Myopia Management

I recently asked a pediatric ophtalmologist about it. She said that the evidence on hard lenses is mixed, including based on her own observations with her patients. However the only thing that has been proven over and over again is that spending at least two hours outside everyday is the best way to slow down or potentially even reverse myopia in children/teens. You have to be diligent about it and potentially make lifestyle changes but apparently being exposed to natural light outdoors is the best and possibly the only way. Good luck! 

My daughter is 18 and graduating from high school this year. She used OrthoK lenses for myopia control for almost 10 years and we couldn't be happier with the program. She was seen at UC Berkeley. She first got glasses in 1st grade, and after 1 year, her eyesight had deteriorated so quickly, we were referred to the myopia clinic. The contacts were easy for her to use and because she chose the hard lenses, it meant she never had to worry about corrective lenses or glasses during the day. She wore them consistently, except when she went to sleepaway camp, and she decided to bring glasses instead. Now that she's older and not getting enough sleep reliably, she decided to switch to soft lenses, giving her the option of wearing contacts or glasses on a daily basis. Amazingly, after weaning off of her OrthoK last month, the doctors determined that her eyesight had not deteriorated AT ALL since second grade when she began wearing them. We probably saved money over the course of the program because her prescription didn't really change (we only replaced her OrthoK once) and the glasses we got her as backups were also only replaced once. I'm not sure if this is typical. 

My experience is slightly different and from a couple of decades ago, but may be a data point to consider. 

My eyes were -7.5 and -7.0 and I used RGP lenses regularly during the day time for about two or three years, and then I was going to go on a backpacking trip and asked for daily disposables so I don't have to worry about carrying solutions and cleaning my lenses. When I was being fitted for soft lenses they tested my vision, and my vision had improved to the -6.5 and -6.0 range due to reshaping of the cornea from the hard lenses. 

So my vote would be for the hard lenses, because it worked for me personally.

Hi, my kiddo (now 11 years old; will turn 12 in a couple months) has been on OrthoK for a little over a year and was on atropine drops for about a year and a half before that. The drops worked for awhile but then his prescription started inching up so we switched to OrthoK. We've been happy with the results so far with the hard lenses -- we just had another follow-up appt and his prescription hasn't changed at all. I have really bad myopia and I remember as a kid my prescription skyrocketed during my pre-teen and early teen years, so the fact that these treatments are available now is pretty wild.

The main thing with OrthoK (and with any lenses, obv) is putting them in and taking them off. I had to do both for my kid for the first, oh, 6-8 months. YMMV! (Our optometrist gave us a little plunger-like tool that makes suctioning them off the eyeball pretty easy.) OTC lubrication drops (*not* the medicated or red eye kind) can make the processes easier and more comfortable.

With OrthoK, we like that he doesn't have to wear anything (glasses or contacts) during the day when he's out and about, and now that he's older can be responsible for cleaning, soaking, washing out the lens case, etc.

FWIW, if you're still considering atropine treatment, my kid did have increased sensitivity to sunlight/bright lights so we ended up getting some snap-on sunglasses that went over his regular glasses for sunny days. Not the "coolest" look, and something to keep in mind if you go that route. Hope this is helpful.

We were in your shoes a couple of years ago and decided not to do the treatment. (I say "decided" but really it was more inertia—we felt unsure about all three options so didn't move forward, and months turned into years. Our optometrist did do regular checks through that time to monitor the progression every six months or so, and we might have changed course if it had suddenly gotten a lot worse, but thankfully it didn't.) Some of our concerns were that we didn't think our child would be consistent about using the atropine drops and didn't love the infection risk for overnight lens usage relying on a tween's care and cleaning. Compounding that was that all of the options were expensive, none were covered by our vision insurance, and at the time, the research on outcomes for all three treatments was very mixed. So...now our child is almost 14 and on the other side of the puberty growth spurt, but the myopia has remained more or less unchanged (much to our optometrist's surprise and our relief). Things may of course still shift since myopia can worsen through adolescence and into the early 20s, but the fact that it hasn't gotten worse over two years of rapid puberty growth apparently means that the odds are in our child's favor for the condition to remain mild. While hindsight is of course 20/20, we're glad that we didn't do the intervention (and it's tricky because if we had done it and this had been the result, that would have been considered successful treatment too). We did double down on the limited screen time and expanded outdoor time recommendations from the American Academy of Opthamology that they believe help prevent myopia from worsening, although again—I have no idea whether that had any impact. Just offering one anecdotal data point to consider. (I think talking with UC Berkeley's pediatric eye center is a great plan too since they specialize in treating this age.)

We have gone to the Myopia clinic so Berkeley for four years. Because of the responsibility and fine motor skills, contact lenses are not a good option right now. 

He's had atropine eye drops for several years and it seems to help. There's been no noticeable side effects, but he's always had lenses that turn into sunglasses when outside. 

He also has Hoya Miyosmart lenses for his glasses, which has also helped. These are not yet approved in the US so we order from Canada. It's very new and promising research.

My daughter was an early adopter of the hard lenses at UCB Optometry Myopia Clinic, when it was still in the study phase. Both parents have/had myopia. She still wears the lenses, and gets regular checkups at the clinic. She is now 23 and neither she nor I would do anything differently. Her prescription has hardly changed in the 12 years since she started wearing the hard lenses at night. She liked the flexibility the night lenses gave her during the day. 

My child is 4 and has been followed by the UC Berkeley myopia clinic. She has been using atropine eye drops for nearly a year. Her prescription went from -1.00/-1.00 to -1.75/-1.50 during that time. We are considering switching to orthoK at her upcoming yearly exam if she is able to tolerate the machine used to get measurements.

My son started OrthoK at 9 years old at UC Berkeley. His eyes weren't bad but they were rapidly getting worse. Almost immediately he had 20/20 vision. It took about a year before he could put in the lenses by himself. He's lost a few lenses so that adds to the expense. UC Berkeley is a teaching program so students do the work, both on the exam and the customer management side. So I'd say it's a bit rough around the edges, for example the students performing the examination often don't introduce themselves or explain what or why they are doing certain exams. It's also always a different student. The students doing the customer service often times don't return calls or worse, sometimes don't fulfill orders. The supervising optometrists are very good and normally stop by at the end and check the students' work. There are several eye doctors that do a similar service in the East Bay and the City. I checked around and their prices seem similar to UC Berkeley's but that was a year ago. 

We did atropine for a year starting at 9 years old. Worked perfectly. Our optometrist was gleeful that absolutely everything was unchanged in comparison to noticeable change in prior years. Beyond the one time large fee from the optometrist for the ongoing monitoring, the drops were $65/month from the compounding pharmacy. We planned for the costs and used HSA funds. The downside of the drops are the constantly dilated eyes and sensitivity to light. We got transition lens and it was manageable. Kid had no pain or issues with the drops. We made it part of the bedtime routine and a parent dropped them in. And we did it consistently - every night - for the entire year.

We started the overnight hard lens a few months ago (10 years) so as to not have to wear glasses mainly. Again, it is working perfectly. It feels weird to have the hard plastic on your eye but our kid was able to get used to it after a few practice sessions. During the second session, we gave a dose of OTC pain meds that took the edge off the uncomfortable feeling. It’s sorta a mental shift that the lens isn’t actually hurting your eye because it feels unusual. We are still helping with inserting, mainly the right eye! The lens require 8 hours of closed eyes (sleep) to work. Kid takes them out in the am unaided by parents. The little plungers that aid in removal are super cool. The optometrist recommended Clear Care Plus. The solution has hydrogen peroxide in it and it reacts with a catalyst in the case to clean. After 6 hours, the reaction is complete and the lens are ready to go. Brilliant way to get the lens clean without rubbing and rinsing. Kid is delighted to do a little science project every morning. It took a couple weeks for distance to clear up but it was only 1-2 days until they could see well enough for normal activities. Lens were $950 and they are expected to last for 2-3 years.

If we’d known what we know now, we’d do hard lens initially. We didn’t originally because the drops cost less, we didn’t know if it would work overall, and our kid has a low pain tolerance. 

My 10 year old son has been using Misight lenses for about six months and they are great. He can insert them and remove them on his own (it took a few days of practice), and at his most recent checkup there has been no progression in his myopia. Like you, we were also deciding between drops, OrthoK and MiSight, and went with the latter because it had good clinical evidence of efficacy with the fewest side effects. For instance, there is no dilation/light sensitivity (which always confused me with the atropine drops option and the recommendation to spend 2+ hours/day outside in daylight), our son finds the lenses very comfortable (we were concerned that he'd find the OrthoK uncomfortable), and there is no blurriness/rings/vision distortion as we'd read and heard about with both atropine and OrthoK. When my son doesn't have lenses in for whatever reason (he takes them out for swimming/showering), he has an inexpensive pair of single vision glasses so that he can see at a distance. But in general he's in the lenses c. 14 hours/day 7 days a week with no complaints.

The downside is that they are expensive, but what we discovered is that different optometrists approach bundling the costs in different ways. We ended up with one that was happy to just bill us for the actual appointments and then we bought the lenses online for much much less than the optometrist was charging. If you're ever traveling to Canada or Europe for work or leisure, the lenses are about half the cost there as they are here, so stock up! Even if you end up going to an optometrist who bundles the lens cost into the "program" cost, shop around--we found variations of c. $500/year among optometrists who bundled the cost.