The Myopia Epidemic – What it is, Why it Matters, and What Moms (and Dads, and Kids and Doctors) Can Do About it

Dr. Thomas Aller, OD, FBCLA

The Myopia Epidemic

Myopia is an eye disease with the symptom of blurred distance vision. If myopia were limited to a small portion of the population, if it were stable over time, if it could be corrected with eyeglasses, and if it rarely caused serious eye problems, it could be treated today the same way it was treated for hundreds of years.

What is becoming more and more clear is that myopia is starting earlier in life, it tends to worsen through young adulthood, it is reaching higher levels in those who develop it, it is affecting greater and greater percentages of the population all around the world, and there are increasing risks of serious negative eye health consequences for every increase in one’s level of myopia(1, 2).

What makes continually worsening myopia a serious eye health concern is not that the prescription number is getting higher or the glasses are getting thicker, or the vision without glasses is becoming worse. These are all annoyances, easily fixed by updating the eyeglass or contact lens prescription. It is what is happening to the eye while the prescription number is increasing which makes it critical that a new approach is used to not only correct the vision in people with myopia but also to slow the worsening.

When the eye increases in myopia, it almost always is because the eye is growing. As it grows, beyond what it was designed to do, the structures and tissues inside the eye stretch and thin. It is these stretching forces that are the likely cause of eye diseases that are linked to myopia.

Many people may be aware that retinal tears and detachments are more likely to occur with high myopia. Less well known, but equally serious, is that myopia is associated with higher risks of myopic maculopathy as well as cataracts and glaucoma. What is really important is that while the risks increase with higher levels of myopia, there are actually measurable increases in risk with any level of myopia(2, 3). This is why it is important to reduce myopic progression, no matter how much or how little myopia there is, as any increase in myopia increases the risk of future visual impairment, and any reduction in progression lessens those risks(4).

While it used to be thought, and many doctors still may think, that myopia was genetically pre-determined, that it would stop worsening at age 16, that there were no health risks associated with low and moderate levels of myopia, and that there was nothing that could be done, or should be done to slow the progression, doctors skilled in the treatment of myopia progression know that myopia can and must be treated in order to reduce excessive elongation of the eye(5).

Much has been learned over the last 30 years about myopia. What started the revolution in treating myopia progression were animal studies which showed that the growth of a young eye could be altered simply by changing the power of lenses that various animals would wear. If those early chickens and monkeys were like some children and refused to wear their little chicken glasses, we might not have made these important discoveries. Luckily for us humans, what has developed is an understanding that there are four effective treatments, proven to significantly slow myopia progression.

The first treatment is easy, free, fun, healthy, and can be done with virtually any child. It has been observed in multiple studies that the longer a child spends outdoors before the development of myopia, the longer the beginning of myopia can be delayed(6). This is important because if a child develops myopia at a very young age, the natural rate of myopia progression will be quite rapid and the level of myopia predicted for young adulthood will be quite high. Now, don’t forget your sunscreen and sunglasses and as they say in Singapore, “keep myopia at bay – go outside and play.”

The next treatment to consider is a treatment that can be used at any age and can slow myopia by an average of 60%. Atropine eye drops have been studied for 50 years as a treatment for myopia and what has made it a useful treatment lately are the findings from many studies that low doses can be quite effective(7, 8). At commonly used lower doses, there are minimal side effects of dilated pupils, leading to sun sensitivity and sometimes to blurred vision up close. These side effects may be managed by using sunglasses outside and by prescribing glasses to help near vision, or the dosage can be adjusted to lessen any annoying side effects(9). In the US, atropine is not approved for the control of myopia and your doctor has to send the prescription to a compounding pharmacy.

Two types of contact lens treatments are known to significantly slow myopia progression, multifocal or bifocal contact lenses (MFCLs), and orthokeratology (OK). While young children and sometimes even adults can be apprehensive the first time they put on a contact lens, most children do remarkably well with contact lenses. There are known risks to wearing contact lenses with eye infections being the primary concern, though, with proper professional care, the risks are minimal and manageable. Young children, in fact, have been shown to have the lowest risks with contact lenses, likely because they are young enough to still listen to their parents10. In multiple clinical studies, all around the world, these two types of contact lens-based treatments have been shown to slow myopia by 40 to 80%(11). The MiSight lens is a daily disposable bifocal contact lens which just achieved FDA approval for the treatment of progressive myopia in children(12).

So, the next step is to schedule an eye examination with an optometrist or ophthalmologist who cares about myopia and works with them to find a treatment that suits you and your child. Remember that most treatments and lenses are not FDA approved, but the FDA doesn’t regulate the practice of medicine and your doctor may use any lens or treatment approved for other conditions and choose to use it to control myopia, based on the available scientific evidence. Remember also that myopia tends to increase rapidly when first discovered, or even the year before and all treatments merely slow down the worsening, so it is best to start early to flatten the myopia curve(5).

Ready to speak to a doctor regarding myopia? Find a doctor and make an appointment here.

References:

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2. Flitcroft DI. The complex interactions of retinal, optical and environmental factors in myopia aetiology. Prog Retin Eye Res. Nov 2012;31(6):622-60. doi:10.1016/j.preteyeres.2012.06.004

3. Haarman AEG, Enthoven CA, Tideman JWL, Tedja MS, Verhoeven VJM, Klaver CCW. The Complications of Myopia: A Review and Meta-Analysis. Invest Ophthalmol Vis Sci. 04 2020;61(4):49. doi:10.1167/iovs.61.4.49

4. Bullimore MA, Brennan NA. Myopia Control: Why Each Diopter Matters. Optom Vis Sci. 06 2019;96(6):463-465. doi:10.1097/OPX.0000000000001367

5. Aller TA. Clinical management of progressive myopia. Eye (Lond). Feb 2014;28(2):147-53. doi:10.1038/eye.2013.259

6. Rose KA, Morgan IG, Ip J, et al. Outdoor activity reduces the prevalence of myopia in children. Ophthalmology. Aug 2008;115(8):1279-85. doi:10.1016/j.ophtha.2007.12.019
   
   
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10. Bullimore MA. The Safety of Soft Contact Lenses in Children. Optom Vis Sci. Jun 2017;94(6):638-646. doi:10.1097/OPX.0000000000001078
    
    
11. Huang J, Wen D, Wang Q, et al. Efficacy Comparison of 16 Interventions for Myopia Control in Children: A Network Meta-analysis. Ophthalmology. Apr 2016;123(4):697-708. doi:10.1016/j.ophtha.2015.11.010
    
    
12. Chamberlain P, Peixoto-de-Matos SC, Logan NS, Ngo C, Jones D, Young G. A 3-year Randomized Clinical Trial of MiSight Lenses for Myopia Control. Optom Vis Sci. 08 2019;96(8):556-567. doi:10.1097/OPX.0000000000001410