Addressing the Myopia Epidemic with New Solutions

The treatment of Myopia has evolved with new innovations and recent research. In this article, we look at these new technologies aimed at treating myopia.

The Growing Threat of Myopia

Myopia, or short-sightedness, is becoming an alarming public health issue. Global prevalence of myopia is projected to increase from 33.9% in 2020 to 49.8% in 2050 if no effective measures are implemented to manage its onset and progression. Particularly in Asia, the situation is much more severe, with myopia rates ranging from 10-30% among adults and an astounding 80-90% among young adults in East and Southeast Asia. Additionally, the annual direct cost of myopia correction in Asian adults is estimated at US $328 billion. With a lifestyle shift to increased indoor and virtual activities due to the COVID-19 pandemic, the myopia figures now are even more exacerbated. Increasing screen time and reducing outdoor activities have impacted the ocular development of children, resulting in elongation of the eyeballs to accommodate short-vision tasks, raising significant concerns for their long-term ocular health. In this article, we explore myopia and its possible long-term health risks, current and emerging solutions to prevent and delay myopia progression, and the pivotal role healthcare professionals play in mitigating its effects.

Significant Health Risks Associated with Myopia

Myopia can lead to several serious ocular conditions in the long term if left untreated. These conditions include:

1. Myopic Macular Degeneration (MMD): A condition where the macula, a part of the retina responsible for sharp, central vision, deteriorates over time.

2. Staphyloma: A bulging of the sclera or cornea due to stretching and thinning, which can lead to permanent vision impairment and blindness.

3. Retinal Detachment: A serious condition where the retina pulls away from the blood vessels that supply it with oxygen and nutrients. It is a medical emergency that can lead to permanent vision loss.

4. Primary Open-Angle Glaucoma: A type of glaucoma that occurs when the eye’s drainage canals become blocked, and the inner eye pressure (intraocular pressure) rises. It can cause damage to the optic nerve and loss of vision.

5. Cataracts: These are cloudy areas in the eye’s lens leading to a decrease in vision. People with high myopia have a higher risk of developing cataracts.

Current Strategies for Myopia Management

Besides standard single-vision spectacles or contact lenses for myopia correction, current solutions to combat myopia also include:

1. Increasing Outdoor Activities: Studies in East Asia demonstrated that just adding an hour of outdoor activity daily can significantly reduce the incidence of myopia. Most interventions encourage at least two hours of outdoor activities daily during childhood, which is a critical time for ocular development. However, implementing and keeping these practices consistent can be challenging especially in academically-driven societies or urban cities where safe, green spaces are scarce.

2. Topical Atropine: Administered in the form of eye drops, atropine is thought to prevent sclera thinning or stretching, thereby reducing refractive changes and axial elongation, and ultimately slowing eye growth. A meta-analysis of 12 randomised control trials and 15 cohort studies involving over 5,000 children has shown that topical atropine effectively reduced myopia progression. There was a clear dose-dependent response, with higher concentrations of atropine reducing both refractive change and axial elongation more effectively.

3. Orthokeratology: The treatment involves wearing specially designed contact lenses overnight to temporarily reshape the cornea. Studies indicated that it reduced axial elongation compared to controls after 1 year and the effect lasted up to 2 years, showing promise in controlling myopia.

Despite all the evidence supporting the efficacy of these promising interventions, their widespread adoption remains limited. In a 2015 global survey, they found that most eye care practitioners still predominantly prescribe standard single-vision lenses for myopia correction. Interestingly, although a 2020 survey in Singapore showed that 80% of practitioners recommend myopia control measures, only about a third of them actively propose solutions during the first consultation. This suggests a gap between recognition of effective treatments and their practical application in clinical settings.

Emerging Research and Innovative Interventions

Researchers argue whether it is the visual landscape or lighting that strongly impacts ocular development. These are some new research and innovations in both areas that could hold some promising future interventions to prevent and slow myopia progression.

New Findings and Technologies in Light Therapy

In a 2015 study in north-eastern China, researchers equipped classrooms with ceiling lights that emit more light than the usual fixtures, along with blackboard lamps. The results showed that the incidence of myopia dropped from 10% to 4% in a year among primary and middle school students. In addition, research on light also disagrees on which wavelength of light is most beneficial to delay myopia progression. One medical-device company based in Berlin, Dopavision, tested a virtual-reality headset that delivers blue light to a ‘blind spot’ in the retina where the optic nerve connects. The treatment showed promise in inhibiting eyeball elongation in its initial pilot testing. In another study conducted in ten primary schools in Shanghai, researchers found that children receiving red-light therapy for three minutes twice a day, five days a week were half as likely to develop myopia compared to controls. These similar trials are also set to commence for preschoolers in Singapore and primary school students in Hong Kong.

Innovative Visual Environment Manipulation

When observing an outdoor landscape, the eye sees a rich, textured environment with details that merge into a more uniform image at great distances. This varied visual experience, with its patterns of blur and distance, contrasts sharply with the flatter, less detailed surroundings of indoor spaces. Researchers speculate that it is the uniformity of focus that signals the eye to stop growing and elongating. To emulate these conditions indoors, some researchers developed new intervention strategies that recreate naturalistic visual environments to promote proper retinal focus. In a study in Sanya, China, researchers placed in classrooms custom-made wallpaper that simulated the complexity of a natural parkland, featuring trees, dogs, and the occasional butterfly, while ceilings were painted to resemble a blue sky dotted with clouds and birds. They found that children who spent a year in these classrooms had significantly reduced eye elongation than those who were taught in the standard control classrooms, suggesting a potential for these immersive environments in managing myopia progression.

Empowering Healthcare Professionals in Myopia Management

As myopia continues to emerge as a significant global health concern, healthcare professionals play a pivotal role in managing this condition through a strategic, evidence-based approach. The standard of care for myopia involves three essential steps: mitigation, which emphasises education on preventive lifestyle choices during early eye exams; measurement, ensuring thorough and regular assessments of eye health and myopia progression; and management, which includes addressing patients’ needs with not only traditional corrective measures but also advanced evidence-based interventions like specialised lenses and pharmaceuticals to slow myopia’s progression.

To bridge the gap between recognition of effective treatments and their practical application in clinical settings, it is crucial for healthcare professionals to actively recommend and propose solutions during the first consultation. By actively participating in ongoing research projects, leveraging the latest technologies in diagnostic and treatment tools, and collaborating with researchers on myopia management, healthcare professionals can enhance their understanding and application of the most current interventions. This commitment not only helps improve patients’ quality of life and eye health outcomes but also contributes to managing the myopia epidemic effectively at both individual and community levels, potentially saving the economy billions of dollars.

References

1. Chen, K. S., Au Eong, J. T. W., & Au Eong, K. G. (2024). Changing paradigm in the management of childhood myopia. Eye, 38(1027-1028). https://doi.org/10.1038/s41433-023-02831-2
2. Spillmann, L. (2020). Stopping the rise of myopia in Asia. Graefe’s Archive for Clinical and Experimental Ophthalmology, 258, 943–959. https://doi.org/10.1007/s00417-019-04555-0
3. Baird, P. N., Saw, S. M., Lanca, C., et al. (2020). Myopia. Nature Reviews Disease Primers, 6, 99. https://doi.org/10.1038/s41572-020-00231-4
4. (2024, May 28). Dopavision Announces Topline Results in Clinical Trial of Targeted Photobiomodulation Approach for Progressive Myopia. BusinessWire. https://www.businesswire.com/news/home/20240528147074/en/
5. He, X., Wang, J., Zhu, Z., et al. (2023). Effect of Repeated Low-level Red Light on Myopia Prevention Among Children in China With Premyopia: A Randomized Clinical Trial. JAMA Network Open, 6(4), e239612. https://doi.org/10.1001/jamanetworkopen.2023.9612
6. Yi, X., Wen, L., Gong, Y., Zhe, Y., Luo, Z., Pan, W., Li, X., Flitcroft, D. I., Yang, Z., & Lan, W. (2023). Outdoor Scene Classrooms to Arrest Myopia: Design and Baseline Characteristics. Optometry and Vision Science, 100(8), 543-549. https://doi.org/10.1097/OPX.0000000000002046