The visual experience: the key to managing myopia in children and adolescents

Adherence: the factor that makes the difference

Visual performance and comfort both influence patient compliance and are the cornerstone of myopia management.[1] For example:

• With soft contact lenses, wearing them for less than five days a week reduces their benefit to practically zero.
• With glasses, children with low myopia tend to take them off for close-up tasks, reducing their effectiveness.
• Orthokeratology leads to almost automatic compliance: if not used, daytime vision deteriorates, which motivates patients to continue the treatment.
• Atropine requires active involvement from the family, as it does not provide immediate visual improvement.

 

Quality of life: visual and emotional well-being

The management of myopia does not merely correct vision: it influences a child’s self-esteem, independence and social participation. The scientific literature shows that contact lenses—both soft and Ortho-K—improve perceptions of physical appearance, participation in sports and social acceptance compared to glasses.[2] In terms of vision-related quality of life, orthokeratology usually ranks first, followed by soft contact lenses and, lastly, glasses.

 

Safety: assurance for patients and families

All current options have robust safety profiles. Daily soft lenses carry a very low risk of microbial keratitis, particularly in the paediatric population. Orthokeratology carries a slightly higher risk, but is still considered safe with proper hygiene and follow-up. [3]

 

Visual quality: the heart of the patient experience

Visual quality is the factor that most influences a child’s willingness to continue with their treatment. Soft contact lenses move with the eye, maintaining stable vision in all directions of gaze. Over 90% of children report seeing ‘very well’ or ‘well’ in everyday activities. Orthokeratology offers freedom during the day, with a slight reduction in contrast sensitivity in low light, which is generally well tolerated. Although all optical methods can slightly affect contrast sensitivity, the differences are usually small and not clinically significant.[4]

 

One patient, one strategy

Managing myopia requires looking beyond the prescription and traditional clinical indicators. The child’s visual experience — how they perceive their surroundings, how they cope with their activities and how they feel about the chosen option — must be central to decision-making. Actively listening to their feelings, involving the family and assessing both objective results and subjective perception allows us to select the option that best suits their daily life.

 

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[1] Bullimore MA, Jong M, Brennan NA. Myopia control: Seeing beyond efficacy. Optom Vis Sci. 1 March 2024;101(3):134–142.

[2] Lipson MJ, Boland B, McAlinden C. Vision-related quality of life with myopia management: A review. Cont Lens Anterior Eye. 2022;45(3):101538. doi:10.1016/j.clae.2021.101538

[3] Wolffsohn J, et al, BCLA CLEAR – Evidence-based contact lens practice. Contact Lens and Anterior Eye, 44, 368-397

[4] Janarthanan, S.D., et al. Exploring the impact of optical corrections on visual functions in myopia control–a scoping review. Int Ophthalmol 44, 47 (2024)

 

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