May 20, 2024
With 700 hospitals in mainland China, AIER Eye Hospital is the largest eye hospital in the country.
During Review of Myopia Management’s recent tour of Shanghai and investigation of myopia management in China, Editor-in-Chief John Sailer had the opportunity to meet with Weizhong (Bruce) Lan, Ophthalmology Professor of AIER Eye Hospital, the largest private eye hospital in China. Not only did Dr. Lan describe how myopia is treated in China, but he also provided insight into why patients and practitioners in his country have a much higher awareness of myopia management treatments than other countries.
In addition, AIER Eye Hospital is the sponsor of the International Myopia Conference (IMC) to be held in Hainan Island, Sept. 25-28, 2024, and for which Review of Myopia Management has been named the Official Media Sponsor. Get an advance insider’s look into the topics that will be covered at the IMC and how they might lend themselves to real-world applications.
Listen to or read the interview here:
John Sailer, Review of Myopia Management, Editor-in-Chief: Hello and welcome to the interview series from Review of Myopia Management. I’m John Sailer, Editor-in-Chief of Review of Myopia Management, and we are here with Professor Bruce Lan of AIER Hospital, the largest private hospital in China. Can you give me some background on how myopia is treated in China in general?
Weizhong (Bruce) Lan, Ophthalmology Professor, AIER Eye Hospital Group: Before I answer your question directly, I would rather introduce a bit about the myopia prevalence in our country now. As you can find in the literature, our country, China, has the largest population of myopia, and it is estimated that more than 300 million people are suffering with myopia, and most of them are children. So, this is a very big problem for our country, especially in terms of the future of our country. Also, because of this, now the practitioners, the scientists, and even the government pay a lot of attention to myopia compared with other countries where the myopia prevalence is much lower.
Far fewer patients visit the hospital in China on weekdays when compared to weekends.
So, in terms of the myopia treatment in China, I would say maybe we have the majority of available techniques or products or solutions to treat myopia, varying from outdoor activity to spectacles to contact lenses and to atropine. So, we have all these kinds of solutions in our country. Also because of the huge population, we have very big data about the efficacy of all these kinds of solutions. So, I would say we have already accumulated a lot of experience in terms of the treatment of myopia or myopia management.
RMM: I would agree. I think compared to the United States and other countries, China’s more advanced in addressing myopia.
AIER: In this area, that’s true.
Treatments Available in China for Myopia Management
RMM: So, step by step, if a patient or a child is diagnosed with myopia, what’s the process for treating that patient?
AIER: As I told you, we have so many solutions available in our country, it is a little bit difficult to standardize the process to treat myopia. But, very often, especially based on the evidence, we would like to individualize the myopia treatment for every single child. Factors we would consider would include the age of onset, the myopic history of the parents, the current degree of myopia, and also the cost and the convenience of the approaches.
Eye hospitals in China also provide optical dispensing.
But a very basic principle is that we usually start from the easier one to the most expensive or difficult one and then to combined therapy. So, the standardized procedure is to, first of all, have very extensive or comprehensive record taking, including the history of the parents and the myopia onset age, and then determine the expectation for this kid’s myopia progression in the coming one or two years, and then select the right solution for him or for her.
In terms of the efficacy, right now we can say that maybe OrthoK is the first line of option because, number one, it has the strongest efficacy, I believe, and also it can bring many benefits for the kids, not only in terms of efficacy but also in terms of dropping out of spectacles so that they can feel very happy in the daytime.
But the disadvantage of OrthoK is the cost, which is very high for many families. So, a following solution might be the recently developed multi-segment spectacle lenses, which are now very popular in our country and which are much less expensive also with acceptable efficacy. The only disadvantage is that it’s a spectacle. You have to wear it every day, and the longer time you wear it, the better benefits you can get.
Then, in terms of combined therapy, the very common combined solution is to add low-dose atropine to either OrthoK or to multi-segment spectacles. But in China, which is very special and contrary to the Western countries like the U.S. or Australia, soft contact lenses are much less common in our country. I think one of the reasons is the price, because one-day disposable soft contact lenses are quite expensive, maybe more expensive than OrthoK. And the second reason is that Chinese parents are always thinking or hoping to throw out the spectacles. So, if you ask the parents about soft contact lenses, although it is invisible to the kid every day, the parents are still thinking, “Oh, these kids are myopic, and they have to use something every day. This is not what I hoped compared to OrthoK.”
Why Is Awareness of Myopia Management Higher in China?
RMM: In parts of the world there’s low awareness of the fact that myopia treatments are available. What’s the awareness like in China among the patients and the parents and also among the practitioners? I believe it’s probably higher than most countries, and how have you achieved that?
AIER: Much higher. That’s a very good question. The number one reason is that we have so many parents with high myopia. So, basically maybe half of the family has at least one myopic kid. So, every parent knows what myopia is at least. And then the other very important reason is the push, or is the effort given by our government because our government regards myopia as a very strong threat to the whole country in terms of national security and in terms of the welfare of the total population.
So, since 2018, our president, president Xi Jinping has made a very strong and very clear signal that everybody, every member of the society should work together to fight against myopia. And from then on, all the media, all the stakeholders put a lot of attention, a lot of effort on this campaign. And I can see very obviously after his push, the public awareness of myopia has increased significantly. So, let’s imagine for example, the president of the U.S. or the president of the U.K., for example, takes similar actions or claims like this, I believe the awareness of myopia should increase.
RMM: I actually read some statistics recently that the onset of myopia has been improved in China to a small degree. Have you heard about those statistics?
Biometers are standard equipment in the AIER Eye Hospital.
AIER: Yeah, that’s true, that’s true. So, I think to raise the public awareness is another solution to slow down myopia incidence, I believe.
RMM: So, you recommend that other countries have their leaders raise awareness?
AIER: And also your media can help.
RMM: There’s also an organization called the Global Myopia Awareness Coalition, which is about raising awareness among consumers.
AIER: I just finished the video interview.
RMM: That’s great. You put the G in GMAC, Global.
AIER: I’m one of the representatives for the advertisement for the promotion of myopia awareness.
Myopia Management Through Hospitals
RMM: So, you represent one of the largest private hospitals in China. Is that the source of myopia management? There are also optical shops. Can patients get myopia management from optical shops also, or just from the hospital?
AIER: Well, as I mentioned earlier, there are several approaches available in Chinese markets. Some are pharmaceutical, some are medical devices, but also some are just spectacles. So, it depends. It depends what kind of solution you are trying to find. Okay. So, if you are trying to find spectacles, then you can just simply have it in the optical shops. But if you want to have OrthoK or atropine, because this is a medication or medical device, you have to go to the eye hospital to have this kind of solution.
And do you know another difference between China and western countries? In China, eye hospitals like AIER hospital where I’m now working, we can also provide the service of optical dispensing. So, for example, for myopia treatment solution, actually from AIER eye hospital group, the majority, maybe half of the total patients or myopic kids we see every year, receive spectacle solutions. Half of them.
RMM: I’ve heard that the hospitals are very busy on the weekends, but they’re not very busy during the week because everybody’s in school.
AIER: That’s true, that’s true. I can tell you the number is maybe very surprising to you. AIER is the largest eye hospital group in the world, and last year we treated six million myopic kids. But, of course, now I’m not talking about one single eye hospital but rather the whole hospital group because we have more than 700 eye hospitals in mainland China. And that’s true because the majority of these patients are kids, students. So, the only available time for them to see the doctors are only weekends or summer or winter breaks. But on the weekdays there are much less outpatients.
RMM: How do you measure efficacy over time?
AIER: We use two parameters. One is the refraction, and the other is the axial length or the change in axial length, both.
RMM: So, the hospitals are equipped with biometers?
AIER: That’s standardized equipment for our eye hospital at least.
What to Expect from the International Myopia Conference
RMM: Okay, so, now you’re also involved with the International Myopia Conference.
AIER: Yeah, we are very lucky to have the chance to host the International Myopia Conference this year in September. So, as we all see that myopia is not only the problem of China, but also the problem of everywhere in the world. So, I really hope this very fantastic meeting, which has already 60 years of history, can produce more important or more recent findings for myopia treatment. Because although we have already several types of solutions, there are still many unanswered questions. For example, how to improve the efficacy to an even higher level and how to make the solutions cheaper and safer. That’s all the questions we want to answer in the future.
RMM: And we’re happy as Review of Myopia Management to be your official media sponsor and help promote the event.
AIER: Our honor, and I also want to thank you very much for promoting this meeting for us in the U.S. and in other western countries.
RMM: Can you give us an idea of what new technologies, what new research will be introduced? A.I., or do you have any idea?
AIER: The meeting this year will be very exciting because traditionally, there is a very long history of meeting, and the content of the meeting involved has been from purely basic science to basic science plus epidemiology studies. And now in the last decades because of so many new data from the clinics. So, this year we would extend the content to the clinical in terms of the efficacy, safety, and especially the real-world data because we can see many, many clinical trials come out in the last two or five years. But remember all these outcomes are based on a very small, sample size in very strict experimental conditions, and those conditions do not reflect the real-world circumstances necessarily. So, I can tell you that there are more clinical data in the real-world settings coming out in this conference.
And you are right. I also invited some well-known experts in artificial intelligence in big data areas to show us how to improve the efficacy or how to improve the capacity for analysis. And also red light therapy, which is very new, but very controversial. And this is also going to be another highlight because there’s a debate section, which is going to happen in this conference, which is very exciting, I believe.
And what else? Another highlight of the content is about high myopia and pathological myopia. Okay. Because remember now the prevalence of high myopia is already quite high, at least in China. So how to treat those myopic patients who have complications properly is another important thing we have to discuss. And also, another important point is that although we have seen so many solutions available in the market, but I can tell you many of them we do not really understand how it works. So, this year I’m also trying to invite some experts, especially from the basic research science area, trying to illustrate how and why this product would work and doesn’t work, and to shed some light about the future directions for us.
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Orthokeratology’s efficacy, awareness among parents, and ability to allow patients to not wear correction during the day make it number one, according to Weizhong (Bruce) Lan, Ophthalmology Professor, AIER Eye Hospital.
RMM: Do you mean the mechanism of action, for example, with atropine?
AIER: Right. And even for defocus lenses, nobody knows how it works, but it works, very interesting.
RMM: So, for my last question, what based on your experience would you like to share or do you think would be beneficial to share with others throughout the world who are trying to slow the progression of myopia? From your experience as involved with myopia management.
AIER: I would say to achieve a satisfactory myopia management outcome, we have to do a lot. And the point I want to make is that it’s not only work by practitioners, but rather, or another very important but regrettable factor is the attention and the compliance of the parents. Because no matter how good the solution is, if the parents don’t believe it, if they don’t use it according to the guidelines from the doctors, then the outcome will not be very satisfactory. But this is very common, very common for the parents because there is so much noise in the media. Somebody says that this is good, this is not good. But they do not have a very strong belief for something. So, to promote the right and scientific message to the parents is very important, I believe.
RMM: So first we need to raise awareness and then we need to instill compliance.
AIER: Exactly. Exactly. Alright.
RMM: Thank you.
AIER: Thank you very much.
