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Charlotte’s Myopia Management Specialist

What is Myopia?

Myopia, or near-sightedness, is a common problem among children due to excessive near work
(more school-work and digital device use), decreased outdoor time, and genetics.

Myopia can decrease the quality of life of children by decreasing school performance and self-confidence1-2. Some studies cite
a higher prevalence of mental health problems in children with myopia2. At young ages, myopia can advance quickly – yielding decreased
functional vision when without vision correction and requiring reliance on glasses or contact lenses to function

Myopia management can help to decrease these progressive & concerning
vision changes to allow your child to reach their full potential.

Solutions to Slow Your Child’s Progressive Myopia:

There are 3 options to help slow the worsening of a child’s vision – Myopia
management contact lenses, such as MiSight daily disposable lenses and
orthokeratology contact lenses, and atropine, an eye drop taken nightly. There are many considerations to determine which option best suites your child, such as the child’s prescription, maturity, motivation, outdoor time, various types of sport
involvement, and after/in school activities.

At the myopia management consultation, Dr. Cerenzie will work with the parents and child to determine the best myopia management treatment option.

Is My Child Too Young for Contacts?

  • This is a normal concern for most parents. According to multiple studies, children are safer contact lens wearers than their adult and teenager counterparts5,6,7.
  • Additionally, the younger the child is when starting myopia management, the more the child benefits in the long run.
  • Myopia progresses very aggressively from ages 6-9, so starting early is key to prevent large prescription changes from occurring, ultimately keeping the myopia as low as possible
  • Contact lens wear has also been found to improve children’s self-esteem4.
  • Dr. Cerenzie will have multiple follow ups to assure optimal ocular health and continual guidance on how to care for and handle the contact lenses.
  • See this great blog article for more information: Blog

Orthokeratology (Ortho-K)

What is Ortho-K?

  • Orthokeratology contact lenses are a great option for children that do not want to wear glasses or contact lenses during the day.
  • Orthokeratology lenses allow children to see and experience the world like children that never needed glasses or contacts! Orthokeratology contact lenses are worn only at night and act as night-time retainer lenses. They will correct the child’s vision to see great during the day, while slowing the progression of myopia.

Is Ortho-K Safe?

  • Countless studies have demonstrated great efficacy and safety of orthokeratology9,10,11. Orthokeratology is often the contact lens of choice for children that are active in sports, love to swim, or simply do not want to deal with the hassle of glasses or contacts during the day.
  • An added benefit is that the contact lens will never leave home, so parents have the ability to monitor how the child is caring for their lenses, assure good hygiene, etc.

How Ortho-K Works

  • Orthokeratology works through fluid hydraulics. The lens rests on the tear layer of the eye. The anatomy of an orthokeratology contact lens allows the tear layer of the eye to shift fluid within the cornea which temporarily results in a shape change of the cornea. This shape change of the cornea functions to allow the child to see clearly when the lens is removed, and also changes the way light comes into the eye to slow the progression of myopia. Often, the shape change can last more than 24 hours, but the child is still encouraged to wear the lens nightly.

MiSight

What is MiSight?

MiSight daily disposable contact lenses are the only FDA approved contact lens specifically
approved for myopia control12. Other options, such as orthokeratology, are FDA approved for myopia correction, but through studies have been shown to effectively reduce myopia
progression.

MiSight contact lenses are worn during
the day and slow the average myopic progression by 59%6,12.

Is MiSight Safe?

During the 6 years FDA clinical trial, there were no adverse events6,12. Clinical trials found that children wearing these lenses experienced great comfort and handling ability with applying and removing lenses 6,12. At the end of a 6-year period of wearing MiSight contact lenses,
23% of the children showed complete
stability of myopia!

How MiSight Works

These contact lenses look and feel like a traditional contact lens but have special optics integrated within the contact lens that prevent abnormal elongation of the eye, and hence, slow myopic progression.

Atropine

What is Atropine?

Atropine is an eye drop that is taken nightly to help slow myopic progression. It is compounded to low-doses for myopia control, specifically 0.05% at Charlotte Contact Lens Institute. This is the best dose for myopia control outcomes and safety. Often, atropine is prescribed for children that are not quite ready for contact lenses or as an added treatment for children with aggressive myopic progression. Glasses will need to be worn during the day. Low-dose atropine slows progression by over 50% 13.

Is Atropine Safe?

Low dose atropine drops are typically tolerated very well by children. Some side effects may include light sensitivity and near vision blur13. If these side effects occur, they usually last up to around two weeks. If children experience these side effects longer, the dosage will be decreased.

How Atropine Works

Atropine is thought to slow myopic progression by acting directly on the layers of the eye that grow abnormally during the myopic process.

Frequently Asked Questions

There are so many great options we have for myopia management. With orthokeratology, multifocal contact lenses (FDA approved preferred option is MiSight), and atropine, all prescriptions can be treated. Dr. Cerenzie will meet with you and your child to determine what option fits best with your child’s lifestyle – including hobbies, school performance, and future goals.

Dr. Cerenzie has experience with children as young as five wearing contact lenses. Studies consistently show that children are safe wearers, even more so than adults. They hardest part is learning how to put them in and out. Often, it may take a few classes to learn the technique, and that’s okay! Dr. Cerenzie and her team will spend as much time as possible to assure that the child wears the lenses safely.

During the initial examination, Dr. Cerenzie will perform the following:
  • Refraction – To assess the most up-to-date prescription
  • Ocular Health Exam– To evaluate ocular health and candidacy for various myopia management treatment options. The front and inside of the eye will be examined thoroughly.
  • Biometry– To perform a baseline of the length of the eye, a very important measurement when determining efficacy of myopia management treatments.
  • Topography– To evaluate the unique shape of the cornea and determine the best fit for a contact lens solution
  • Binocular Vision Assessment– To assure that both eyes are working in synchrony
  • Meibography– All contact lens wearers will have their meibomian glands evaluated (important glands to help keep contact lenses hydrated and comfortable), as well as basic tests to assess for dry eye syndrome

A treatment option will be chosen based on candidacy and lifestyle goals/hobbies. For example, children that love to swim often elect for orthokeratology to allow for clear vision during the day, without the need for glasses or contact lenses while in the water.

For new contact lens wearers, there will be a contact lens application and removal class – This class will also include instruction on how to properly care for contact lenses and overall hygiene during contact lens wear. The lessons do not end here. Children are constantly quizzed on their skills and learnings.

 

There will be an additional 1 week follow up to assist with potential difficulties with contact lens wear, as well as an additional ocular health examination to assure great eye and contact lens compatibility.

MiSight Resources

Orthokeratology Resources

Citations for Scientific Reviews on
Myopia Management

1. Modjtahedi, Bobeck S., et al. “Reducing the global burden of myopia by delaying the onset of myopia and reducing myopic progression in children: the Academy’s Task Force on Myopia.” Ophthalmology 128.6 (2021): 816-826.


2. Huang, Juerong, et al. “Myopia and Depression among Middle School Students in China—Is There a Mediating Role for Wearing
Eyeglasses?.” International journal of environmental research and public health 19.20 (2022): 13031.

3. Hu, Yin, et al. “Association of age at myopia onset with risk of high myopia in adulthood in a 12-year follow-up of a Chinese cohort.“ JAMA ophthalmology


4. Dias, Lynette, et al. “Myopia, contact lens use and self-esteem.“ Ophthalmic and Physiological Optics 33.5 (2013): 573-580.


5. Chalmers RL, Wagner H, Mitchell GL, et al. Age and Other Risk Factors for Corneal Infiltrative and Inflammatory Events in Young Soft Contact Lens Wearers from the Contact Lens Assessment in Youth (CLAY) Study. Invest Ophthalmol Vis Sci 2011;52:6690-6.

6. Chalmers, Robin L., et al. “Adverse event rates in the retrospective cohort study of safety of paediatric soft contact lens wear:
the ReCSS study.” Ophthalmic and Physiological Optics 41.1 (2021): 84-92. 

7. Chamberlain P, Peixoto-de-Matos SC, Logan NS, et al. A 3-Year Randomized Clinical Trial of Misight Lenses for Myopia Control.
Optom Vis Sci 2019;96:556-67. 

8. Chua, Sharon YL, et al. “Age of onset of myopia predicts risk of high myopia in later childhood in myopic Singapore children.“
Ophthalmic and Physiological Optics 36.4 (2016): 388-394.


9. Bullimore, Mark A., et al. “The risks and benefits of myopia control.“ Ophthalmology 128.11 (2021): 1561-1579.


10. Bullimore, Mark A., and Noel A. Brennan. “Myopia control: why each diopter matters.” Optometry and Vision Science 96.6 (2019): 463-465. 


11. Si, Jun-Kang, et al. “Orthokeratology for myopia control: a meta-analysis.” Optometry and Vision Science 92.3 (2015): 252-257.

12. Chamberlain, Paul, et al. “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 (2022): 204-212. 

13. Yam, Jason C., et al. “Three-Year Clinical Trial of Low-Concentration Atropine for Myopia Progression Study: Continued Versus Washout Phase 3 Report.”