Uncorrected myopia remains the leading cause of distance vision impairment globally,1 and its rising prevalence could cost billions of dollars in lost productivity in the coming decades, if unaddressed.
The World Health Organisation (WHO) has designated myopia as a global public health issue, estimating annual global costs of productivity losses associated with vision impairment from uncorrected myopia at US$244 billion in 2015.2
To help address the rising prevalence, it is likely most countries will implement a minimum standard of care requirement for the treatment of children with myopia within the next five years.
Now is the time for eye care professionals, (ECPs) who have yet to incorporate myopia management into their practice, to prepare for this important shift in how the profession manages myopia.
MYOPIA IN THE ASIA-PACIFIC
Studies have shown the increased intensity of pressure on young children to excel academically has coincided with the rapid rise in myopia cases in Asian countries in recent decades.3 In many East Asian countries, myopia is a major public health concern that affects between 80 to 90% of high school graduates, of which about 10 to 20% have sight-threatening pathologic myopia.4
The early onset and rapid progression of myopia in Asia has been linked to increased time spent on near work activities and classwork, coupled with limited time spent outdoors; both of which have been exacerbated by the COVID-19 pandemic. According to one Hong Kong study, during the COVID-19 pandemic, the estimated one-year incidence of myopia is 28%, 27%, and 26% for six, seven and eight-year-olds respectively, compared to 17%, 15%, and 15% before the pandemic.5
Individuals with high myopia (nearsightedness of -5.00 diopters or more) face a greater risk of sight-threatening disorders later in life including glaucoma, cataract, retinal detachment, and myopic macular degeneration, an irreversible condition that can cause severe vision impairment or permanent blindness. The risk of visual impairment increases 3.4 times with myopia between 6.00 diopters and 10.00 diopters, and 22 times when above 10.00 diopters.6
GLOBAL STANDARD OF CARE REQUIRED
With the clarion call from WHO, governments are realising they will be facing an enormous burden to public healthcare systems in future decades if they do not address myopia during childhood. They will have to treat millions of adults with much higher complication rates and more serious eye conditions which could have potentially been avoided had their myopia been managed in childhood.8
Other organisations have also called for more coordinated action on myopia. The Asia Optometric Management Academy (AOMA) and Asia Optometric Congress (AOC) recently collaborated to create a single region-wide consensus on myopia management.9 The standard practice model provides a systematic approach for practitioners to treat myopic patients, using a holistic approach in the myopia management process. The World Council of Optometry (WCO) have made a similar resolution,10 and in Australia and New Zealand, a white paper written by the Child Myopia Working Group advocates adopting a standard of care.11
NIPPING MYOPIA IN THE BUD
Low levels of myopia may not ring alarm bells for many parents. However, because myopia is a progressive condition, the younger the child is when myopia sets in, the higher the risk of severe sight-related complications later in life, if the myopia is untreated. Even a 1.00 diopter increase in myopia has been associated with a 67% increase in the prevalence of myopic maculopathy. Conversely, slowing myopia by just 1.00 diopter should reduce the individual’s likelihood of myopic maculopathy by 40%.12
Several studies suggest myopia progression can be controlled and slowed with a combination of lifestyle modifications and treatment approaches. A randomised clinical trial of children aged six to 12 years old in Guangzhou, China showed that children who spent additional time outdoors from 40 minutes to an hour each day, had a reduced rate of myopia.13
In addition to lifestyle modifications, some of the tools and treatments used in the management of myopia include atropine eye drops, spectacles, orthokeratology or ‘ortho-k’ lenses and soft dual-focus contact lenses.14§
In East Asia especially, people do not consider children requiring vision correction through contact lenses or spectacles a serious concern. Many do not realise that like blood pressure or diabetes, if left unchecked and untreated, myopia can lead to more serious issues later.
Early intervention is crucial in the control of myopia, and the latest findings from CooperVision’s seven-year clinical trial demonstrate myopia management contact lenses can help slow down the rate of myopia progression.15 The pivotal MiSight 1 day contact lens clinical trial demonstrated that 12 months following treatment cessation, mean axial elongation data, which is used to measure myopia, showed no evidence of rebound effect; only MiSight 1 day is proven to retain myopia control benefits after treatment has ended.16,17 The study is the longest-running soft contact lens study among children for myopia control.
Previously, CooperVision reported that MiSight 1 day cuts myopia progression by half across multiple years of treatment. This was observed in the children that wore MiSight 1 day for the study’s first six years as well as the children who wore the single vision Proclear 1 day lens for the first three years and were subsequently refitted with MiSight 1 day.18
Results from the first three years of the same seven-year trial show that in spite of 52 children wearing myopia management contact lenses for a mean number of around 13 hours per day, there were no serious or significant ocular-adverse events.19,†
Myopia management is a relatively new concept in many countries, so the onus is on ECPs to detect, report, and manage childhood myopia. By increasing awareness of myopia management tools and enlisting the support of ECPs and other healthcare professionals, we hope to help children see well now and as they grow and age.
Read the CPD article, Myths Busters in Myopia Management, by Dr Mark Bullimore and Dr April Jasper on page 65 of this issue.
Hamish Thrum, Senior Director of Myopia Asia Pacific (APAC) at Coopervision, has specialised in healthcare for over 20 years. With success in education and business management roles across the medical devices industry, he takes pride in connecting patients with innovative technologies and healthcare providers to create a positive impact in the APAC region and beyond.
- Flitcroft DI. The complex interactions of retinal, optical and environmental factors in myopia aetiology. Prog Retin Eye Res. 2012;31:622-60.
- Tideman JW et al. Association of axial length with risk of uncorrectable visual impairment for Europeans with myopia. JAMA Ophthalmol. 2016;134:1355-1363.
- Ruiz-Pomeda A, Villa-Collar C. Slowing the progression of myopia in children with the MiSight contact lens: a narrative review of the evidence. Ophthalmology and Therapy. 2020 Dec;9(4):783-95.
- Chamberlain P, Arumugam B, Jones D. Myopia progression in children wearing dual‐focus contact lenses: 6‐year findings. Optom Vis Sci. 2020;97:200038.
- Chamberlain P, Arumugam B, et al. Myopia Progression on Cessation of Dual-Focus Contact Lens Wear: MiSight 1-day 7-Year Findings. Optom Vis Sci 2021;98:E-abstract 210049.
- Hammond D, Arumugam B, et al. Myopia Control Treatment Gains are Retained after Termination of Dual-focus Contact Lens Wear with No Evidence of a Rebound Effect. Optom Vis Sci 2021;98:E-abstract 215130.
- Arumugam B, Chamberlain P, Bradley A et al. The Effects of Age on Myopia Progression with Dual-Focus and Single Vision Daily Disposable Contact Lenses. OptomVis Sci 2020;97(E-abstract):205340, AAO 2020 Poster.
- Chamberlain P et al A 3-year Randomized Clinical Trial of MiSight Lenses for Myopia Control. Optom Vis Sci 2019;96:556-567.