness is a contributing factor. Additionally, spending a lot of time indoors may play a role in myopia development, as studies show that children who spend more time outside have less incidence of myopia. Lastly, near point stress, which can be caused from looking at a near object for an extended period of time, can prompt the eye to grow longer and result in myopia. Several eye doctors recommend following the 20-20-20 rule when using digital devices (stopping every 20 minutes to look 20 feet away for 20 seconds) to reduce near point stress caused by computer use.

What Can Be Done To Prevent or Treat Myopia?

There are several treatments that have been shown to slow the progression of myopia.

Orthokeratology (ortho-k):

Also known as corneal reshaping, this treatment uses rigid gas permeable contact lenses that are worn while the patient sleeps to reshape the cornea, which is the clear, front part of the eye. During the day, the patient is usually able to see clearly, glasses-free. In addition to allowing glasses-free vision during the day, this treatment has been shown to reduce the progression of myopia in many children.

Distance Center Multifocal Contact Lenses:

This treatment uses distance center (which means the area for seeing at a distance is in the center of the lens) multifocal soft contact lenses to provide clear vision and slow the progression of myopia. The lenses are worn as normal contact lenses during the day.

Atropine Drops:

Atropine drops are a daily-use prescription eye drop that has been shown to reduce myopia progression. It can be used alone or in combination with ortho-k or multifocal contact lenses.

Additional Myopia Treatments:

While these treatments are available in all of North America, some countries offer additional options that are approved for myopia control. For example, in Canada, Zeiss^TM MyoVision glasses that have an innovative lens curvature design are available to help reduce the rate of myopia progression. Additionally some doctors in Canada offer Coopervision MiSight^® lenses, which are 1-day contact lenses that are worn during the daytime. These contacts have a multifocal lens design with distance centre and near surround that is specifically designed for children.

Myopia & Your Child

If your child’s vision keeps getting worse, it’s more than an annoyance – it can be a serious risk factor for their eye health and vision in the future. The best strategy for myopia control depends on the child and the severity of the case, and requires consultation with an experienced eye doctor in order to determine the best solution. If your child wears glasses, make his or her vision a priority; schedule an eye exam to ensure stable vision and healthy eyes.

Healthy eyes and good vision are essential for your child’s growth and development. In fact, learning is 80% visual, which means a child’s success in school, athletics and many other aspects of life can be impacted by poor vision. Good vision goes beyond how far you can see, and also includes a number of other skills such as visual processing and eye movement abilities.

Often times vision deficiencies are at the root of learning problems and behavioral issues and may unfortunately go unchecked and misdiagnosed. Remember, if your child is having trouble in school, an eye exam and a pair of prescription glasses is a much easier solution than treating a learning disorder or ADHD; yet many people fail to check that first.

It is common for children to think that their vision deficiency is normal and therefore they often won’t report it to parents or teachers. That is why it is even more important to know what to look for. Here are some signs that your child may have a vision problem:

Vision Signs

• Squinting or blinking often
• Eye rubbing
• Tilting the head to the side
• Covering one eye
• One eye that turns out or in
• Reporting double vision
• Holding books or reading materials very close to the face

Behavioral Signs

• Complaining of headaches or eye fatigue
• Short attention span
• Difficulty reading
• Losing their place frequently when reading
• Avoiding reading or any activity that requires close work
• Problems with reading comprehension or recall
• Behavioral issues that stem from frustration and/or boredom
• Poor performance and achievement in school or athletics
• Working twice as hard to achieve minimal performance in school

Another issue is that many parents and teachers think that a school vision screening is sufficient to assess a child’s vision, so if that test comes back okay, they believe there is no vision problem. This however, is far from the case. A school vision test usually only assesses visual acuity for distance vision or how far a child can see. Even a child with 20/20 vision can have significant vision problems that prevent them from seeing, reading and processing visual information.

Every child of school age should have comprehensive eye and vision exams on a regular, yearly basis to assess their eye and vision health, and ensure that any issues are addressed as soon as possible. It’s also important to have an exam prior to entering kindergarten, as undetected lazy eye may be more complicated to treat past seven years of age.

Some of the issues the eye doctor may look for, in addition to good visual acuity, are the ability to focus, eye teaming and tracking, visual perception, hand-eye coordination, depth perception and peripheral vision. They will also assess the health of the eye and look for any underlying conditions that may be impairing vision. Depending on the problem the eye doctor may prescribe eyeglasses, contact lenses or vision therapy to correct the issue.

During the school years a child’s eyes and vision continue to develop and change so it is important to continually check in on your child’s vision. If you have a family history of vision problems, follow-ups are even more important. Progressive conditions like progressive myopia, strabismus (crossed eyes), amblyopia (lazy eye) or astigmatism can be treated and monitored for changes with early treatment so it’s important to seek a doctor’s diagnosis as soon as signs or symptoms are present.

Make sure that your child has the best possible chances for success in school and add a comprehensive eye exam to your back to school to-do list.

Your toddler may show every sign of good eyesight including the ability to see objects in the distance, however that doesn’t necessarily mean that he or she doesn’t have a vision problem.

Amblyopia is one common eye condition that is often hidden behind the appearance of good eyesight.

Also known as “lazy eye” it usually occurs when the brain begins to ignore the signals sent by one eye, often because that eye is weaker and doesn’t focus properly. Sometimes it can occur in both eyes, in which case it’s called bilateral amblyopia. This eye condition is especially common in preemies, and tends to run in families as well, so it’s important to provide your eye doctor with a complete medical and family history.

There are several factors that can cause amblyopia to develop. These include:

• astigmatism,
• high nearsightedness or farsightedness,
• uneven eye development as an infant,
• congenital cataract (clouding of the lens of the eye),
• strabismus (where the eyes are misaligned or “cross-eyed”)

However in many cases of amblyopia there may be no obvious visible structural differences in the eye. In addition to the fact that the eyes may look normal, vision often appears fine as the brain is able to compensate for the weaker eye by favoring the stronger one. Because of this, many children live with their eye condition for years before it is diagnosed. Unfortunately, as a person ages, the brain loses some of its plasticity (how easy it is to train the brain to develop new skills), making it much harder – if not impossible – to treat amblyopia in older children and adults. That’s why it’s so important for infants and young children to have a thorough eye exam.

Are There Any Signs of Amblyopia?

If you notice your child appears cross-eyed, that would be an indication that it’s time for a comprehensive eye exam to screen for strabismus and amblyopia development.

Preschoolers with amblyopia sometimes show signs of unusual posture when playing, such as head tilting, clumsiness or viewing things abnormally close.

However, often there are no signs or symptoms. The child typically does not complain, as he or she does not know what normal vision should look like. Sometimes the condition is picked up once children begin reading if have difficulty focusing on the close text. The school nurse may suggest an eye exam to confirm or rule out amblyopia following a standard vision test on each eye, though it might be possible to pass a vision screening test and still have amblyopia. Only an eye doctor can make a definitive diagnosis of the eye condition.

So How Do You Know If or When To Book a Pediatric Eye Exam?

Comprehensive eye and vision exams should be performed on children at an early age. That way, hidden eye conditions would be diagnosed while they’re still more easily treatable. An eye exam is recommended at 6 months of age and then again at 3 years old and before entering first grade. The eye doctor may need to use eye drops to dilate the pupils to confirm a child’s true refractive error and diagnose an eye condition such as amblyopia.

Treatment for Amblyopia

Glasses alone will not completely correct vision with amblyopia in most cases, because the brain has learned to process images from the weak eye or eyes as blurred images, and ignore them. There are several non-surgical treatment options for amblyopia. While your child may never achieve 20/20 vision as an outcome of the treatment and may need some prescription glasses or contact lenses, there are options that can significantly improve visual acuity.

Patch or Drops

In order to improve vision, one needs to retrain the brain to receive a clear image from the weak eye or eyes. In the case of unilateral amblyopia (one eye is weaker than the other), this usually involves treating the normal eye with a patch or drops to force the brain to depend on the weak eye. This re-establishes the eye-brain connection with the weaker one and strengthens vision in that eye. If a child has bilateral amblyopia, treatment involves a regimen of constantly wearing glasses and/or contact lenses with continual observation over time.

Your eye doctor will prescribe the number of waking hours that patching is needed based on the visual acuity in your child’s weak eye; however, the periods of time that you chose to enforce wearing the patch may be flexible. During patching the child typically does a fun activity requiring hand eye coordination to stimulate visual development (such as a favorite video game, puzzle, maze etc) as passive activity is not as effective.

The earlier treatment starts, the better the chances are of stopping or reversing the negative patterns formed in the brain that harm vision. Amblyopia treatment with patches or drops may be minimally effective in improving vision as late as the early teen years (up to age 14) but better results are seen in younger patients.

Vision Therapy

Many optometrists recommend vision therapy to train the eyes using exercises that strengthen the eye-brain connection. While success rates tend to be better in children, optometrists have also seen improvements using this occupational therapy type program to treat amblyopia in adults.

The key to improvement through any non-surgical treatment for amblyopia is compliance. Vision therapy exercises must be practiced on a regular basis. Children that are using glasses or contact lenses for treatment, must wear them consistently. Your eye doctor will recommend the schedule of the patching, drops, or vision therapy eye exercise and the best course of treatment.

Amblyopia: Take-home Message

Even if your child is not showing any signs of vision problems, and especially if they are, it is important to have an eye examination with an eye doctor as soon as possible, and on a regular basis. While the eyes are still young and developing, diagnosis and treatment of eye conditions such as amblyopia are greatly improved.

It is important to teach your children about eye health and safety from a young age. This includes awareness about how your overall health habits affect your eyes and vision as well as how to keep your eyes safe from injury and infection. Starting off with good eye habits at a young age will help to create a lifestyle that will promote eye and vision health for a lifetime.

10 Eye Health Tips for All:

1. Eat right. Eating a balanced diet full of fresh fruits and vegetables (especially green leafies such as kale, spinach and broccoli) as well as omega-3s found in fish, such as salmon, tuna and halibut, help your eyes get the proper nutrients they need to function at their best.
2. Exercise. An active lifestyle has been shown to reduce the risk of developing a number of eye diseases as well as diabetes – a disease which which can result in blindness.
3. Don’t Smoke. Smoking has been linked to increased risk of a number of vision threatening eye diseases.
4. Use Eye Protection. Protect your eyes when engaging in activities such as sports (especially those that are high impact or involve flying objects), using chemicals or power tools or gardening. Speak to your eye doctor about the best protection for your hobbies to prevent serious eye injuries.
5. Wear Shades. Protect your eyes from the sun by wearing 100% UV blocking sunglasses and a hat with a brim when you go outside. Never look directly at the sun.
6. Be Aware: If you notice any changes in your vision, always get it checked out. Tell a parent or teacher if your eyes hurt or if your vision is blurry, jumping, double or if you see spots or anything out of the ordinary. Parents, keep an eye on your child. Children don’t always complain about problems seeing because they don’t know when their vision is not normal vision. Signs of excessive linking, rubbing, unusual head tilt, or excessively close viewing distance are worth a visit to the eye doctor.
7. Don’t Rub! If you feel something in your eye, don’t rub it – it could make it worse or scratch your eyeball. Ask an adult to help you wash the object out of your eye.
8. Give Your Eyes a Break. With the digital age, a new concern is kids’ posture when looking at screens such as tablets or mobile phones. Prevent your child from holding these digital devices too close to their eyes. The Harmon distance is a comfortable viewing distance and posture – it is the distance from your chin to your elbow. There is concern that poor postural habits may warp a child’s growing body. Also, when looking at a tv, mobile or computer screen for long periods of time, follow the 20-20-20 rule; take a break every 20 minutes, for 20 seconds, by looking at something 20 feet away.
9. Create Eye Safe Habits. Always carry pointed objects such as scissors, knives or pencils with the sharp end pointing down. Never shoot objects (including toys) or spray things at others, especially in the direction of the head. Be careful when using sprays that they are pointed away from the eyes.
10. Keep Them Clean. Always wash your hands before you touch your eyes and follow your eye doctors instructions carefully for proper contact lens hygiene. If you wear makeup, make sure to throw away any old makeup and don’t share with others.

By teaching your children basic eye care and safety habits you are instilling in them the importance of taking care of their precious eye sight. As a parent, always encourage and remind your children to follow these tips and set a good example by doing them yourself.

Of course don’t forget the most important tip of all – get each member of your family’s eyes checked regularly by a qualified eye doctor! Remember, school eye screenings and screenings at a pediatrician’s office are NOT eye exams. They are only checking visual acuity but could miss health problems, focusing issues and binocularity issues that are causing health and vision problems.

Since studies show that learning is 80% visual, children with untreated vision problems can really suffer when it comes to school. Most people think that good “vision” means 20/20 acuity but in reality, vision is much more complex. Your brain is actually what completes the processing of the visual world around you and visual processing disorders can be present even when there is no evidence of a so-called “vision problem”.

The American Optometric Association reports that 2 out of 5 children have a vision condition that affects learning and estimates that 10 million American children have undiagnosed and untreated vision problems. In Canada, it’s reported that one in 4 school age children have undiagnosed vision problems, many with no obvious symptoms.

A major reason for this is that when parents and teachers see issues in school, they often run to learning or behavioral issues first. In reality, difficulty in reading, understanding, focusing, paying attention and even disruptive behavior can all be symptoms of an underlying vision disorder.

There are a number of skills that we need in order to successfully see and process the outside world. These include, eye teaming (being able to use the eyes together as a team), focusing, tracking, recognition and comprehension. When these skills are delayed or insufficient, learning, reading, understanding and motor skills can all be affected. Most of these visual processing issues cannot be treated by corrective glasses or contact lenses alone. Sometimes a regime of vision therapy exercises may be prescribed to teach the brain how to properly process the information that is coming in through the eyes.

Vision Therapy

Vision therapy often involves a combination of glasses, to optimize visual acuity if needed, and therapeutic exercises designed to train eye coordination and comfortable focusing ability. Typically, there is a comprehensive in-office assessment, then half-hour in-office sessions once every 1-3 weeks. The patient is given home eye exercises to be done 15-20 minutes per day, often with help from the parent.

Vision therapy is a process that can take up to several months before improvement or goals are met. In addition, going through vision therapy does not ensure that your child will get better grades, we are simply trying to give them all the proper learning tools so they can achieve to their fullest potential.

Identifying Vision Disorders

One example of a visual processing disorder is Convergence Insufficiency (CI), a common eye coordination disorder in which the eyes have problems viewing near tasks due to convergence problems. This is when the eyes have difficulty working together and focusing as a team, resulting in eyestrain, headaches and double vision. Children with CI often report that words appear to be “moving across the page”, making reading and comprehensive impossibly difficult.

As with many vision problems, children often don’t realize that their experience is abnormal so they often don’t report the difficulties they are having. Here are some indications that your child might have a vision problem:

• Headaches
• Avoiding close tasks such as reading or playing certain games
• Frequent Blinking and Eye Rubbing
• Difficulty reading – losing place frequently
• Covering one eye when trying to focus
• Double vision
• Poor memory or reading comprehension
• Short attention span
• Clumsiness or poor hand-eye coordination

If your child is having difficulty in school, particularly with tasks involving reading, it is worth getting an eye and vision exam. The sooner a visual processing issue is diagnosed and treated, the greater chance your child with have to thrive and enjoy the school years.