2024 International Myopia Conference: Learning to Stem a Rising Tide

The 2024 International Myopia Conference (IMC), held from 24–28 September in Sanya on Hainan Island in China, was a major global event in the field of vision science. This year’s IMC, hosted by the AIER Eye Hospital, which operates 1,000 medical institutions, was the largest ever, attracting over 1,000 attendees hailing from over 50 countries.

Attendees, comprised of leading researchers, clinicians and industry experts, came together to share and discuss the latest research and advancements in the management and understanding of myopia, a condition that has been estimated to affect half of the world’s population by 2050. This statistic, which was repeated throughout the conference, emanates from the landmark paper published in 2016, Global prevalence of myopia and high myopia and temporal trends from 2000 through 2050.¹

The program was jam packed with over 80 presentations and 400 research posters presenting the latest advancements in myopia research and treatments, including public health strategies, risk factors, genetics, animal and experimental models, ocular imaging, binocular vision, myopia complications, the use of pharmacological, optical, and technological agents, and much more.

… while myopia research is better than it has ever been, there is still a long way to go

Are We There Yet?

The Chew Sek-Jin Memorial Lecture was awarded to Professor Ian Flitcroft (United Kingdom), asking the question ‘Are we there yet?’ He argued that myopia management needs to be simplified without oversimplifying the condition. He highlighted the need for outdoor time, especially in urban environments where much of the world now resides. He discussed the importance of axial length, comparing it to intraocular pressure in glaucoma as a marker of risk of visual impairment. He pointed out that while myopia research is better than it has ever been, there is still a long way to go, however he has hopes for the future that include preventing myopia onset, slowing its progression, and ensuring lifelong visual health by translating research into clinical practice.

From Singapore, Professor Saeng-Mei Saw’s ‘three-pronged preventative strategy to tackle the myopic epidemic’ includes primary – environmental modifications to prevent onset; secondary – early detection and treatment; and tertiary – managing its risks and complications. Professor Haotian Lin (Hong Kong) followed, discussing the use of big data analysis assisted by artificial intelligence (AI) to analyse risks for myopia. One of his findings was that increased school green space significantly reduced the rate of myopia progression in Chinese school-aged children.

Novel studies included creating ‘outdoor-appearing classrooms’, i.e. classroom walls and ceilings painted to mimic the natural scenery. After one year they did not appear to slow progression, but did manage to delay onset of myopia, so could be effective in younger age groups.

Other risk factors for myopia onset and progression included genetics, regional differences with significantly higher rates of myopia in urbanised areas, higher level of education, and private tuition.

Let There be Light

Light – outdoor light, bright light, red light, blue light, cyan light, and violet light were all discussed. There is a significant correlation between outdoor activity and later myopia onset and the use of devices shining red, blue, and/or violet light into the eyes and cyan light into the blind spot were all found to be effective. However, another study presented by Associate Professor Neema Ghorbani Mojarrad (United Kingdom) found that the average compliance with repeated low-level red-light (RLRL) therapy was only 66% in UK over a six-month period. Associate Professor Lisa Ostrin and her group from the University of Houston (United States) assessed the safety profile of various red light laser instruments, finding that some of the commercially available RLRL therapies exceeded the safe level of irradiance for the American National Standards Institute at the recommended treatment lengths.

Public Health Burden

We understand the myopia epidemic imposes a massive burden on the public health systems. Dr Ling Lee (Australia) estimated the lifetime myopia costs with traditional myopia treatments, i.e. single vision spectacles vs active myopia management, and found a dramatic reduction in lifetime cost in active myopia management, with the largest reduction in cost in using anti-myopia spectacles. This counters the argument for delaying active treatment given the perceived increased cost of treatment.

Retrospective studies about OK confirmed safety and efficacy in myopia control

Myopia Control Methods

There were plenty of posters about the efficacy of current popular myopia control methods, including dual focus contact lenses (MiSight) and myopia control spectacles including MiyoSmart and Stellest, all showing good evidence for the efficacy of the treatments. Some other studies showed that combination treatment also increased efficacy. There were other novel spectacle and contact lens treatments presented, which also appear promising, however do not have the long-term data that the established treatments currently do.

Orthokeratology (OK) continues to be popular for myopia control, with researchers diving deeper to analyse other factors of the modality including treatment zone size. Retrospective studies about OK confirmed safety and efficacy in myopia control, and pleasingly received overwhelmingly positive feedback with 98% of children and 95% of parents reporting high satisfaction with this modality.

Research was presented on scleral biomechanics, looking at interventions targeted to strengthen the sclera to reduce axial elongation, including crosslinking the sclera, a technique that has been used widely for corneal crosslinking to reduce progression in ectasias such as keratoconus.

Predictors and Predictions

The latest International Myopia Institute (IMI) 2025 White Papers were presented. Dr Nina Tahhan (Sydney) reported that cycloplegic hyperopic reserve at a young age is the strongest predictor for myopia. Tim Fricke (Melbourne) presented Updates on global myopia epidemiology, looking at meta-analyses of all recent data. This found that the predictions from Prof Holden’s 2016 paper1 were actually reasonably close, however found that they had under-estimated myopia in the Sub-Sahara Africa and Latin American regions. They also found that the rates of myopia were significantly lower than predicted in older East Asians due to the sheer volumes of cataract surgeries performed, eliminating myopic refractive error in this cohort. Re-analysing the data almost one decade later, Mr Fricke said with current rates of myopia growth, the new prediction is alarmingly 72.2% myopic by 2050.

The Update on myopia control interventions and comparing efficacy will include new interventions including 7-MX, caffeine, hypotensive drugs, RLRL, blue light, surgical interventions (posterior scleral reinforcement, macular buckling) and behavioural monitoring. The IMI White Papers are due in the next few months – and will be freely available on the IMI website in multiple languages.

To conclude the event, hot topics in myopia management were debated by experts, which proved to be not only informative yet engaging and fun! Debates included: ‘Should combination therapies be the standard of care to maximise treatment efficacy?’ ‘Do we need to treat all young myopic patients or just those at recognised high risk of myopia progression’, and ‘Can short-term changes in the choroid in humans predict long-term eye growth?’. The results of most of the debates, as voted by the audience, were close, revealing how controversial some of these issues in myopia are.

MiyoSmart Case Contest

During IMC, HOYA Vision Care held its first international MiyoSmart case study contest. Contestants from around the globe submitted thought-provoking cases of patients managed with MiyoSmart. They were shortlisted by a panel of esteemed judges based on four criteria including, practical relevance, educational value, data and analysis quality, and presentation delivery.

The finalists included, Max Aricochi from Austria, Dr Tang Yan from China, Dr Daniela Goicea from Romania, Martelie Burger from South Africa, and Australia’s own SooJin Nam, all of whom presented their fascinating clinical cases in front of a panel of esteemed judges. It was a close call with Dr Yan taking out the prize, however Ms Nam’s case also proved extremely popular. Australia is a country that packs well above its weight considering the relatively low population – not just in Olympics but also in the field of myopia research, with the event seeing many Australians take the stage.

A Chinese Spectacular

Of course, all conferences cannot be all work and no play; the gala dinner was truly spectacular with multiple performers, heaps of light and action, and an incredible feast of local produce and seafood: a grand show that only China can achieve.

There were also opportunities to get active, including taking part in the Oakley run, and a tour to Wuzhizhou Island for scuba diving. Hainan is stunningly beautiful and tropical, often being referred to as the ‘Hawaii of the East’.

IMC 2024 was an impressive conference, smashing the record set by the last IMC held at Rotterdam with 750 attendees. This massive attendance evidences the weight of concern for the myopia epidemic.

The next IMC will be held in 2026, in Houston, Texas.

For those that missed out, many of the recordings can be found at live.cme365.cn/live/page/951785328?v=1727757248000.

Jessica Chi is the Director of Eyetech Optometrists, an independent speciality contact lens practice in Melbourne. She is the current Victorian, and a past National President of the Cornea and Contact Lens Society, and an invited speaker at meetings throughout Australia and beyond. She is a clinical supervisor at the University of Melbourne, a member of Optometry Victoria Optometric Sector Advisory Group and a Fellow of the Australian College of Optometry, the British Contact Lens Association, and the International Academy of Orthokeratology and Myopia Control.

Reference

1. Holden BA, Fricke TR, Resnikoff S, et al. Global prevalence of myopia and high myopia and temporal trends from 2000 through 2050. Ophthalmology. 2016 May;123(5):1036-42. doi: 10.1016/j.ophtha.2016.01.006.