Myopia

Many clinical trials have been undertaken to find ways to stomp out nearsightedness in young developing eyes. At best, these methods only slow the progression of myopia. There is no cure. You’ll feel better if you don’t think of myopia as a disease when your child gets that first prescription. Optical treatments with glasses, contact lenses, and even eventual elective Lasik surgery work nicely in healthy nearsighted eyes. As long as your child corrects to 20/20 or close to it, the amount of power in the glasses should not worry you excessively.

There is a more serious form of myopia associated with very high refractive error, retinal fragility, and other complications. The treatments designed to slow the progression of myopia are not likely to prevent the complications of this type of myopia.

With this in mind, the crucial characteristic of any method to moderate myopia must be that it is safe for your child’s eyes. Based on research and results of clinical trials, the only approach I would consider for my patients at this time is the nightly use of atropine eye drops which has been studied extensively. It’s not a miracle, however, so your expectations should not be set too high. After several years of treatment, your child may hope to be one to two diopters less myopic than they would have been without treatment.

This prescribed nightly eye drop is a diluted form of atropine, and the mechanism of action for myopia control is not obvious. Atropine itself is a well known physiologic medicine that has been around for centuries. Atropine at a concentration of 1% is used for various eye diseases. At this concentration, it will dilate the pupil and blur vision for several days. There can be systemic effects if the drop travels down the tear duct and is swallowed.

In contrast, the atropine used for myopia control has a starting concentration of 0.01%. This means that one drop of the usual therapeutic medicine is placed in a bottle with 99 drops of saline, greatly reducing its chance of causing blurred vision or side effects on the body. Allergic reactions are possible, and these would manifest as red eyes, eyelid skin rashes, and itching.

The recommendation is that you place one drop of atropine 0.01% in each eye nightly. To be most effective, you should not skip daily drops for any length of time. There may be a benefit to starting treatment when your child is in the early stages of myopia and if you continue treatment into the later teen years. There is no guarantee that the lesser degree of myopia will be maintained or that the myopia won’t progress on cessation of the drops even after many years of treatment.

Stay tuned.