It’s a new year with new challenges and opportunities, however, whatever your resolution was there’s one thing that isn’t going to change in 2023 and that’s the global problem of myopia. Rates of the disease are rising exponentially across the globe and particularly in East Asian countries like China, Japan, Singapore, and others. As such, the condition was a common subject at a number of ophthalmology conferences last year and especially at those events held in the Asia-Pacific region where myopia is so heavily concentrated.
The 15th Congress of the Asia-Pacific Vitreo-Retina Society (APVRS 2022) held last November in Taipei, Taiwan, was one such event where myopia was discussed in depth by many of its attendees, most of whom were coming from the wider East Asia region. High Myopia, which surely should be in contention for the most concise symposium name of 2022, was held on the first day of the conference, November 18, and brought together some of global ophthalmology’s leading minds to discuss how to address the myopia pandemic. The session covered all aspects of the condition, from childhood prevention and vision-threatening complications to treatment therapies and vitreoretinal surgeries. Here are some of the highlights.
Prevention is the Best Intervention
Prevention is the best cure as the saying goes, and we all know that early intervention is crucial in boosting patient outcomes in myopia, so we enjoyed listening to Dr. Jason C.S. Yam’s presentation, the similarly concise Myopia Prevention. Dr. Yam is an associate professor at the Chinese University of Hong Kong (Hong Kong) and was able to draw on his own experience of treating pediatric patients at the university’s department of ophthalmology. In particular, much of his presentation focused on the use of low-concentration atropine for myopia progression, drawing attention to one study involving 438 children aged 4-12 years old who received concentrations of atropine between 0.05% to 0.01% or placebos.
The study found that low-concentration atropine was effective and tolerated at all ranges, with the 0.05% rate proving to be particularly effective at a year-one follow-up. Dr. Yam reported that younger patients predominantly required a higher concentration of atropine and that when this is applied it can prove effective at halting the progression of myopia, especially if utilized consistently over a three-year period from the initial dose. He also reported that the atropine treatment was considerably more effective than other alternatives, such as a washout regimen, and that stopping treatment at an older age with a lower concentration is associated with a smaller rebound.
Five Billion Could be Prone to Glaucoma
Of all the ocular conditions that could rival myopia in terms of prevalence and effect on global populations, glaucoma is absolutely a major contender, which was the subject of a presentation by Dr. Eun Ji Lee, an associate professor at the Seoul National University College of Medicine in South Korea. Keeping the theme of brief names, Glaucoma examined how this disease affects patients already afflicted with myopia and how the combination of both conditions could pose a severe challenge for clinicians in the future. Glaucoma is associated with aging populations after all but it‘s also associated with myopia, and according to Dr. Lee, nearly 5 billion people could be affected by the latter condition by 2050.
The question that Dr. Lee posed is whether myopia is a risk factor for glaucoma or whether the disease is co-incidentally associated, and Dr. Lee reports that the answer is yes, it could be. This is because the ‘peripapillary morphologic changes during myopia progression may increase the risk of developing glaucomatous damage.’ However, this is primarily the case with younger patients as their eyes are at higher risk of damage-induced myopia progression, and in older patients, this means that glaucomatous damage caused by myopia may not progress after time.
Time for a Good Probing
Surgical interventions are always a topic of interest to the Media MICE team and while it’s not the first or indeed second line of treatment in myopia there are of course several high-quality options available. Dr. Tzyy Chang Ho, from the department of ophthalmology at the National Taiwan University in Taipei, walked us through some of the latest developments in myopia surgery. In particular, he spoke about his experience of using an extended long-shaft vitrectomy probe while using a 3D display viewing system in the surgery of highly myopic eyes.
This probe that Dr. Ho referred to was 30 mm-long (3mm longer than standard) with a similarly long axial length, posterior staphyloma, a 25-gauge, and was provided by Alcon (Geneva, Switzerland) for use as part of the Alcon Constellation system. Dr. Ho reported that his preliminary results from using this device showed that out of 86 patients, ‘in two-thirds of cases traditional probes were not long enough to perform surgery without removing the cannula and the lens.’ As the longer probe is also easier to bend and can avoid the removal of the aforementioned ocular aspects, Dr. Ho recommends it, as it can also avoid prolonged retinal contact.
These were just a few highlights from the APVRS session and there are other fascinating lectures available to view online by following the included URL. If you still have your login credentials for the conference you can simply sign in and view the entire symposium at your leisure. If you manage to watch the entire session then let us know what you think by dropping us a comment on our social media pages, we’d love to hear your perspective about the latest developments in high myopia treatment.
Editor’s Note: The 15th Congress of the Asia-Pacific Vitreo-retina Society (APVRS 2022) was held on November 18 to 20, 2022, in Taipei, Taiwan. Reporting for this story took place during the event.