Can OK lenses and atropine actually be used? These myopia management measures are very important, as the degree of myopia in children increases dramatically. Atropine | Children | OK lenses
During the three years of the epidemic, most school-age children have taken many online classes, and the pediatric ophthalmology clinic has experienced a continuous peak of visits. Even on Saturdays, it is necessary to receive up to 600 patients for outpatient visits. The outpatient appointment on Saturdays often needs to be scheduled one month in advance. A large number of children who requested eye examinations crowded the outpatient department, and the scene continued to demand extra signs. The inspection team surrounded the hall and even lined up at the elevator entrance. After the examination, many children wore small glasses. But we also found that many children who started controlling myopia before the epidemic have achieved good results.
Xixi is one of them. He is already 12 years old this year. Three years ago, during a school physical examination, it was found that he had 100 degrees myopia. His mother noticed that he occasionally squinted his eyes. When examining Xixi at that time, it was found that although he was only 100 degrees myopic, the child's corneal curvature was particularly flat, and the corresponding eye axis was very long, about 25.50 millimeters.
What is this concept? We know that the axial length of highly myopic eyes is over 26.5 millimeters. That is to say, there is still 1 millimeter of room for Xixi's eye axis to reach the category of highly myopic eye axis. Once the value of high myopia axis is reached and exceeded, even in adulthood, the degree of myopia in children will continue to increase, ultimately leading to high myopia fundus lesions.
Therefore, although Xi Xi's myopia is not high at this stage, I still matched him with a corneal shaping lens, and gave him a joint scheme of low concentration atropine with a corneal shaping lens every night. In the subsequent follow-up examination, both visual acuity and axial control achieved ideal results. Over the past three years, Xixi has undergone a large number of online courses, but the effect of myopia control is still very ideal, with an annual growth rate controlled within 25 degrees. I believe that there must be many children who benefit from the protection of corneal reshaping lenses during the pandemic.
Xi Xi has been wearing corneal reshaping lenses since the early stages of the pandemic in June 2020. During the pandemic, she has undergone a large number of online classes, and due to the dual protection of corneal reshaping lenses and low concentration atropine eye drops, her myopia has been effectively controlled without outdoor exercise.
What is a corneal reshaping lens? How does it control the growth of myopia? Is your child suitable for wearing corneal shaping glasses?
Corneal reshaping lens is a rigid corneal contact lens designed in inverse geometry. Unlike traditional contact lenses, it is worn at night and removed during the day. Shaping principle: After a night of pressure from the lens, the corneal shape is reshaped, making the center of the cornea flatter and the periphery of the cornea steeper. Multiple studies have shown that corneal reshaping lenses can delay the progression of myopia by 35% to 80%, making them the most effective optical correction method for controlling myopia.
Corneal reshaping lenses, also known as "OK lenses", are suitable for children over 8 years old with rapid progression of myopia, as well as children with strabismus with myopia degree below 500 degrees, astigmatism below 250 degrees, and no obvious ocular surface diseases. Its advantages are good myopia control effect, no need to wear glasses during the day, which can meet the needs of children's sports, learning, and daily life. The disadvantage is that it is expensive, needs to be used under adult supervision, and requires lens care and frequent re examination. It should be noted that OK lenses belong to Class III medical devices and must be matched by ophthalmologists and optometrists in formal medical institutions.
Low concentration atropine was once known as a "miracle drug," but where is it? Parents have mixed opinions on low concentration atropine.
Low concentration atropine can delay the progression of myopia to a certain extent and is one of the most cost-effective methods for controlling myopia progression, which is simple and effective. Its mechanism of action is to increase the blood supply to the fundus choroid and delay the growth of myopia. The myopia control effect and side effects of atropine are concentration dependent. Therefore, in order to balance efficacy and safety, the academic community has been exploring its appropriate concentration. A 5-year ATOM study conducted in Singapore showed that 0.01% atropine eye drops have a good effect on delaying the progression of myopia, and compared with high concentration atropine eye drops, they have the smallest adverse reactions and the smallest rebound effect after discontinuation, with a myopia delay effect of about 50%. Similar studies have also pointed out that the myopia prevention and control effect of 0.01% atropine eye drops can reach 27% to 46%. This control effect is very meaningful for controlling myopia itself and reducing complications of high myopia.
At present, the most commonly used concentration of atropine in clinical practice for the treatment or control of myopia is 0.01%, which has the least side effects and definite therapeutic effects. Therefore, for children with poor efficacy of 0.01% atropine eye drops, it may be considered to increase the drug concentration or increase the frequency of medication administration. But the problem also arises: as the efficacy improves, side effects will become more prominent, and symptoms of photophobia and blurred vision will become more pronounced. In addition, about 10% of children do not respond to atropine, so not every child who uses low concentration atropine eye drops is effective.
Children with myopia that has increased by more than 75 degrees in a year, or those with initial myopia less than 9 years old, may consider using low concentration atropine eye drops. Use once before bedtime every night, usually continuously for 2 to 3 years. Current guidelines suggest that low concentration atropine can be used continuously until the end of puberty.
However, before using atropine eye drops, it is necessary to determine whether the child's basic development rate of myopia is fast or slow, because once atropine is started, it needs to be used continuously for 2 years. Even if the medication is stopped, it needs to be reduced in dosage, such as taking it every other day until it is stopped. Therefore, it is necessary to undergo professional ophthalmic and refractive examinations. Doctors can objectively judge the basic development speed of myopia in children, inform them of possible control effects, and provide different myopia prevention and control plans. If the child's myopia progression is not rapid and does not increase by more than 50 degrees per year, there is no need to take atropine eye drops; If the child's myopia increases by 75 degrees or more in one year, low concentration atropine eye drops can be considered; If the child experiences an increase of 200 degrees of myopia per year, a combination therapy is needed to control myopia, such as low concentration atropine eye drops combined with corneal reshaping lenses, multifocal soft lenses, or defocus frame glasses.
It should be noted that it is not recommended for children who suffer from glaucoma or have a tendency towards glaucoma, are allergic to scopolamine alkaloids, or have brain trauma. The advantage of low concentration atropine eye drops is that they are easy to use, but the disadvantage is that although they can be used to control the progression of myopia, children with myopia still need to wear frame glasses or OK glasses to meet their daily eye needs. The main adverse reactions are photophobia, insufficient close range regulation, and allergic reactions to the eyelids and conjunctiva.
It can be said that myopia prevention and control focus on correct cognition and long-term persistence. Once a child's true myopia is formed, it cannot be reversed. When the degree of myopia increases by more than 75 degrees per year, it indicates that the child's myopia is progressing rapidly and should be taken seriously. As children return to campus, coupled with sufficient outdoor activities, less exposure to electronic screens, more distance viewing, and reduced continuous close range eye use, myopia can be prevented and controlled. In addition, it is important to eat less sweet and fried foods, as these foods can affect calcium absorption, leading to increased axial length and myopia. Try not to let children develop high myopia, otherwise it can cause many complications in the eyes, leading to irreversible damage to vision.
