Treatment Options for Myopia (Nearsightedness)
Eyeglasses are the primary and most cost-effective treatment option for myopia and should be considered before contact lenses or refractive surgery. 1
Optical Correction Options
Eyeglasses
- Individuals with low myopia may not need eyeglass correction except for specific distance activities like driving or schoolwork 1
- Caution: Overcorrecting myopic patients will cause excessive accommodation, potentially creating symptoms 1
- Some patients may require increased minus correction for clearer night vision due to night myopia 1
- High-index lenses are recommended for high myopia to reduce lens thickness and weight 1
- Regular screening examinations every 1-2 years are recommended for children and adolescents due to the progressive nature of myopia 1
Contact Lenses
- Options include:
- Soft hydrogel contact lenses
- Silicone hydrogel contact lenses (greater oxygen transmissibility)
- Rigid gas-permeable contact lenses 1
- Contact lens wearers should have examinations every 1-2 years to monitor for adverse effects 1
- Patients using contact lenses should still have a pair of eyeglasses for when the eye is red or inflamed 1
Myopia Control Options for Children
- MiSight multifocal daily disposable soft contact lens - FDA-approved for myopia control in children 1
- Orthokeratology - emerging evidence supports its role in myopia control 1
- Caution: Risk of microbial keratitis must be considered 1
- Bifocal or multifocal contact lenses may slow myopia progression by reducing peripheral hyperopic defocus 1, 2
Surgical Options
Corneal Refractive Surgery
- LASIK (Laser-Assisted In Situ Keratomileusis) 1, 3
- PRK (Photorefractive Keratectomy) 1, 3
- Small-incision lenticule extraction - newer procedure requiring further study 3
Lens-Based Surgery
- Clear lens extraction
- Phakic intraocular lenses
- Cataract surgery (when applicable) 1
Ineffective Treatments to Avoid
- Pressure-lowering eyedrops (e.g., timolol maleate) - clinical trials failed to show retardation of myopia progression 1
- Visual training exercises - no scientifically acceptable studies document clinical effectiveness 1
- Acupuncture - insufficient evidence to draw conclusions 1
- Nutritional changes - largely anecdotal with no scientifically valid studies available 1
Special Considerations
Exotropia with Myopia
- Correcting even mild amounts of myopia may be beneficial for controlling exotropia 1
- In some cases, increasing myopic correction in myopes may improve fusional control of intermittent exotropia 1
Myopia Progression in Children
- Regular monitoring is essential as myopia typically progresses during childhood and adolescence 1
- Screening examinations including visual acuity are recommended every 1-2 years 1
Safety Considerations
- Polycarbonate lenses are recommended for eye protection, especially for individuals with good vision in only one eye 1
- Safety glasses are strongly recommended for sports and hazardous activities 1
Follow-up Care
- Adults under 40 years: comprehensive eye examination every 5-10 years
- Adults 40-54 years: every 2-4 years
- Adults 55-64 years: every 1-3 years
- Adults 65+ years: every 1-2 years 1
The treatment approach should be based on the degree of myopia, patient age, lifestyle needs, and risk factors for progression, with eyeglasses being the first-line treatment for most patients due to their safety and cost-effectiveness.