Myopia is a common vision disorder, affecting approximately 1/3 of the US population and over 90% of the population in some East Asian countries. High amounts of myopia show an increased risk of more serious problems, such as retinal detachment, choroidal degeneration, cataracts, and glaucoma.
Slowing the progression of myopia can benefit millions of people, but few strategies used for myopia control have proven to be effective. There’s conflicting science on how to stop myopia progression. My goal for this article is to give you a complete overview of the options that are have been tried.
I’ll go over the science behind each option, focusing on the more promising ones and giving my opinion on some of them. So let’s begin, in no particular order:
Under-correction of Myopia
Under-correction of myopia is simply using weaker lenses than what you would need to see perfectly clear. For example, my prescription is -2.00 but I would wear -1.75 lenses and see slightly blurry (myopic defocus).
The science is conflicting on this. For example, in this study, the conclusion is that:
myopic defocus speeds up myopia development in already myopic humans
On the other hand, this study says:
myopic defocus slows the progression of myopia in already myopic children
Both these studies had under similar conditions. So what conclusion can we make? The only thing I can do is present you with the facts and give you my opinion. You will then have to see what makes the most sense for you.
Personally, I think it makes sense to take my glasses off once in a while and give them some rest, especially on days I spend a lot of time doing close-up work. I say this because the lens of the human eye is capable of changing the optical power to maintain a clear image and focus on an object as its distance varies.
But in order for the lens to do this for close-up work, there needs to be tension in the muscle responsible for shaping the lens (ciliary muscle) to make it smaller.
Because of this, I believe it’s good to relax this muscle once in a while, either by taking my glasses off or by spending time outdoors and looking in the distance.
There’s a lot of anecdotal evidence claiming that a slight under-correction combined with changes in lifestyle to limit time doing close-up work is effective at, not only stopping myopia progression but also correcting it.
This overlaps with what some of the things I’ve said in the previous option.
Outdoor time as a way to stop myopia progression also has different results in different studies. But several studies show the association between outdoor time and a lower likelihood of developing myopia.
Basically, it might not make a difference in stopping the progression of myopia after you already have myopia, but it’s effective at stopping children from developing myopia in the first place.
In my opinion, it will absolutely never hurt your eyes to spend more time outdoors. Especially taking into account the modern lifestyle, which is very different from what the life of a hunter-gatherer looked like.
Also, genetics can’t be the only cause for the extremely rapid increase of myopia in recent years. It’s not enough time to change human biology. So to me, it makes sense that myopia is associated with recent changes in lifestyle like spending more time inside and not getting enough sunlight.
Bifocal lenses allow to see distant objects clearly through the top portion of the lens while the bottom portion of the lens contains the reading power (“plus” power). This may control myopia progression by reducing or eliminating the effort to shape the lens to see close objects mentioned earlier.
When compared to single vision lenses, bifocal or multifocal lenses can slow the progression of myopia. The problem is the difference in progression rates is temporary, typically not clinically meaningful, and not enough to warrant a routine prescription.
Breathable Contact Lenses
The fancy name for this type of contact lens is rigid gas permeable contact lenses.
There are two main types of contact lenses: soft contact lenses and rigid gas permeable contact lenses. Soft contact lenses are more comfortable and easier to adapt to than rigid gas permeable lenses. On the other hand, rigid gas permeable contact lenses are more durable and resistant to deposit buildup. They’re also more breathable, allowing more oxygen to the cornea (front part of the eye).
Studies show that gas permeable contacts can slow down the progression of myopia. But this was a temporary effect likely caused by corneal flattening.
The cornea is responsible for receiving the light and focusing it alongside the lens. When you have myopia, light focuses in front of the retina. For clear vision, it’s necessary that the light focuses exactly on top of the retina. Corneal flattening achieves this because it pushes the focus point further back to the retina, but in this case, it’s a temporary result.
The authors concluded it’s not recommended for myopic people to use rigid gas permeable contact lenses solely for the purpose of myopia control.
Soft Bifocal Contact Lenses
These are contact lenses with a design that has more “plus” power in the peripheral part of the contact lens. This creates a myopic defocus in the periphery. Sometimes we call these lenses multifocal contact lenses.
According to this review of the literature, soft bifocal contact lenses can be effective in slowing myopia progression. This is because they provide myopic blur to the retina, which acts as a signal to slow myopic eye growth. I go over the theory on why this happens in this article.
In opposition, the results of this study indicate that multifocal soft contact lenses are not effective at night. And that more research needs to include tests in dark environments with low contrast.
Orthokeratology contact lenses are used overnight to flatten the central cornea and temporarily reduce the amount of myopia. These contact lenses provide clear vision without the need for vision correction during the day. They also have been shown to reduce myopia progression.
Personally, I don’t like the idea of temporarily deforming the natural shape of your cornea. With that said, science has shown it can be effective at addressing the underlying cause of myopia — the elongation of the eye — when compared with normal contact lenses and glasses.
Atropine is used to temporarily paralyze the muscle that adjusts the curvature of the lens of the eye to focus on nearby objects (ciliary muscle, mentioned earlier). Basically, atropine drops keep the ciliary muscle in a “relaxed” position, which is how we want it for distant vision. On the other hand, the “price” to pay for this relaxed position is that the muscle can’t contract to make the lens smaller and accommodate for close objects. The picture below illustrates this well.
So when atropine drops are applied to the eye, the lens loses elasticity and close objects will appear blurry. Atropine drops also dilate the pupils.
Based on this review, there’s evidence supporting the use of atropine to prevent myopic progression. There are reports of myopia progressing quickly again after the treatment is discontinued, but this seems to be minimized by using low doses (especially atropine 0.01%).
Low doses also minimize potential side effects of these medications, including light sensitivity and blur when looking at near objects. The problem is they are not yet commercially available, so their use is limited and not practical.
Conclusion — How to Stop Myopia Progression
In this article, we went over all the options on how to stop myopia progression.
Treatment options such as gas permeable contact lenses and bifocal glasses have been proven to be ineffective for myopia control due to their temporary nature or not enough meaningful results.
Under-correction of myopia and more outdoor time are interesting options, that even though are not always supported by science will never hurt your eyes.
Multifocal contact lenses, orthokeratology, and atropine drops are promising options that have been getting more and more positive results in clinical studies.
The best way to determine which option is right for you or your child is to speak with your eye doctor. They can assess your specific needs and find a solution that fits your unique lifestyle to answer the question of how to stop myopia progression.
Have any questions? Leave them below in the comments!
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