The American Academy of Ophthalmology (AAO) is currently leading a global initiative to address and combat the myopia epidemic.1 In the next 50 years, it’s estimated that almost half of the world’s population will become myopic. Taking steps to combat axial lengthening is the task force’s main goal.
The health burden of myopia is far from insignificant. Unlike refractive errors, which are often correctable with contact lenses or spectacles, myopia induces anatomic changes to the eye that increase a patient’s risk of developing visual impairment that can’t be fixed with correction. Serious ocular complications include retinal detachment, cataract, glaucoma, staphyloma, myopic macular degeneration and myopic choroidal neovascularization. A 2016 study projected that uncorrectable visual impairment resulting from myopia may face as high as a 13-times increase in certain high-risk areas, such as East Asia, by 2055.2
Current myopia control strategies include behavioral, optical and pharmacologic interventions. Identifying which children are at the highest risk will offer insight on how to structure these interventions.
Studies have found that adulthood myopia is strongly associated with higher degrees of baseline myopia, parental myopia, younger age of onset and time spent on near work, such as reading and digital device use.3 Time spent outdoors may effectively slow progression, but Michael X. Repka, MD, the AAO’s medical director for governmental affairs, cautions, “Significant questions remain on the amount of outdoor time and the quality and intensity of light needed.” He notes that most of the data we have regarding the influence of outdoor time on myopia is from East Asian studies. “We think the mechanism is likely related to dopamine levels in the retina, which slow axial elongation,” he says. “[But] we don’t know the quantitative impact in the West.”
Susan Cotter, OD, says that spectacle- and soft contact lens-based approaches are the current optical strategies. “In the COMET and COMET 2 studies, progressive addition lenses were able to slow myopia progression over three years more effectively than single vision lenses,” she says.4 This difference, however, was not clinically significant. Contact lenses, such as multifocals and keratology lenses, have also demonstrated the ability to slow axial elongation.5-7
Pharmacologic interventions center around low-dose topical atropine. Early studies demonstrated efficacy in moderate slowing of progression, but the AAO task force notes that atropine’s practical usefulness is limited by photophobia and glare resulting from pupillary dilation and reduced accommodation.1 However, atropine seems to the be most effective pharmacological solution available now, as shown in a meta-analysis of 16 myopia control interventions.8
The task force looks to address this international challenge by bringing together a multidisciplinary team of eye care professionals, government agencies, school authorities, industry members and family physicians and pediatricians. Next steps include:
- Education for ophthalmologists, optometrists, the health care community and public policy-makers about the public health burden imposed by myopia. The AAO aims to provide educational resources to promote myopia as a public health problem and encourage the development of novel approaches to its management.
- Advocacy in the United States and abroad to promote myopia as a public health concern, including patient access to methods of myopia control, such as pharmaceuticals or devices.
- Research collaboration with industry members to develop interventions, promote multicenter, randomized clinical trials, big data analyses from registries and observational studies to identify risk factors.
- Public health initiatives to prevent and slow the progression of myopia. The AAO will also work with educational authorities to promote school-based programs that focus on increasing outdoor time while maintaining educational standards.
1. Modjtahedi BS, Abbott RL, Fong DS, et al. Reducing the global burden of myopia by delaying the onset of myopia and reducing myopic progression in children: the Academy’s task force on myopia. Ophthalmology. 2020;S0161-6420(20):31043-5.
2. Holden BA, Fricke TR, Wilson DA, et al. Global prevalence of myopia and high myopia and temporal trends from 2000 through 2050. Ophthalmology. 2016;123(5):1036-42.
3. Pärssinen O, Kauppinen M. Risk factors for high myopia: a 22-year follow-up study from childhood to adulthood. Acta Ophthalmol. 2019;97(5):510-8.
4. Gwiazda J, Hyman L, Hussein M, et al. A randomized clinical trial of progressive addition lenses versus single vision lenses on the progression of myopia in children. Invest Ophthalmol Vis Sci. 2003;44:1492-500.
5. Li SM, Kang MT, Wu SS, et al. Efficacy, safety and acceptability of orthokeratology on slowing axial elongation in myopic children by meta-analysis. Curr Eye Res. 2016;41(5):600-8.
6. Chamberlain P, Peixoto-de-Matos SC, Logan NS, et al. A 3-year randomized clinical trial of MiSight lenses for myopia control. Optom Vis Sci. 2019;96(8):556-7.
7. Walline JJ, Walker MK, Mutti DO, et al. Effect of high add power, medium add power, or single-vision contact lenses on myopia progression in children: the BLINK randomized control trial. JAMA Ophthalmol. 2020;324(6):571-80.
8. Huang J, Wen D, Wang Q, et al. Efficacy comparison of 16 interventions for myopia control in children: a network meta-analysis. Ophthalmology. 2016;123(4):697-708.