The World Health Organization, in its Vision 2020 campaign for the prevention of blindness, declared myopia one of the top 10 eye diseases.1 With the striking increases in myopia seen globally, modeling efforts with eventual targeted intervention appear to be a major thrust for future efforts.
The American Academy of Ophthalmology last year established a task force on myopia and recently published a summary of actions necessary to reduce the global burden of myopia.2 They have focused on both delaying the onset of myopia and reducing progression.
These goals are laudable and should receive high priority for future public health initiatives and collaborative research for interventions for myopia control.2 The task force has chosen to address the pillars of education, advocacy, research and public health.2
Current treatment options show consistent evidence for being a benefit. They range from pharmaceutical use of a wide range of dosages of atropine to optical approaches (spectacles and contact lenses) that induce peripheral myopic defocus. Overall, practitioners must first weigh the risk/benefit before recommending each treatment option. Future studies should examine: (1) the optimum dosage of atropine, (2) frequency and best time of application, (3) duration of treatment and (4) any long-term consequences of treatment.2
There may be an additive effect using both pharmaceuticals and optical corrective devices, but unfortunately there is a lack of long-term follow-up, and how interventions (when used concurrently) interact is uncertain.3,4 We welcome the addition of new devices such as Essilor’s Stellest for myopia management, Cooper Vision’s MiSight and Johnson & Johnson’s Acuvue Abiliti.
Lifestyle changes may help reduce myopic progression and delay its onset. Interventions include diet, lighting conditions, posture, reading position and distance and time spent on near tasks, to name a few.2,3
A well-known and frequently cited modifiable risk factor is the time children spend outdoors. Several studies have shown a protective effect in essentially both delaying onset and reducing progression with increased outdoor exposure. More evidence is needed to quantify the ideal type of exposure outdoors, along with the amount and duration of exposure necessary to reduce progression.2,3
Fight for Tomorrow
Do we need more effective treatment options? Of course we do. However, in the meantime, don’t hesitate to add these beneficial options now to your management plan when appropriate. I can appreciate and understand some reluctance, as I have often been slow to employ treatment options.
Atropine has greater efficacy at higher doses but also carries a higher rate of side effects. Reduced concentration atropine use requires formulations made by compounding pharmacies. Dilution results in a reduced concentration of preservative and buffers. But, there’s not much tolerance for rare vision-threatening events in children, so careful screening and scrutiny is imperative.
By all measures, myopia is truly an epidemic, and there certainly are unmet needs in delaying and reducing progression. To move forward, we must first identify the major gaps that exist in knowledge. Surely, we’d like to know which kids are at significant risk and at what age, as well as what works best with currently available options and in what order (contacts then pharmaceuticals, or the converse). Also, is there an alternative pathway not yet known to slow progression and/or delay onset past the “magic age” of nine?
Even though myopia treatment presents challenges due to its multifactorial nature, I look forward to advances beyond what’s available today. It would be interesting to be like the fictional character Rip Van Winkle, who comes back after sleeping for two decades to a changed world. Would it not be nice to come back to a changed world where myopia has been slowed in its progressive nature, or even cured? For now, take advantage of the viable options available to us today. You might just save someone from significant visual impairment years later.
1. Prousali E, Haidich AB, Fontalis A, et al. Efficacy and safety of interventions to control myopia progression in children: an overview of systematic reviews and meta-analyses. BMC Ophthalmol. 2019;19(1):106.
2. Modjtahedi BS, Abbott RL, Fong DS, et al. Reducing the global burden of myopia by delaying the onset of myopia and reducing the progression in children: the Academy’s Task Force on Myopia. Ophthalmol 2021; 128(6):816-26.
3. Sánchez-González JM, DeHita-Cantalejo C, Baustita-Liamas MJ, et al. The combined effect of low-dose atropine with orthokeratology in pediatric myopia control: review of the current treatment status for myopia. J Clin Med. 2020; 9(8):2371.
4. Jonas JB, Ang M, Cho P, et al. IMI prevention of myopia and its progression. Invest Ophthalmol Vis Sci. 2021;62(5):6.