Myopia and Astigmatism in Children: Key Concerns for Parents

Q: Myopia and Astigmatism in Children: Key Concerns for Parents

Hello： <br>1. <br>When measuring the axis, even a slight tilt of the head can cause a minor deviation in the axis measurement. <br>The degree of astigmatism is related to the measurement point, so slight variations are normal. <br>Therefore, it is important to measure multiple de

Children's prescription glasses and issues with myopia and astigmatism?

Dear Doctor,
My child is ten years old and was diagnosed with astigmatism of 200 and 175 during kindergarten.
I would like to ask you a few questions:
1.
During the first examination about five years ago, the astigmatism axis was measured at 180 and 10.
A few days ago, the doctor measured the prescription again, and the axis was 180 and 5 (measured after dilation).
Could you explain why the axis changed from 10 to 5? (Astigmatism sometimes changes from 175 to 150 as well.) My child’s myopia has increased significantly, and we need to get glasses, so I requested a prescription from the doctor.
I only noticed the change in axis after returning home and didn’t have time to ask the doctor.
When I go to the optical shop, should I just follow the doctor’s prescription? Previously, all three pairs of glasses I had made had an axis of 10, and I would like to keep the old ones for reading.
However, if the axis differs by 5, is it still acceptable?
2.
My child is in the fourth grade and already has a myopia of 300 degrees.
The doctor estimates that if this continues, it could easily lead to high myopia.
However, I am concerned about the long-term use of atropine, as it keeps the pupils dilated, and I worry about potential issues in old age.
The consequences of high myopia are indeed concerning.
I am unsure how to choose between these options.
Are there any research studies that confirm the long-term safety of using atropine? I do not allow my child to play video games or use the computer, but my child tends to be slow in completing homework, takes too long to read extracurricular books, and does not know to take breaks.
Additionally, my child does not like wearing glasses, claiming to see clearly, which adds to a parent's worry.
3.
If only Tropicamide is used, is it effective for myopia?
I apologize for the trouble, and I appreciate your clarification.
Thank you.

Fanrao de Mama, 10~19 year old female. Ask Date: 2013/07/11

Dr. Gao Pilin reply Ophthalmology

Hello:
1.
When measuring the axis, even a slight tilt of the head can cause a minor deviation in the axis measurement.
The degree of astigmatism is related to the measurement point, so slight variations are normal.
Therefore, it is important to measure multiple degrees and axes to ensure accuracy when prescribing glasses.
An axis difference of 5 degrees can still be acceptable if there is no blurriness or discomfort in vision.
2.
The main concern after using atropine is light sensitivity, so it may be necessary to wear sunglasses when going outside to prevent retinal damage; however, there are currently no related statistical reports.
If children are willing to use it, atropine is currently the only medication for the prevention and treatment of myopia.
3.
Tropicamide has only a short duration of action and is not effective for the prevention and treatment of myopia; it is used solely for examinations.

Thank you for your message.

Reply Date: 2013/07/11

More Info

Understanding myopia and astigmatism in children is crucial for parents, especially when it comes to managing their children's eye health. Your concerns about your child's vision, particularly regarding the changes in astigmatism and the implications of myopia, are valid and warrant careful consideration.

1. Changes in Astigmatism Axis
The axis of astigmatism refers to the orientation of the cylindrical correction needed to address the uneven curvature of the cornea or lens. It's not uncommon for the axis measurement to change slightly over time, especially in children whose eyes are still developing. The change from 10 degrees to 5 degrees in your child's astigmatism axis could be attributed to several factors, including natural growth and development of the eye, changes in the corneal shape, or even measurement variability.
When you go to the optical shop, you should follow the prescription provided by the eye doctor. If the doctor has prescribed new glasses with the updated axis, it is generally advisable to use that prescription for optimal vision correction. While you may want to keep the old glasses for reading, using glasses with a significantly different axis may not provide the best visual clarity and could lead to discomfort or strain.

2. Concerns About Myopia Progression and Atropine Use
Your child's myopia of 300 degrees at such a young age is indeed concerning, as it can lead to high myopia, which is associated with various ocular complications later in life, such as retinal detachment, glaucoma, and cataracts. Atropine eye drops have been shown in studies to effectively slow the progression of myopia in children. The long-term safety of low-dose atropine (typically 0.01% concentration) has been supported by research, indicating that it is generally well-tolerated with minimal side effects.
However, it is essential to have a thorough discussion with your child's eye care provider about the risks and benefits of long-term atropine use. They can provide guidance tailored to your child's specific situation and help you weigh the potential benefits of slowing myopia progression against any concerns you may have about long-term effects.

3. Effectiveness of Tropicamide for Myopia
Tropicamide is primarily used for dilating the pupils during eye examinations and does not have a therapeutic effect on myopia itself. It is not intended for the treatment or management of myopia. If your goal is to manage your child's myopia, you should focus on treatments specifically designed for that purpose, such as atropine, orthokeratology (special contact lenses worn overnight), or multifocal glasses, depending on what your eye care provider recommends.

Additional Considerations
As a parent, it is essential to encourage healthy visual habits in your child. This includes ensuring they take regular breaks during homework or reading, practicing the 20-20-20 rule (every 20 minutes, look at something 20 feet away for 20 seconds), and promoting outdoor activities, which have been shown to help reduce the risk of myopia progression.

In conclusion, managing your child's vision requires a collaborative approach with eye care professionals. Regular check-ups, adherence to prescribed treatments, and fostering good visual habits at home can significantly contribute to your child's eye health and overall well-being. Don't hesitate to reach out to your child's eye doctor with any further questions or concerns you may have regarding their vision care.

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