Visual Impairment and Blindness from Myopic Macular Degeneration Predicted to Rise Significantly

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

By Dwight Akerman, OD, MBA, FAAO
Chief Medical Editor
Review of Myopia Management

Many people, especially parents, believe that myopia is an inconvenience that merely requires refractive correction with spectacles, contact lenses, or surgery. Unfortunately, they do not understand that myopia, and high myopia, in particular, increases the risk of serious, sight-threatening complications.

Researchers conducted a systematic review and meta-analysis of 17 studies (137,514 participants) to understand better the impact of visual impairment (VI) and blindness associated with myopic macular degeneration (MMD). The results are worrisome.

They found roughly 10 million people had visual impairment due to MMD in 2015, a total prevalence of 0.13%. Of those 10 million people, 3.3 million were blind. Even more concerning is the predictive value of the analysis, which suggests VI from MMD could grow to 55.7 million people by 2050 and blindness from myopia could reach 18.5 million by 2050. This systematic review, meta-analysis, and predictive modeling could have “significant implications for planning comprehensive eye care services globally,” including managing and potentially preventing ocular complications and VI that “may occur among almost a billion people with high myopia,” the researchers wrote.

The researchers suggest myopia prevention/delay onset strategies, such as increased outdoor time and regular breaks from near work, could help reduce this predicted quality of life and socioeconomic burden. Treatments to reduce myopia progression, including specific contact lens and spectacle designs and low-dose atropine, could also play a significant role, as could improved access to care, case management, and treatment options.

Abstract
Global prevalence of visual impairment associated with myopic macular degeneration and temporal trends from 2000 through 2050: systematic review, meta-analysis and modeling
Fricke, T.R., Jong, M., Naidoo, K.S., Sankaridurg, P., Naduvilath, T.J., Ho, S.M., Wong, T.Y. and Resnikoff, S.  

Purpose: We used systematic review and meta-analysis to identify and assimilate evidence quantifying blindness and visual impairment (VI) associated with myopic macular degeneration (MMD), then derived models to predict global patterns. The models were used to estimate the global prevalence of blindness and VI associated with MMD from 2000 to 2050.

Methods: The systematic review identified 17 papers with prevalence data for MMD VI fitting our inclusion criteria. Data from six papers with age-specific data were scaled to relative age-dependent risk and meta-analysed at VI and blindness levels. We analysed variance in all MMD VI and blindness data as a proportion of high myopia against variables from the place and year of data collection, with a model based on health expenditure providing the best correlation. We used this model to estimate the prevalence and number of people with MMD VI in each country in each decade.

Results: We included data from 17 studies comprising 137 514 participants. We estimated 10.0 million people had VI from MMD in 2015 (prevalence 0.13%, 95% CI 5.5 to 23.7 million, 0.07% to 0.34%), 3.3 million of whom were blind (0.04%, 1.8 to 7.8 million, 0.03% to 0.10%). We estimate that by 2050, without changing current interventions, VI from MMD will grow to 55.7 million people (0.57%, 29.0 to 119.7 million, 0.33% to 1.11%), 18.5 million of whom will be blind (0.19%, 9.6 to 39.7 million, 0.11% to 0.37%).

Conclusion: The burden of MMD blindness and VI will rise significantly without efforts to reduce the development and progression of myopia and improve the management of MMD.

Source: Fricke, T. R., Jong, M., Naidoo, K. S., Sankaridurg, P., Naduvilath, T. J., Ho, S. M., … & Resnikoff, S. (2018). Global prevalence of visual impairment associated with myopic macular degeneration and temporal trends from 2000 through 2050: systematic review, meta-analysis and modelling. British Journal of Ophthalmology, 102(7), 855-862.      

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