Dr. Charuta Bapaye guides you through the maze of queries from parents of kids with myopia, which despite being a common condition still has various myths attached to it.

Doctor, why does my child need glasses at such a tender age? Can I do anything about it?These are distress questions from parents, which, not only ophthalmologists but general practitioners and paediatricians also have to answer in daily practice. 

As a Pediatric Ophthalmologist, I come across such parents every day and I have come to realise that there are still so many myths, so much social stigma associated with the simple act of a child having to wear glasses. The purpose of this article is to improve the understanding of myopia for practitioners, thereby facilitating proper dialogue between them and parents, and in turn, help in better management of the issue. 

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Management of paediatric myopic patients and their parents

First and foremost the parents need to remove the negativity from their mind regarding glasses. We, as doctors, need to counsel the parents to take a positive approach so that the child who is diagnosed with myopia will wear the glasses without any apprehension and his vision will develop to the fullest in the growing age.

1. Next, we need to address patiently the queries put forth by anxious parents. Here are some common patient queries and the best possible answers to those.

Why is my child pre-disposed to getting myopia?

1. Myopia has a combination of both genetic and environmental predisposing factors. Children of myopic parents have more chance of developing myopia, particularly if both parents are myopic, however, myopia can also occur in children of non-myopic parents. Different genes have been identified for myopia, which controls nerve cell function, processing of light, and eye development. People who have more of these genes have a 10-fold higher incidence of developing myopia.
2. Recently, insufficient sunlight exposure has been shown to be an important predisposing factor in myopia development.
3. Also, excessive near work like reading, writing, and working on a computer is also an independent risk factor.

Thus increased levels of education, ever increasing screen time in children and lack of outdoor activities are causing this disorder to increase in recent days. Once a child is diagnosed to have myopia, yearly screening of siblings is also essential.

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Could I have prevented myopia? (OR) Can I do anything to reduce the power now? (OR) Can I at least do something so that the power will not increase?

The onset of Myopia cannot be totally prevented. And nothing can reduce the power naturally, except doing Lasik or refractive procedures after the age of 18 years. As is the myth of every mother, myopia does not occur due to nutritional deficiency. So nutritional supplementation like eating carrots every day does not play a direct role in reducing myopia.

As long as the child eats a balanced diet, no tonics are essential. Parents also expect that if the child wears glasses constantly, the power should reduce. It is necessary to make them understand that that is not the case, and use of glasses in children is necessary to improve vision, prevent lazy eye, and eye strain, not to decrease power.

However, we do have options to suggest that can slow down the progression of myopia. Those are

• limiting screen time to 1 hour per day
• decreasing the amount of near activity
• having adequate illumination in the room and holding books at a proper distance when the child is performing near tasks
• encouraging 1 hour of outdoor activity and sunlight exposure every day

With the advent of smart learning, limiting screen time is becoming more and more difficult, but at least parents should be strongly recommended not to allow mobile games and to not allow social networking till children are 18 years of age.

It is common for parents to say, "Doctor, you only tell him, he does not listen to us." I tell the parents, "The change has to start with you. If you do not have games on your mobile, how will the child get addicted to them?" If the child does not listen to the parents he will not listen to anyone in the world. So you really need to counsel parents more than children in this aspect.

Nowadays companies also recommend nutritional supplements with antioxidants to prevent the harmful effect of screens on the children’s eyes. This is unnecessary in most cases and the easiest thing would be to not let the child get addicted to the screen in the first place.

Previous treatments to reduce the progress of myopia like orthokeratology (special contact lenses) and progressive lenses have not been very effective. 1% Atropine eyedrops have been tried but are associated with pupillary dilatation and loss of focusing ability for near and so are not popular.

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I have been using it in my patients for the last 2 years, and I would strongly recommend that it can be suggested by practitioners to their patients.

However as it is a long-term treatment, it should be used under proper monitoring by a paediatric ophthalmologist to avoid misuse. It is useful only for axial myopia, not all refractive errors, so patients selection is important. The effect is seen more after the first 6 months, so parent counselling is necessary to ensure continuity of the treatment.

If it slows the progression to 0.5D, it is continued for at least 2 years. After discontinuing, if myopia again increases, it can be restarted and continued till eye growth stops. The mechanism by which it works is not by preventing muscle strain by relaxing eye muscles, but by actually slowing down elongation of the eyeball.

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How can my child get rid of his glasses? 

There are modalities like contact lenses which children can use, preferably after 10th standard as by this time, they are mature enough to maintain the lenses properly and infections and corneal complications may be less. Lasik and other refractive surgeries are recommended only after 18 years once the growth of the eyeball is complete.

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Apart from the fact that my child has to wear glasses, are there any other problems that I need to anticipate and what do I do to prevent them? 

Myopic patients have stretching of the retina in the elongated eye, which causes it to become thin. It can develop breaks, which lead to detachment of the retina and vision loss. This can be prevented by yearly eye examination including a retina examination performed after dilating the pupils.

If any weak areas are identified they can be lasered, so they do not cause further complications. Thus, even if we cannot totally prevent myopia, we as a team (ophthalmologists, paediatricians, general practitioners and parents) can attempt to limit visual disability due to myopia in the young productive population.

Disclaimer- The views and opinions expressed in this article are those of the author's and do not necessarily reflect the official policy or position of M3 India.