Myopia Management

What to know about myopia

Myopia has typically been viewed as an inconvenience treated with simple glasses or contacts. We now know it's so much more. Myopia is a chronic, progressive disease, that can lead to blindness later in life.^1-3

Why does myopia matter?

Chronic & progressive disease^1-3

Due to the excessive elongation of the eye, myopia can lead to increased risk of sight-threatening complications later in life.^1-3The benefits of proactively treating myopia outweigh the risks of leaving children untreated.

Myopia is a growing public health crisis⁴

By 2050, more than half of the world’s population is projected to be myopic.⁵Children in the first wave of high myopia prevalence (those born after 1970) are now on the cusp of experiencing sight-threatening complications as adults.^6-8

All children should be monitored, and treated once diagnosed⁹

From an early age, measuring and monitoring both axial length and refractive error is highly recommended in all children.⁹ It is important not to “wait and see” for progression before starting treatment in children once they are diagnosed.

Every diopter of myopia increases risk of ocular disease^10-11

No safe level of myopia

While high levels of myopia tend to increase the risk of sight-threatening complications later in adulthood, there is no safe level of myopia.¹

Every diopter matters. Even lower levels of myopia are associated with an increased risk of eye issues.¹⁰

For example, every additional diopter of myopia increases the risk of Myopic Macular Degeneration by 67%.¹⁰

Degree of Myopia and Likehood of Complications ⁸

	-0.50 to -3.00 D	-3.00 to -6.00 D	-6.00 D or more myopic
MMD	13.6	73	846
Retinal Detachment	3.2	8.8	12.6
Visual Impairment	0.9	1.7	5.5

Risk factors for myopia

Minimal time outdoors¹²

Less than 2 hours/day

Genetics¹⁴

Myopic parents

Near work¹³

Near work activities like reading and screen-time for longer duration or short working distance

Age of Onset^,15

Developing myopia at a younger age increases progression risk

Likelihood of myopia progression or onset and recommended clinical action by age and refractive status¹⁶

REFRACTIVE STATUS	Pre-myopia* (≤ 12 yrs)	Myopia (≤ 12 yrs)	Myopia (13+ yrs)
PROBABILITY	Myopia onset highly likely	Progression highly likely	Progression possible
CLINICAL ACTION^†	Close monitoring^‡	Myopia management highly recommended	Present myopia management

^*Pre-myopia is defined as a refractive error of ≤ +0.75 D and > -0.50 D in a child when accommodation is relaxed²⁰

^† Lifestyle guidance is a suggested component.

^‡ Treatment of pre-myopia is at the discretion of the parent/patient and clinician.

Make a difference in your myopia patient's lives

No matter where you are in your myopia management journey, you can immediately recommend simple but impactful lifestyle changes to help delay the onset or manage the progression of your patient’s myopia, including:

More time outdoors¹⁷

Reducing near work¹⁸

Taking breaks from near work¹⁹

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Clinical resources

Practice management resources

Patient education resources

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References

1. Flitcroft DI. The complex interactions of retinal, optical and environmental factors in myopia aetiology. Prog Retin Eye Res. 2012;31(6):622-660.
2. Donovan L, Sankaridurg P, Ho A et al Myopia progression rates in urban children wearing single-vision spectacles. OVS 2012;89(1):27-32.
3. Pärssinen O, Kauppinen M. Risk factors for high myopia: a 22-year follow-up study from childhood to adulthood. Acta Ophthalmologica. 2019;97(5):510-518.
4. Holy C, Kulkarni K, Brennan NA. Predicting Costs and Disability from the Myopia Epidemic – A Worldwide Economic and Social Model. Investigative ophthalmology & visual science. 2019;60(9):5466-5466.
5. Holden BA Fricke TR Wilson DA Jong M Naidoo K et al Global Prevalence of Myopia and High Myopia and Temporal Trends from 2000 to 2050. Ophthalmol 2016,123(5):1036-1042
6. Morgan IG, French AN, Ashby RS, et al. The epidemics of myopia: Aetiology and prevention. Prog Retin Eye Res. 2018 Jan;62:134-149.
7. Sensaki S, Sabanayagam C, Verkicharla PK, Awodele A, Tan KH, Chia A, Saw SM. An Ecologic Study of Trends in the Prevalence of Myopia in Chinese Adults in Singapore Born from the 1920s to 1980s.
Ann Acad Med Singap. 2017 Jun;46(6):229-236.
8. Haarman AEG, Enthoven CA, Tideman JWL, et al. The Complications of Myopia: A Review and Meta-Analysis. Invest Ophthalmol Vis Sci. 2020 Apr 9;61(4):49.
9. American Optometric Association Comprehensive Pediatric Eye and Vision Examination Evidence-Based Clinical Practice Guidelines. 2017.
10. Bullimore MA, Brennan NA. Myopia Control: Why Each Diopter Matters. Optom Vis Sci 2019;96:463-5.
11. Bullimore MA, Ritchey ER, Shah S, et al. The Risks and Benefits of Myopia Control. Ophthalmology 2021;128:1561-79.
12. Wu PC, Chen CT, Chang LC, Niu YZ, Chen ML, Liao LL, Rose K, Morgan IG. Increased Time Outdoors Is Followed by Reversal of the Long-Term Trend to Reduced Visual Acuity in Taiwan Primary School Students. Ophthalmology. 2020 Nov;127(11):1462-1469. doi: 10.1016/j.ophtha.2020.01.054.
13. Huang HM, Chang DS, Wu PC. The Association between Near Work Activities and Myopia in Children-A Systematic Review and Meta- Analysis. PLoS One. 2015 Oct 20;10(10):e0140419.
14. Tedja MS, Haarman AEG, Mees ter- Smoor MA, Kaprio J, Mackey DA, Guggenheim JA, Hammond CJ, Verhoeven VJM, Klaver CCW; CREAM Consortium. IMI - Myopia Genetics Report. Invest Ophthalmol Vis Sci. 2019 Feb 28;60(3):M89- M105
15. Chua SY, Sabanayagam C, Cheung YB, et al. Age of onset of myopia predicts risk of high myopia in later childhood in myopic Singapore children. Ophthalmic Physiol Opt. 2016; 36:388-94.
16. Zadnik K et al. Prediction of Juvenile Onset Myopia. JAMA Opthalmol 2015;133:683-9.
17. Wu PC, Chen CT, Lin KK, et al. Myopia Prevention and Outdoor Light Intensity in a School- Based Cluster Randomized Trial. Ophthalmology 2018;125:1239-50.
18. Huang PC, Hsiao YC, Tsai CY, Tsai DC, Chen CW, Hsu CC, Huang SC, Lin MH, Liou YM. Protective behaviours of near work and time outdoors in myopia prevalence and progression in myopic children: a
2-year prospective population study. Br J Ophthalmol. 2020 Jul;104(7):956-961.
19. Johnson & Johnson Vision. Schedule an Eye Exam: Tips to Prioritize Your Eyes At Home. https://www.jjvision.com/prioritizeyoureyes.
20. He M, Xiang F, Zeng Y, et al. Effect of time spent outdoors at school on the development of myopia among children in China a randomized clinical trial. JAMA - Journal of the American Medical Association. 2015;314(11):1142-1148.

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What to know about myopia

Why does myopia matter?

Every diopter of myopia increases risk of ocular disease10-11

No safe level of myopia

Degree of Myopia and Likehood of Complications 8

Risk factors for myopia

Minimal time outdoors12

Genetics14

Near work13

Age of Onset,15

Likelihood of myopia progression or onset and recommended clinical action by age and refractive status16