A new report has highlighted the increasing severity and prevalence of myopia in children in order to raise awareness among non-ophthalmic healthcare providers.
Published by Global Business Media with support from CooperVision, Advancing the Treatment of Myopia in Children noted the need for collaboration among healthcare professionals when treating myopic patients.
Elizabeth Lumb, head of professional services for MiSight 1 day at CooperVision, said: ‘Addressing the problem of myopia progression requires collaboration across the healthcare spectrum, with physicians, nurses and other care providers working alongside optometrists and ophthalmologists.
‘As a global research, clinical and education leader on the topic, it’s our privilege to gather several experts to succinctly frame the issue, highlight the science and review intervention options. Our hope is this special report is one more step toward establishing myopia management as standard of care by eye care professionals for the millions of children who are affected.’
Elizabeth Lumb
The report included insights from four global experts who provided an overview of myopia’s prevalence, available interventions to slow progression, the risks and benefits of contact lens (CL) options, as well as why every dioptre of myopia progression matters.
Lumb added: ‘This report lays bare a real urgency to act by all health professionals, who can gain a better grasp of myopia progression’s expanding impact, help encourage routine eye examinations for children and refer parents to optometry and ophthalmology peers for counsel and care.’
Myopia matters
Dr Annegret Dahlmann-Noor, consultant ophthalmologist and director of the Children’s Service at Moorfields Eye Hospital, opened the report by highlighting why myopia matters.
She noted that myopia was no longer an inconvenience because its rise would place increased burdens on quality of life and cause a rise in healthcare expenditure to patients and healthcare systems.
Dhalmann-Noor said: ‘Across Europe, myopia now seems to start at a younger age and to progress faster. In the UK, the prevalence has doubled over the past 50 years. Now, 1.9% of six-year-olds, 10-16% of 12 to 13-year-olds and 28% of 15 to 16-year-olds have myopia.’
The ophthalmologist said that while the prevalence of myopia increased, the number of people suffering permanent vision loss from complications later in life was also on the rise.
‘Myopia increases the lifetime risk of permanent sight loss from retinal detachment, myopic macular degeneration and optic neuropathy,’ she said.
Addressing the financial impact of myopia, Dhalmann-Noor
commented that costs are incurred from its onset through the price of spectacles, CLs or corrective refractive surgery.
In addition, major costs are linked to secondary complications and treatments, as well as the impact of sight loss on productivity and quality of life.
Specific figures for myopia-associated costs were not available, but Dahlmann-Noor commented: ‘The UK NHS currently spends £3bn a year on eye care and the cost of sight loss is £15.8bn a year.’
Dahlmann-Noor highlighted an increased amount of time spent indoors and the use of electronic devices as an associated cause of myopia prevalence in children.
She noted UK surveys found children today spend 68 minutes a day outdoors or on sports, including indoor sports. In addition, children from ethnic minorities and socio-economically disadvantaged communities spend less time outdoors than their more affluent peers.
‘In addition to a lack of time spent outdoors, increased near-vision activities and education are considered an additional environmental risk factor for myopia development, though the causal relationship is less clear,’ Dahlmann-Noor said.
When addressing whether myopia was a preventable condition, Dahlmann-Noor said that early detection may enable families to delay the onset of myopia. ‘As the evidence of the burden of the
condition on individuals and society increases and low risk interventions emerge, the identification of children at risk of developing myopia and pre-emptive management options may become ethically acceptable,’ she added.
Integrating interventions
Professor Nicola Logan from Aston University discussed the myopia management interventions that were critical to minimise the irreversible visual impairment of myopia-related ocular pathologies.
‘These interventions may prevent or delay the onset of myopia, or halt or slow its progression. The physiological axial length changes associated with the progression of myopia is the precipitating factor in sight-threatening ocular conditions such as retinal detachment. Consequently, any intervention to slow myopia progression must also reduce the rate of axial elongation of the eye,’ Logan said.
In her article, Logan highlighted the research behind these interventions and discussed the evidence to integrate these into clinical practice.
Detailed was a review and analysis that found the odds of myopia could be reduced by 2% per additional hour of time spent outdoors. Logan then highlighted that two intervention trials in China were launched off the back of these findings. In both, an extra 40 minutes of outdoor activity was introduced to the school day and a significant reduction in myopia progression of 11% and 18% was found,
respectively.
She noted that while it has been widely investigated, how spending time outdoors works to protect against myopia progression was unclear. However, Logan said: ‘Despite the lack of certainty surrounding the mechanism of the protective effect of time outdoors, it should be considered as an effective and straightforward strategy to reduce the risk of myopia development in children.’
Logan said children should have full correction of their myopia as a minimum because evidence suggested that under-correction accelerated rates of growth of the eye and faster myopia progression.
She highlighted the research into the effectiveness of spectacles and CLs in slowing myopia progression, including orthokeratology, multifocal and dual focus CLs, as well as pharmacological interventions such as atropine.
Logan concluded by noting that although no one treatment was 100% effective in all patients, substantial benefits were found. ‘Myopia management is time sensitive with greater impact on younger children. By slowing myopia progression and rate of axial length growth in a child’s eye we not only benefit the individual from reduced risk of future ocular pathology but make gains on a public health scale,’ she said.
Overcoming preconceptions
In a risk-to-risk benefit comparison of myopia controlling CLs, Dr Kate Gifford, addressed the short and long term challenges that could arise with daily wear.
The Australian optometrist and founder of Myopia Profile, said:
‘In addition to myopia control, there are clear functional and
psychological benefits of paediatric CL wear, especially in younger children aged eight to 11 years who feel that their confidence, physical appearance, competence in school and sport activities and social acceptance is improved.’
Gifford debunked the belief that CL wear in adolescents was not as safe as in adults and noted evidence that suggested this was the case, including the finding that those aged eight to 12 were perhaps safer than teenagers and adults.
‘The safest modality of the myopia controlling CL wear is daily disposable soft CLs, although the risk of adverse events is also very low for reusable soft CLs and orthokeratology modalities,’ she said.
Gifford highlighted an analysis of the likelihood of CL related infection in children and found it was safe in the short term and beneficial in the long term.
‘The comparative lifetime risks of CL wear commenced at age eight for myopia control, and continued throughout life until age 65, are relatively less than the lifetime risks of vision impairment from myopia-associated pathology when myopia is over 3D or axial length in excess of 26mm. When only childhood CL wear is considered, the risk comparison is clearly skewed towards the positive impact of CL wear, especially in daily disposable CL wear,’ she said.
Gifford concluded that the functional, psychological and preventative eye health benefits of myopia control CLs presented a compelling first line management option for children under 12 with progressive myopia.
Slowing progression
In the final section of the report, myopia consultant and adjunct professor at the University of Houston, Professor Mark Bullimore responded to a common question asked by eye care professionals – when we can correct myopia with spectacles, CLs and refractive surgery, should we worry about slowing its progression?
He said that in 30 years, one-third of all visual impairment would be attributable to myopia and slowing it by even one dioptre could reduce the prevalence of such impairment by 10%.
Bullimore commented: ‘Central to these issues is the need to care about the long-term visual health of every patient and not just address their current visual needs.’
He said the increased risk of eye disease and visual impairment later in life because of high levels of myopia was the driving interest in myopia management.
‘Reducing the incidence or prevalence of any disease by a meaningful amount is of huge public health significance. Myopia has long been associated with increased risk of cataract, glaucoma and retinal detachment, but the greatest myopia-related cause of irreversible vision loss is myopic maculopathy, also referred to as myopic retinopathy or myopic macular degeneration.
‘Furthermore, recent research has allowed for the quantification of the risks associated with the level of myopia and we now know that slowing myopia progression by one dioptre in children can make a huge difference,’ Bullimore said.
He added that one dioptre of myopia has the same effect on the risk of visual impairment as two years of ageing. Each additional dioptre was associated with an extra year of visual impairment experienced by an individual patient.
‘Myopia should no longer be considered an inconvenience, but a manageable condition with a narrow window of opportunity to have the biggest impact. Stay informed and connected to remain up to date in this rapidly advancing field,’ Bullimore concluded.