January 2, 2025
By Leila Sara Eppenberger, MD, FEBO, FMH, MSc ETH
Photo Credit: Getty Images
Over the past few decades, the options for controlling myopia progression in children and adolescents have significantly increased. Various methods include environmental and behavioral approaches, eye drops, next-generation spectacles, contact lenses, and other novel techniques. This raises questions regarding the effectiveness, safety, and cost of these treatments.
Clinicians face the challenge of determining the best myopia management strategy for their patients amidst a growing array of options. It is essential to consider the available treatments rather than solely relying on those that are most commonly used in practice.
To aid in navigating these choices, Eppenberger et al.1 provide an updated review titled “Myopia control: Are we ready for an evidence-based approach?” In this review, the authors systematically assess and compare different intervention groups — environmental/behavioral, pharmacological, optical, and novel therapies — based on published randomized controlled trials (RCTs) and earlier reviews.
Their synthesis mainly focuses on the East Asian region, where most research has been conducted. It presents a qualitative analysis of the evidence, effectiveness, safety, and costs associated with major interventions for myopia control.
Although environmental and behavioral interventions, such as increased outdoor activity, are free and beneficial, their implementation remains challenging and necessitates greater public and governmental support. Currently, atropine eye drops represent the only established pharmacological option with proven efficacy, particularly in Asian populations. Optical interventions, ranging from special contact lenses to spectacles, exhibit varied evidence for efficacy and safety and are often associated with high costs. Finally, new methods, such as red light therapy, require careful safety considerations.
Photo Credit: Leila Sara Eppenberger, MD, FEBO, FMH, MSc ETH. Click graphic to enlarge.
The review visualizes all analyzed aspects of the main available intervention types in an explicative illustration, depending on the stages of myopia (see figure). It concludes that evidence for these interventions varies widely, with a notable absence of long-term outcome data. There will not be a one-size-fits-all solution. Hence, the authors emphasize the need for a consensus to balance risk and effectiveness in personalized myopia management.
Abstract
Myopia Control: Are We Ready for an Evidence-Based Approach?
Leila Sara Eppenberger, Andrzej Grzybowski, Leopold Schmetterer, Marcus Ang
Introduction: Myopia and its vision-threatening complications present a significant public health problem. This review aims to provide an updated overview of the multitude of known and emerging interventions to control myopia, including their potential effect, safety, and costs.
Methods: A systematic literature search of three databases was conducted. Interventions were grouped into four categories: environmental/behavioral (outdoor time, near work), pharmacological (e.g., atropine), optical interventions (spectacles and contact lenses), and novel approaches such as red-light (RLRL) therapies. Review articles and original articles on randomized controlled trials (RCT) were selected.
Results: From the initial 3224 retrieved records, 18 reviews and 41 original articles reporting results from RCTs were included. While there is more evidence supporting the efficacy of low-dose atropine and certain myopia-controlling contact lenses in slowing myopia progression, the evidence about the efficacy of the newer interventions, such as spectacle lenses (e.g., defocus incorporated multiple segments and highly aspheric lenslets) is more limited. Behavioral interventions, i.e., increased outdoor time, seem effective for preventing the onset of myopia if implemented successfully in schools and homes. While environmental interventions and spectacles are regarded as generally safe, pharmacological interventions, contact lenses, and RLRL may be associated with adverse effects. All interventions, except for behavioral change, are tied to moderate to high expenditures.
Conclusion: Our review suggests that myopia control interventions are recommended and prescribed on the basis of accessibility and clinical practice patterns, which vary widely around the world. Clinical trials indicate short- to medium-term efficacy in reducing myopia progression for various interventions, but none have demonstrated long-term effectiveness in preventing high myopia and potential complications in adulthood. There is an unmet need for a unified consensus for strategies that balance risk and effectiveness for these methods for personalized myopia management.
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Leila Eppenberger, MD, FEBO, FMH, MSc ETH, is a clinician scientist at the Ocular Imaging Research Group of the Singapore Eye Research Institute. She graduated from the University of Basel in 2013 and earned her Doctorate in 2015. After serving as a resident physician in Internal Medicine, Emergency Care, and Neurology, she specialized in Ophthalmology, completing her training and becoming a Fellow of the European and Swiss Board of Ophthalmology in June 2023. In 2021, Leila earned a Master’s degree with honors from ETH Zurich in Health Sciences and Technology. Her research focuses on myopia and ocular imaging. She is currently involved in projects aimed at enhancing the early detection and monitoring of eye diseases, especially myopia. |
References
1 Eppenberger LS, Grzybowski A, Schmetterer L, Ang M. Myopia Control: Are We Ready for an Evidence Based Approach? Ophthalmol Ther. 2024;13(6):1453-1477. doi:10.1007/s40123-024-00951-w
