July 2, 2019
Dwight Akerman, OD, MBA, FAAO, FBCLA
Professor Ian Flitcroft wrote, “… there is no evidence of a safe threshold level of myopia for any of the known ocular diseases linked to myopia including myopic maculopathy” (Flitcroft, D. I., 2012). While most myopes will have normal visual acuity with appropriate optical correction, myopia has significant public health consequences from a variety of perspectives, including financial, psychological, quality of life and ocular co-morbidities. Unfortunately, eye care professionals and parents of myopic children often take a wait-and-see approach to myopia control.
Bullimore and Brennan propose three broad, long-term benefits of lowering a patient’s ultimate level of myopia: less visual disability when uncorrected; better options for, and outcomes from, surgical myopia correction; and reduced risk of blindness associated with higher levels of myopia.
The researchers applied data from five extensive, population-based studies of the prevalence of myopic maculopathy on 21,000 patients and demonstrated that a one diopter increase in myopia is associated with a 67 percent increase in the prevalence of myopic maculopathy. Restated, slowing myopia by one diopter should reduce the likelihood of a patient developing myopic maculopathy by 40 percent. Furthermore, this treatment benefit accrues regardless of the level of myopia. Thus, while the overall risk of myopic maculopathy is higher in a –6.00D myope than in a –3.00D myope, slowing their myopic progression by one diopter during childhood should lower the risk by 40 percent in both.
Abstract
Reducing the incidence or prevalence of any disease by 40 percent is of huge public health significance. Slowing myopia by one diopter may do just that for myopic maculopathy–the most common and serious sight-threatening complication of myopia. There is a growing interest in slowing the progression of myopia due to its increasing prevalence around the world, the sight-threatening consequences of higher levels of myopia and the growing evidence-based literature supporting a variety of therapies for its control. We apply data from five large, population-based studies of the prevalence of myopic maculopathy on 21,000 patients. We show that a one-diopter increase in myopia is associated with a 67 percent increase in the prevalence of myopic maculopathy. Restated, slowing myopia by one diopter should reduce the likelihood of a patient developing myopic maculopathy by 40 percent. Furthermore, this treatment benefit accrues regardless of the level of myopia. Thus, while the overall risk of myopic maculopathy is higher in a -6.00D myope than in a -3.00D myope, slowing their myopic progression by one diopter during childhood should lower the risk by 40 percent in both.
Bullimore, M. A., & Brennan, N. A. (2019). Myopia Control: Why Each Diopter Matters. Optometry and Vision Science, 96(6), 463-465.
Dwight Akerman, OD, MBA, FAAO, is chief medical editor for Review of Myopia Management
