August 9, 2019
By Dwight Akerman, OD, MBA, FAAO
Chief Medical Editor, Review of Myopia Management
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.”1 Myopia was once considered a simple refractive error with few, if any, long-term eye health consequences, but it is now recognized as one of the most significant causes of blindness worldwide. Unfortunately, eye care professionals and parents of myopic children often take a wait-and-see approach to myopia management.
Myopia increases the risk of serious, sight-threatening complications. Often it is difficult to explain the co-morbidities and lifelong risks associated with myopia to a parent, especially those parents who are emmetropic. The following chart, available for download as a patient handout on Review of Myopia Management, illustrates the increased risks of ocular disease associated with myopia. Using odds ratios, which describe the increased risk of a condition over a reference of 1 (this being the risk at emmetropia), the chart below shows that even 2.00D of myopia doubles the risk of myopic maculopathy and triples the risk of retinal detachment compared to emmetropia.
Odds Ratio of Ocular Disease as a Function of Myopia Relative to Emmetropia1
| Eye Disease | -2.00 D | -4.00 D | -6.00 D | -8.00 D |
| Myopic Maculopathy2 | 2.2 X higher | 9.7 X higher | 40.6 X higher | 126.8 X higher |
| Retinal Detachment3 | 3.1 X higher | 9.0 X higher | 21.5 X higher | 44.2 X higher |
| PSC Cataract4 | 1.6 X higher | 3.2 X higher | 5.4 X higher | 12.3 X higher |
| Glaucoma5 | 1.7 X higher | 2.5 X higher | 2.5 X higher | N/A |
Educating patients, parents and other stakeholders about WHY management is essential for all myopic children is vital to stemming the myopia epidemic we are facing. Explaining the increased risks of ocular disease associated with myopia is critical to this discussion.
As always, I welcome your suggestions and comments.
Best professional regards,
Dwight H. Akerman, OD, MBA, FAAO
Chief Medical Editor
dwight.akerman@gmail.com
Dwight H. Akerman, OD, MBA, FAAO is chief medical editor of Review of Myopia Management.
References
- Flitcroft, D. I. (2012). The complex interactions of retinal, optical and environmental factors in myopia aetiology. Progress in retinal and eye research, 31(6), 622-660.
- Vongphanit, J., Mitchell, P., & Wang, J. J. (2002). Prevalence and progression of myopic retinopathy in an older population. Ophthalmology, 109(4), 704-711.
- Ogawa, A., & Tanaka, M. (1988). The relationship between refractive errors and retinal detachment–analysis of 1,166 retinal detachment cases. Japanese journal of ophthalmology, 32(3), 310-315.
- Chang, M. A., Congdon, N. G., Bykhovskaya, I., Munoz, B., & West, S. K. (2005). The association between myopia and various subtypes of lens opacity: SEE (Salisbury Eye Evaluation) project. Ophthalmology, 112(8), 1395-1401.
- Marcus, M. W., de Vries, M. M., Montolio, F. G. J., & Jansonius, N. M. (2011). Myopia as a risk factor for open-angle glaucoma: a systematic review and meta-analysis. Ophthalmology, 118(10), 1989-1994.
