December 2, 2024
By Dwight Akerman, OD, MBA, FAAO, Dipl AAO, FBCLA, FIACLE
At virtually every professional meeting, I speak with eye care professionals who still need to implement myopia management in their practices. When I ask why, the answers vary from not being lucrative and children taking too much chair time to being busy enough. However, the number one reason is that “I don’t see enough children in my practice to justify creating a myopia management sub-specialty.”
Myopia management poses a threat to many eye care professionals because it is unfamiliar. Incorporating it into a primary care practice will require changing clinical protocols, modifying appointment schedules, updating fee schedules, adding new equipment, and retraining staff. When faced with a juvenile-onset progressive myope, most eye care practitioners play it safe, add another -0.50 DS to the child’s prescription, and tell the parents to bring the child back in one year for another eye exam. Sadly, nothing is prescribed to slow the progression of myopia.
The prevalence of myopia and high myopia is increasing in the U.S. and globally at an alarming rate, with significant increases in vision impairment risks from pathologic conditions associated with high myopia, including retinal detachment, myopic macular degeneration, cataracts, and glaucoma.1 In U.S. children and adolescents aged 5 to 19, the overall prevalence of myopia greater than or equal to -1.00D was estimated to be a shocking 42% in 2018.2
The recently published paper by Liang et al. (2024) provides a comprehensive analysis of the global prevalence, trends, and projections of myopia in children and adolescents from 1990 to 2050.3 The researchers reported that from 1990 to 2023, the global prevalence of myopia in people aged 5 to 19 increased from 24% to 36%. The prevalence of myopia in young people worldwide could reach nearly 40% by 2050, exceeding 740 million cases. Notably, North American myopia prevalence is projected to be 26% in 2030, 31% in 2040, and 35% in 2050.
According to the United Nations 2024 population report, there are over 74 million U.S. children under 18 years old. That means almost 20 million children and adolescents are estimated to be myopic. There are about 42,000 FTE optometrists in the U.S. in 2024, which means there are nearly 460 myopic children and adolescents for every practicing optometrist. “I don’t see enough children in my practice to justify creating a myopia management sub-specialty.” Really?
Myopia is the most significant threat to eye health in the 21st century. While lowering a child’s ultimate level of myopia has profound eye health benefits, the practice and financial benefits of managing myopia are also considerable. I urge you to commit to the highest level of care and prescribe the most appropriate evidence-based interventions for children at risk of progressive myopia or refer them to a qualified colleague.
Best professional regards,
Dwight H. Akerman, OD, MBA, FAAO, Dipl AAO
Chief Medical Editor
dwight.akerman@gmail.com
References
- Holden, B. A., Fricke, T. R., Wilson, D. A., Jong, M., Naidoo, K. S., Sankaridurg, P., … & Resnikoff, S. (2016). Global prevalence of myopia and high myopia and temporal trends from 2000 through 2050. Ophthalmology, 123(5), 1036-1042.
- Theophanous, C., Modjtahedi, B. S., Batech, M., Marlin, D. S., Luong, T. Q., & Fong, D. S. (2018). Myopia prevalence and risk factors in children. Clinical ophthalmology (Auckland, NZ), 12, 1581.
- Liang, J., Pu, Y., Chen, J., Liu, M., Ouyang, B., Jin, Z., … & Chen, Y. (2024). Global prevalence, trend and projection of myopia in children and adolescents from 1990 to 2050: a comprehensive systematic review and meta-analysis. British Journal of Ophthalmology.
