Managing Myopia Progression in Children: Concerns About Axial Length Growth - Ophthalmology

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Managing myopia progression in children is a significant concern for many parents, especially as the prevalence of myopia continues to rise globally. Your son's recent eye examinations indicate a concerning trend in axial length growth, which is closely associated with the progression of myopia. Let's address your questions systematically.

1. Current Axial Length and Future Myopia Progression: Your son’s left eye has an axial length of 25mm, which is indeed above the average adult axial length of approximately 24mm. The increase in axial length from 24.45mm to 25mm over the past year, alongside the increase in myopia from -0.25 to -0.50 diopters, suggests that his myopia is progressing. Generally, as axial length increases, the risk of further myopia progression also increases. While it is difficult to predict the exact degree of future myopia based solely on current measurements, the correlation you mentioned—where an increase of 1mm in axial length can lead to an increase of approximately 300 degrees of myopia—holds true in many cases. Therefore, it is plausible that if the axial length continues to increase, your son may experience a significant increase in myopia.

2. Methods to Slow Axial Length Growth: There are several strategies to manage and potentially slow the progression of myopia in children:
- Atropine Eye Drops: As you mentioned, your son is currently using long-acting atropine drops. Research has shown that low-dose atropine can effectively slow the progression of myopia in children. The exact mechanism is not fully understood, but it is believed to involve the modulation of eye growth.

- Orthokeratology (Ortho-K): This involves wearing specially designed contact lenses overnight that temporarily reshape the cornea. Studies have indicated that Ortho-K lenses can slow down the progression of myopia by reducing the rate of axial elongation.

- Multifocal Contact Lenses or Glasses: These lenses are designed to provide different focal points, which may help reduce the strain on the eyes and slow myopia progression.

- Increased Outdoor Time: Encouraging your child to spend more time outdoors has been associated with a reduced risk of developing myopia and slowing its progression. The exact reasons are still being studied, but exposure to natural light and the opportunity to focus on distant objects may play a role.

3. Concerns About Retinal Changes: As axial length increases, there is indeed a heightened risk of retinal complications, including retinal detachment, myopic maculopathy, and other degenerative changes. These risks are more pronounced in individuals with higher degrees of myopia. Regular eye examinations are crucial to monitor your son’s eye health and detect any early signs of complications.

4. Future Axial Length Projections: It is challenging to predict exactly how much your son’s axial length will increase in the future. However, if the current trend continues, it is possible that his axial length could exceed 26mm, which would further increase his risk of developing significant myopia-related complications.

In conclusion, it is essential to maintain regular follow-ups with your eye care professional to monitor your son’s myopia and axial length. Discuss the various management options, including the potential benefits and risks of each, to determine the best course of action tailored to your son's specific needs. Early intervention and consistent management can make a significant difference in controlling myopia progression and preserving long-term eye health.