What you need to know about myopia

It is a global issue affecting people of all ages and has been declared as an epidemic by WHO. In the last 20 years the prevalence in North America has increased by 50%. It is predicted that by 2050 there will be ~5 billion people worldwide with myopia. Myopia doesn’t just mean having to wear glasses or contact lenses, myopia also means an increased risk to eye health in adulthood. Each diopter increase in myopia results in 67% increased risk of myopic macular degeneration (MMD)

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Risk factors for myopia progression

• Earlier age of onset of myopia
• Glasses Prescription
• Excessive time indoors
• Excessive time performing nears tasks
• Disruptions in diurnal/circadian rhythms via Lights at night
  • Myopic parents

What can we do about this?

• Eye care professionals now have the opportunity to slow myopia progression rather than just correct the visual symptoms
• Increased time outdoors can delay myopia’s onsetand may slow its progression. We recommend at least 2 hours a day. The 20-20-20 rule suggests taking a break every 20 minutes, looking at something at least 20 feet away, for 20 seconds to reduce fatigue and eye strain.
• Several myopia control therapies have shown efficacy of over 0.3 mm (around 0.75 D) over two to three years of treatment

Importance of early treatment: every diopter matters

• Other than a lower final prescription in adulthood, eye growth is slowed. A longer eye length is associated with an increased risk for developing ocular disease such as cataracts, glaucoma, myopic maculopathy, retinal detachments, and can result in visual impairment.
• Clinical treatment should begin for all myopic children 12 years of age or less and begin lifestyle guidance at a minimum for pre-myopic children.
• Progression is highly likely once a child is identified as pre-myopic or myopic.
• Reducing myopia by even just 1.00 D decreases the chances of a patient developing myopic macular degeneration by ~ 40%

Average myopia control treatment effect

multiple studies find a reduction of a ~0.75D in elongation (0.3mm) over 2-3 years . To date the maximum documented effect observes was ~1.00D (0.44mm) over 7 years, which suggests that treatment should begin as early as possible. combining multiple treatment strategies may be more effective at controlling myopia progression than a single treatment therapy.

Monitoring

Myopia control therapy use, maintenance, and compliance should be monitored frequently after treatment initiation or modification every six (6) months at the least once treatment is finalized. Close monitoring helps to maintain compliance, identify risky behaviours, and address any problems as early as possible, ensuring safe and consistent use of the myopia control therapy. Knowing efficacy is similar across treatments, the patient’s lifestyle, expectations, motivation, and their abilities are critical in choosing the right treatment.

Myopia Control Recommendations:

1. Spend at least 2 hours a day outdoors

• Increased time outdoors has shown to slow progression.
• Illuminants rich in blue light, like from the sun, can protect against myopic eye growth when the eye is exposed to slow changes in luminance contrast as might occur with near work.

2. Reduce blue light from electronic devices and indoor lights 3 hours before bed.

• light and blue light increases eye growth when exposed in the evening

3. Perform near tasks later in the day and take frequent breaks from near tasks

• Reading activities (imposing Hyperopic defocus) should be done later in the day as near tasks have shown to increase eye growth in the mornings only
• The 20-20-20 rule suggests taking a break every 20 minutes, looking at something at least 20 feet away, for 20 seconds to reduce fatigue and eye strain.

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