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Nearly 1 billion myopes at risk of myopia-related sight-threatening conditions
by 2050 time to act now
Clin Exp Optom 2015; 98: 491493 DOI:10.1111/cxo.12339
Brien A Holden OAM DSc PhD
Monica Jong PhD BOptom
Stephen Davis MA
David Wilson PhD BEc BA(hons)
Tim Fricke BOptom MSc FAAO
Serge Resnikoff PhD MD
Brien Holden Vision Institute, University of New South
Wales, Kensington, New South Wales, Australia
In March 2015, the World Health Organiza-
tion (WHO) and Brien Holden Vision Insti-
tute (BHVI), held the WHO-BHVI Global
Scientic Meeting on Myopia in Sydney, at
the BHVI, located on the campus of the
University of New South Wales. Key scientists,
researchers and clinical experts from around
the world, supported by the Australian
Government Vision CRC program, joined
together to address the rapidly increasing
prevalence and the visual, social and eco-
nomic impact of myopia.
It was a historic step in placing myopia on the
world health agenda. An important contribu-
tion from the meeting was the denition of my-
opia and high myopia and a description of a
potentially blinding retinal condition associated
with myopia; myopic macular degeneration
(MMD). As a result, future epidemiological sur-
veys will be able to accurately record the num-
ber of people who are blind or permanently
vision impaired from myopia.
This recognition by the WHO will hope-
fully be the catalyst for increased government
engagement with the issue, including greater
support for programs for myopia and invest-
ment in the development of solutions, en-
hancing our capacity to reach populations
with the timely interventions and treatments
this vast problem requires.
The prevalence of myopia has been growing
rapidly, particularly in urban areas of East
Asia, where some ndings have been
astonishing. A study of military conscripts (19-
year-olds) in South Korea found that 97 per
cent of them were myopic.
China, Taiwan,
Singapore have rates of myopia in young
adults of 70 to 80 per cent.
In Western coun-
tries, the prevalence is also increasing, rising
from 25 to 42 per cent among 12 to 54-year-
olds in the United States over the last
30 years,
while a recent study in Australia
found 31 per cent of 17-year-olds to be
We conducted a comprehensive meta-
analysis on prevalence of myopia, in which
we projected the change in prevalence over
the next 35years. We estimated that in 2010,
there were almost two billion people with
myopia but if current trends continue, ve
billion people will be myopic by 2050 (half
the 2050 world population). Of these, almost
one billion people will be highly myopic (5.00
D or more) and at a signicantly increased
risk from sight-threatening conditions asso-
ciated with high myopia, such as retinal
damage, cataract and glaucoma.
The good news is that several promising
approaches to control myopia offer hope that
we can signicantly reduce the number of
people progressing to high myopia and elim-
inate the increased risk of blindness associ-
ated with the condition. What is absolutely
necessary is substantial backing from govern-
ments, health-care systems, education systems
and private funders to support the research
and public health programs, which need to
be implemented to counter this threat.
High myopia (5.00 D or more) signicantly
increases the risk of sight-threatening condi-
tions and is now being recognised as a major
cause of blindness. High myopia increases
the risk of glaucoma (14.4 times for 6.00 D
or more of myopia),
retinal detachment
(7.8 times for 8.00 D or more)
and cataract
(3.3 times for 6.00 D or more of myopia).
The risk of visual impairment is increased
3.4 times with myopia between 6.00 D and
10.00 D and 22 times when above 10.00 D.
Our projections indicate that if current
trends continue, over 900 million people will
have high myopia (5.00 D or more) by 2050
up from around 200 million in 2010. In Singa-
pore, for example, we estimate that nearly
half the population will have high myopia by
Myopic macular degeneration is the cause of
6.3 to 26.1 per cent of cases of blindness in
population studies across the world, being
ranked either the rst, second or third most
frequent cause of blindness in studies con-
ducted on Asian populations and the second
to fth most frequent cause of blindness in
Caucasian populations.
In the general popu-
lation, visual impairment due to myopic
macular degeneration occurs in one to ten
people per 100,000 annually.
Myopic macular degeneration is the lead-
ing cause of monocular blindness in Tajimi,
and the leading cause of new cases
of blindness in Shanghai, China.
ahead of
glaucoma, age-related macular degeneration
and corneal opacity.
The fact that myopic macular degene-
ration is one of the most common causes of
blindness in people with high myopia, re-
mains relatively unknown. Signs of myopic
macular degeneration include atrophic reti-
nal macular changes or subfoveal choroidal
neovascularisation leading to atrophy, in the
presence of high myopia.
Higher levels of myopia are also associated
with other retinal abnormalities such as
chorioretinal atrophy, lattice degeneration,
lacquer cracks, posterior staphyloma, Fuchs
spot, retinal breaks, retinal detachment, reti-
noschisis and posterior vitreous detachment.
The risk of visual loss signicantly increases
with these changes.
The prominent role myopia has in blind-
ness is yet to be ofcially recognised by major
© 2015 Optometry Australia Clinical and Experimental Optometry 98.6 November 2015
bodies such as the WHO, International
Agency for the Prevention of Blindness or
the National Eye Institute in the US. It is
hoped that the recent WHO meeting in Syd-
ney will see this change in attitude toward
Several optical, pharmacological and behav-
ioural interventions have shown promise in
controlling myopia but generally require fur-
ther investigation, clinical evaluation and/or
improvement in performance.
Spectacle interventions tested include ex-
ecutive bifocal lenses, progressive addition
lenses and lenses designed to reduce periph-
eral retinal hyperopic defocus. The most suc-
cessful of these has been executive bifocals
with near prism providing a 51 per cent re-
duction in the rate of progress of refractive
error and 34 per cent for axial length.
other option is orthokeratology, which has
also shown promise at 40 to 50 per cent re-
duction in axial length growth,
one long-term (ve years) study observed a
decrease in control of myopia over time
(years four and ve), averaging a 30 per cent
reduction over the ve years.
Pharmacological agents that have demon-
strated an ability to slow myopic progression
clinically include: pirenzepine
and atro-
both of which have reported side ef-
fects. The higher concentrations of atropine
such as 0.5% and 1.0% produce side-effects,
such as xed pupils, loss of accommodation
and potentially allergic reactions, with a re-
bound effect observed after cessation of treat-
Low-dose atropine (0.01%) is
proving to be the most effective and com-
monly prescribed in Asia, with a 49 per cent
reduction in myopic progression
and fewer
side-effects, although the lack of effect on ax-
ial elongation is puzzling. Tablets containing
7-methylxanthine have been reported to re-
duce progression by 66 per cent, by causing
scleral collagen thickening and proliferation
but longer-term studies are needed.
Several studies
have found that in-
creased time outdoors (light exposure) is pro-
tective against myopia and is being widely
tested. Further to this, it appears progression
is slower during summer months, suggesting
that light may play a role.
At the moment, the best approach may be
a combination of interventions, but evidence
is needed on interventions that work
What is heartening, is that a model based
on the data of Vitale, Sperduto and Ferris
and assuming a 50% reduction in the rate of
progression of myopia (commencing treat-
ment at the age of seven years) would result
in almost 90% per cent fewer high myopes
(5.00 D or more).
This would substantially
reduce the risks of sight-threatening compli-
cations of myopia later in life.
What we do know is that we need to ring the
alarm bell now and co-ordinate our efforts
and resources to bring this issue to the atten-
tion of the world. Outside of Asia, myopia is
not generally regarded as a public health issue.
To build on the momentum generated by
the WHO-BHVI Global ScienticMeetingon
Myopia, we are launching The Myopia Insti-
tutein the near future aglobalcollaboration
of researchers, public health specialists, op-
tometrists and ophthalmologists, to deliver
the knowledge and information needed to
inform the world about the global challenge
of myopia (
This virtual organisationwill investigate
and report on evidence-based strategies for
reducing visual impairment and blindness
caused by myopia. It will provide evidence
for governments, professionals, teachers, chil-
dren and society in general, on the nature of
the potential adverse inuence of myopia on
health, education, social and economic wel-
fare and vision.
Optometry should be on the frontline of this
battle. It not only has a responsibility to pro-
vide the best care to patients but to remain in-
formed about epidemiological trends and
understand the latest range of treatment op-
tions for progressive myopia. Optometry
should also be assuming a leading advocacy
role in raising awareness about this threat, de-
signing broad-based programs and assuming
the position as the profession that can
provide the solutions. We have professional
bodies, non-government organisations and
research and educational institutions to un-
dertake much of the formal advocacy work
and we need to engage with and contribute
to these. Control of myopia brings a broader,
therapeutic commitment to controlling re-
fractive errors and thereby better serves the
eye-care needs of all people, especially
children. Myopia brings a threat but at the
same time, an inspiring challenge that we
can meet at the individual level.
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Guest Editorial
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Guest Editorial
© 2015 Optometry Australia Clinical and Experimental Optometry 98.6 November 2015
... It is accepted as the major cause of visual loss by World Health Organization if not corrected properly [1]. The prevalence of myopia is 28.3% and high myopia is 4.0% globally and by 2050 these figures are expected to increase to 49.8% and to 9.8%, respectively [2,3]. This means myopia and high myopia will affect nearly 5 billion people and 1 billion people by 2050 [3,4]. ...
... The prevalence of myopia is 28.3% and high myopia is 4.0% globally and by 2050 these figures are expected to increase to 49.8% and to 9.8%, respectively [2,3]. This means myopia and high myopia will affect nearly 5 billion people and 1 billion people by 2050 [3,4]. This increase is expected to create a significant economic burden since most of the myopic patients are at working age [3]. ...
... This means myopia and high myopia will affect nearly 5 billion people and 1 billion people by 2050 [3,4]. This increase is expected to create a significant economic burden since most of the myopic patients are at working age [3]. ...
Full-text available
Purpose To grade myopic choroidal neovascularization (CNV) patients according to the new myopic maculopathy classification (A: atrophy, T: traction, N: neovascularization-ATN) and analyze the correlation in between atrophy, traction and neovascularization. Methods Fifty-one eyes of 41 patients with the diagnosis of pathologic myopia and myopic CNV were included in this clinical practice study. Patients were graded according to the recently described ATN classification. Color fundus photographs were used to grade the atrophy and spectral domain optical coherence tomography scans were used to grade traction and neovascularization. Active myopic CNVs were treated with intravitreal anti-vascular endothelial growth factor (VEGF) injections. Chi-square test was used to test the categorical variants and univariate logistic regression analysis was used to predict the independent risk factors of myopic CNV scar formation. Results Active myopic CNV was observed most frequently in the group with patchy chorioretinal atrophy. Grade of the atrophy and female gender were significantly associated with myopic CNV scar in the univariate logistic regression tests. Multivariate logistic regression showed that atrophy grading is the independent predictor of myopic CNV scar. Conclusion ATN classification is a practical and comprehensive system to grade myopic CNV. Atrophy is an independent predictor for myopic CNV scar and patchy chorioretinal atrophy requires a more careful examination and close follow-up for the risk of CNV development.
... Globally, myopia affected 22.9% of the world's population in 2000, with projections of an increase to 49.8% by 2050 affecting 4.8 billion people [2], representing a 117% increase over 50 years. According to a 2015 report, it was estimated that globally, about 1.89 billion people are myopic and 170 million have high myopia [3]. ...
... D can significantly affect vision to be regarded as a cause of moderate visual impairment and blindness, respectively [8]. Apart from its direct impact on visual impairment, high myopia [usually defined as a spherical equivalent � 5.00D [4,9,10] of myopia, although the definitions used to grade myopia are variable] increases the risk of potentially blinding ocular pathologies such as retinal holes; retinal tears; retinal degeneration; retinal detachment; and myopic macular degeneration [3,11]. Uncorrected myopia has huge social, economic, psychological and developmental implications [12]. ...
... Globally, myopia affected 22.9% of the world's population in 2000, with projections of an increase to 49.8% by 2050 affecting 4.8 billion people [2], representing a 117% increase over 50 years. According to a 2015 report, it was estimated that globally, about 1.89 billion people are myopic and 170 million have high myopia [3]. ...
... D can significantly affect vision to be regarded as a cause of moderate visual impairment and blindness, respectively [8]. Apart from its direct impact on visual impairment, high myopia [usually defined as a spherical equivalent � 5.00D [4,9,10] of myopia, although the definitions used to grade myopia are variable] increases the risk of potentially blinding ocular pathologies such as retinal holes; retinal tears; retinal degeneration; retinal detachment; and myopic macular degeneration [3,11]. Uncorrected myopia has huge social, economic, psychological and developmental implications [12]. ...
Full-text available
Purpose: Increased prevalence of myopia is a major public health challenge worldwide, including in Africa. While previous studies have shown an increasing prevalence in Africa, there is no collective review of evidence on the magnitude of myopia in African school children. Hence, this study reviews the evidence and provides a meta-analysis of the prevalence of myopia in African school children. Methods: This review was conducted using the 2020 Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Five computerized bibliographic databases, PUBMED, Scopus, Web of Science, ProQuest, and Africa Index Medicus were searched for published studies on the prevalence of myopia in Africa from 1 January 2000 to 18 August 2021. Studies were assessed for methodological quality. Data were gathered by gender, age and refraction technique and standardized to the definition of myopia as refractive error ≥ 0.50 diopter. A meta-analysis was conducted to estimate the prevalence. Significant heterogeneity was detected among the various studies (I2 >50%), hence a random effect model was used, and sensitivity analysis was performed to examine the effects of outliers. Results: We included data from 24 quality assessed studies, covering 36,395 African children. The overall crude prevalence of myopia over the last two decades is 4.7% (95% CI, 3.9-5.7) in African children. Although the prevalence of myopia was slightly higher in females (5.3%, 95%CI: 4.1, 6.5) than in males (3.7%, 95% CI, 2.6-4.7; p = 0.297) and higher in older [12-18 years 5.1% (95% CI, 3.8-6.3) than younger children (aged 5-11 years, 3.4%, 95% CI, 2.5-4.4; p = 0.091), the differences were not significant. There was a significantly lower prevalence of myopia with cycloplegic compared with non-cycloplegic refraction [4.2%, 95%CI: 3.3, 5.1 versus 6.4%, 95%CI: 4.4, 8.4; p = 0.046]. Conclusions: Our results showed that myopia affects about one in twenty African schoolchildren, and it is overestimated in non-cycloplegic refraction. Clinical interventions to reduce the prevalence of myopia in the region should target females, and school children who are aged 12-18 years.
... Относительно недавно, буквально последние 100 лет, отмечается прогрессивный рост заболеваемости миопией. Согласно прогнозам, к 2050 году почти 5 миллиардов человек будут близорукими и приблизительно у 1 миллиарда из них будут высокие риски развития серьезных заболеваний органа зрения [2]. ...
«Эпидемия близорукости», охватившая мир во второй половине XX века, по прогнозам, приведет к тому, что каждый второй житель планеты к 2050 году будет иметь миопическую рефракцию. Мероприятия по предотвращению развития этого сценария включают также исследование факторов, влияющих на возникновение и прогрессирование близорукости. Кроме генетических факторов, значимой представляется роль используемой пациентом коррекции миопии. Дуализм подходов врачей-офтальмологов к назначению коррекции близорукости основой своей имеет противоречивость результатов исследований середины прошлого века или современности. В этой статье авторами проводится анализ известных клинических исследований, а также собственных наблюдений в области назначения коррекции близорукости. Анализу были подвергнуты амбулаторные карты пациентов, всего обследовано 20 случаев (n=20) миопии разных степеней. Всем пациентам были проведены измерения клинической рефракции в условиях циклоплегии и измерение передне-заднего размера глаза. Предварительные результаты работы показывают, что назначение неполной коррекции при близорукости слабой и средней степеней у пациентов младшего и среднего школьного возраста (9–15 лет) приводит к значимому росту глаза в сагиттальном размере и усилению клинической рефракции. Использование же полной коррекции миопии у пациентов этой группы уже в первые 6 месяцев вызывало снижение темпов роста этих показателей. В то время как в более старшем возрасте и при миопии высокой степени заметных различий при назначении полной и неполной коррекции не выявлено. Авторами делаются выводы об актуальности полной коррекции близорукости, особенно пациентам в возрасте до 15 лет. The "epidemic of myopia" that swept the world in the second half of the XX century, according to forecasts, is predicted to lead to the fact that every second inhabitant of the planet by 2050 will have myopic refraction. Measures to prevent the development of this scenario also include the study of factors influencing the onset and progression of myopia. In addition to genetic factors, the role of myopia correction used by the patient seems to be significant. The dualism of ophthalmologists’ approaches to prescribing the correction of myopia is based on the inconsistency of the results of studies from the middle of the last century or the present. In this article, the authors analyze well-known clinical studies, as well as their own observations in the field of prescribing correction of myopia. Outpatient patient records were analyzed, a total of 20 cases (n=20) of myopia of various degrees were examined. All patients underwent measurements of clinical refraction in conditions of cycloplegia and measurement of anterior-posterior eye size. Preliminary results show that the appointment of incomplete correction for mild and moderate myopia in patients of primary and secondary school age (9–15 years) leads to a significant growth of the eye in sagittal size and increased clinical refraction. The use of full correction of myopia in patients of this group already in the first 6 months caused a decrease in the growth rate of these indicators. While at an older age and with a high degree of myopia, there were no noticeable differences in the appointment of complete and incomplete correction. The authors draw conclusions about the relevance of complete correction of myopia, especially for patients under the age of 15.
... States, East Asia, and worldwide. 1,2 The serious implications of these trends are being recognized. 3,4 Various methods of treatment for myopia and myopic progression have been prescribed and studied in an effort to determine one that is effective, safe, and that patients will be compliant with. ...
Intervention to slow axial elongation and progressing degree of myopia has become an important public health issue. Although orthokeratology (OrthoK) has been prescribed to temporarily reduce or eliminate refractive error, myopic children undergoing OrthoK have shown significant slowing of axial elongation and myopic progression. This review presents data on the efficacy, benefits, and risks of the use of OrthoK to slow axial elongation in myopic children. It also discusses how OrthoK fits into an overall strategy of myopia management in practice compared with alternative prescribed interventions to slow myopic progression. Other factors discussed are patient candidacy, impact on vision-related quality of life, and use of OrthoK in combination with pharmaceutical agents. With precise fitting, careful follow-up, and patient compliance with recommended lens cleaning and disinfection, OrthoK is a safe and effective method to slow axial elongation in children.
Dr Kate Gifford offers an analysis of the safety of myopia controlling contact lens wear in childhood compared to the lifetime risks of eye disease and vision impairment associated with myopia.
Professor Desmond Fonn starts our series on myopia and therapy with a review of the nature of myopia and its current and projected impact.
Myopic traction maculopathy (MTM), one of the complications of pathologic myopia, is a spectrum of pathological conditions that are attributed to tractional changes in the eye characterised by retinoschisis, lamellar or full thickness macular hole, and foveal retinal detachment. Considering the global public health burden of MTM and pathologic myopia, it is important to understand these sight-threatening complications and their associations. We conducted an evidence-based review of the prevalence and natural history of MTM and associated risk factors. The prevalence of MTM in the general population is low, but is increased among high myopes. MTM is associated with preretinal tractional structures, myopic refractive error and axial elongation, posterior staphyloma, dome-shaped macula, chorioretinal atrophy, and myopic macular degeneration. The clinical course of MTM tends to be stable; however, MTM may progress, resulting in visual acuity deterioration, although spontaneous improvement also occurs. The associations of MTM progression include vitreous traction, location, and extent of MTM, and lamellar macular hole-specific factors. More high-quality population-based studies that assess MTM prevalence and natural history are needed.
Purpose: To evaluate the trans-ancestry portability of current myopia polygenic risk scores (PRS) to predict high myopia (HM) and myopic macular degeneration (MMD) in an Asian population. Design: Population-based study. Subjects: A total of 5,894 (2,141 Chinese, 1,913 Indians and 1,840 Malays) adults from the Singapore Epidemiology of Eye Diseases (SEED) study were included in the analysis. The mean age was 57.0 (standard deviation, SD = 9.31) years. A total of 361 adults had HM (spherical equivalent, SE <-5.00D) from refraction measurements, 240 individuals were diagnosed with MMD graded by the Meta-PM criteria from fundus photographs and 3,774 individuals were controls without myopia (SE >-0.5D). Methods: The PRS, derived from 687,289 HapMap3 SNPs from the largest genome-wide association study of myopia in Europeans to-date (n = 260,974), was assessed on its ability to predict HM and MMD versus controls. Main outcome measures: The primary outcomes were the area under the receiver operating characteristic curve (AUROC) to predict HM and MMD. Results: The PRS had an AUROC of 0.73 (95% CI: 0.70, 0.75) for HM and 0.66 (95% CI: 0.63, 0.70) for MMD versus no myopia controls. The inclusion of the PRS with other predictors (age, sex, educational attainment (EA), and ancestry; age-by-ancestry; sex-by-ancestry and EA-by-ancestry interactions; and 20 genotypic principal components) increased the AUROC to 0.84 (95% CI: 0.82, 0.86) for HM and 0.79 (95% CI: 0.76, 0.82) for MMD. Individuals with a PRS in the top 5% had 4.66 (95% CI: 3.34, 6.42) times higher risk for HM and 3.43 (95% CI: 2.27, 5.05) times higher risk for MMD compared to the remaining 95% of individuals. Conclusion: The PRS is a good predictor for HM and will facilitate the identification of high-risk children to prevent myopia progression to HM. In addition, the PRS also predicts MMD and will help to identify high-risk myopic adults who require closer monitoring for myopia-related complications.
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Several haplotypes of the cone opsin genes, OPN1LW and OPN1MW , cause exon 3-skipping during pre-messenger RNA splicing and are associated with high-myopia (nearsightedness). Cone photoreceptors expressing these haplotypes have substantially less photopigment than cones in the same retina expressing non-exon-skipping haplotypes. Thus, we hypothesized that abnormal contrast signals arising from adjacent cones with different amounts of photopigment stimulate axial elongation of the eye, causing myopia. If so, opsin gene haplotypes exhibiting milder exon-skipping might be associated with common juvenile-onset myopia, and it may be possible to use contrast-reducing spectacles to slow myopia progression. We present experimental evidence that opsin gene haplotypes are major risk factors for juvenile-onset myopia rivaling all other known polymorphisms combined. Moreover, contrast-reducing lenses significantly slowed axial elongation of eyes of myopic children, thereby slowing the progression of myopia. Combined, contrast-reducing spectacles and early intervention through genetic identification of myopia-susceptible children illuminate a pathway to end myopia.
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Objective To study the frequency and causes of visual impairment in relation to refractive error. Design Population-based cohort study. Participants A total of 6597 participants from Rotterdam Study I (baseline and 4 follow-up examinations) and 2579 participants from Rotterdam Study II (baseline and 2 follow-up examinations), all 55 years or older, were included. Methods Participants underwent an extensive ophthalmic examination, including best-corrected visual acuity and objective refraction, fundus photography, visual field perimetry, and optical coherence tomography imaging of macula and optic disc. We calculated cumulative risks and odds ratios of visual impairment for various refractive error categories and determined causes by using all screening information as well as medical records. Main Outcome Measures Unilateral and bilateral low vision (World Health Organization [WHO] criteria, VA <0.3 and VA ≥0.05; United States (US) criteria, VA <0.5 and VA ≥0.1) and blindness (WHO criteria, VA <0.05; US criteria, VA<0.1). Results Cumulative risks of visual impairment ranged from virtually 0 in all refractive error categories at 55 years of age to 9.5% (standard error, 0.01) for emmetropia and 15.3% (standard error, 0.06) for high hyperopia to 33.7% (standard error, 0.08) for high myopia at 85 years of age. The major causes of visual impairment in highly hyperopic persons were age-related macular degeneration (AMD), cataract, and combined causes (each 25%); in highly myopic persons, the major cause was myopic macular degeneration (38.9%). The major causes of visual impairment for the other refractive error categories were AMD and cataract. Compared with those with emmetropia, those with high myopia had a significantly increased lifetime risk of visual impairment; those with −6 diopters (D) or less and −10 D or more had an odds ratio (OR) risk of 3.4 (95% confidence interval [CI], 1.4–8.2) of visual impairment; those with less than −10 D had an OR of 22.0 (95% CI, 9.2–52.6). Conclusions Of all refractive errors, high myopia has the most severe visual consequences. Irreversible macular pathologic features are the most common cause of visual impairment in this group.
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Importance: Myopia is a significant public health problem, making it important to determine whether a bifocal spectacle treatment involving near prism slows myopia progression in children. Objective: To determine whether bifocal and prismatic bifocal spectacles control myopia in children with high rates of myopia progression and to assess whether the treatment effect is dependent on the lag of accommodation and/or near phoria status. Design, setting, and participants: This 3-year randomized clinical trial was conducted in a private practice. A total of 135 (73 female and 62 male) Chinese-Canadian children (aged 8-13 years; mean [SE] age, 10.29 [0.15] years; mean [SE] myopia, -3.08 [0.10] D) with myopia progression of at least 0.50 D in the preceding year were randomly assigned to 1 of 3 treatments. A total of 128 (94.8%) completed the trial. Interventions: Single-vision lenses (control, n = 41), +1.50-D executive bifocals (n = 48), and +1.50-D executive bifocals with 3-Δ base-in prism in the near segment of each lens (n = 46). MAIN OUTCOMES AND MEASURES Myopia progression (primary) measured using an automated refractor following cycloplegia and increase in axial length (secondary) measured using ultrasonography at intervals of 6 months for 36 months. RESULTS Myopia progression over 3 years was an average (SE) of -2.06 (0.13) D for the single-vision lens group, -1.25 (0.10) D for the bifocal group, and -1.01 (0.13) D for the prismatic bifocal group. Axial length increased an average (SE) of 0.82 (0.05) mm, 0.57 (0.07) mm, and 0.54 (0.06) mm, respectively. The treatment effect of bifocals (0.81 D) and prismatic bifocals (1.05 D) was significant (P < .001). Both bifocal groups had less axial elongation (0.25 mm and 0.28 mm, respectively) than the single-vision lens group (P < .001). For children with high lags of accommodation (≥ 1.01 D), the treatment effect of both bifocals and prismatic bifocals was similar (1.1 D) (P < .001). For children with low lags (<1.01 D), the treatment effect of prismatic bifocals (0.99 D) was greater than of bifocals (0.50 D) (P = .03). The treatment effect of both bifocals and prismatic bifocals was independent of the near phoria status. Conclusions and relevance: Bifocal spectacles can slow myopia progression in children with an annual progression rate of at least 0.50 D after 3 years. These results suggest that prismatic bifocals are more effective for myopic children with low lags of accommodation. TRIAL REGISTRATION Identifier: NCT00787579.
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Myopia is the most frequent cause of distance impairment in the world and is creating an alarming global epidemic with deleterious ramifications for the quality of life and economic health of individuals and nations as a whole. In addition to being immediately disadvantageous, myopia increases the risk of serious disorders such as myopic macular degeneration, retinal detachment, glaucoma, and cataract and is a leading cause of visual impairment and blindness across many countries. The reduction in age of onset of myopia is of great concern since the earlier the onset, the more myopic the individual will become, with all the attendant increased risks of accompanying debilitating eye conditions. The economic burden is great; both in consequences of uncorrected refractive error and also in the provision of devices for correcting visual acuity. Earlier onset of myopia increases the lifetime economic burden related to loss of productivity and independence, leading to a reduced quality of life. Recent data suggest addressing accommodation per se has little direct amelioration of myopia progression. Pharmacological interventions that effect changes in the sclera show promising efficacy, whereas optical interventions based on a myopic shift in the retinal image are proving to effect up to 55% reduction in the rate of progression of myopia. Early contact lens and spectacle interventions that reduce the rate of progression of myopia are able to significantly reduce the burden of myopia. These non-pharmacological interventions show profound promise in reducing the overall associated morbidity of myopia.Eye advance online publication, 20 December 2013; doi:10.1038/eye.2013.256.
The objective of this case-control study of idiopathic retinal detachment was to evaluate previously suggested hypotheses about risk factors for retinal detachment and to investigate whether new ocular or systemic risk factors could be identified. Between 1986 and 1990, data were obtained at five US clinical centers on 253 patients with idiopathic retinal detachment and 1,138 controls. Patients with pathologic myopia were excluded. Data were collected from interviews, clinical examinations, and laboratory analyses of blood samples. Only one clearly relevant risk factor, myopia, emerged from the analyses. An eye with a spherical equivalent refractive error of −1 to −3 diopters had a fourfold increased risk of retinal detachment compared with a nonmyopic eye; if the refractive error was greater than −3 diopters, the risk was increased 10-fold. The data suggest that almost 55% of nontraumatic detachments in eyes without previous surgery are attributable to myopia. The etiology of retinal detachment appears to be related to the architecture of the eye. The study found no evidence that systemic factors, particularly cardiovascular factors, play a role.
Objective: To investigate the risk factors for rhegmatogenous retinal detachment (RRD), including myopia, blunt trauma, cataract extraction and family history of RRD. Methods: 1:1 case control study was performed on 200 cases with RRD and 200 without RRD (control group). The criteria of controls included: without the history of RRD and a good match with cases in age, sex and residential area. The odds ratio (ORs) and population attributed risk proportion (PARPs) of the risk factors were calculated and tested. Results: The ORs of blunt trauma, myopia, cataract extraction and family history of RRD were 6.55 (95% CI, 2.65 ∼ 25.32, P < 0.001), 5.34 (95% CI, 2.27 ∼ 6.69, P < 0.001), 21 (95% CI, 3.35 ∼ 99, P < 0.001) and 3 (95% CI, 0.24 ∼ 0.99, P > 0.05), respectively. The PARPs of blunt trauma, myopia and cataract extraction were 12%, 62% and 9.1%, respectively. Conclusion: Myopia, blunt trauma, and cataract extraction are risk factors for RRD, and family history of RRD is not found to be related to RRD.
Objective: To investigate the efficacy of different administration of 1% atropine gel on the myopia progression in adolescents with low myipia. Design: Prospective comparative case series. Participants: 150 cases (300 eyes) myopic children between 9 to 12 years old, who visited to optometry clinic in Ningbo Eye Hospital between January 2011 and April 2011, whose diopters were -0.50 to -1.50 DS. Methods: 150 cases were divided randomly into three groups (50 cases in each group). Control group: used 1% atropine gel one time every night. Group B: twice a week. Group C: one time every week. All the participants were followed up for two years with return visiting every three months. Main Outcome Measures: Visual acuity, refraction, intraocular pressure, the axial length of the eyes. Results: 133 children completed the two-year follow-up, in which 38 cases in the group A, 47 cases in the group B, and 48 cases in the group C. The dropout rate was 11.3%. After treatment, the myopia diopter progression in the group A, B, and C was (-0.33 ± 0.11) D, (-0.36 ± 0.13) D, and (-0.62 ± 0.30) D, respectively. The axial growth was (0.32 ± 0.08) mm, (0.33 ± 0.10) mm, and (0.48 ± 0.17) mm, respectively. The changes of the spherical diopter and axis length between group A and group B were not different significantly (all P > 0.05). Compared with group A and B, the visual acuity was declined, the diopter was increased, and the axis length got longer in the group C (all P < 0.05). Conclusion: Persistent use of 1% atropine eye gel can control effectively the myopia progression in adolescents with low myopia. There is no significant difference between the administration of every day and twice every week. Two times a week medication is more tolerance, which is more suitable for administration.
To conduct a meta-analysis on the effects of orthokeratology in slowing myopia progression. A literature search was performed in PubMed, Embase, and the Cochrane Library. Methodological quality of the literature was evaluated according to the Jadad score. The statistical analysis was carried out using RevMan 5.2.6 software. The present meta-analysis included seven studies (two randomized controlled trials and five nonrandomized controlled trials) with 435 subjects (orthokeratology group, 218; control group, 217) aged 6 to 16 years. The follow-up time was 2 years for the seven studies. The weighted mean difference was -0.26 mm (95% confidence interval, -0.31 to -0.21; p < 0.001) for axial length elongation based on data from seven studies and -0.18 mm (95% confidence interval, -0.33 to -0.03; p = 0.02) for vitreous chamber depth elongation based on data from two studies. Our results suggest that orthokeratology may slow myopia progression in children. Further large-scale studies are needed to substantiate the current result and to investigate the long-term effects of orthokeratology in myopia control.
To study the change in spherical equivalent and other ocular parameters 1 year after stopping the administration of atropine. Prospective randomized double-masked clinical trial. We assigned 400 myopic children, 6 to 12 years of age, to receive atropine 0.5%, 0.1% or 0.01% for 24 months, after which medication was stopped. Parents and children gave informed consent to participate in the research. Children were reviewed at 26, 32 and 36 months, and changes in cycloplegic spherical equivalent (SE), axial length (AL), visual acuity, pupil size, and accommodation were assessed. Of the children, 356 (89%) entered into the washout phase. At entry, there was no significant difference in age, gender, SE, or AL among the children in the various atropine groups. Over the following 12 months, myopic progression was greater in the 0.5% eyes (-0.87 ± 0.52 D), compared to the 0.1% (-0.68 ± 0.45 D) and 0.01% eyes (-0.28 ± 0.33 D, P < 0.001). AL growth was also greater in the 0.5% (0.35 ± 0.20 mm) and 0.1% (0.33 ± 0.18 mm) eyes, compared to the 0.01% eyes (0.19 ± 0.13 mm, P < 0.001). Pupil size and near visual acuity returned to pre-atropine levels in all groups, but accommodation at 36 months was less in the 0.5% eyes (13.24 ± 2.72 D) compared to the 0.1% (14.45 ± 2.61 D) and 0.01% eyes (14.04 ± 2.90 D, P < 0.001). The overall increase in SE over the entire 36 months in the 0.5%, 0.1% and 0.01% groups was -1.15 ± 0.81 D, -1.04 ± 0.83 D and -0.72 ± 0.72 D, respectively (P < 0.001). There was a myopic rebound after atropine was stopped, and it was greater in eyes that had received 0.5% and 0.1% atropine. The 0.01% atropine effect, however, was more modulated and sustained.
To summarize the epidemiology of pathologic myopia and myopic choroidal neovascularization (CNV) and their impact on vision. Systematic literature review of all English-language studies evaluating the epidemiology and visual burden of pathologic myopia or myopic CNV. PubMed and EMBASE were searched with no time limits using predefined search strings for English-language studies evaluating the epidemiology and visual burden of pathologic myopia and myopic CNV. In total, 39 relevant publications were identified. Population-based studies reported pathologic myopia to be the first to third most frequent cause of blindness. The prevalence of pathologic myopia was reported to be 0.9%-3.1%, and the prevalence of visual impairment attributable to pathologic myopia ranged from 0.1%-0.5% (European studies) and from 0.2%-1.4% (Asian studies). The prevalence of CNV in individuals with pathologic myopia was reported to be 5.2%-11.3%, and was bilateral in approximately 15% of patients. All studies of visual outcome in patients with myopic CNV (duration ranging from less than 3 months to 21.5 years) reported deterioration in best-corrected visual acuity over time. Older age, subfoveal CNV location, and larger baseline lesion size were predictors of worse visual outcomes. Pathologic myopia is an important cause of vision loss worldwide, affecting up to 3% of the population. Of these, a substantial proportion of patients develop myopic CNV, which mostly causes a significant progressive decrease in visual acuity. This condition should therefore be a target for new treatment strategies.
Purpose: To examine the risk factors for incident myopia in Australian schoolchildren. Design: Population-based, longitudinal cohort study. Participants: The Sydney Adolescent Vascular and Eye Study (SAVES) was a 5- to 6-year follow-up of the Sydney Myopia Study (SMS). At follow-up, 2103 children were reexamined: 892 (50.5%) from the younger cohort and 1211 (51.5%) from the older cohort. Of these, 863 in the younger cohort and 1196 in the older cohort had complete refraction data. Methods: Cycloplegic autorefraction (cyclopentolate 1%; Canon RK-F1; Canon, Tokyo, Japan) was measured at baseline and follow-up. Myopia was defined as a spherical equivalent refraction of ≤-0.50 diopters (D). Children were classified as having incident myopia if they were nonmyopic at baseline and myopic in either eye at follow-up. A comprehensive questionnaire determined the amount of time children spent outdoors and doing near work per week at baseline, as well as ethnicity, parental myopia, and socioeconomic status. Main outcome measures: Incident myopia. Results: Children who became myopic spent less time outdoors compared with children who remained nonmyopic (younger cohort, 16.3 vs. 21.0 hours, respectively, P<0.0001; older cohort, 17.2 vs. 19.6 hours, respectively, P=0.001). Children who became myopic performed significantly more near work (19.4 vs. 17.6 hours; P=0.02) in the younger cohort, but not in the older cohort (P=0.06). Children with 1 or 2 parents who were myopic had greater odds of incident myopia (1 parent: odds ratio [OR], 3.2, 95% confidence interval [CI], 1.9-5.2; both parents: OR, 3.3, 95% CI, 1.6-6.8) in the younger but not the older cohort. Children of East Asian ethnicity had a higher incidence of myopia compared with children of European Caucasian ethnicity (both P<0.0001) and spent less time outdoors (both P<0.0001). A less hyperopic refraction at baseline was the most significant predictor of incident myopia. The addition of time outdoors, near work, parental myopia, and ethnicity to the model significantly improved the predictive power (P<0.0001) in the younger cohort but had little effect in the older cohort. Conclusions: Time spent outdoors was negatively associated with incident myopia in both age cohorts. Near work and parental myopia were additional significant risk factors for myopia only in the younger cohort. Financial disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.