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Myopia (nearsightedness) as a widespread phenomenon

Nearsightedness (myopia) is very widespread worldwide. In Switzerland, about 35 percent of the adult population is nearsighted, in Asia even up to 90 percent. The reason for nearsightedness in children and adolescents is almost always an increase in the length of the eyeball. As a result, the focal point in the eye shifts to the front of the retina and those affected see blurred in the distance, while the visual acuity of the near remains very good.

The onset of myopia and its progression varies from person to person. If there is a corresponding predisposition, myopia usually begins between the 8th and 13th year of life and then increases untreated usually over several years until it stabilizes. However, an earlier or later onset of myopia is also possible and not uncommon. A too long eyeball is a risk factor for changes at the back of the eye, especially for retinal diseases.

Factors in the development of myopia

Genetic predisposition and environmental factors play an important role in the development of myopia. Children of myopic parents have a significantly higher risk of developing myopia than children of normal-sighted parents. Studies have shown that natural outdoor daylight is very important for development and especially for the regulation of eye length growth. Children who spend two to three hours outdoors are significantly less likely to develop myopia than children who spend less than two hours outdoors. Good lighting, preferably bright and indirect, and adequate working distance when reading and doing other close work is very important. In addition, when reading for a long period of time, short breaks should be taken so that the eye has the opportunity to look into the distance and to relax.

Risks of myopia

Progressive myopia increases the risk of eye diseases, especially changes in the back of the eye, called the retina. The risk for retinal tears and retinal detachment increases with increasing myopia. In addition, with high myopia, comfortable reading is often no longer possible due to the short distance between the eyes and the reading text. Above all, myopia of more than 5 diopters should therefore be prevented. Very high myopia of more than 10 diopters is rare, but from this range onwards there are usually already significant changes in the fundus of the eye and the lifetime risk of retinal detachment is greatly increased.

Treatment options through myopia management

Since the last 10 years, various options are available to slow down the progression of myopia and excessive eye length growth as much as possible. Modern myopia management includes optical methods such as multisegment spectacle lenses or special contact lenses, as well as a drug approach using highly diluted atropine eye drops. Myopia management is individualized for each patient and success is measured by regular ophthalmologic examinations.

Myopia management with glasses

Myopia should be corrected to the fullest extent possible. If the myopia is only slight and the patient is wearing glasses for the first time, a conventional spectacle lens is suitable for this purpose. Whether myopia increases or remains stable in the course of time varies greatly from individual to individual. In many children and adolescents, however, myopia progresses over a number of years and the eyeball length increases continuously during this period. Since May 2021, so-called multisegment lenses are available in Switzerland. Multisegment spectacle lenses are based on the principle of “peripheral defocus”. Children and young people look through a central zone surrounded by many very small plus lenses. This is intended to curb the incentive for the eyes to become excessively long. The glasses look like normal lenses, and for the children there is hardly any adjustment compared to conventional lenses.

Myopia management with atropine

Since the last few years, the administration of atropine 0.01% eye drops has been recommended for progressive myopia. Before the so-called multisegment lenses came on the market in spring 2021, atropine eye drops were the only way to additionally slow down progressive myopia, besides conventional lenses with full myopia correction and so-called myopia control contact lenses. The scientific bases for this originate from Asia, where there are very many short-sighted children and young people. In the meantime, however, European study results are also available on the effect of atropine 0.01% eye drops on the development of myopia. Atropine has been known as an active ingredient in ophthalmology for many decades and is used in higher doses to dilate pupils. The very low dosage of Atropine 0.01% eye drops is usually very well tolerated by children and has little effect on near visual acuity and hardly any effect on pupil width.

Myopia management with contact lenses

For myopia management with contact lenses, soft multifocal contact lenses or so-called “night lenses”, which are custom-made (orthokeratology), are available. According to scientific studies to date, night lenses have a similar efficacy against progressive myopia as atropine 0.01% eye drops. Soft multifocal contact lenses, on the other hand, are less effective according to current studies. With all contact lenses however there is a risk of inflammation or infection of the ocular surface with possible scarring, which should be weighed against the benefits. To minimize the risk, very careful handling of the contact lenses and strict adherence to hygiene measures are necessary. Therefore, especially in the case of children, spectacle lenses are mostly used, as they do not pose the above-mentioned risks.

Professional consultation in the field of myopia management

Myopia is a very individual condition. Likewise, the needs of children and adolescents are very different. We will be happy to advise you and your child in detail and to find the optimal myopia management for your child together.

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