Blurred vision, squinting to see in the distance, getting too close to objects, blinking excessively, or having headaches. These are some of the signs of the appearance of myopia in children that parents have to pay attention to. Children, unlike adults, have more difficulties expressing what problem they have or whether they see well or not. Teachers also usually detect it in class if they do not follow the marked instructions or look at their classmate when they are told something.
When myopia appears in younger children, its progression is more rapid, so the younger the age of onset, the greater the risk of developing higher myopia. And that is why it is important to detect and treat it in time. The prevalence of myopia in children between 5 and 7 years old in Spain in 2023 was 20.3%according to the ‘Myopia Barometer in Spain’, prepared by the Complutense University of Madrid (UCM) and the Alain Afflelou Foundation. While among university students between 17 and 27 years oldcoinciding with the stage where more time is spent studying, outdoor activities are reduced and the time spent in front of electronic device screens increases, the number of myopes rises to 62%according to the report ‘Prevalence of myopia in young people in Spain’ by the Vision and Life organization.
«There are more and more short-sighted people. The problem is that it’s not just about having to wear glasses. Myopia can continue to evolve and increases the risk of associated pathologies such as retinal detachment, macular problems, glaucoma and cataracts in the future. In 2050, half of the world’s population will be myopic and health systems have to be prepared for what is coming to us in a few years,” explains Luis Fernández-Vega Cueto-Felgueroso, specialist at the Fernández-Vega Ophthalmological Institute.
The ophthalmologist recommends having an eye examination every year, even when myopia is low (less than 3 diopters). It is considered moderate between 3 and 6, and magna when there are more than 6. “In the annual check-up with the ophthalmologist, lesions can be detected in the peripheral retina, which we do not realize, and it is a warning of retinal detachment,” he warns. the doctor Furthermore, under normal conditions, it is recommended ltake children for their first eye exam at age 4 of age. «You can see very well in one eye and not so well in the other and that creates a lazy eye. We can improve or solve it until they are 8-9 years old, from then on, no,” explains the expert.
Adolescence is also a critical age for the progression of myopia, so it is recommended to go for check-ups. And, from the age of 40, the specialist can also early detect other pathologies such as glaucoma, which takes away our vision without us realizing it.
Screens and little natural light
Ophthalmologists are seeing increasingly early myopia. What is behind this increase? “The use of screens and closed environments,” says Fernández-Vega. It is not the light from the screen that damages the eye but the fact that look closely for a long time. Studying too much also increases myopia. And doing all this indoors also plays a role. «If we all lived more on the street, there would be less myopia. With natural light we generate more dopamine, which is protective against myopia. If we do not have natural light to study, we must use a good lamp pointing at what we read and do it about 40-45 centimeters away. If we are working with the computer and tablet, it is also necessary to have good light in the room, not to be in the dark,” advises the ophthalmologist.
Myopia appears because, due to these factors, the eye becomes elongated, elongated. «Myopic eye is larger than normal», clarifies the expert. It is very important to properly adjust the child’s vision because otherwise lazy eye, headaches or accommodation problems may appear. To do it correctly, in children, the ophthalmologist recommends graduating by dilating the pupils.
Currently, there are several methods to try slow the growth of myopia: he atropine eye dropsand the peripheral blur glasses and contact lenses (they blur the image so that it does not go to the center of the retina but to the periphery). «It is proven that they could reduce the progression of myopia. And the best results have been seen combining the two techniques. But it is a complex issue because there are still many studies needed to know who is the perfect patient for this type of treatment,” he clarifies.
Pioneering Spanish study
There is no cure for myopia, but research is being done to find a treatment that slows its progression or at least makes it grow at a slower rate. At the San Carlos Clinical Hospital in Madrid, which belongs to the public network, since 2022 they have been carrying out a pioneering study on the combined effect of ophthalmic lenses with DIMS technology and atropine eye drops diluted to 0.025% for the treatment of childhood myopia. This randomized, controlled clinical trial has been recognized for its promising preliminary results.
Presented at the 2024 ARVO (Association for Research in Vision and Ophthalmology) conference, initial findings indicate that the combination of ophthalmic lenses and atropine eye drops is more effective in controlling myopia growth compared to use alone of diluted atropine, which is the current standard treatment. The trial involved myopic children, between 4 and 16 years old, with between 1 and 6 diopters, who attended the Pediatric Ophthalmology Unit of the San Carlos Clinical Hospital and who had not previously used atropine.
«At the beginning of 2022, this trial was designed to last two years. Right now we are about to publish the one-year results, although we have children who are already in their third year. The results have been so promising “They have approved us to extend the clinical trial to a third year,” explains Dr. Noemí Güemes, director of the study and ophthalmologist at the San Carlos Clinic.
The treatment of myopia seeks to control two parameters: the refractive error (diopters) and the axial length, so that the eyeball does not elongate at that speed. «In myopia, most people are concerned about the diopters, but it is just as important, or even more important, the axial lengththe size of the eyeball. As they increase, these tissues are subjected to greater stress and this means that these children, in adult life, with a more elongated eye, have a greater risk of pathologies such as retinal detachment, glaucoma or early cataracts,” warns Dr. Rosario Gómez of Liaño, in charge of the Pediatric Ophthalmology and Ocular Motility Unit at the San Carlos Clinical Hospital and professor of Ophthalmology at the UCM.
In this clinical trial, a group of children receives 0.025% atropine with a standard spectacle; and the other group, the same dose of atropine with a specific glasses for myopia control (DIMS lenses). What they have seen is that myopia grows much less with combined treatment than only with atropine and the eye elongates less. «With the combined treatment, between three and four patients out of ten have not had their eyes grow (increased axial length). With drop treatment alone, this is achieved in one in ten patients. But they all grow less than if they were not treated,” explain the two ophthalmologists.
Refractive surgery
Surgery groups a series of surgical techniques that treat the eye and whose objective is to eliminate one or more refractive defects of the eye (such as myopia, hyperopia, astigmatism, and even presbyopia). The goal of surgery is eliminate the need to wear glasses or contact lensesbut they do not cure myopia. We can operate up to 30 diopters, but that eye will always be myopic», warns Dr. Fernández-Vega. It means that with surgery the patient will be able to see well, but will continue to have a higher risk of retinal detachment, glaucoma, macular problems and cataracts than a non-myopic person.
After the operation, you must continue to undergo annual fundus examinations. Additionally, myopia may continue to progress. «When we propose refractive surgery, we must explain to the patient what we are operating on at that moment, but that it may be necessary to make an adjustment in the future. And you have to choose the appropriate technique that allows these adjustments,” explains the ophthalmologist. Myopia can be operated on from 22-23 years old and there is no age limit. It can even be combined with cataract surgery, but it will be your ophthalmologist who will best advise you.
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