Progressive Myopia Isn’t Just for Kids

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May 2, 2022

By Dwight Akerman, OD, MBA, FAAO, FBCLA, FIACLE

It is abundantly clear that many myopes continue progressing into adulthood and that many previous emmetropes develop myopia after age 18. Research suggests that the highest risk factors for adult myopia progression and onset appear to be extensive near work with short working distances, high AC/A ratio, and high accommodative lag.^1,2   

The seminal COMET Trial (2013) enrolled 469 ethnically diverse children aged 6 to 12 years with spherical equivalent refraction between −1.25D and −4.50D.³ In all, 426 of the original cohort had at least seven measurements over 11 years of follow-up. The trial showed that around a quarter of myopes are still progressing at age 18, 10% at age 21, and 4% at age 24. These data may underestimate the actual age when myopia stabilizes, as they only include myopia that developed at a relatively young age.

Parssinen et al. (2014) reported a mean progression of -0.45D +/- 0.71D over eight years in 147 subjects ranging from 23 to 31 years old.⁴ In 45% of cases, progression was ≥0.50D, and in 18% of cases, myopia increased by ≥1.00D. Likewise, Bullimore et al. reported that 16% of 219 myopes (mean age = 31 years) progressed by at least -0.50D over 5 years.⁵

Lee et al. (2022) recently reported on a prospective eight-year study conducted in Australia.⁶ The researchers studied the incidence and progression of myopia in the third decade of life. Participants were examined at age 20 years and age 28 years. The final analysis included 691 participants. A myopic shift of at least -0.50D was observed in 37.8% of participants. The findings suggest that myopia progression continues for more than one-third of adults during their 20s, albeit at lower rates than in childhood.

What should eye care professionals do to treat progressing myopia in adults? Although adult myopia progression is frequently encountered in clinical practice, we have few publications to guide management. However, data is beginning to emerge. Given that both juvenile and adult myopia progression are due to axial elongation, it is reasonable to believe that established modalities would be effective in adults.

Fromstein et al. (2019) investigated the efficacy of orthokeratology lenses in controlling myopia and axial elongation in young adults with high educational demands (age range: 21 to 35 years) over 24 months.⁷ In this prospective, randomized study, OrthoK significantly reduced axial elongation compared to the control group (p=0.004.) 

Specific treatment recommendations include:

• Measure the axial length with an optical biometer to understand the risk for ocular disease.
• Perform a dilated retinal exam annually to rule out pathology, especially in patients with an axial length of 26mm or greater.
• Perform corneal topography to rule out pathology such as keratoconus. 
• Emphasize the 20-20-2 Rule 
• Ergonomic advice may make the patient more comfortable and productive.
• Discuss OrthoK, dual focus/EDOF single-use contact lenses, and topical low-dose atropine (0.01% to 0.025%) with engaged patients.
• Adults may be more visually demanding than children, so visual quality should be monitored closely.

For more information on this fascinating topic, read Myopia Onset and Progression in Young Adults: ‘It Happens’ by Dr. Mark Bullimore.

Best professional regards,

Dwight H. Akerman, OD, MBA, FAAO, FBCLA, FIACLE
Chief Medical Editor
dwight.akerman@gmail.com

 

References

1. Bullimore MA, Reuter KS, Jones LA, Mitchell GL, Zoz J, Rah MJ. The Study of Progression of Adult Nearsightedness (SPAN): design and baseline characteristics. Optom Vis Sci. 2006 Aug;83(8):594.
2. Jiang, B. C., & Morse, S. E. (1999). Oculomotor functions and late-onset myopia. Ophthalmic and Physiological Optics, 19(2), 165-172.
3. COMET Group. (2013). Myopia stabilization and associated factors among participants in the Correction of Myopia Evaluation Trial (COMET). Investigative ophthalmology & visual science, 54(13), 7871.
4. Pärssinen, O., Kauppinen, M., & Viljanen, A. (2014). The progression of myopia from its onset at age 8–12 to adulthood and the influence of heredity and external factors on myopic progression. A 23‐year follow‐up study. Acta ophthalmologica, 92(8), 730-739.
5. Bullimore, M. A., Mitchell, G. L., Jones, L. A., & Reuter, K. S. (2008). Progression of myopia in an adult population. Investigative Ophthalmology & Visual Science, 49(13), 2606-2606.
6. Lee, S. S. Y., Lingham, G., Sanfilippo, P. G., Hammond, C. J., Saw, S. M., Guggenheim, J. A., … & Mackey, D. A. (2022). Incidence and Progression of Myopia in Early Adulthood. JAMA ophthalmology.
7. Fromstein, S. Chaglasian, E., Pang, Y., A Prospective Study of Orthokeratology on Controlling Myopia and Axial Elongation in Young Adults: Final 24-month Results. American Academy of Optometry 2019.