Question: What is myopia?
Dr. Rosenblatt: Myopia is commonly known as nearsightedness, which is the inability to see far away with your naked eye or natural eye. Myopes can focus on things which are near and close to them, but have blurry vision in the distance. From a physical standpoint, this means that the eye is too long for the power of the eye.
Question: How do we get myopia?
Dr. Rosenblatt: The eye itself is designed to be perfect. Most people’s eyes start growing, making them nearsighted, sometimes as early as ages 3, 4 and 5. Certainly through the younger years - most nearsightedness comes about in childhood. You will typically see the greatest changes from about age 8 to 18.
Question: What is myopia control?
Dr. Rosenblatt: The real thing we are trying to do with myopia control is to retard the further lengthening of the eyeball. There are two things we need to determine to do this. One, is trying to determine the cause of the myopia, the nearsightedness, so we can hopefully reduce those things. That's what happens: the eyes, for whatever reason, continue to keep lengthening and getting longer, which makes them more and more nearsighted. We are looking at how to prevent that from happening.
The second part is to determine what treatments are available to help slow the growth of the nearsightedness for that person. The idea is to catch someone early enough. At the age of 5, 6, or 7, the eyes should still be farsighted. They should be 2, 3, or 4 steps farsighted.
I actually had a conversation with a patient today, and both she and her husband are very nearsighted. I was looking at their 5-year-old son, and I found his eyes to be neither farsighted nor nearsighted - no prescription whatsoever – something we call emmetropic.
That is unusual for a 5-year-old, and so I told her that I want to put him on some of my treatments for myopia control. At 5 years of age, he's not supposed to be emmetropic. Therefore, I already know he's moving in the direction of becoming nearsighted, and we want to do what we can to slow it down, especially with that family history of two nearsighted parents.
Question: What are some of the methods you use for myopia control?
Dr. Rosenblatt: First we have diluted atropine drops, second is a specially designed rigid contact lens which is only worn at night which offers perfect vision during the day without glasses or contacts, and then third option is soft multi-focal lenses which are to be worn during the day. Any and all of these methods can be used alone, or together, and in conjunction with certain types of glasses, to help slow the rate of change - the further lengthening of the eye.
Question: Is myopia control for children?
Dr. Rosenblatt: Yes. The lengthening of the eye usually occurs in childhood and we want to retard that growth to keep the child seeing as best as they can without getting further myopic.
We know that the longer the eyeball is, the greater health risks there are. We are all born with the same amount of retinal tissue, same number of cells, and everything in the eye. If someone has a longer eye, that equates to stretching of those layers in the eye, causing potential issues and risk of retinal tears and attachments.
Also, this creates a greater risk of macular degeneration, and glaucoma. These are the big issues faced when someone becomes more nearsighted. If we can reduce or prevent nearsightedness, then there will be less health risks in the future.
Adult myopia is a whole different thing. An adult’s eyes aren't typically lengthening. This is usually a focusing issue - something going on with their focusing system.
Question: You mentioned rigid lenses, do you mean orthokeratology or Ortho-k?
Dr. Rosenblatt: Yes. That is what the lens is, but for myopia control, it is for a slightly different purpose. Ortho-k is done because someone already has a prescription and you are then using special rigid lenses to reshape the cornea to rid them of that prescription.
That is a great benefit, but here we are talking about creating a blurred area in the peripheral part of their cornea. By doing so, it seems to reduce the stimulus for growth. Those lenses accomplish that. The center part of the lens is clear with clear vision, kind of like a doughnut, and the zone outside of that is the one that creates peripheral blur. This created peripheral relaxation, and seems to help the most with slowing down the growth.
A lot of the new lenses we are using for myopia control have different purposes, different sized center zones, because we are finding that the smaller we can make the clear center zone and get the peripheral blur sooner, the less it bothers the individual in terms of what they are seeing. Meaning, it doesn't affect their vision. The smaller we make that zone, the better affect we get.
With ortho-k we go large, usually about a 6 millimeters clear zone, and we are finding with myopia control, even though it sounds very small, it makes a big difference that we can often times do a 5.6 or 5.5 millimeters clear zone and that makes a big difference in slowing down the progression vs. the standard ortho-k lens.
Question: How do you make the decision of which method of myopia control is best for the patient?
Dr. Rosenblatt: It comes down to how old the patient is, what the prescription is at this point, and from those findings, how aggressive do we need to be. In addition, we need to take into consideration their genetics and history.
For example, regarding the 5-year-old we mentioned before with no prescription: we won't put contacts in his eyes because he's already at 0 power, as we call it. Meaning neither + plus or - minus, then we already know he's heading towards becoming myopic. Next year he will be a little more, then the next even more and more. For this case, the atropine makes the most sense. It's a single drop in the eye, which is easy enough to do.
These special Atropine drops are used to relax the focusing system. Atropine is also used to dilate the eye. However, our drops for myopia control are .01% as opposed to 1.0% for dilation.
Meaning, these special drops used for myopia control are only 1/100th of the strength. With that, we don't get dilation at all. What we do get is enough relaxation of the focusing system, which all by itself is proven to reduce the rate of change by up to 65%.
So, let's say someone was supposed to become -10 myopic - after using these drops they may only get to -4. That's a huge difference!
Question: Does someone's budget affect which treatment method will be used?
Dr. Rosenblatt: We have to keep in mind that myopia control is a treatment for your eyes and vision. Just as orthodontics is for your teeth. We are going to use what we have at our disposal to perform the treatment.
In the end, all three of our treatment methods cost about the same on an annual basis or so. If things are going well, then you only pay for the initial treatment plan, then yearly monitoring. Hopefully we won't have to do much else but monitor the progress – to make sure the eyeball is not growing anymore.
Question: What else would you like to tell us about myopia control?
Dr. Rosenblatt: Myopia control is a very new field for eyecare. There are lots and lots of studies going on as new products are becoming available. What we have is working well. We think we can make it work even better. If we use some the methods in combination, we can reduce myopia by 85%. There is lots of information out there, such as Berkley Optometry School's website.
The biggest thing is awareness, and the health aspect of myopia control. People have ignored the health aspect of being nearsighted. The risks are being ignored. People just think, "I guess I will have to wear glasses or contacts for the rest of my life and that's fine." As we know, there are dangers. We have seen a significant increase in the cases of nearsightedness, and an increase of the levels of nearsightedness. So, both the prevalence and the severity have increased, meaning we will be seeing more health problems in the future.