5 Year Old High Myopia

[Mainer47]

My 5 1/12 year old was diagnosed at 2 years of age with myopia (-5.5 bilaterally).  She is now ~ minus 11 bilaterally.  She also has a right strabismus that is worsening, despite patching for 2 years, and now prism glasses.  She's awaiting strabismus surgery.  There is no family history of pediatric ophthalmological problems (my husband has had glasses for myopia since early 20s, and I just got reading glasses at age 47, and none of our siblings or parents had any issues).  She was not born prematurely, she does not have Marfan's, nor Stickler's nor any other genetic abnormality (she was seen by a geneticist, just in case, about 3 years ago, and was cleared).  A couple of years ago I looked into the possibility of atropine eye drops, but the research did not seem compelling, given the potential risks.  

I have two questions:  Since her myopia appears to be aggressive, and is associated with worsening strabismus, are there other options we should consider?  Are there clinics in the US or other countries who are on the forefront of early childhood high myopia?  

Thank you!!  

[eifgs]

Actually, there is ongoing research into what causes myopia. Go to google and do a search on 'myopia research'. There are some interesting articles on the topic. I find particularly interesting the trend of thinking that the retina can somehow detect blurry images and send signals to the sclera to control its growth. Which might mean that the progress of myopia could be reversed in growing children.

I myself have been diagnosed with myopia at age 7. My 1st prescription was somewhere in the -0.5 to -1.0 range. I stayed away from wearing glasses my whole life (unless I absolutely had to) and now in my 40s I have -1.5 in both eyes and my vision is about 20/50 Snellen without glasses. Did I stop my myopia from progressing by not wearing glasses? Did I make it worse? Did it make no difference? Unfortunately neither myself or my eye MD can answer that question.

[kg17]

oops...I meant to say "I was also never found without my nose in a book."  I guess writing late at night after a glass of wine can make for some interesting writing misshaps.

[kg17]

As an avid researcher myself, I am very much beholden to well-conducted scientific studies (with adequate control condition) to establish scientific "fact."  However, that notwithstanding, I have an interesting anecdotal tale to tell.  I have four siblings - all of us have myopia.  If you were to rank order us according to the degree of myopia and the amount of reading we each did during childhood and adolescence, you would have a perfect correlation.  It was my misfortune to have acquired the greatest degree (-17 diopters bilaterally).  I was also never found without a book in my nose.  My sister who never read (except when forced) has the least degree (-4 bilaterally).  I encourage my own children to spend as much time using their distance vision as spent reading and discourage what I believe to be unnecessary close-up work such as computer games.  My own ignorant opinion is that myopia is determined by an interaction between genetics and environment.  As I have myopic degeneration, I sincerely wish that this area of opthalmology would be bettter attended to.  

[Michael J Kutryb, MD]

I recenty saw a pediatrician's daughter around age 9, who was developing worsening myopia.  I researched the possible treatments to try to slow progression of myopia, in particular bifocal glasses, reducing near work, and atropine type cycloplegic drops.  There are many excellent scientific studies on pubmed and you can do plenty of research for yourself.  The bottom line is there is no truly effective treatment.  Some can work for a few years but the end result from treated to untreated groups tend to be about the same after a few years.  In this situation it appears that genetics are playing a major role.   Some children can become more nearsighted due to long hours of intense close up vision work - but I doubt your daughter is spending hours pouring over books or computer work - although not unheard of.  WIth regard to my patient I mentioned earlier, she did end up getting a trial of bifocals because the young girl was reading books all day long and we wanted to try to reduce her accommodative effort to try to potentially slow down the myopia progression.  THis treatment was not mainstream but did have some scientific merit from several studies.  I don't believe there is any dangerous downside to the bifocal trial in this case.  In your daughter's case you might look at atropine treatment and bifocals in particular.  I cannot make any recommendations - but if your truly do your research you can then have a good conversation with your pediatric ophthalmologist about the options.  Consider a second opinion if you want - but please make sure it is with a very good board-certified pediatric ophthalmologist.

This a really good topic and I am quite interested in it.  There are dozens of studies available on pubmed.  Read them all.  Please remember, I am not a expert in this field and not a pediatric ophthalmologist. I just want to encourage more research in this field and give you incentive to keep looking into this yourself.   I hope others will jump in and add to this discussion.

MJK MD