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In myopia, light from far away is focused to a point in front of the retina, which results in blurred vision – only light from nearby objects are focused on the retina properly, and therefore appears sharp and in focus. The issue is myopia – particularly high myopia – can cause problems in the eye, later in life, even if the vision is corrected with spectacles, lenses or refractive surgery. One example is people with high myopia have a 5-6 times greater risk of retinal detachment than people with low myopia.
The human eye receives optical stimuli and transmits them to the brain. Like a camera, it has an optical system and a photosensitive layer. The optical system of the eye consists of the cornea and the eye lens, with the cornea responsible for two thirds and the lens for one third of the refractive power.
If the eye is “too long,” it is called myopia, and if it is “too short,” that error is called hyperopia. In European countries, 15-20% of the population is short-sighted and about 5% are far-sighted.
Myopia develops in childhood, when the eye grows faster than the optics contained therein. Too long a growth of only 1 mm already means 3 diopters of myopia.
Myopia is increasing massively. In 2010, 2 billion people were short-sighted. By 2050, according to the World Health Organization (WHO), 5 billion people will already be short-sighted, or 50% of the world’s population.
Long screen work (close-up work) and a lot of time under artificial light are among the triggers.
Nowadays, we spend much more time reading distance than our ancestors. Computers, but also smartphones and tablets cause our optics to be constantly focused at a distance of 20 to 60 cm. This constantly activates the process of so-called accommodation: we make an effort to focus in the vicinity. This stimulates our brain to make the eye short-sighted, because myopia means that you can see close up without any effort.
Another reason for the strong increase in myopia is probably also the artificial light that accompanies us over long stretches of our everyday life. The composition of the artificial light, in contrast to natural sunlight, does not release the messenger substance dopamine. And it is precisely the dopamine that can slow down a progression of myopia.
Contact lenses, spectacles, and in adults, refractive surgery, can change how the light is focused so it lands on the retina correctly. However, these people are still myopic; their vision has simply been corrected, but they still carry all of the risks associated with being myopic.
It’s important to understand that myopia is a disorder that forms during childhood. Myopia occurs if the eye grows too long to focus light from far away onto the retina. Childhood is therefore the only opportunity to influence the progression of myopia.
There are two types of childhood myopia, stable and progressive, and it is the latter we can influence, with either eyedrops or special contact lenses. As mentioned above, it is worth trying to slow the progression of myopia, not because of the requirement for thicker spectacles, but to try to improve your child’s depth of focus with spectacles, and to reduce the risks of developing myopia-caused retinal detachments in later life.
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Is the increase in myopia a problem unique to Asia? Not at all. Here in Zurich and throughout Switzerland, too, the number of people with myopia is increasing rapidly. Our living and reading habits are also changing rapidly with us.
More important that we can now help with various measures to slow down the increase in myopia. In addition to changing habits (more time in natural light, greater reading distance from screens, smartphones, tablets), therapy with atropine and / or special contact lenses can slow down the increase in myopia.
The German ophthalmologist Hermann Cohn had already established in the mid-19th century that close work and too little sunlight have an influence on the progression of myopia.
In other words, what our grandparents always said to us “Do not read so much and go out to the fresh air” makes perfect sense…
Source: Wikimedia Commons
Studies on children and adolescents in Asia have shown that the development of myopia can be slowed down by the use of highly diluted atropine 0.01% eye drops. The mechanism of action of atropine to slow down eye length growth is not fully understood.
The drops are dripped once a day (in the evening) and, depending on the course, are usually used over a period of several years. Regular appointments for follow-up examinations must be performed during the application
Atropine is a so-called belladonna alkaloid and has been used for centuries for pupil dilation. In the Middle Ages, it was used to make people look more attractive (“Belladonna”). In ophthalmology, 1-percent atropine has been used for more than 100 years in certain eye exams.
In 0.5% and 1% doses, atropine eye drops are used as a drug approved by the Swiss Medicines Agency for pupil dilation.
What is new, however, is the use of atropine for a different purpose, namely to slow down myopia. Such use is called “off-label”, meaning that the drug’s use for this purpose has not yet been approved by the Swiss Medicines Agency and there is no obligation to pay the health insurance companies.
Ortho-K lenses are special contact lenses that are worn at night and flatten the cornea in the center and the periphery. Multifocal contact lenses contain various optical zones and are worn during the day.
Both systems affect how the image from the periphery of the cornea is projected onto our retina. Both systems can be used to slow the progression of myopia. Which system can be used with your child, we will discuss with them after a detailed preliminary investigation.
At the beginning of the consultation, a detailed ophthalmological examination is carried out, in which we thoroughly examine the eye and, among other things, measure the total length of the eye using ray tracing technology. After consultation with the pediatrician then the therapy with contact lenses is initiated. Your child will be cared for throughout the duration of the treatment. In most cases, such a therapy continues until the natural growth of the child slows down so much that a further progression of myopia is unlikely.
Special contact lenses or atropine? Both systems give similar results in slowing myopia. Which one we will use depends on the individual circumstances of your child.
The side effects of the 0.01% atropine eye drops should not be compared with the side effects that can occur with (100 times stronger) 1% eye drops.
The major studies on the subject have not described any serious side effects, however:
Quelle: Chua et al, Ophthalmology, 2006
Contact lenses have the general risks of wearing contact lenses, especially the risk of infection.
All three approaches slow myopia progression; the choice will depend on the individual circumstances of your child.
As ELZA is a world-leading refractive center, we have highly experienced doctors and optometrists with access to the most sophisticated instruments to examine your child’s eyes. These include ray-tracing technology to measure the total length of the eye, as well as corneal tomography and epithelial maps to fully understand if there are any other pathologies in the cornea that might cause myopia.
Yes, a detailed ophthalmological examination is necessary. Among other things, the length of the eyeball is measured using state-of-the-art ray-tracing technology.
No, the costs of myopia control are currently not covered by the health insurance in Switzerland.
You can always make an appointment with us either by phone (044 741 81 81) or by e-mail (info@elza-institute.com) or via our contact form. In a first step, we will perform a detailed ophthalmological diagnosis.
At the beginning of the treatment, the controls are more frequent. Once the treatment has been initiated, checks are carried out every three months.
The goal of the classic CXL surgery is to stabilize the keratoconus. We cannot heal the disease, but we can “freeze” the current condition and prevent it from progressing even further. When using a customized approach, we even manage to reverse the ectasia to a certain degree. However, this can’t be guaranteed in advance.
In a second step, a few months after the surgery, measures to improve the sight can be taken. Whether this might be special contact lenses and/or additional laser treatment depends on the state of each patient’s cornea.
For many decades, in ophthalmology, we believed that myopia can not be slowed down. But modern ophthalmology has learned a lot in the field of myopia control over the past 10 years. A number of large-scale studies have proven in recent years that this form of myopia control is effective.
Yes. It used to be thought that children should only wear contact lenses when they were teenagers. However, a number of studies have shown that contact lenses are safe for younger children, as long as the hygienic handling of the lenses is practiced. It also depends very much on how you, as a parent, judge your children. Also in terms of contact lens materials and designs, these have improved significantly in recent years.
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