A collection of frequently asked questions about refractive error in children

This is the 3163th article of Da Yi Xiao Hu

I come into contact with many patients with refractive errors (myopia, hyperopia and astigmatism) in the outpatient clinic. After completing a series of examinations, their family members often have many questions when they show me the reports. Today, I will summarize some common questions for your convenience.

-Why is my child's myopia progressing so quickly?

The doctor replied: We hope that the increase will be within 50 degrees within a year, otherwise the myopia will progress quite fast. It is mainly related to the children using their eyes too much at close range and using their eyes incorrectly. Many children tilt their heads when doing homework, or lower their heads very low, and use tablets or mobile phones a lot during the winter and summer vacations. When we check, we find that the myopia progresses very fast.

-Can myopia be corrected?

The doctor replied: Myopia is irreversible. Once you have it, you can't go back. In general, the eyes are tested in hospitals by applying eye drops and dilating the pupils, so the degree is very accurate, unlike the eyes in the glasses shop, which often has a high degree (children have strong accommodation, and often do not dilate the pupils, which will cause pseudomyopia).

- Can you not wear glasses?

Doctor's answer: According to the guidelines of the "Expert Consensus on Pediatric Refractive Correction", children over 3 years old with myopia of more than 100 degrees, hyperopia of more than 300 degrees, and astigmatism of more than 150 degrees are recommended to wear glasses. And it is recommended to wear them all the time, and do not take them off and on. Because myopia may increase whether you wear them or not, but it will increase faster for those who do not wear them.

-How to control the progression of myopia?

Doctor's answer: The more scientific method is low-concentration atropine eye drops (0.01% concentration), OK lenses (orthokeratology lenses) and outdoor activities. Generally, I would recommend the first phase plan for children: wear glasses first, reduce close-up use of the eyes, pay attention to eye posture, increase outdoor activities, and recheck in half a year. If the increase is indeed very fast in half a year, then enter the second phase: in addition to continuing the first part of the plan, you can add low-concentration atropine or OK lenses (choose 1 of the two is enough), and observe for another half a year. If it is still not well controlled, then you can use eye drops and OK lenses together.

-What is low concentration atropine?

Doctor's answer: Low-concentration atropine eye drops refer to 0.01% (concentration) atropine eye drops. Research from the Singapore National Eye Center shows that it can effectively control the progression of myopia, and it is not easy to rebound after stopping the drug, and the side effects are small. There is no ready-made drug in China, but our hospital has 0.01% (concentration) atropine eye drops configured by the pharmacy department, which can be prepared for children in need. However, there are a few points to note. This drug is not a miracle drug and is not 100% effective. It is about 50-60%. Myopia control cannot rely solely on drops. At the same time, you must also pay attention to eye posture and increase outdoor activities. Some children may be afraid of light or have difficulty seeing close up. In addition, it is not clear whether long-term use of drugs will have adverse reactions to the whole body, so I generally recommend using it only when the control is really poor. At the same time, come to the hospital for a follow-up check every 3 months. After applying eye drops, press the inner corner of the eye for at least 2 minutes to avoid absorption by the nasal mucosa. (Attached at the end of the article is how to apply eye drops correctly)

-What are Ortho-K lenses?

The doctor's answer: The scientific name of OK lenses is orthokeratology lenses. They are contact lenses that are worn at night and not during the day. On the one hand, they can control the progression of myopia, and on the other hand, you don't have to wear frame glasses during the day. However, there are some precautions that parents also need to know: 1. It is the same as low-concentration atropine eye drops. This thing is not omnipotent. The control effect is about 50% on average, which means that half of the children will increase their myopia after wearing it. They still need to pay attention to eye posture and increase outdoor activities. 2. It has age requirements. It can only be worn by people over 8 years old, and there are also requirements for the degree. Different brands have different requirements. The maximum is 500 degrees of myopia and 150 degrees of astigmatism. 3. This is the most important thing, because it is a special contact lens. It is worn on the cornea, so you must pay extra attention to eye health, come to the hospital for regular check-ups, and ensure corneal health. It is recommended to go to a regular hospital near home for fitting to ensure safety.

-Are you going to do anything outdoors?

Doctor's answer: You don't actually need to do any exercise when you go outdoors. Just let your children get in touch with nature. It's very simple. You just need to have enough time. Theoretically, it should be 2 hours a day, but not every family can do it. There is a consensus that increasing outdoor activities can prevent myopia, but the effect of controlling myopia is still controversial. However, I still recommend increasing outdoor activities regardless of whether you have myopia or not, at least it can reduce close-up eye use.

-Can astigmatism be corrected?

Doctor's answer: Generally speaking, astigmatism is congenital and cannot be corrected. Be careful not to rub your eyes. Normal astigmatism does not change much. Theoretically, if the astigmatism exceeds 150 degrees, it is recommended to wear glasses to avoid amblyopia. However, if the astigmatism increases year by year, you should be alert to bad astigmatism (keratoconus), which requires corneal topography to determine.

-Can children undergo laser surgery for myopia?

The doctor replied: No. You must be 18 years old and become an adult, and then consider myopia surgery when your degree is stable. If you have astigmatism at that time, you can also correct myopia and astigmatism together through surgery.

-Is poor eyesight the same as amblyopia?

The doctor replied: No. Maybe your vision is poor without glasses, but your vision reaches standard vision with glasses. This is not amblyopia. Amblyopia means that even if you wear glasses, your vision cannot be improved. Excluding organic lesions, it is amblyopia. If you don't treat it well now, laser surgery in the future will not help you. Early detection and early treatment during the sensitive period of visual development between 3 and 10 years old, otherwise it will be difficult to treat after this golden period.

-How often do you come for a checkup?

Doctor's answer: Normally, check once every six months. Children's bodies grow fast and their eyes change fast, so six months is a good time to monitor the dynamic changes of the eyes and check the control effect in the past six months. If there is a problem, intervene in time. If you use low-concentration atropine eye drops or wear OK glasses, you need to shorten the cycle, usually check every 3 months.

This is the summary for now. If there are any inappropriate parts, you are welcome to point them out. You can also leave a message to ask questions you want to know. I will update it later.

This article is reproduced from the WeChat public account of "Dr. Zheng Ke"