July 1, 2022
By Dwight Akerman, OD, MBA, FAAO, FBCLA, FIACLE
Myopia is a leading cause of visual impairment and has raised significant global concern in recent decades with rapidly increasing incidence and prevalence worldwide. Hundreds of peer-reviewed and non-peer papers are published monthly on every aspect of myopia. For example, as of this writing, if you enter the terms “myopia” and “2022” into PubMed, 1,051 results are displayed.
To stay at the forefront of knowledge and provide the best evidence-based patient care, attending myopia-related continuing education courses and reading as many articles as possible is essential. As the Chief Medical Editor of Review of Myopia Management, I must keep up with new publications, so I read dozens of myopia papers each month. A memorable data point, quote, or fact from an article frequently sticks with me. The following lists some of my favorites (in no particular order):
- The global prevalence of myopia and high myopia is rising rapidly. “…by 2050, 50% and 10% of the world will have myopia and high myopia, respectively, a 2-fold increase in myopia prevalence (from 22% in 2000) and a 5-fold increase in high myopia prevalence (from 2% in 2000).”
Holden et al. 2016 - The global burden of myopia is growing. “Overall, the current global cost estimates related to direct health expenditure and lost productivity are in the billions. Health expenditure is greater in adults, reflecting the added costs due to myopia-related complications.”
Sankaridurg et al. 2021 - Myopia is the biggest threat to eye health of the 21st century. “Eye care professionals should embrace new therapies treating children as soon as signs of myopia appear in order to reduce the risk of sight-threatening complications in later life.”
Managing Myopia: A Clinical Response to the Growing Epidemic 2021 - Each diopter matters. “… a 1-diopter increase in myopia is associated with a 67% increase in the prevalence of myopic maculopathy. Restated, slowing myopia by 1 diopter should reduce the likelihood of a patient developing myopic maculopathy by 40%. Furthermore, this treatment benefit accrues regardless of the level of myopia.”
Bullimore and Brennan, 2019 - There is no safe level of myopia. “…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, 2012 - Most ECPs play it safe. “For over a century, parents have asked clinicians if anything can be done to slow the progression of myopia in their children. Most practitioners shrug their shoulders, add another -0.50 DS to the child’s prescription and see him or her in a year. The tide has now turned.”
Bullimore, 2014 - Only managing the supposedly fast progressors will ignore large numbers of children who could benefit from myopia management.
“Age, ethnicity, and greater myopia were significant predictors of future refractive error and axial length, while prior progression or elongation, near work, time outdoors, and parental myopia were not.”
Mutti et al., 2022 - Axial length rather than myopic refractive error should be the primary target for myopia management. “…those at the more extreme ends of the axial length spectrum were at great risk of visual impairment; risk increased from 3.8% in eyes with an axial length less than 26 mm to 25% in eyes with an axial length of 26 mm or greater and more than 90% in eyes with an axial length of 30 mm or greater.”
Tideman et al., 2016 - Treating juvenile-onset myopia is worth it. “Financial investment in active myopia management during childhood may be balanced or exceeded across a lifetime by reduced refractive progression, simpler lenses, and reduced risk of pathology and vision loss.”
Fricke et al. - The addressable myopia management market potential is enormous. “…we estimate the U.S. myopia management contact lens market to be around $1.5 billion from a manufacturer’s perspective. …the total addressable global market is well over $5 billion.”
CooperVision 2020
I urge you to read the myopia literature regularly to ensure that you are up to date on the latest knowledge, commit to the highest level of patient care, and prescribe the most appropriate evidence-based interventions to children at risk of progressive myopia. It’s your professional responsibility.
Best professional regards,
Dwight H. Akerman, OD, MBA, FAAO, FBCLA, FIACLE
Chief Medical Editor
dwight.akerman@gmail.com
