AEVR Briefing Educates about Myopia, A Looming Public Health Crisis


Jason Compton, OD (Compton Eye Associates,
New York, New York)

On October 20, AEVR's Research Saving Sight, Restoring Vision Initiative and co-sponsors (see box below) held a virtual global Congressional Briefing entitled Myopia: A Public Health Crisis. Refractive errors, which are the most common cause of vision impairment, occur when the eye cannot clearly focus images from the outside world. Myopia, or nearsightedness, is the most prevalent refractive error, along with Hyperopia (farsightedness), Astigmatism (distorted vision resulting from an irregularly curved cornea, the clear covering of the eyeball), and Presbyopia, difficulty in reading/seeing at arm’s length, often linked to aging. Although refractive errors such as myopia cannot be prevented, they can be diagnosed by an eye exam and treated. If corrected in time, according to the error and the age of the person and requirements of their activities, they do not impede development of good visual function.

The Briefing featured two clinicians who treat myopia patients on a daily basis—Jason Compton, OD (Compton Eye Associates, New York, New York and Assistant Adjunct Faculty for the SUNY State University) and Katherine Lee, MD, PhD (St. Luke’s Children’s Hospital, Boise, Idaho). Both speakers have been engaged in their respective professional society’s activities regarding myopia—Dr. Compton has served as the 2020-2021 Chair of the American Optometric Association’s Contact Lens and Cornea Section, while Dr. Lee is Past President of the American Association for Pediatric Ophthalmology and Strabismus (AAPOS) and is active in clinical research through the Pediatric Eye Disease Investigator Group (PEDIG), which was formed in 1997 with support from the National Eye Institute (NEI) within the National Institutes of Health (NIH). NEI funds all aspects of refractive error research.


Katherine Lee, MD, PhD (St. Luke’s Children’s Hospital,
Boise, Idaho)

Dr. Lee explained that eye growth is regulated by visual input into the retina, the light sensitive-back of the eye. If the light entering the eye is not focused properly on the retina, it causes the eye to grow, resulting in “not enough retina to go around” for normal vision. Myopia generally begins when children are about 5 years old and start school and then progresses, with about half of this pediatric population’s vision stabilizing by age 15. Those who do not stabilize can develop “high myopia.” All persons with  myopia are at increased risk for retinal detachment, glaucoma, cataract, and myopic macular degeneration. As a result, she emphasized that early diagnosis and treatment of myopia is critical, especially to avoid visual impairment and other eye conditions later in life.    

Dr. Compton reported that, in the past 20 years, myopia and high myopia prevalence has increased dramatically, varying between regions and ethnic groups around the world. In the United States, myopia prevalence in people aged 12-54 increased to 41.6 percent of the population between 1999-2004. Myopia prevalence is expected to grow to 50 percent of the world’s population by year 2050 and, currently, its burden is most acute in East Asia, where incidence rates can be as high as 90 percent.

Dr. Lee recognized that, although myopia’s exact cause is unknown, there may be genetic and environmental considerations. While there are more than 600 genes associated with myopia and an increased risk if parents are myopic, the current increase in prevalence is not genetically based. Development may be affected by how a person uses their eyes—individuals who spend considerable time reading, working at a computer, or doing other intense close visual work may be more likely to develop it, while research has shown a relationship between increased outdoor time and reduced myopia development. As a result, behavioral changes could be a low-cost means to reduce myopia progression, such as taking a break while reading or conducting close work to look into the distance or increasing  outdoor time.

Stressing the importance of myopia management, Dr. Compton reviewed how clinicians are addressing vision correction through ways to slow myopia progression, including the use of a soft multifocal contact lens—reported as effective in an NEI-funded clinical trial released in 2020, a spectacle lens, which contains multiple smaller lenses that direct the volume of light correctly to the retina to slow down elongation of the eye, or orthokeratology (ortho-k), which uses specially designed and fitted contact lenses to temporarily reshape the cornea to improve vision. Dr. Lee added her perspective on pharmacologic treatment of myopia, citing numerous studies on the use of the drug atropine to reduce progression and describing a current PEDIG/NEI study on the use of low-dose atropine expected to report results next year.      

In concluding comments, and in response to participant questions on myopia management, both Dr. Compton and Dr. Lee emphasized the importance of early diagnosis and treatment with the goal of reducing vision impairment later in life. In that regard, they also stressed the importance of research in better understanding why myopia occurs and the development of effective therapies to treat or prevent it.    

Cost of Refractive Errors, Including Myopia
The World Health Organization (WHO) reports that uncorrected refractive errors (UREs) are the most common cause of vision impairment and the second most common cause of blindness. A 2013 Prevent Blindness study projected that, by 2021, refractive errors will account for $18.2 billion of the estimated $177 billion annual cost of eye disorders and vision loss—reflecting the largest component of those costs. Many factors affect the socioeconomic impact of myopia, including the direct costs of refractive correction and health care costs for myopia-associated diseases, as well as the indirect costs of lost productivity and quality of life. Studies estimate that the global impact of uncorrected myopia results in a $244 billion annual productivity loss, while blindness from myopic macular degeneration results in a $6 billion annual productivity loss.

Increasing prevalence of myopia and corresponding clinical and societal impacts necessitate a coordinated response. 

 

AEVR wishes to thank co-sponsors the American Academy of Ophthalmology, the American Optometric Association, the American Association for Pediatric Ophthalmology and Strabismus, Research to Prevent Blindness, and the Association for Research in Vision and Ophthalmology (streaming support) and Novartis (event management support).