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Myopia Management

A group of smiling young adults, looking at their smartphones

Nearsightedness: What's the Big Deal?

Myopia, or nearsightedness, is a condition where the light entering the eye focuses in front of the retina, rather than on the retina, creating a blurred image for far away objects. Objects up close are often seen clearly, so this is how this condition got its name.

The eye on the left is a normal eye. The eye on the right has myopia, notice the light focusing in front of the retina.

The eye on the left is a normal eye. The eye on the right has myopia, notice the light focusing in front of the retina. Photo taken May 5, 2023 from:
https://webvision.med.utah.edu/book/part-xvii-refractive-errors/the-science-behind-myopia-by-brittany-j-carr-and-william-k-stell/

Nearsightedness is becoming much more common now than it was several years ago, and the problem has only been exacerbated by the COVID-19 pandemic. According to CooperVision, in a study of Canadian school children aged 11-13, 30% were nearsighted. There are multiple risk factors including family members with nearsightedness, time spent outdoors and the amount of time we are spending on the computer and tablets, often at close working distances.

So every time you or your child goes to the optometrist, the prescription increases and stronger glasses are needed to see clearly. Why is this important? Your child can simply get a new eyeglass or contact lens prescription and they will be able to see well again right?? WRONG!! Nearsightedness does not come without complications!!!
We want to make every effort to keep the length of the eye below 26mm. Myopic individuals with an axial length less than 26mm have a lifetime risk of vision loss of 3.8% (best corrected vision of 20/40 or worse by age 75)1. If the eyeball then grows larger than 26mm, this risk jumps to 25%. That statistic has really driven home for me, the importance of treating young myopes as early as possible so that the growth of the eye can be slowed enough to allow the eye to continue growing at a normal rate throughout the rest of childhood and through adolescence.

Who is at risk for Myopia?

There are multiple risk factors for the onset of myopia as well as myopia progression:

  • Age 9 or under-one or both parents are nearsighted
  • Asian ethnicity
  • Lots of time spent on nearwork
  • Minimal time spent outdoors
  • Size of the eyeball increased from the age expected value (eyeglass prescription out of range for a child’s age). At Sage Creek eye centre, we are equipped with a device called an ocular biometer that can measure the length of the eyeball. This service is offered to all children during their routine eye exam.

Why is Myopia a problem?


Having myopia puts you or your child at an increased risk for eye disease later in life. In some cases, eye disease caused from myopia can cause blindness. These include:

  • Retina tear or detachment
  • Pre-mature cataracts
  • Glaucoma
  • Myopic maculopathy (myopia induced macular degeneration)

As our eyes continue to become more nearsighted, the eyeball continues to grow larger and larger. The problem with this is that as the eye grows, the retina (the thin layer of tissue that contains the photoreceptors (seeing cells)) gets stretched thinner and thinner to cover a larger eyeball. This can cause an increased risk of vision problems in the future, some with the potential to cause blindness.

According to the information on MyopiaProfile.com, a -1.00 to -3.00 myope has 3X the risk of having a retinal detachment at some point in their lifetime. This risk increases to 9X if you get in the range of -5.00 to -7.00 and as high as 44X more likely if over -7.00!!!!!

This is VERY alarming! But the GOOD NEWS is, there is something you can do to slow down or prevent this progression.

Growth Curves and Percentile Categories

The Tideman study looked at 12,386 European children with the purpose of generating percentile groups comparing the axial length of children, and their risk of nearsightedness in adulthood. In this study cohort, 87% or more of those found to have axial lengths in the 90th percentile or higher, were nearsighted. In the same group, 8% or more became highly nearsighted (greater than -6.00D of myopia) by adulthood. Those in the 98th percentile or higher, were very likely to end up with an axial length greater than 26 mm.

A similar study was done for a Chinese database of 12, 554 children by the San Diez group.


What can I do to slowdown the progression of nearsightedness?

Some of the most effective options are prescription eye drops, specialized soft contact lenses, hard lenses called orthokeratology lenses or specialized eyeglass lenses such as the HAL and SAL technology, among others. A certain combination of these may be indicated in certain cases. Book a myopia management consultation with one of our optometrists today and ask which option would be best for you or your child.

Once myopia increases, it very rarely (almost never) decreases, so it is extremely important to begin treatment early if the trend of increasing nearsightedness is observed or even in cases where we suspect they may become nearsighted at all.

Further scientifically-based, independent advice on childhood myopia and its management, can be found at myopia profile.

To learn more about low dose atropine for myopia management, click here.
To learn more about orthokeratology lenses for myopia management, click here.
To learn more about the soft contact lenses for myopia management, click here.
To learn more about the eyeglass lenses for myopia management, click here.  

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    Myopia Management: What are the treatment options?

    Daily soft contact lenses for myopia management

    Daily soft contact lenses such as the Coopervision Misight, Acuvue Abiliti and Naturalview multifocal lenses have been shown to reduce the progression of nearsighteness when worn for a minimum of 10 hours per day, 6 days per week. They are a great option for those with little to no astigmatism correction.

    References citing the efficacy and safety of orthokeratology for myopia management are listed here:
    1. Chamberlain, Paul BSc1∗; Bradley, Arthur PhD; Arumugam, Baskar PhD, FAAO; Hammond, David PhD; McNally, John OD, FAAO; Logan, Nicola S. PhD; Jones, Deborah BSc, FAAO; Ngo, Cheryl MBBS, Mmed; Peixoto-de-Matos, Sofia C. MSc; Hunt, Chris MSc; Young, Graeme PhD, FAAO. Long-term Effect of Dual-focus Contact Lenses on Myopia Progression in Children: A 6-year Multicenter Clinical Trial. Optometry and Vision Science 99(3):p 204-212, March 2022.
    2. Jill Woods, Debbie Jones, Lyndon Jones, Susanna Jones, Chris Hunt, Paul Chamberlain, John McNally,Ocular health of children wearing daily disposable contact lenses over a 6-year period,Contact Lens and Anterior Eye,Volume 44, Issue 4, 2021.
    3. Chamberlain P , Lazon de la Jara P , Arumugam B , & Bullimore MA . Axial length targets for myopia control. Ophthalmic Physiol Opt. 2021; 41: 523–531.
    4. Chamberlain, Paul BSc (Hons)1∗; Peixoto-de-Matos, Sofia C. MSc; Logan, Nicola S. PhD; Ngo, Cheryl MBBS, MMed; Jones, Deborah BSc, FAAO; Young, Graeme PhD, FAAO. A 3-year Randomized Clinical Trial of MiSight Lenses for Myopia Control. Optometry and Vision Science 96(8):p 556-567, August 2019.
    5. Chamberlain P, Hammond DS, Arumugam B, Bradley A. Six-year cumulative treatment effect and treatment efficacy of a dual focus myopia control contact lens. Ophthalmic Physiol Opt. 2024; 44: 199–205.

    Peripheral Defocus Eyeglass Lenses

    Orthokeratology Lenses (orthoK)

    Orthokeratology lenses are hard lenses, or molds, worn on the eye overnight during sleep. They gently reshape the front surface of the cornea to correct for the prescription so that no additional eyeglasses or contact lenses need to be wor during the day.

    References citing the efficacy and safety of orthokeratology for myopia management are listed here:
    1. Cho, P., Cheung, S. W., & Edwards, M. (2005). The Longitudinal Orthokeratology Research in Children (LORIC) in Hong Kong: A Pilot Study on Refractive Changes and Myopic Control. Current Eye Research, 30(1), 71–80. https://doi.org/10.1080/02713680590907256
    2. Pauline Cho, Sin-Wan Cheung; Retardation of Myopia in Orthokeratology (ROMIO) Study: A 2-Year Randomized Clinical Trial. Invest. Ophthalmol. Vis. Sci. 2012;53(11):7077-7085.
    3. Takahiro Hiraoka, Tetsuhiko Kakita, Fumiki Okamoto, Hideto Takahashi, Tetsuro Oshika; Long-Term Effect of Overnight Orthokeratology on Axial Length Elongation in Childhood Myopia: A 5-Year Follow-Up Study. Invest. Ophthalmol. Vis. Sci. 2012;53(7):3913-3919.
    4. Jacinto Santodomingo-Rubido, César Villa-Collar, Bernard Gilmartin, Ramón Gutiérrez-Ortega; Myopia Control with Orthokeratology Contact Lenses in Spain: Refractive and Biometric Changes. Invest. Ophthalmol. Vis. Sci. 2012;53(8):5060-5065.
    5. Walline JJ, Jones LA, Sinnott LT. Corneal reshaping and myopia progression. Br J Ophthalmol. 2009 Sep;93(9):1181-5. doi: 10.1136/bjo.2008.151365. Epub 2009 May 4. PMID: 19416935.
    6. Zhu MJ, Feng HY, He XG, Zou HD, Zhu JF. The control effect of orthokeratology on axial length elongation in Chinese children with myopia. BMC Ophthalmol. 2014 Nov 24;14:141. doi: 10.1186/1471-2415-14-141. PMID: 25417926; PMCID: PMC4280707.

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      Our Doctor's Certifications in Myopia Management

      Certificate of Completion from BHVI for Dr. Kelly Enns Certificate of Completion of the Be Free Advanced Ortho K System for Dr. Kelly Enns Certificate of Achievement from HOYA Vision Care Canada for Dr. Kelly EnnsCertificate of Professional Development from CooperVision for Dr. Kelly Enns
      “This is a really exceptional eye care practice! My kids and I both go here and the whole team are incredible. They're kind, helpful and personable with grown ups and little ones. Our doctor is really thorough and explains everything well. Really impressed with the care we receive here from everyone. Keep up the great work!”Erin Cummings Google Review
      “Both my husband and I had eye exams today with Dr. Enns. We were very impressed with the facility, equipment, and Dr. Enns. She is wonderful with her patients and explains everything. Would highly recommend her and Sage Creek Eye Centre for your next eye exam. My husband says it is the best eye exam he has ever had and he has had a few!”Martha V Google Review
      “Highly recommended based on level of care, expertise and ability to meet my exact needs. At the start of the pandemic, remote work was hard on my eyes and they were great at accommodating my needs. I left understanding more about my own role in my eye care health and tooled with amazing glasses that keep my eyes in check!”Amy Nadeau Google Review
      “I highly recommend! I recently moved to the area and required an adjustment to my glasses. I was greeted right away and out the door in minutes. No charge for repair. I will be going here for my future eyewear needs.”Craig Gillon Google Review
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