January 3, 2023
By Dwight Akerman, OD, MBA, FAAO, FBCLA, FIACLE
There is an abundance of evidence-based knowledge on myopia, including its onset, progression, risk factors, screening and detection, follow-up, and interventions for myopia management. The significant increase in articles published about myopia generally does not match information and discussion about the roles and responsibilities of eye care professionals in preventing myopia and reducing its progression. This editorial article by Nemeth et al. provides an overview of recommended actions from a European perspective.
- Primary prevention refers to procedures used to prevent the onset of a disease. The highest level of evidence supports the need for children to spend more time outdoors and do less near vision activities to prevent or at least delay the onset of myopia. Strong evidence has shown the significant preventive nature of increased reading distance (more than 20–30 cm), limitation of continuous reading (less than 30–45 min), and use of incandescent or fluorescent light bulbs instead of LED lamps. Further actions might be:
- Regular education of nurses and social services
- Education of nursery school staff about the importance of light and outdoor activities
- Education of schoolteachers and health care officers about proper reading distance, light intensity, and the importance of recess and outdoor activities
- Regular education of students, showing them spectacles and how they will see if they develop myopia
- Provision of leaflets using simple layperson terms can be made available at schools and GP practices
- Discussions and workshops about the national and regional possibilities of myopia prevention in the national and regional optometric and ophthalmological societies
- Development of a national plan for myopia prevention
- Organization of national, regional, and local media campaigns on myopia prevention. “Save our children’s sight” might be a campaign slogan.
- Undertaking actions to increase the awareness of the problem among local, regional, and national health authorities
- Secondary preventative strategies involve detecting and addressing an existing disease before symptoms arise. Secondary prevention in the case of myopia aims to keep pre-myopes from advancing to myopia. Screening and monitoring pre-myopes to avoid progression to myopia are secondary preventative methods. Further actions might be:
- Regular teaching of nurses and social services who perform vision screenings
- Pediatric ophthalmologists or optometrists checking the binocular vision of preschool children and young schoolchildren regularly
- Clinicians should educate those who examine children about the importance of axial length and its measurement
- Creation of screening protocols
- Advocacy in local, regional, and national health care and education authorities to develop and perform screening programs for screening and monitoring pre-myopes
- Tertiary prevention is managing a condition to delay or stop its progression after it has been diagnosed. Tertiary prevention strategies are myopia-controlling methods that slow the progression of myopia. Tertiary prevention to avoid progression to high myopia necessitates active work by eye care professionals. Further actions might be:
- Potential projects and programs to implement myopia treatment guidelines
- Organizing training courses for eye care professionals on the application of myopia control methods suggested by the latest peer-reviewed literature
- Providing flowcharts to assist in selecting the best myopia control method for a child
- Definition of the timing of control examinations in a protocol
- Selection of the most appropriate intervention individualized for the children
- Advocacy for proper funding of anti-myopia examinations, therapies, and equipment
The authors conclude that because the myopia pandemic began in East Asia, there are lessons to be learned from colleagues in that region of the world.
The Impact of the Pandemic Highlights the Urgent Need for Myopia Guidelines: The Clinicians’ Role
János Németh, Wagih A Aclimandos, Beáta Tapasztó, Jost B Jonas, Andrzej Grzybowski, Zoltán Zsolt Nagy
Myopia is already one of the leading causes of permanent vision impairment, including blindness, and the COVID-19 pandemic has exacerbated the global myopia-related burden among children owing to home confinement, increased screen time (e-learning), and decreased outside activities. To reverse the rising trend of myopia and myopia-related blindness, collaborative efforts are required. There is a wealth of evidence-based medicine data on the epidemiology of myopia and effective interventions, but very little has been published on the clinicians’ roles and responsibilities. However, this aspect is critical because preventing the onset and progression of myopia necessitates extensive health promotion and advocacy efforts among decision-makers. Only broad medical expert collaboration can bring about the necessary changes in children’s lifestyle and education. This article discusses clinicians’ critical roles in preventing the onset and progression of myopia.
Németh, J., Aclimandos, W. A., Tapasztó, B., Jonas, J. B., Grzybowski, A., & Nagy, Z. Z. (2022). The impact of the pandemic highlights the urgent need for myopia guidelines: The clinicians’ role. European Journal of Ophthalmology, 11206721221143008.