Editor’s Perspective

Six Insights About Myopia Management You May Not Remember, But Should

February 3, 2025

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

To stay at the forefront of knowledge and provide the best evidence-based patient care, it’s crucial to engage in myopia-related continuing education courses and read as many peer-reviewed and non-peer-reviewed articles as possible. Additionally, when prescribing myopia management for a child whose parents are not familiar with juvenile-onset myopia, it’s helpful to have memorable data points, quotes, or insights readily available for discussion. Here are six memorable insights to keep in mind:

  1. Myopia is the biggest threat to eye health in the 21st century. “Eye care professionals should embrace new therapies, treating children as soon as signs of myopia appear in order to reduce the risk of sight-threatening complications in later life.”
  2. Each diopter matters. “… a one diopter increase in myopia is associated with a 67% increase in the prevalence of myopic maculopathy. Restated, slowing myopia by one diopter should reduce the likelihood of a patient developing myopic maculopathy by 40%. Furthermore, this treatment benefit accrues regardless of the level of myopia.”
  3. There is no safe level of myopia. “…there is no evidence of a safe threshold level of myopia for any of the known ocular diseases linked to myopia, including myopic maculopathy.”
  4. Only managing the supposedly fast progressors will ignore large numbers of children who could benefit from myopia management.
    “Age, ethnicity, and greater myopia were significant predictors of future refractive error and axial length, while prior progression or elongation, near work, time outdoors, and parental myopia were not.”
  5. Axial length rather than myopic refractive error should be the primary target for myopia management. “…those at the more extreme ends of the axial length spectrum were at great risk of visual impairment; risk increased from 3.8% in eyes with an axial length less than 26 mm to 25% in eyes with an axial length of 26 mm or greater and more than 90% in eyes with an axial length of 30 mm or greater.”
  6. Myopia Management Begins with Lifestyle and Visual Hygiene Guidance.
    • Recommend the WHO Guidelines for children under the age of 5.
    • Ensure that children over 5 spend more time outdoors and less time on digital devices. 
    • Suggest outdoor sports and play for at least two hours each day, divided between school activities and after school. 
    • Children should not spend more than three hours a day — in addition to school time — on close work such as reading, homework, or screen time. 
    • Reading and digital device usage should be conducted at a distance of at least 12 inches (30 cm).

To stay informed about the latest developments in myopia management, deliver the highest standard of patient care, and recommend the most appropriate evidence-based interventions for children at risk of progressive myopia, regularly read Review of Myopia Management. We understand that, as busy clinicians, it can be challenging to keep up with the rapidly evolving myopia management field. We take on the responsibility of reviewing the myopia literature, both peer-reviewed and non-peer-reviewed, and succinctly summarizing the most clinically relevant articles.

Best professional regards,

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

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