Myopia Management: Helping Your Child See Clearly
Myopia, or nearsightedness, is a common eye condition where distant objects appear blurry while close ones are clear. This condition often worsens as children grow. Early treatment is essential to manage myopia and prevent complications that could lead to more serious vision problems later in life.
At Mudgil Eye Associates, our pediatric optometrist Dr. Reetu Julakanti, OD, leads our myopia control program and provides a variety of myopia treatments, including FDA-approved MiSight 1 day contact lenses and low-dose atropine, designed to help children maintain healthy eye development and clear vision. Our myopia program is part of the practice's pediatric eye care led by Dr. A. Vijay Mudgil, the only fellowship-trained pediatric ophthalmologist in private practice in Chester County (Johns Hopkins / Wilmer Eye Institute). We care for myopic children from West Chester, Exton, Downingtown, Glen Mills, Kennett Square, Chadds Ford, and across the greater Main Line.
What Causes Myopia in Children?
Myopia occurs when the eye grows too long or the cornea has too much curvature. This results in light focusing in front of the retina rather than directly on it. While genetics play a role, environmental factors like too much screen time or not enough outdoor activity can also contribute to myopia.
Signs of myopia in children:
Myopia, or nearsightedness, often develops in children around the ages of 9 or 10. It's commonly first noticed when your child has trouble seeing objects at a distance, like reading the blackboard at school, but can still read up close without issues. If your child struggles to see faraway objects clearly, it may be time to schedule an eye exam.Along with blurry vision at a distance, there are several other signs that may indicate your child has myopia, including:
- Frequent Headaches: Myopia can cause eye strain, leading to headaches, especially after activities like reading or using a screen for extended periods.
- Nausea or Discomfort after Reading: Some children with myopia experience nausea or discomfort after focusing on near tasks for too long.
- Holding Books or Devices Too Close: If your child is constantly holding their book or device very close to their face, it could be a sign of myopia.
- Writing with Their Head Close to the Table: A child with myopia may lean in too closely while writing, as they struggle to see clearly from a normal distance.
- Sitting Too Close to the TV: If your child sits right in front of the TV or computer screen, they might be trying to compensate for blurry distance vision.
- Squinting: If your child squints when looking at things far away, it could be an instinctive way to make objects appear clearer.
If you notice any of these symptoms, it's important to have your child’s eyes checked by a professional. Early detection and treatment of myopia can help prevent the condition from worsening and ensure your child has clear vision as they grow.
Why is it important to address myopia early?
Myopia in children tends to worsen as they grow. Without proper management, it can lead to higher levels of nearsightedness, increasing the risk of future eye problems such as cataracts, glaucoma, or retinal detachment.
Treatment options to slow myopia in children:
- Lifestyle Changes: Spend more time outside. Not read in dark. Spend less time on electronic devices and take frequent breaks to "stretch" the eyes.
- Atropine Eye Drops: Low-dose atropine drops, applied daily, have been shown to slow the progression of myopia in children.
- Specialized Multifocal Lenses: These include myopia control glasses and contact lenses (like MiSight) designed to reduce myopia progression in children.
MiSight vs. Low-Dose Atropine: Which Is Right for Your Child?
Both MiSight contact lenses and low-dose atropine drops are proven, evidence-based ways to slow how fast a child's nearsightedness gets worse. They work differently, and the right choice depends on your child's age, prescription, and comfort with contact lenses. Dr. Julakanti will help you decide and adjust the plan over time.
MiSight 1 day contact lenses
- FDA-approved specifically to slow myopia progression in children.
- A soft daily-disposable lens worn during the day that also corrects vision, so no daytime glasses.
- Best for kids responsible enough to handle a daily lens (able to remove it themselves).
- Not suitable for children with significant astigmatism.
Low-dose atropine eye drops
- A simple once-a-night eye drop, widely used to slow myopia (used off-label for this purpose).
- Great for younger children and those not ready for contact lenses; the child keeps wearing regular glasses.
- Very well tolerated, with uncommon side effects.
- Prepared by a compounding pharmacy.
The bottom line: MiSight suits an older, contact-lens-ready child who would also like to be free of daytime glasses, while atropine suits a younger child or one not ready for lenses. Some children use one and switch later. We tailor the plan to your child and track progress at regular visits.
Atropine Drops & MiSight Lens FAQs
A promising intervention in the current literature, validated by several international studies, is low-dose atropine eye drops given once a day.
- What are the side-effects of atropine drops?: Most kids receiving atropine treatment have no side effects. About 1 percent of children report an allergic reaction that presents as redness or itching in or around the eye.
- Does atropine reverse myopia? Atropine does not reverse myopia, and children treated with low dose atropine still require glasses. The goal of treatment is to reduce the rate at which myopia increases.
- Is myopia dangerous to the health of the eye? Myopia results in a greater risk of eye diseases, such as glaucoma, cataract, retinal detachment, and macular degeneration later in life.
- How long will my child have to be on atropine drops or MiSight lens? Most children can expect to be on the atropine drops at least 2 years or until the age of 15, which ever is longer. The duration is necessary for a meaningful reduction in the rate of myopic progression.
MiSight 1 day contact lenses should be worn for at least 10 hours per day, 6 days per week. They should be worn until your eyes stop growing and your prescription stabilizes, which is usually in early adulthood
- Does this work in all patients? Results vary from child to child. For most children, myopia management with atropine or MiSight meaningfully slows how quickly nearsightedness progresses, although it does not stop it completely or reverse myopia that is already present. Some children respond more than others. Dr. Julakanti monitors each child's progress at regular visits and adjusts the plan as needed to give them the best possible outcome.
- How quickly do the drops show a reduction in myopic progression? For the first 6 months myopia may still progress. However, after this we would expect significant reduction in the rate to around -0.50 diopters or less over a year.
- What is the best age to start using atropine drops? We do not treat children under the age of 5 with 0.01% atropine, and most patients are between 6 to 15 years. The sooner we start atropine for myopia, the less nearsighted the child will become overall.
MiSight lenses are typically introduced when a child has developed enough coordination to safely remove the lens on their own. While parents may assist with lens insertion, it's essential that the child can independently remove the lens
- What are the limitations of the MiSight Lens? The MiSight lens can not be used in children with astigmatism as it is unable to correct for the astigmatism.
- What are the risks of MiSight Lens? The risk of MiSight lens is similar to any other contact lens. These include infection, dry eye, allergic reaction, and lens discomfort. While MiSight lenses are a promising tool for myopia management, the risks can be minimized with proper hygiene, correct lens care, and regular eye exams.
- How often will my child have to be examined? With atropine the first visit is usually 3 months after starting the drop to assess for side-effects, and we then examine your child every 6 months or so to confirm that we are achieving the expected response. With MiSight lens, once the child has been fitted with the contact lens they should be followed up every 6 months.
- Is this an FDA approved treatment? Atropine for the reduction of myopia is “off-label,” as it is not yet FDA approved for this purpose. Nonetheless, it has become widely adopted across the US, and particularly the world, for this purpose. However, MiSight lens is FDA approved to slow progression of myopia.
- What else can I do to reduce progression of myopia? Encourage your child to play outdoors. Kids who spend less time outdoors and get less sunlight exposure are more likely to become myopic. In general, kids today are getting less exposure to natural light, spending more time indoors on computers, TVs and smartphones. Also, make sure your child has enough ambient light when pleasure reading and doing homework; reading in the dark is thought to facilitate myopia.
- Why is the drop not available in my usual pharmacy? Atropine 0.01% is not commercially produced by a standard pharmaceutical company. It therefore has to be diluted and individually prepared by a compounding pharmacist.
- Is the drop expensive? If your prescription plan does not cover compounded medications, the typical cost is roughly $100 for a one month supply (at the time of this writing).
- What about the use of orthokeratology lenses or progressive bifocal glasses? Orthokeratology, often called ortho-K, uses rigid lenses worn overnight to gently reshape the cornea while a child sleeps, so vision is clearer during the day without glasses. Progressive bifocal glasses are another approach you may come across. The evidence behind both is more limited or mixed than it is for MiSight lenses and low-dose atropine, which is where we focus. We are always glad to talk through any option you have read about and whether it might suit your child.
- What about eye exercises? Eye-exercise programs are popular online, but the evidence that they meaningfully slow nearsightedness is limited. We are glad to talk them through, while focusing on the approaches with stronger research behind them.
