Myopia Control

Myopia, or shortsightedness, is increasing around the world, with many calling it an epidemic. Urbanisation and screen availability seem to be the primary drivers for the increase in short sighted eyes. The adaptations of the eye to focus at nearer objects not only reduces distance vision and requiring glasses or contact lenses, but it also increases the risk of irreversible eye disease. If you would like to know more about the treatment options we offer here at Innovative Eye Care to slow the progression of myopia, book an appointment or find out more by giving our friendly staff a call.

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How prevalent is myopia?

For most people short-sightedness evokes the harmless image of a school-aged child using glasses to see the television and school board clearly. But the real change that progressive myopia represents is a lengthening of the eyeball which increases the risk of eye disease. These changes are happening at a rapid rate, with the prevalence of myopia predicted to reach half the world’s population by 2050. Some groups of people seem to be developing more myopia than others. Those that are higher educated, those living in more densely populated regions, and those of Asian descent tend to be more adversely affected.

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How does myopia affect the eye?

By definition, myopia is a condition caused by light focusing behind the retina rather than on it, causing blurred distance vision. The eye will try to correct this by lengthening to catch up with the light focused behind it. This lengthening happens as a result of stretching of the tissue of the eye, not growth, and as a result the people with high levels of myopia are at increased risk for retinal detachments. Myopia can start to develop at any age but the younger the start, the more aggressive the progression of myopia and eye lengthening tends to be. High myopes will be highly dependent on more expensive, heavy, high-powered glasses or contact lenses for any visual tasks. They may also have to keep updating their prescription lenses each year as their eye becomes more shortsighted.

What are the associated risks of myopia?

Historically, low myopia was considered a normal variation of the eye, a harmless adaptation to increased near vision demands, and a distinction was made between:

  • Physiological myopia between -0.25 and -5.00 D, assumed to have no associated eye disease
  • Pathological myopia beyond -5.00 D, where increased eye length growth causes retinal stretching and subsequent risk of detachment, maculopathy, glaucoma and cataract

For this model to be valid, there should be a cutoff under which the degree of myopia has an acceptably low level of risk for eye disease, but this does not appear to happen. Any magnitude of myopia carries significant increased risk of permanent, uncorrectable vision loss compared to a non-myopic eye.

How bad are the risks, even just for low myopia?

A study published in 20121 on the interactions of several factors on myopia found the following:

“Myopia in the so-called ‘physiological range’ represents a major risk factor for ocular disease that is comparable with the risks associated with hypertension for cardiovascular disease or with the risks of stroke from smoking more than 20 cigarettes per day. For retinal detachment and myopic maculopathy, myopia carries a risk far in excess of any identified population risk factor for cardiovascular disease.”

These conditions are far from rare: myopic maculopathy, a progressive condition causing breakdown of retinal cells, is the forth most common cause of visual impairment in the UK, ahead of diabetic eye disease.

An important concept to re-iterate is that while the risks of eye disease later in life are present for any degree of myopia, the higher the amount of myopia, the higher the risk. An Australian study showed myopes of above -5.00 D had a myopic retinopathy prevalence 60 times that of lower myopes. The lifetime chance of a retinal detachment in patients with more than -5.00 D of myopia is around 5% compared to 0.3% for the general population. If we can stop the progression of myopia into these high levels then a significant amount of blindness can be prevented. Studies suggest that even a modest reduction in the rate of myopia of 33 % could produce a 73 % reduction in myopia above 5.00 D.

Case study: Alex Petty

The personal case of one of our previous optometrists, Alex Petty, highlights why myopia control is so important. Alex developed myopia at the age of 9. This progressed throughout his teenage years, eventually stabilising at a high -7.50 D in each eye. As a result, Alex suffered two retinal detachments in his left eye in 2009 and another in 2014 in his right. Fortunately, through timely surgery the damage was controlled with only slight vision loss. If Alex had access to myopia control treatments when he was a teenager, it is unlikely his prescription would have worsened as quickly and these ocular emergencies might have been prevented. His experience has fuelled a passion to treat young people with myopia and prevent eye disease later in their lives.

How can myopia be controlled?

Prescribing standard spectacle lenses or contact lenses will do nothing to halt the lengthening of the eye. As a result, the patient will require frequent spectacle lens updates and will be put at risk of sight-threatening disease in the future. Unfortunately, the lengthening of the eye which causes myopia cannot be reversed, making it critical to control myopia sooner rather than later.

The good news is, there is convincing evidence that certain treatments can slow and even halt the progression of myopia. Orthokeratology and topically administered atropine drops have been shown to be the two most effective tools currently available to control myopia. These options have different pros and cons, so it is necessary to determine an appropriate treatment plan with your optometrist. Other treatment options do exist, though they do not show the same level of myopia control.

Innovative Eye Care’s myopia control treatment options


Orthokeratology (or ortho-K) is a type of contact lens wear which has been practiced at Innovative Eye Care for many years. Ortho-K involves wearing a custom-designed contact lens overnight which reshapes the surface of the eye, providing clear vision the next day without the lenses. As well as being convenient for the patient, the treatment actually slows and in some cases stops myopia progression. As the surface of the eye changes, so does the point at which light entering it is focused. As we know, myopes focus light behind the retina. When reshaped, the light is focused on the retina and the eye no longer attempts to elongate.

Research has now shown a range of 32%-100% slowing of myopia progression depending on the study. Most reports suggest an average of a 50% reduction in the rate of myopia progression with ortho-K contact lens wear. Results in our practice and from other myopia control practices in Australasia show complete halting of myopia progression in some patients.

Atropine drops

Atropine drops have been used for many years to control myopia; however, until recently they have been prescribed at a normal concentration of 0.5% - 1%. Atropine at this concentration causes loss of focusing in young children for near tasks and dilates the pupil leading to light sensitivity. For young patients that show aggressive myopia progression we will still recommend 1% atropine in order to best control their myopia progression. These drops are used in conjunction with tinted transitions progressive lenses to give protection from bright light and the ability to see for reading tasks.

Studies over the last decade have found that much lower concentrations of atropine, such as 0.02%, have a comparable reduction in myopia progression, without any noticeable effect on pupil size or near-focusing. For example the ATOM2 study showed the myopia control effect of 75% reduction for the 1%, 0.5% and 0.1% concentrations and 65% reduction with 0.01%. Studies have told us that 0.02% is the highest concentration of atropine that shows no significant change to near focusing or pupil size in children, and has no reported allergic side effects.

It was initially thought that as atropine drops paralyse the focusing muscles of the eye, this was the reason for the myopia control. Our understanding now suggests that the atropine molecule affects a receptor in the choroid or sclera of the eye (the vascular and structural layers of the eyeball), signalling to the eye not to continue to elongate. This mechanism is still being studied.

Atropine drops need to be instilled nightly and can be combined with ortho-K therapy to maximise the myopia control effect. Visual and general side-effects are highly unlikely at 0.02%. Atropine drops will need to be specially formulated at a compounding pharmacy as they are not readily available at concentrations below 0.5%.

Soft contact lenses

Certain types of soft contact lenses have been used and developed to control myopia. Multifocal soft contact lenses are typically used by people over 40 to improve their near vision. These have a similar peripheral area of steepening on the lens like ortho-K, although at a lower level (maximum +3.00 D, whereas the ortho-K example above shows a +8.00 D difference). As a result, when these soft contacts have been used by young patients, studies have only reported a modest range decreased progression of 29-45%. Specialised soft contact lenses called MiSight (Coopervision) show a 40% reduction in myopia progression. Similarly, a recent case study of VTI brand NaturalVue soft lenses showed that 91% of participants showed an over 70% decrease in myopia progression. If ortho-K lenses are not suitable, these soft contact lenses may be discussed by your optometrist as an alternative option, and may be used in conjunction with atropine drops.

Spectacle lens options

As mentioned previously, regular spectacles offer no myopia control benefit. In some individuals that are myopic and progressing and that show a near esophoria (tendency of the eyes to turn in more than required when reading) or an accomodative lag (eyes do not focus close enough when reading) then progressive addition spectacles lenses may offer some myopia control benefit. The near conditions mentioned above are tested by your optometrist during their appointments. Studies are varied but suggest a reduction of myopia progression in the range of 12-55% with these lenses.

Myovision spectacle lenses are specially designed for controlling myopia but studies suggest they only slow progression by 0-30%. As a result they are infrequently used.

Other considerations

Apart from active interventions, there is also sufficient evidence for the modification of lifestyle factors of time spent on near work and time spent outdoors. Less near work, or more regular breaks plus more time outdoors in natural light are protective against eye length growth.

There is an excellent website by Richard Anderson ( which explains in detail all aspects of myopia control with the relevant research included.

Axial eye length is the best metric of risk and progression for myopia. It has the with the least variability and directly relates to the disease processes that myopia can create. If you are concerned about your child’s eyes becoming progressively short-sighted, please contact our friendly team to arrange a consultation with one of our optometrists to discuss their myopia and what may be done to arrest this progression.

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