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The risk of becoming myopic increases with the number of myopic parents, 21– 23 monozygotic twins have significantly stronger correlation of refractive error than dizygotic twins, 24, 25 and genetic factors are more responsible for variability in refractive error than environmental factors. Genetics appear to play a role in determining a child’s refractive error status. 17– 20Īlthough myopia is a prevalent disease, little is known about the risk factors that lead to the development and progression of myopia. 12– 14 Myopia typically develops at approximately 8 years of age and progresses through 15 or 16 years of age, 15, 16 and the average rate of progression is approximately 0.50 D (diopter) per year. 6, 7 Some studies report a greater proportion of myopic females, 8– 11 but others report a similar prevalence between sexes. 3 In general, the prevalence of myopia is highest in Asian children, 4– 7 followed by Hispanic, and then black and white children. Myopia affects approximately one-third of the US population, 1 but the prevalence ranges from as low as 3% for Sherpa in Nepal 2 to over 90% in Taiwan University students. Light focused in front of the retina results in blurry vision while looking at far away objects but clear vision while looking at close objects. Myopia, also known as nearsightedness, is caused by an increase in eye length or corneal curvature and this condition causes light from distant objects to focus in front of the retina. This review provides an overview of the myopia control information available in the literature and raises questions that remain unanswered, so that eye care practitioners and parents can potentially learn the methods that may ultimately improve a child’s quality of life or lower the risk of sight-threatening complications. While the progression of myopic refractive error is slowed with lower concentration of atropine, the growth of the eye is not, indicating a potentially reversible form of myopia control that may diminish after discontinuation of the eye drops. Several studies have shown that lower concentrations of atropine slow the progression of myopia control with fewer side effects than 1% atropine. Pirenzepine provides myopia control with little light sensitivity and few near-vision problems, but it is not yet commercially available as an eye drop or ointment. The most effective myopia control is provided by atropine, but is rarely prescribed due to the side effects. Topical pharmaceutical agents such as anti-muscarinic eye drops typically lead to light sensitivity and poor near vision. Parents and eye care practitioners should work together to determine which modality may be best suited for a particular child. Both orthokeratology and soft bifocal contact lenses have shown to slow myopia progression by slightly less than 50% in most studies. Although none of these modalities are US Food and Drug Administration-approved to slow myopia progression, they have been shown to slow the progression by approximately 50% with few risks. The most effective methods are the use of orthokeratology contact lenses, soft bifocal contact lenses, and topical pharmaceutical agents such as atropine or pirenzepine.
ASIAN AGE PROGRESSION TRIAL
Treatment options such as undercorrection of myopia, gas permeable contact lenses, and bifocal or multifocal spectacles have all been proven to be ineffective for myopia control, although one recent randomized clinical trial using executive top bifocal spectacles on children with progressive myopia has shown to decrease the progression to nearly half of the control subjects.
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To date, few strategies used for myopia control have proven to be effective.
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Slowing the progression of myopia could potentially benefit millions of children in the USA. High amounts of myopia are associated with an increased risk of sight-threatening problems, such as retinal detachment, choroidal degeneration, cataracts, and glaucoma. Myopia is a common disorder, affecting approximately one-third of the US population and over 90% of the population in some East Asian countries.