Myopia: The Time to Act is Now

By Dwight Akerman, OD, MBA, FAAO
Chief Medical Editor, Review of Myopia Management

Myopia is the most common ocular abnormality in the world, yet many patients and parents do not understand the significance of myopia and particularly high myopia to potential ocular health issues later in life. Myopia is often considered benign because it is easily corrected with glasses, contact lenses, or refractive surgery. Nevertheless, it is often overlooked that high myopia often leads to blindness, particularly among the working-age population. The most severe complication, myopic maculopathy, is the only leading cause of blindness without an established treatment.

The authors of this review paper suggest that efforts to reduce the prevalence and progression of myopia could have a profound public health impact. The focus of intervention in the past has been to correct the refractive error, this focus should move towards understanding the underlying pathology and developing strategies to (a) prevent the condition developing in the first instance and (b) control the rate of progression of myopia once it does develop. Several strategies have been developed to try to control myopia progression including the following: (i) optical interventions such as multifocal contact lenses, specialized spectacle lenses, and orthokeratology; (ii) pharmaceutical interventions such as low dose atropine; (iii) lifestyle interventions such as increased outdoor activity.

The researchers conclude by suggesting that it is necessary to identify those at high risk based on their genetics, their geographic location, and their behaviors and provide timely intervention with existing and emerging treatments. By identifying at-risk children and intervening before they become myopic, eye care professionals can prevent or delay the onset of myopia, reduce the risk of the myriad of myopic complications and thereby improve the patient’s quality of life and positively impact its socio-economic effects.

Abstract

Background
Myopia is becoming increasingly prevalent throughout the world. It is an overlooked but leading cause of blindness, particularly among the working aged population. Myopia is often considered benign because it is easily corrected with glasses, contact lenses, or refractive surgery. Traditionally myopia has been classified into physiological and pathological subtypes based on the degree of myopia present. Higher levels of myopia are associated with increased risk of pathological complications, but it is important to note that there is no safe level of myopia. Even low levels of myopia increase the risk of retinal detachment and other ocular comorbidities which will be discussed in detail later. The most serious complication, myopic maculopathy, is the only leading cause of blindness without an established treatment and therefore leads to inevitable loss of vision in some myopes, even at a young age.

Aim
To highlight the current myopia epidemic and the sight threatening complications associated with it

Design
This is a commissioned review article. Data was gathered by performing a literature review, searching the PubMed database for recent articles regarding myopia.

Conclusions
Myopia is a potentially blinding disease. By identifying at risk individuals and intervening before they become myopic, eye care practitioners can prevent or delay spectacle use, reduce the risk of the myriad of myopic complications and thereby improve the patient’s quality of life and positively impact its socio-economic effects.

Bourke, C. M., Loughman, J., Fltcroft, D. I., Loskutova, E., & O’Brien, C. (2019). We can’t afford to turn a blind eye to myopia. QJM: An International Journal of Medicine.

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3 COMMENTS

  1. Hi Dr. Akerman,
    Thank you for highlighting the importance of myopia management. I am involved in a project to make myopia clinical outcomes available to providers utilizing a clinical registry. With proper outcomes data, every OD when seeing a patient at risk of progressive myopia, should be able to predict and educate the patient on the expected amount of myopia increase based on how their myopia is managed.

    Myopia management is one of the best examples of how Optometry can and should be moving to outcome based care.

  2. Hello Dr. Grue,
    Thank you for your message. I agree that all eye care professionals providing myopia care should be driven by outcomes. The Eye Care Registry which you and Dr. Ron Snyder have created is an innovative new approach. Clinical outcomes analytics has the potential to become a powerful new tool in giving doctors more quality data to work with, helping them to improve the experience of patient care, improve the health of populations, and to reduce the cost of care.
    Best regards,
    Dwight

  3. Thank you, Dr. Akerman, for your work in this field. I express every day to parents of young patients the importance of treating not just the prescription, but prevention of ocular health complications. Whether via lifestyle, ortho-k, multifocal CLs, etc.

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