the Surge in Myopia Among Children: Causes and Solutions

The surge in myopia among children?

Hello, doctor.
My daughter is currently in the second grade of elementary school (just turned seven).
She has been having her eyes checked since she was three years old.
The results from her dilated eye exams showed myopia of -0.50/-0.75 and astigmatism of -1.50/-1.75.
In August of the year before last (just turned five), her dilated eye exam showed myopia increased to -1.50/-1.75, with astigmatism remaining unchanged.
She was prescribed a long-acting dilating agent, but we discontinued it due to allergic reactions causing itchy eyes.
Last August, when she entered first grade (just turned six), her dilated eye exam showed myopia had increased again to -2.75/-3.00, with astigmatism unchanged (an increase of -1.25 in six months)! Since my daughter enjoys reading and does not like outdoor activities after class, we discovered that many ophthalmologists recommend students wear glasses with a lower prescription (reducing by 1.00 to 1.50 diopters) due to prolonged near work.
Therefore, in December of last year, I had another pair of glasses made for her (reducing myopia by -0.75 diopters each and astigmatism by -0.50 diopters) for everyday use, while her regular prescription glasses were for distance vision.
Subsequently, she almost always wore the lighter prescription glasses, and when asked if she could see clearly in class, she always replied that she could see very well.
However, in July of this year, I suddenly noticed that she was squinting while watching TV with her original glasses of -2.75/-3.00 myopia and -1.50/-1.75 astigmatism.
When we took her to the ophthalmologist, her myopia had surged to -5.50/-6.00, but her astigmatism, which was not supposed to decrease, had dropped to -1.50/-1.00.
This was a shocking revelation!
I understand that the causes of myopia are "genetics" and "near work." I have a myopia of -13.00/-14.00 diopters, and my father has about -4.00 diopters.
I have several questions:
1.
My daughter enjoys reading and does not like outdoor activities after class, so she indeed often uses her eyes at close range.
Theoretically, wearing glasses with a lower prescription should prevent myopia from worsening.
Why did her myopia increase by -3.00 diopters in eight months while wearing the lighter prescription glasses?
2.
Could this be due to genetics?
3.
I have also heard some ophthalmologists say that insufficient prescription in myopic glasses may also contribute to worsening myopia.
Is this a significant cause of myopia progression?
4.
Could wearing glasses with an insufficient prescription (reducing myopia by -0.75 diopters each and astigmatism by -0.50 diopters) over the past eight months lead to amblyopia? The doctor did not mention this.
With her previous glasses of -2.75/-3.00 myopia and -1.50/-1.75 astigmatism, she could see the same distance with both eyes, but with the new glasses of -5.50/-6.00 myopia and -1.50/-1.00 astigmatism, her right eye sees 0.9 and her left eye only sees 0.75.
Is it possible for astigmatism to decrease by -0.75 diopters in one year? With the new glasses of -5.50/-6.00 myopia and -1.50/-1.00 astigmatism, her right eye sees 0.9 and her left eye only sees 0.7.
Could this be related to the -0.75 diopter decrease in astigmatism in her left eye? The doctor did not use trial lenses after measuring her prescription with dilation.
5.
Currently, she is wearing plano glasses.
Should she have another pair of glasses for reading or doing homework (my doctor said it is unnecessary)? How much should the prescription be reduced? Or does she need to wear glasses with reduced pressure?
6.
Have orthokeratology lenses been proven to control the progression of myopia? Are they still only suitable for individuals over 12 years old? Thank you—this is a very concerning and guilt-ridden mother.

sylvia, 0~9 year old female. Ask Date: 2012/09/18

Dr. Wang Zhishun reply Ophthalmology

Hello,
1.
To prevent children from developing myopia or increasing their myopic degree, outdoor activities are as important as using eye drops.
It is recommended to address both aspects simultaneously.

2.
Astigmatism generally does not change significantly unless there is trauma or pathological changes.
A thorough refraction and eye examination can determine the source of any changes in astigmatism.

3.
High myopia may have a genetic component.

4.
I apologize, but I cannot provide recommendations for your child's glasses prescription based on your description.

5.
Orthokeratology lenses seem to be improving and may be effective in controlling the progression of myopia.
This year, Taiwan may approve the use of orthokeratology lenses for children aged 9 and above.

Thank you for your inquiry, and feel free to discuss further.

Reply Date: 2012/09/18

More Info

Understanding the surge in myopia (nearsightedness) among children is a complex issue that involves various factors, including genetics, environmental influences, and lifestyle choices. Your concerns about your daughter's vision are valid, especially given her rapid progression of myopia. Let's address your questions systematically.

1. Rapid Increase in Myopia: The significant increase in your daughter's myopia from 275/300 to 550/600 in just eight months, despite wearing glasses with a reduced prescription, is concerning. While wearing lower prescription glasses can help reduce eye strain, it may not be sufficient to prevent myopia progression, especially if the underlying causes, such as prolonged near work and lack of outdoor activity, are not addressed. The effectiveness of reduced prescriptions can vary from child to child, and in some cases, it may not adequately correct vision, leading to further strain and worsening myopia.

2. Genetic Factors: Genetics plays a crucial role in myopia development. If you have high myopia (1300/1400 degrees), it increases the likelihood that your children may also develop myopia. The combination of genetic predisposition and environmental factors, such as excessive near work and insufficient outdoor time, can lead to a higher risk of developing significant myopia.

3. Insufficient Prescription: There is some debate among eye care professionals regarding the impact of under-corrected myopia on its progression. Some studies suggest that wearing glasses that do not fully correct myopia may lead to increased strain on the eyes, potentially contributing to further progression. However, this is not universally accepted, and more research is needed to establish a definitive link.

4. Risk of Amblyopia (Lazy Eye): Wearing glasses with an insufficient prescription for an extended period can potentially lead to amblyopia, especially if one eye is significantly more nearsighted than the other. Amblyopia occurs when the brain favors one eye over the other, leading to reduced vision in the less favored eye. Regular eye examinations are essential to monitor your daughter's vision and ensure that any signs of amblyopia are addressed promptly.

5. Astigmatism Changes: It is indeed possible for astigmatism to change over time. A reduction in astigmatism of 75 degrees in a year is not unheard of, but it should be monitored closely. The changes in your daughter's astigmatism could be related to various factors, including the way she uses her eyes or changes in her eye structure.

6. Need for Additional Glasses: Whether your daughter needs a separate pair of glasses for reading or homework depends on her comfort and visual acuity with her current glasses. If she is experiencing difficulty seeing clearly for close tasks, it may be beneficial to have a pair of glasses specifically for that purpose. Your eye care provider can help determine the best course of action based on her specific needs.

7. Orthokeratology (Ortho-K) Lenses: Orthokeratology lenses, or corneal reshaping lenses, have shown promise in controlling myopia progression in children. These lenses are typically worn overnight to temporarily reshape the cornea, allowing for clear vision during the day without glasses or contact lenses. While they are primarily used in children aged 8 and older, some practitioners may consider them for younger children based on individual circumstances. It is essential to consult with an eye care professional who specializes in myopia management to discuss the suitability of Ortho-K for your daughter.

In conclusion, managing myopia in children requires a multifaceted approach that includes regular eye examinations, appropriate corrective lenses, and lifestyle modifications such as increased outdoor activity and reduced screen time. It is crucial to maintain open communication with your eye care provider to monitor your daughter's vision and make necessary adjustments to her treatment plan. Your proactive approach as a concerned parent is commendable, and with the right support and interventions, you can help your daughter maintain healthy vision.

Similar Q&A

Managing Significant Myopia Difference in Children: Tips and Concerns

My child is currently 14 years old, and there is a 300-degree difference in myopia between the left and right eyes. A year ago, the difference was 150 degrees, and a recent examination indicates that the disparity seems to be worsening. What measures can be taken to prevent this ...

Dr. Qiu Hanqing reply Ophthalmology
Thank you for your concern regarding your child's vision issues! Generally, myopia can be classified into: 1. Refractive myopia: caused by excessive curvature of the cornea or lens, spherical lens, or nuclear cataract. 2. Axial myopia: this type is common among school-aged c...

Understanding Fluctuating Vision: Causes and Solutions for Eye Health

Hello Doctor, I am nearly 34 years old this year. Since childhood, my family strictly limited my reading, writing, and television viewing distances. During fifth and sixth grade, when I loved reading the most, I did not have myopia. However, during middle school, the educationa...

Dr. Cai Wenyuan reply Ophthalmology
Hello, I believe your issue is not serious. I recommend visiting a medical center for a check-up. Wishing you peace and good health. Sincerely, Dr. Tsai Wen-Yuan, Director of the Ophthalmology Department, Taoyuan Hospital, Ministry of Health and Welfare.

Managing Excessive Axial Length in Children's Eyes: Concerns and Solutions

Thank you, doctor, for your prompt response to my questions! Yesterday, I inquired about my child's axial length of 25mm. This year, my son turns 8 years old and has 200 degrees of astigmatism in both eyes. In July last year, his right eye had +75 degrees of hyperopia and hi...

Dr. Gao Pilin reply Ophthalmology
Hello Kelvin: 1. It is still within the normal range; a flat cornea indicates a lower refractive value, not a thin cornea. 2. The current proactive management methods include the use of long-acting atropine eye drops or wearing orthokeratology lenses. However, there are individua...

Understanding Your Child's Vision: Addressing Nearsightedness and Astigmatism

My child will turn three in four days. A month ago, we visited an ophthalmologist because since birth, the lower eyelashes have been rubbing against the eyeball, causing excessive tearing and discharge. During that visit, the right eye was found to have a refractive error of -4.0...

Dr. Zhuang Yamin reply Ophthalmology
Dear Min-Hsin, Hello! The visual development of a three-year-old child is not yet complete, and a visual acuity of 0.7 is not considered abnormal. In simple terms, his current visual development status is normal (no amblyopia). However, due to the presence of significant refract...