Myopia Management

What is myopia?

Myopia (or “nearsightedness”) is the inability to see objects clearly at a distance and is the most common refractive error among children and young adults. The condition is a vision disorder, not a disease, however, patients who have myopia are at an increased risk of developing certain eye diseases later in life.

​​​​​​​“Normal” vision, or seeing clearly without corrective lenses, requires light to focus directly on the retinal tissue in the back of your eye. Myopia occurs as the eye develops and grows longer than it should, which causes light to focus in front of the retina instead of directly on it. It is most commonly treated with prescription glasses or contact lenses that focus the light correctly on the retina, as shown in the image below. There are also preventative treatments available to help slow the progression of myopia over time, which is the primary goal at our Myopia Management Center.

Who is at risk for myopia?

Myopia typically develops during childhood when the eyes are experiencing rapid growth. It is usually diagnosed between the ages of 5 and 11 years old and will continue to worsen every year at a fairly predictable rate until plateauing around 18 to 22 years old.

The Centers for Disease Control and Prevention (CDC) now views progressive myopia as an epidemic, as 1 in 3 children are currently affected. In fact, recent studies predict that by 2050, over 50% of the world’s population (over 5 billion people!) will be myopic.

Although many factors may be contributing to the rise in myopic patients, researchers and doctors agree that the two main risk factors are genetics and modern lifestyle.

  • Genetics: A child with two myopic parents is six times as likely to develop myopia compared to a child with either one or no myopic parent. Additionally, children of Asian descent are more likely to be affected, with the prevalence being close to 90% in some Eastern Asian cities.

  • Modern lifestyle: Children should be spending at least two hours per day exposed to sunlight to help promote distance viewing. Nowadays, most children are not spending enough time outdoors. This, along with prolonged work and poor lighting, has all been shown to be contributing factors to the increase in myopia. Excessive time spent focusing on items up close, such as phones, computers, tablets, handheld games, and even studying and reading is causing myopia to develop at younger ages and progress more rapidly than in years past.

What are the symptoms of myopia?

The primary symptom of myopia is having a difficult time seeing objects clearly at a distance while closer objects remain clear. However, because this condition most commonly occurs in childhood, it can be difficult for a child to recognize what “blur” actually means, as they may believe everyone sees as they do. Some symptoms to watch out for include:

  • Squinting when trying to see far away

  • Sitting too close to the TV

  • Having a hard time seeing the board at school

  • Holding devices too closely

  • Leaning forward or placing their head on their desk while doing schoolwork

  • Complaining of headaches or eye strain (some children may not be able to verbalize this feeling but it may be noticed as rubbing their eyes, short attention span, or excessive blinking.)

  • Avoiding or being uninterested in activities that require good distance vision

  • Difficulty performing in school or sports

Nearsighted vision can be difficult to explain to a child who doesn’t understand the concept of blur or to those who have never experienced a less-than-perfect vision. Check out this helpful myopia simulator which demonstrates how vision deteriorates as myopia increases.

If you feel you or your child may be struggling with undiagnosed myopia, please contact our office or click here to schedule an annual eye exam. Our doctors can help explain various treatment options during your visit!

What are the dangers of myopia?

The most common treatment of myopia is prescription glasses or contact lenses. While these treatments are effective at improving vision, they are not preventative, and myopia will continue to worsen exponentially with time.

The dangers of this span far beyond having to update your prescription each year. Patients with myopia are at an increased risk of developing serious, vision-threatening diseases such as cataracts, glaucoma, retinal detachments, and maculopathy. The risk of these conditions increases as the level of myopia increases, as shown in the graph below.

What’s more concerning is that progressive myopia is more prevalent in children, but the related diseases typically don’t arise until much later in life. This can make it difficult for parents of myopic children to prioritize preventative treatment.

Our goal at the Myopia Management Center at Handel Vision Clinic is to fully educate our patients and their parents on the risks and rewards of treating myopia proactively to help facilitate a lifetime of healthy eyes and clear vision!

How do you treat myopia?

There are three methods available for treating myopia: temporary, permanent, and preventative.

  1. Temporary treatment is the most common and involves an annual eye exam where our doctors can prescribe glasses or standard contact lenses. This is termed as “temporary” because while your vision will improve with these corrective lenses, it only works while wearing them.

    Temporary treatment does not slow (or hasten, for that matter) the progression of myopia.

  2. Permanent treatment would involve refractive surgery such as LASIK, PRK, and even refractive lens exchange. This would involve an annual eye exam, an additional refractive surgery consultation with specialized testing to ensure candidacy and a referral to a surgeon.

    This type of treatment is only available to patients over the age of 18 and requires a stable prescription, healthy ocular surface, as well as additional criteria that would be discussed at your consultation.

  3. Preventative treatment is the goal of our Myopia Management Center and involves either the fitting of specialty soft or hard contact lenses or the use of daily eye drops. Our doctors offer several evidence-based, customized treatment plans to help slow the progression of myopia in children and teens.

    By stopping or slowing down the progression of myopia, we reduce long-term risks to best ensure that your child enjoys the world with healthy eyes throughout their lifetime. We stay at the forefront of the latest research and work closely with each family to help customize treatment programs for each child based on their individual needs to ensure maximum success. The treatments we offer are:

    • Corneal Molding

    • Specialty soft contact lenses

    • Atropine eye drops

Click here to learn more about our treatment options available through the Myopia Management Center at Handel Vision Clinic, or call our office to schedule an appointment!

Myopia Management Options

At Handel Vision Clinic, we strive to help you manage myopia so that you or a loved one can see life clearly. We offer several management options for this common eye disorder, which can improve vision as well as slow the progression of myopia.

Our doctors carefully monitor each patient as they progress through myopia management and each case is reviewed every 6-12 months to ensure progress and efficacy in treatment.

We are proud to offer this evidence-based treatment that works to prevent the onset or reduce the progression of nearsightedness in our patients. Our dedicated team prides itself on staying at the forefront of eye care advancements so you can feel confident choosing us for your treatment.

Corneal Molding

Corneal molding is the process of fitting a specially designed contact lens that is to be worn while sleeping to temporarily reshape the front surface of the eye (the cornea). Similar to wearing a dental retainer from an orthodontist, the lens works overnight to gently and gradually reshape the cornea to help eliminate or reduce myopia. This provides clear vision upon awakening without having to wear glasses or contact lenses throughout the day!

If you’d like to hear an honest review of the results, check out Dr. Handel’s daughter Maren discussing her first-day experience with her corneal molding lenses!

The process of corneal molding may also be referred to as orthokeratology, Ortho-K, Corneal Refractive Therapy, CRT, Gentle Molding, Vision Shaping Treatment, VST, The Gentle Vision Shaping System, GVVS, or Gentle Molding.

Our doctors are part of an elite group who have been specially certified in designing and dispensing both the MOONLENS as well as Wave lenses. You may also hear corneal molding lenses be called Ortho-K lenses, retainer lenses, vision retainers, or CRT lenses.

The visual effects of corneal molding are temporary as the lenses must be worn nightly to be effective. However, the long-term benefit is that it has been proven to slow myopia progression in children, resulting in a lower prescription and reduced risk of certain ocular diseases in their lifetime.

Corneal molding is also a great option for patients who would like to see clearly throughout the day without the assistance of glasses or contact lenses. For example, athletes, lifeguards, construction workers, and even patients with dry eyes or allergies can all greatly benefit from the freedom that comes with no daytime corrective wear.

These lenses slow the progression of myopia by creating a peripheral myopic distortion on the retina. This is a fancy way of saying that it makes light focus in front of the retina instead of behind it, which is what occurs in traditional myopia therapy (standard glasses and contact lenses).

Traditional myopia therapy (standard glasses and contacts):

Traditional myopia therapy (standard glasses and contacts):

Several studies have shown the effectiveness of this type of treatment, including the CANDY study (Controlling Astigmatism and Nearsightedness in Developing Youth) which concluded that corneal molding “does both significantly reduce and even stop the rate of change of nearsightedness and astigmatism in developing youth (ages 9-18).”

To learn more about myopia and the science behind myopia management, check out this video from Dr. Peter Wilcox, one of the optometrists behind the CANDY study:

Common corneal molding questions

  • Is it safe?

    • Yes! Corneal molding was approved by the FDA in 2002 and is safe as well as reversible. There is a slight risk of infection, as with any type of contact lens wear, but this can be treated by our doctors with antibiotic drops and avoided by following our recommended cleaning and disinfecting regimen that will be discussed at your visit.

  • Why have I never heard of this before?

    • Although corneal molding has been around for years, it is not nearly as common as being prescribed standard glasses or contact lenses. A successful fitting process requires specialized optical measuring equipment, advanced training, and years of experience. We are proud to be one of the few practices that have been trained and certified to offer this elite style of myopia management!

  • Can adults have this treatment?

    • Yes! Although corneal molding is designed to help slow the progression of myopia throughout childhood, it can also be used for adults who would benefit from not having to wear daytime corrective lenses. This can be especially helpful to athletes, those who work in dusty or dirty environments, or anyone who wants to experience improved vision without undergoing surgery.

  • What if my child isn’t ready for contact?

    • You may feel that your child isn’t ready for the responsibility of daily contact lenses just yet, but this doesn’t necessarily exclude them from a myopia management plan!

      Many children excel with corneal molding lenses since they are only worn at night and they are able to handle the lenses in the comfort of their home. They are typically motivated by the idea of not having to wear their glasses and are less likely to lose or abuse their lenses compared to daytime lens wearers.

      As with any type of contact lenses, corneal molding lenses require a certain level of responsibility, maturity, and dexterity for healthy and successful wear. If it is decided your child is not a good candidate for any type of lenses at this time, we may still have the option of atropine therapy for managing their myopia!

  • What type of testing will be done?

    • Testing for myopia management is more extensive than what is performed at a standard annual eye exam. Each of the below tests is non-invasive, and your comfort is our top priority. We are happy to explain anything you or your child have questions about on the day of your consultation.

      • Axial length and retinal shape measurements

      • Corneal topography and choroidal thickness measurements

      • Cycloplegic axial and peripheral autorefraction

      • Lifestyle questionnaire to determine the amount of time spent outdoors and doing near-work

      • Ocular health assessment

      • Discussion of the results

      • Development of a personalized treatment plan

  • What will happen if we don’t do any myopia management?

    • If you decide that you’d like your child to stay with standard daytime glasses or contact lenses for now we have plenty of wonderful options! However, please remember that this form of treatment is temporary and that without preventative management, your child’s myopia will continue to worsen with time.

      Your child’s prescription by adulthood will be much higher than it would be with prevention, which increases their risk of developing certain ocular diseases later in life. This could also potentially result in driver's license restrictions and the inability to work certain jobs such as a pilot or a police officer.

      You may schedule an appointment with our Myopia Management team at any time, although the sooner preventative treatment begins the more successful it will be!

  • Does this work on all prescriptions?

    • Corneal molding is approved for correcting mild to moderate amounts of prescription. Generally, we are able to effectively correct up to -5.00 diopters (D) of myopia as well as lesser degrees of astigmatism.

  • How long does it take to see results?

    • In most cases, it typically takes about one to four weeks to achieve clear vision, but depending on your initial prescription, you may see an improvement in as little as one day! Our doctors may provide temporary soft contact lenses to use until we reach the optimum daytime vision.

  • What happens if we stop using corneal molding lenses?

    • The clear vision that results from wearing corneal molding lenses is transient, meaning if you stop wearing them the front surface of your eye (the cornea) will return to its normal shape and you would need to return to wearing daytime glasses or contact lenses.

      Since standard glasses and contacts do not slow the progression of myopia, if your child stops wearing their corneal molding lenses, their prescription will continue to worsen with time.

  • How do I know if I (or my child) am a good candidate?

    • If you can answer yes to any of the below questions, you may be a great candidate for corneal molding! Additional testing performed at your consultation will help us confirm your candidacy and treatment potential.

      • Do your child’s eyes keep getting worse every year?

      • Do you dislike the look or feel of glasses?

      • Are you interested in LASIK but not yet ready or qualified?

      • Is your child being bullied for wearing glasses and/or refusing to wear them?

      • Would you like to hike, camp, swim, or exercise without having to wear glasses or contacts?

      • Are you constantly losing or breaking your glasses?

      • Do you (or your child) have a tendency to abuse or overwear your contact lenses?

      • Are you tired of your glasses fogging up, sliding down, or getting dirty?

      • Do you have dry eyes or allergies that prevent you from comfortably wearing your contacts?

      • Would you like to help protect your child’s ocular health and avoid potentially blinding diseases in the future?

      • Are you an athlete who is hindered by glasses?

      • Do you work in a dusty or dirty environment that is always coating your contacts or glasses?

      • Does your job require good vision without the assistance of glasses or contacts?

If you or your child can answer yes to any of these questions, call our office to schedule an appointment and mention you are interested in meeting with our Myopia Management team!

Speciality soft contact lenses

Another myopia management option involves the fitting of speciality soft contact lenses. This originally began by using soft multifocal lenses that have a certain design that creates the same type of peripheral myopic distortion that is created with corneal molding lenses. These lenses are still used as an off-label treatment for myopia management and children have been studied to show 25% less progression over two years than those in standard single-vision lenses.

In addition to these multifocal lenses, our doctors are also certified to fit Coopervision MiSight lenses. This daily lens is the first soft contact that has been FDA-approved for myopia control and has been proven to slow myopia progression in children ages 8 to 12 at an average rate of 60% over 3 years.

These lenses work to simultaneously correct a child’s nearsighted prescription while also working to slow its progression. They must be worn throughout the day since they do not cause any type of eye reshaping like corneal molding lenses.

Atropine eye drops

A non-lens treatment option that is offered through our Myopia Management Center is a drop therapy called atropine. Atropine 0.01% is dropped into both eyes at nighttime and works to mildly dilate the pupil and relax the focusing mechanism inside of the eye.

This drop concentration is low enough to not create any significant side effects yet strong enough to help reduce the progression of myopia by 50% over 5 years. It is a great option for younger children or those who are not quite ready for contact lens wear.

Since this method of treatment does not reshape the cornea, it still requires your child to wear their glasses throughout the day.

To learn more about these treatment options and discuss which method is right for your child, call our office and ask to schedule an appointment with our Myopia Management team!

Myopia Management Resources

Myopia is the most common refractive error in kids and young adults and is now viewed as an epidemic due to its drastically increasing in prevalence and severity.

Although many people have heard of being nearsighted, few are aware that being myopic increases the risk of dangerous and potentially blinding ocular diseases. In fact, 85% of people view myopia as simply a lifestyle inconvenience rather than a true health risk.

At Handel Vision Clinic, it is our job to educate our patients on these risks and offer management strategies to help minimize them in order to promote a lifetime of healthy eyes and clear vision.

If you’re interested in learning more about the science behind myopia management, there are numerous scholarly articles and research studies available on the topic. We have compiled a list of our favorites that further explain the risks of myopia as well as the evidence-based treatments we offer in our clinic such as corneal molding, specialty soft contact lenses, and atropine drops.

General Myopia Information

Genetic and Lifestyle Links to Myopia