Case example: A 6-year-old Asian female who presented for an exam already had –1.00D of myopia, and both her parents were significantly myopic. As studies have shown, early manifestations of myopic refractive error and the number of myopic parents are significant predictors of the child’s risk of myopia progression. Her young age and the onset of myopic shift related to refractive error and axial length before the onset of juvenile myopia.
We could obviously prescribe glasses to correct the presenting ametropia (refractive error) and re-evaluate in six months, or flat-top bi-focals or progressive addition lenses could be used to relax accommodative stress. However, these options will not have a lasting effect on myopic progression, delaying it by only 0.25D to 0.50D.
We could also consider using atropine in conjunction with corrective spectacle lenses. Studies suggest that might be appropriate, particularly if the child is not ready to be fit with contact lenses.
There are also behavioral modifications, such as an extra 40 minutes of time outdoors, which research shows can re-duce the progression of myopia, and following the 20-20-20 rule (a 20-second break to view something 20 feet away every 20 minutes) to reduce eyestrain from increased use of digital devices. The other option: using contact lenses to halt the progression of myopia.
The goal of a proper contact lens design is to control the stress of accommodation in which the eye tries to refocus the image shell. The result of this stress is increased axial length of the eye, which causes myopia to progress.
Standard gas permeable contact lenses cannot control this stress successfully, because the basic lens design only provides refractive correction. To control accommodative stress, a gas permeable design requires central corneal epithelial compression, with the spread of the tissue to the periphery. This allows the paracentral region to refocus the image shell onto the peripheral parafoveal.
As such, in this case we would highly suggest Extended Depth of Focus soft multifocal daily disposable contact lenses (NaturalVue® or the MiSight®) which have been shown to be as effective as orthokeratology and atropine. More importantly, the child can be easily taught in the insertion and removal of soft lenses with higher and safer compliance with their use.