Cram school attendance correlates with a high risk of myopia

Written By: Aparna Ramasubramanian MD
courtesy of AAO

This prospective cohort study examined the association between near visual activities and incidence of myopia among Taiwanese children.

Study design

Investigators assessed 1,958 Taiwanese children aged 7 to 12 years. Children were interviewed in the presence of an adult proxy respondent in 2009, and linked to claims data from the National Health Insurance system collected between 2009 and 2013.

The outcome variable was myopia. The exposure variable was near visual activities, which were divided into reading, use of computer, internet and games and cram school attendance (i.e., tutorial or coaching classes outside of the regular school system).


At baseline, 26.8% children had myopia. Almost 28% of those without myopia at baseline developed the condition between 2010 and 2013. Each day, participants spent an average of 0.68 hours on computers, 0.63 hours reading and 2.78 hours on cram school. Children attending cram schools for 2 or more hours a day exhibited a higher risk of incident myopia (HR 1.31).


Cram school attendance cannot alone be considered a risk factor because it could be related to

other factors. A broad increase in near time could lead to less outdoor time for children; reduced outdoor time is the primary cause of myopia. Cram school is also related to continuous near work and problems with illumination and contrast sensitivity. A detailed study breaking down these factors would improve the understanding of underlying causes for progressive myopia.

Clinical significance

Myopia is a modern pandemic estimated to affect 50% of the world’s population. These epidemiologic studies are important to discover the cause of myopia and the factors that lead to disease progression. Multiple studies indicate that increased near work and reduced outdoor activities lead to myopia so parents should be counselled accordingly.

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Parental myopia tied to higher risk of early onset myopia

Written By: Aparna Ramasubramanian MD
courtesy of AAO

Review of: Association of Parental Myopia With Higher Risk of Myopia Among Multiethnic Children Before School Age

Jiang X, Tarczy-Hornoch K, Cotter S, et al. JAMA Ophthalmology, May 2020

This study investigated the association of parental myopia with refractive error and ocular biometry in multiethnic children aged 6 to 72 months.

Study design

Researchers used pooled data from children in 3 population-based studies with comparable design, namely MEPEDS in Los Angeles, California; STARS in Singapore; and SPEDS in Sydney, Australia. The analysis cohort included a total of 9,793 children, including 4,003 Asian participants, 2,201 African American participants, 1,998 Hispanic White participants and 1,591 non-Hispanic White participants. Comprehensive eye examinations had been performed in all of the children.


Maternal and paternal myopia were associated with a greater prevalence of myopia in the study participants. Early-onset (before 12 years of age) parental myopia was associated more strongly with myopic refractive error in children than was adult-onset parental myopia. Having 2 parents with myopia was consistently associated with a higher risk of myopia in the study participants. Compared with children without parental myopia, the odds ratios for early onset myopia were 1.42 for children with 1 parent with myopia, 2.70 for children with 2 parents with myopia and 3.39 for children with 2 parents with childhood-onset myopia.


The study defined myopia as a spherical equivalent refractive error of -0.5 D or less in the more myopic eye; however, in young children (<36 months) the myopia may resolve with emmetropization. In addition, the parental history of myopia and age of onset was based on history reported by a single parent or guardian, which could lead to recall bias.

Clinical significance

In study participants, parental history of myopia was strongly associated with a greater risk of early onset myopia. The risk was higher if both parents had history of myopia, particularly if the age of onset in the parents was earlier than 12 years.

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Ortho-K Lenses

Orthokeratology (Ortho-K) is now available at Sparks & Feros Optometrists

Orthokeratology or Ortho-K (also known as sleep lenses) uses an oxygen permeable contact lens to temporarily reshape the cornea. The main advantage of Ortho-K is that if effectively controls the progression of myopia in children. The lenses are worn while sleeping and taken out upon wakening. This enables your child’s to have clear sight during the day allowing him/her enjoy school, exercise, and swim without needing glasses or contact lenses. Adults can also share the benefits of Ortho-K lenses and are particularly useful for sportspeople, surfers, swimmers, and for those working in dusty environments and in outdoor occupations where glasses or contact lenses are a disadvantage.


Why choose to use Ortho-K?

The aim of Ortho-K lens treatment is to control progression of myopia also known as short-sightedness. It has the additional benefit of giving clear vision without having to wear glasses or contact lenses during the day. The lenses are worn overnight to reshape the cornea bringing the light rays into sharp and clear focus. The corneal reshaping effect of Ortho-k is temporary and lasts for about a day, so the lenses need to worn every night for best vision.

Controlling Myopia with Ortho-K lenses

Standard glasses Vs Ortho-K contact lenses

Standard glasses and contact lenses focus the light rays on the centre of the retina (known as the fovea) to correct myopia. The problem being is that they cause a steady increase in the level of myopia. Ortho-K lenses reshape the central cornea allowing you to see clearly, while changing the peripheral cornea to reduce the progression of myopia. Children as young as 7 years of age can benefit from Ortho-K treatment.

Sparks & Feros provides eye screening for children from the age of 4 for early detection of any potential eye problems.

It has been shown that children using Ortho-K lenses had their myopia slowed down by about 43% as compared to children using conventional spectacles.



How do Ortho-K lenses work?

Ortho-K is a non-surgical alternative to wearing daytime contact lenses and glasses to correct vision. Ortho-K lenses are worn while you sleep and are removed in the morning. They have a unique design, which generates pressure in the thin layer of tears under the contact lens. It’s like braces for your teeth. The cornea is highly elastic and will return to its original shape if the lenses are not worn on a regular basis. For this reason, Ortho-K lenses are usually worn every night to maintain the re-shaping effect once the desired cornea shape has been achieved. After you remove the lenses in the morning, you have clear vision for the whole day, without the need of glasses or contact lenses. Ortho-K causes no permanent ocular change, giving you ultimate control and flexibility of your vision correction without the risks involved in laser eye surgery and is a safe and effective way of controlling myopia progression in children. If your child is myopic then Ortho-K treatment should be considered.

History of Ortho-K technology

Ortho-K has been around for over 50 years. Recent developments in corneal mapping technology such as the Medmont E300 topographer, now available at Sparks & Feros Optometrists, combined with new contact lens materials has enabled very high accuracy in both lens manufacture and improved lens comfort. Modern Ortho-K wearers can expect very safe, comfortable overnight wear and clearer vision during the day.


Benefits of Ortho-K lenses


Ortho K is a powerful way to control the progression of myopia in children. If your child is myopic then Ortho-K treatment should be considered. Ortho-K is safe and for children form ages 7 years and above.


Ortho-K is recommended for people who want to be free of glasses and contact lenses during waking hours. It is also recommended for sportspeople, surfers, swimmers, and for those working in dusty environments and in outdoor occupations where glasses or contact lenses are a disadvantage.

Other Treatments 

Atropine Eye Drop Treatment – Studies show that 0.01% atropine slows the progression of myopia with very little side effects. However, 0.01% atropine is not yet commercially available and is only dispensed by compounding pharmacists in Australia. It is worth mentioning that 1% Atropine has also shown an effective result in myopia control, however, it leads to light sensitivity and poor near vision and is rarely prescribed due to its side effects. This treatment is not currently available at Sparks & Feros Optometrists.
Sparks & Feros Optometrists are members of the Orthokeratology Society of Oceania (OSO) and American Academy of Orthokeratology and Myopia Control which are both dedicated to promoting research, professional development of Orthokeratology.

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If you would like to discuss myopia control phone us on 9872 1555 to arrange an appointment or Book Online.

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Myopia: The Different Stages of your Child's Vision

People are not usually born myopic, they become myopic! Most children are born with eyes that are too short and their vision may be blurred. As the child's body develops, the eyes also lengthen and this natural development allows for clear vision. However, sometimes the elongation does not stop and the eyes become too long. This usually happens around the age of 6 or 7 – a condition known as infantile myopia. For others, myopia can start around puberty or more rarely, in the late teens or even twenties. Whatever the age of myopia onset, the underlying issue of having an eye that’s too long is the increased risk of ocular pathologies later in life.

Find out the different stages of development of your child’s sight, from pre-natal to adolescence.

Our advice: The earlier myopia is detected, the sooner it can be corrected and controlled. And limiting the progression of a child’s myopia means limiting the possible complications and visual pathologies that might develop later in life.

Book your child for an eye test today for early detection of myopia.
Give us a call on 9872 1555 to book an appointment here.


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MiYo Smart Myopia Control: Protecting your child's eyesight

Your child may be suffering from Myopia. How can you protect them from it?

MiYOSMART by HOYA Lens Australia is a Myopia Control lens that helps prevent and reduce the risks of developing sight threatening conditions.

Find out more about MiYOSMART and how it can effectively control your child's myopia.

Book in for an eye test online or give us a call on 9872 1555

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