How to Evaluate Myopia Treatments | Singapore National Eye Centre

Be curious. Question if:

Are your sources reliable?

Is it presented by a reputable agency? E.g., World Health Organization (WHO), Ministry of Health (MOH), Health Promotion Board (HPB)
Does it provide a balanced view of all options?
Best sources may be independent sources with no financial interest in the products in question.

What is the quality of evidence?

Best evidence are from well conducted studies with publication in recognisd peer-reviewed journals
Weakest evidence include small case series or testimonials

Currently, treatment for myopia based on evidence include atropine eye drops, some select contact lens and glasses.

There is, at this time, no evidence that oral supplements, eye exercises, eye relax machines, acupressure, magnetic therapy, pin-hole glasses, anti-oxidant eye drops or medication work.

Where can I get good advice?

Most ophthalmologists (eye doctors) and optometrists should able to provide you with balanced information so you can come to an informed decision.
However, as information in the field is developing rapidly, not all may have the latest information and some biases may exist.
Do your research and if necessary, get a second opinion.

When should I start my child on treatment?

Treatment is useful if there is documented myopia progression especially if:
your child is still young (<9 years old) as children with early onset myopia are more likely to develop high myopia, and
Your child's myopia is very high (e.g., more than -4D).

The aim of treatment is to keep the myopia as low as possible so as to reduce the risk of visual threatening eye complication (e.g., retinal detachment, macular degeneration, early cataract and glaucoma) later on in life.

What treatment should I start my child on?
Treatment choices may depend on

a. Availability

Not all treatment may be available where you are located
Not all treatment may be available in degrees your children require. This is especially if your child has very high myopia or astigmatism

b. Efficacy or effectiveness

Different studies may report different efficacies even for the same treatment. Factors such as which children were included, the design and duration of the study may alter outcome. E.g., if study includes older, more slowly progressive children then outcome may be better than that which included younger more high risk children.
The efficacy stated, however, does give some indication how effective a treatment is, at least in the test-population.
When efficacy is 50%, this means the average myopia progression was 50% that of average progression in children without treatment. This means half the children will have a better outcome than 50%, and half a worse outcome. As such, there will often be a percentage of children in whom treatment will not work as well.

c. Tolerance and lifestyle

Some children may be less tolerant of certain treatments e.g., if the child is very sensitive about anything touching their eyes or face, then eye drops may be difficult, and contact lenses impossible.
Some children may have a reaction to eye drops or contact lens; or be particular about how their glasses look.
Some children may have cultural or sport activities which make one treatment less attractive (e.g., gymnast may prefer contact lens to glasses, and swimmers may not be able to wear contact lens when swimming).

d. Safety/Side-effects

The safest treatment is glasses unless it causes significant visual discomfort, blur, distortion or problems with depth perception.
Low-dose atropine which has little or no side-effect, while higher doses can cause near blur or glare.
Contact lenses carry a risk of cornea irritation or infective keratitis which may cause visual impairment. Risk is lowest in daily disposable contact lens, and highest in over-night wear contact lens.

e. Costs

Some treatments are more expensive than others.

What if my child is still progressing despite treatment? Can I swap between treatments or combine treatments?

Get advice from your eye care specialist before changing treatment. Some treatments can have a rebound effect when stopped suddenly. While some treatments can he combined, others may not go as well together.

How long should my child require treatment for myopia progression?

Each child is different, because myopia will progress differently in each child. Treatment is usually continued till eyeball growth stops, and myopia stabilises. For most children this occurs in the early-mid teens.

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