Myopia Management: Looking to the Future

Advancements in personalised myopia control solutions are progressing rapidly, driven by the increasing prevalence of myopia and the need for effective, individualised treatments. To find out about some of the most exciting advancements on the horizon, mivision asked Dr Foo Li Lian, Consultant, Cataract and Comprehensive Ophthalmology Department, Singapore National Eye Centre and Tacy Song, Head of Professional Affairs, Myopia, Asia Pacific at CooperVision.

Technological advancements in personalised myopia control solutions can also ensure more consistent adherence to treatment, by integrating smart technologies for real-time monitoring and management. This can directly impact treatment efficacy and is a key consideration for myopia management. These include innovations such as advanced contact lenses or smart glasses designed for continuous wear and comfort, which can monitor eye health and provide timely reminders for optimal eye care practises.

Q. Last year, scientists from Singapore’s Nanyang Technological University announced the development of a salinepowered battery small and flexible enough to fit into a contact lens. How might this be used to treat myopia?

The battery uses the natural saline solution in the eye as an electrolyte to generate power. This technology is safe, non-toxic, and capable of powering various smart contact lens functions.

In the realm of myopia management, smart contact lenses powered by a battery like this could revolutionise drug delivery. They can include reservoirs and release mechanisms to administer drugs like low-dose atropine directly to the eye. Additionally, these lenses could sync with smartphone apps to give users feedback and reminders about their visual habits, such as taking breaks during prolonged near work or encouraging outdoor activities, both of which help manage myopia.

While it is still in its early days, this technology holds promise for both practitioners and patients, potentially transforming the tools available for myopia management.

Q. What are some of the most promising advancements in the pipeline for personalised myopia control solutions?

Some of the more promising treatments include new pharmacological agents in the form of eye drops and oral tablets, which target different pathways and mechanisms involved in myopia progression. Multifocal and dual-focus lenses that correct astigmatism will cater to a wider group of children, particularly those with lifestyle needs such as sports activities. Additionally, augmented reality glasses, designed to reduce eye strain by dynamically adjusting focus and providing real-time visual feedback, are also on the horizon. These innovations offer tailored, proactive, and technologically advanced solutions that are applicable to different settings around the clock. They also hold the potential to significantly improve outcomes for individuals with myopia, making management more effective and personalised.

Q. When can we expect to see some of these innovations come to fruition?

While some innovations in myopia management are already in practice and will see incremental improvements and broader adoption in the near term, others, especially those involving new pharmaceuticals or advanced biomedical technologies, will take longer to become mainstream. Regulatory approvals, clinical trial results, and technological advancements will all play crucial roles in determining the precise timelines for these innovations. These can take a while as clinical trials for myopia progression require several years of monitoring to establish safety and effectiveness.

In spite of the promising advancements ahead, our current priority should lie in implementing accessible interventions to control myopia cases. By establishing myopia management as a standard of care today, we can pave the way ahead for future widespread acceptance and integration of technological eye health innovations, ensuring a brighter future for eye health.

Q. How is AI being used for research and myopia management, and how is it expected to improve outcomes?

AI holds significant promise in accurately predicting risks, offering precise screening, aiding in diagnosis, understanding pathogenesis, and potentially suggesting personalised treatment plans for rapidly emerging myopia cases in the near future.

Within the myopia ecosystem, AI has shown its usefulness in various areas. It can predict the degree of myopia in children using fundus photos, monitor myopia progression in school children, track eyeball growth, assess the extent of myopia in adolescents, and detect issues such as retinal tears through ultra-wide retina photography.

Recently, we developed algorithms to predict the five-year risk of developing high myopia in a diverse group of schoolchildren aged six to 12 years.^1,2 Our algorithms achieved good predictive performance, with accuracy ranging from 90-98% in identifying children who eventually developed high myopia. Notably, using just a retinal image, we achieved 94% performance.¹ Understanding the reasoning behind AI predictions is crucial, and our system could pinpoint specific areas within the eye that led to the prediction.

Our AI algorithms can potentially be integrated into community or school-based programs by being installed in commercially available retinal cameras to identify atrisk children for further assessment and intervention if needed. With future development and maturation, this AI system could serve as a clinical assistant to determine which children are at greater risk of developing high myopia. Early identification could allow for targeted and timely myopia control therapies to reduce the risk in these children.

Q. How will AI change the treatment landscape for practitioners?

AI is set to significantly change the treatment landscape for practitioners in the field of myopia through several key advancements. AI-powered tools can analyse large datasets from clinical trials and patient records, including retinal scans and other imaging studies, to detect early signs of myopia with greater accuracy and speed. This allows for earlier intervention, which is crucial in managing myopia progression, especially in children. It can also predict the progression of myopia by analysing historical patient data, including retinal imaging, and identifying risk factors. By understanding how myopia is likely to develop in individual patients, practitioners can implement more effective, personalised treatment plans aimed at slowing or preventing further progression. This predictive capability is instrumental in tailoring interventions that can mitigate the worsening of myopia over time.

Furthermore, AI algorithms have the potential to assess a variety of data, including genetics, lifestyle, and environmental influences, to create highly personalised treatment strategies. These strategies could, in future, encompass recommendations for specific types of corrective lenses, pharmacological treatments, or lifestyle modifications tailored to the individual needs of each patient. This level of personalisation enhances the effectiveness of treatments and improves patient outcomes.

AI also has the potential to advance research and treatment breakthroughs by analysing vast clinical data. It can also enable unprecedented collaboration among top scientists, subject matter experts, and engineers to optimise existing therapies and identify new treatment options. This continuous innovation will provide practitioners with the latest tools and methods for myopia control.

Overall, AI functions as a useful adjunctive tool for practitioners, thereby enhancing their ability to diagnose, monitor, and treat myopia more effectively. By leveraging AI technologies, practitioners can offer more precise and personalised care, ultimately improving patient outcomes in the management of myopia.

Q. How are groups in the Asia Pacific region collaborating to advance the landscape for myopia management?

The Asia-Pacific region is proactively addressing the urgent need for myopia management through increased awareness and enhanced collaboration among stakeholders, including policymakers, eye care professionals, educators, parents, and children. This collaborative effort is evident in several countries, such as Singapore, China, Japan, and South Korea. However, there remains considerable room for improvement. Expanding awareness and educational initiatives, as well as improving access to myopia control treatments, are crucial steps. Ensuring that these treatments are available and accessible to everyone, regardless of location or socioeconomic status, is essential in effectively combating the myopia epidemic.

The Asia-Pacific region’s response to the urgency of myopia management has gained significant momentum recently. With high myopia prevalence rates in the region, there is growing awareness among healthcare professionals, parents, and policymakers about the long-term consequences of untreated myopia. Innovative approaches are being explored, such as in China, where the impact of changing the spatial frequency spectra of classrooms to mimic outdoor scenery on myopia onset and progression is currently being assessed.

Another significant initiative is the Australia and New Zealand Child Myopia Working Group, which brings together leading optometrists and ophthalmologists from both countries. Established in 2018 and kickstarted by CooperVision, the group aims to define a recommended Standard of Care for managing childhood myopia, with a primary focus on slowing its progression.

The group published reports in 2018 and 2022 outlining the recommended best practice standard of care for myopia management, emphasising actions needed to effectively manage and mitigate its impact both locally and globally. It also urged parents and caregivers to prioritise their children’s eye health by scheduling regular eye tests and discussing management options if diagnosed. A coordinated effort in public health initiatives is crucial to motivate parents and caregivers towards proactive myopia management.

Despite these advancements, much work remains to be done to establish myopia management as the standard of care. This includes comprehensively highlighting the multifaceted impact of myopia, its public health implications, risk factors, pathogenesis, and treatment options from various perspectives.

Q. What is your vision for future collaborations?

Our vision for future collaborations involves creating a global network of stakeholders dedicated to addressing the myopia epidemic. This includes continued partnerships with eye care professionals, researchers, educators, and policymakers to develop and implement comprehensive myopia management strategies.

Ultimately, our goal is to build a robust, collaborative network that uses the latest scientific advancements and technological innovations to improve the quality of life for individuals with myopia worldwide.

Dr Li Lian Foo is a distinguished eye surgeon and Consultant Ophthalmologist at the Singapore National Eye Centre (SNEC). Specialising in childhood myopia control and refractive surgeries, she is the first ophthalmologist to complete the Myopia fellowship at SNEC. Recognised as one of the top 10 rising stars by The Ophthalmologist Power List in 2023, her expertise and dedication have established her as a trailblazer in the field, continuously pushing the boundaries of knowledge and innovation in myopia management.

In addition to her clinical roles, Dr Foo is a Clinical Assistant Professor at DUKE-NUS Graduate Medical School and is an active contributor to the scientific community, boasting numerous publications in reputable ophthalmology journals focussing on myopia and related topics.

 

Tacy Song is an optometrist based in Singapore, and she also holds a Master of Science in Management from University College of Dublin. Ms Song is currently the Head of Professional Affairs where she leads the myopia management strategy for the Asia-Pacific region and is the program chair for the Asia-Pacific Myopia Management Symposium. Prior to joining CooperVision, she was the Asia-Pacific Associate Director for clinical applications in Alcon and has travelled extensively in the region to provide technical and clinical training, education, and ongoing clinical support to surgeons and optometrists in refractive and cataract procedures.

References

1. Foo, L.L., Using AI to predict high myopia risk in children. Singapore National Eye Centre. Available at snec.com.sg/ eyesight-issue1-2023-using-ai-to-predict-high-myopia-riskin- children.
2. Foo, L.L., Lim, G.Y.S., Lanca, C., et al., Deep learning system to predict the five-year risk of high myopia using fundus imaging in children. npj Digit. Med. 6, 10 (2023). DOI:10.1038/s41746-023-00752-8.