November 1, 2024
By Dwight Akerman, OD, MBA, FAAO, FBCLA, FIACLE
Myopia is not just a simple vision problem, disorder, or condition — it’s a disease that is becoming more common worldwide. According to the World Health Organization (WHO), a disease is “any harmful deviation from the normal structural or functional state of an organism, generally associated with certain signs and symptoms and differing in nature from physical injury. A diseased organism commonly exhibits signs or symptoms indicative of its abnormal state.” Myopia fits this definition because it involves structural changes in the eye that affect its function.
The National Academies of Sciences, Engineering, and Medicine (NASEM) recently published a new 374-page consensus study entitled Myopia: Causes, Prevention, and Treatment of an Increasingly Common Disease. The consensus study report states, “Myopia, in our opinion, is indisputably a disease and should be treated as such. At present, especially in the United States, it is generally considered a visual inconvenience. However, the impact on visual function and the risk for blinding complications later in life are significant. The increasing prevalence of myopia is an urgent issue that requires better awareness to attract the funding dollars needed for effective treatments, screening, and research study.”
The report makes a series of recommendations. The final and potentially most crucial recommendation is “Myopia is a disease with increasing worldwide prevalence and severity, and the impact of its downstream complications needs to be taken seriously. Federal agencies have an important role to play in promoting behaviors that may be protective against myopia, as well as promoting the screening, diagnosis, and treatment of myopia. An important first step is for the Centers for Medicare & Medicaid Services (CMS) to classify myopia as a disease and, therefore, a medical diagnosis. This reclassification is needed to ensure that efforts are made not only to treat blurry vision resulting from uncorrected or undercorrected refractive error but also to prevent and manage the progression of myopia. This may help get the warranted attention from stakeholders such as federal and state agencies, professional associations, patients, and caregivers, thus increasing the feasibility of care for the public beyond a simple pair of glasses.”
Recognizing myopia as a disease is vital for shaping health policies, funding, and interventions. Acknowledging it as such promotes a comprehensive approach to prevention, management, and treatment, with the ultimate goal of reducing its prevalence and associated eye health risks.
Similarly, several years ago, the terminology for dry eye was updated. The definition of a dry eye, according to the 2017 Tear Film and Ocular Surface Society (TFOS) Dry Eye Workshop II (DEWS II) is, “Dry eye is a multifactorial disease of the ocular surface characterized by a loss of homeostasis of the tear film, and accompanied by ocular symptoms, in which tear film instability and hyperosmolarity, ocular surface inflammation and damage, and neurosensory abnormalities play etiologic roles.” From calling dry eye a condition or syndrome, dry eye became dry eye disease (DED) or ocular surface disease (OSD.) This change in terminology has made treating dry eye a serious business and opened enormous research funding and insurance coverage.
Effective communication is critical to the acceptance of your recommendations for treating juvenile-onset myopia, so practice incorporating the concept of myopia as a disease into your discussions with parents and children. Disease is an emotional term, so be careful about how you use it, especially when parents have never heard of myopia management prior to your presentation.
Best professional regards,
Dwight H. Akerman, OD, MBA, FAAO, FBCLA, FIACLE
Chief Medical Editor
dwight.akerman@gmail.com
