It’s remarkable how quickly we became used to pandemic measures with relative alacrity that working from home and zoom calls all became mundane, run-of-the-mill activities. But does this mean we are now getting accustomed to diseases of pandemic proportions that we don’t recognize them for the threat that they are? The myopia pandemic is real and it’s one of the most troubling trends in ophthalmic care today.
When COVID-19 emerged as a pandemic, governments were quick to act with massive interventions. National lockdowns and restrictions on personal movement were just some of the protocols that were put in place to manage the crisis. Huge upticks in healthcare spending became the norm.
Granted, myopia is not as novel and fatal as COVID-19 so the lack of attention on the public’s part is perhaps understandable, but the condition has already reached pandemic proportions and it now represents a serious threat to global healthcare industries. As such, myopia should be made a priority by optometrists, ophthalmologists, and other key stakeholders, as without profound intervention by medical professionals and governments, most of the global population will be affected by it. That may sound like hyperbole — and perhaps that’s true to a degree, but the facts speak for themselves.
Three out of five people will develop myopia
We spoke with two leading experts on myopia about the spread of the disease in different parts of the world, why we should all be focusing more attention on it, and what can be done to arrest its spread.
Dr. Cheryl Chapman is an orthokeratologist at Gretna Vision Source in Nebraska, USA, and president of the American Academy of Orthokeratology and Myopia Control — and she is particularly concerned about the growing rates of myopia across the world.
“Myopia is on the rise around the world, and, globally, the prevalence of the disease exceeds 28%. Alarmingly, it’s predicted that approximately half of the world’s population (five billion people) will have some degree of myopia by the year 2050. Not only are more children becoming myopic, but the rate of high myopia is also increasing,” shared Dr. Chapman.
“In the United States, the number of myopic patients has increased from approximately 25% in the 1970s to over 40% by 2000; and this figure is predicted to climb to 60% by 2050,” she continued.
That’s a huge increase, and it’s not even the tip of the iceberg as North America is far away from being the epicenter of the myopia crisis — that dubious honor belongs to Asia, specifically the Asia-Pacific region. In this region, myopia is particularly common with prevalence rates of 80% to 90% among young adults. In contrast, the prevalence of myopia is lower in some African and South American countries, with rates typically ranging from 20% to 30%.
Mr. Ryan Ho, optometrist and CEO of Malaya Optical in Petaling Jaya, Malaysia, is on the frontlines in the fight against myopia in Asia. Mr. Ho has witnessed cases of the disease explode in both his country and at his clinic and has noted that it is particularly prevalent in urban areas. He shared that this can be attributed to a number of factors.
“The increasing prevalence of myopia is a major public health concern as it can lead to significant vision impairment and other related health problems. The exact causes of this increase in myopia are still being studied, but it is believed to be associated with a combination of genetic, environmental, and lifestyle factors, including increased screen time and less time spent outdoors,” Mr. Ho said.
“We have seen a significant increase in cases of myopia at our practice over time, especially during the COVID-19 pandemic. Our optometrists are prescribing more myopia control lenses and orthokeratology lenses today than ever before,” he said.
An extra diopter here, even more damage there
Short-sightedness is such a common condition that most members of the lay community wouldn’t look twice at it. And often, they would struggle to understand why so many clinicians are worried about the disease. Granted, many people who have myopia have relatively mild symptoms that are easily treated with lenses, refractive surgery, etc., but for other patients, the consequences are more severe.
Remember the 60% of the American population that was predicted to become myopic by 2050? Out of this group, one in four would be expected to experience vision loss by age 75 for eyes exceeding 26 mm in length — and the bad news doesn’t end there. That’s according to Dr. Chapman, who paints a very bleak picture of how ocular health in the United States will look at this point due to the ongoing march of myopia.
“For every additional 1.00 diopter of power, the risk of pathology in patients with myopia increases as follows: 58% will experience myopia maculopathy, 20% — primary open-angle glaucoma (POAG), 21% — posterior subcapsular cataract, and 30% — retinal detachment,” Dr. Chapman explained.
“In my daily practice, I have seen an uptick in ocular pathology with older myopic patients, much more so than I did 20 years ago when I started practicing,” she continued. “I believe it is a harbinger of the level of pathology we will see a generation from now as more and more of our young myopic patients age. That’s why I am focused on supporting patients who want to start myopia management therapy, and patient education is provided at every exam we perform,” she said.
The profound impacts of myopia
As you can imagine, the impact of myopia on the society is considerable, both in terms of the resulting financial cost and on quality of life. It’s usually diagnosed in children and causes the most severe symptoms in the elderly, two population groups that are naturally more vulnerable to health complaints. From the small scale to the macro, the impact of myopia on societies across the world is profound.
“As myopia can cause difficulty seeing objects at a distance, it can make everyday tasks like driving or watching a movie more difficult. This can lead to frustration and reduced quality of life for those affected. There’s also the increased risk of eye complications as well as associated healthcare costs in some countries,” Mr. Ho said.
“Myopia is a concern not only because of the increased risk of pathology. It is well-documented that myopia affects children’s self-esteem and self-confidence. It impacts their social development and affects participation in activities such as theater, dancing, sports, and other active pastimes. It can also affect career opportunities. So there is an intrinsic cost burden to society of high myopia that progresses to vision loss and beyond,” Dr. Chapman added.
New hope with new options
Myopia is proving to be a difficult condition for governments and medical professionals to manage, and it’s a challenge for overstretched healthcare systems, especially in the wake of COVID-19.
The good news, however, is that while public awareness of the severity of the disease may still be lacking, optometrists and ophthalmologists from around the world are now taking action. Myopia dominates the schedules of almost every ocular health conference and congress today, especially in the Asia-Pacific region where the disease is so entrenched.
Where once the only options available to optometrists were to increase glasses and contact lens prescriptions as the patients’ eyes grow longer in order to maximize their vision, nowadays, there are a number of options on the table.
Dr. Chapman points to orthokeratology, myopia management soft contact lenses, topical low-dose atropine ophthalmic formulations, and myopia management spectacle lenses as all offering real efficacy to ocular health professionals. She also believes in the importance of following the latest technological developments in this field and being ready to make the best use of them.
“I think it is important for optometrists to be aware of the changing landscape and to realize that myopia management is now considered a basic standard of care. As such, it is important to seek proper education to stay abreast of this rapidly developing subspecialty,” advised Dr. Chapman.
“A great resource for this is the American Academy of Orthokeratology and Myopia Control (AAOMC). Their annual conference, Vision By Design, focuses on providing unbiased education and creating a strong peer support network among practitioners seeking to improve better outcomes in myopia treatment,” she continued.
As for Mr. Ho, his advice on how to better manage and control myopia conflagration was focused on the group which is experiencing the greatest rates of the disease — the children. He believes that early intervention is the best policy, especially in urban areas where people appear more vulnerable to myopia. Not only is it all about getting in early, but it’s also about getting into communities and making sure the locals understand the enemy they’re up against.
“At Malaya Optical, we prescribe myopia control prescription lenses or ortho-k lenses to help slow the rate of increase of myopia in kids. We also work to provide vision school for children in harder-to-reach local communities. It’s important to act as a champion for the cause of myopia prevention and reduction,” Mr. Ho enthused.
The way out of the myopia pandemic
It’s this strategy that exemplifies what is likely going to be the only way out of the myopia pandemic — if that’s even entirely possible, and that’s education, both in the professional setting and among the general public.
Educating the former is important and, as we’ve covered, myopia is now receiving the attention it deserves, and optometrists are beginning to be made more aware than ever of the perils of the condition. Enlightening the latter, on the other hand, is a more difficult proposition, a task further complicated by the necessity of liaising between healthcare organizations, public regulatory bodies, schools, and clinics, among others.
For Mr. Ho, the path forward is clear: Public awareness programs and education provided by optometric professionals combined with early intervention will alleviate the treatment burden caused by myopia as it’s targeted at the most vulnerable groups. This process has to be ‘from cradle to grave,’ and people working in optometry must consider how to properly teach their pediatric patients about the dangers of myopia, and why it’s so important to treat the disease.
“Myopia as a disease is not receiving the attention it deserves, both from the public and the medical field. We can get it the attention it deserves via more public education, and starting from school and training teachers to detect vision problems at a very young age,” Mr. Ho said.
As for Dr. Chapman, she believes in adopting a cross-discipline, collaborative approach to treating the myopia pandemic, pointing out that it’s thanks to new research and education that new solutions will be found.
Again praising the work of the AAOMC, Dr. Chapman said that organizations like this can provide invaluable support to optometrists, regardless of whether or not they’re based in the US.
The AAOMC and other organizations provide solid support and education, Dr. Chapman said, but it’s up to individual optometrists to take that information and run with it to provide the best possible outcomes for their patients. Where once the medical community lagged behind, it is now recognizing the serious challenge posed by myopia, that spell of ignorance is now broken, and there is good reason to be optimistic about the direction of cooperation, research, and more.
“We are still in the infancy of modern-day myopia management. The growth of new research and studies is exponential and new information is coming out at such a rapid rate that it is difficult to stay informed if you are not extremely focused on it. As such, there is a natural lag with educating the public and medical fields that have their attentions elsewhere,” Dr. Chapman said.
“This firmly places the responsibility in the hands of optometry. We are uniquely poised to make this one of our greatest legacies. Supporting organizations such as the AAOMC is a prime way that optometrists can help bring attention to the myopia pandemic,” she concluded.
Editor’s Note: This article was first published in COOKIE magazine Issue 11.
