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MYOPIA MANAGEMENT �

Myopia is often seen as an eye-focusing disor-der, easily corrected with monofocal specta-cles. However, a rising prevalence of myopia has led to a greater emphasis on prescribing myopia control. Myopia affects 27% of people

worldwide, and that prevalence is projected to double by 2050.1 In some Asian countries, the prevalence of myopia can be as high as 84%.2

This article provides several perspectives on the importance of myopia management.

THE MEDICAL PERSPECTIVEIt is essential for clinicians to consider myopia not

just as a refractive disorder, but also as a disease with the potential to cause permanent vision loss. Myopia is associated with an increased risk of retinal complica-tions, cataracts, and glaucoma.3-9 The World Health Organization defines high myopia as spherical equivalent objective refractive error of ≥ -5.00 D in either eye.10 Depending on the magnitude, myopia can increase the risk of retinal detachment by 2.4 to 24.0 times and pri-mary open-angle glaucoma by 2.0 to 2.5 times.9-11 Even low amounts of myopia are associated with increased risk of developing posterior subcapsular cataracts.6

To look at the risk ratios for ocular complications from a different perspective, think of moderate systemic hypertension.12 A systolic blood pressure of 150 mm Hg to 159 mm Hg increases the risk of stroke by 2.2 times.13 Most doctors would agree that this level of elevated blood pressure warrants efforts to prevent stroke and

WHY MYOPIA CONTROL SHOULD BE A PRIORITY

Myopia management is an increasingly important aspect of optometry practice. BY KIM S. DUONG, OD, MS, FAAO

� MYOPIA MANAGEMENT

66 | MARCH 2019

other cardiovascular disease with education and preventive medicine. Although myopic ocular complica-tions may be considered less serious than strokes, the high risks of ocular complications associated with high myopia are concerning and should be addressed clinically.

THE ECONOMIC PERSPECTIVEIn a cross-sectional survey distribut-

ed globally to eye care professionals, 67.5% of respondents reported pre-scribing only single-vision spectacles or contact lenses to manage myopia.14 Of these practitioners, 35.6% reported being concerned about the cost associated with myopia control.14 Practitioners must not be nearsighted about the cost of myopia control.

The cost of optical correction in Singaporean adults alone is estimated

to be about $755 million.15 Vitale et al estimated the direct cost of refrac-tive error in the United States to be between $3.9 billion and $7.2 billion per year.16 The cost of care is expected to increase significantly due to the increasing prevalence of high myopia.16

High myopia causes even greater direct optical costs for patients. For example, high-refractive-index spec-tacle lenses are typically costlier than polycarbonate lenses. Complications from high myopia can lead to increased direct care costs from sur-gery and doctor visits. Indirect costs may result from decreased productiv-ity as a result of vision loss.

THE PATIENT PERSPECTIVEThe patient’s quality of life is

an aspect of myopia that is often overlooked by practitioners; how-

ever, it should be considered in managing myopia. A survey found that orthokeratology had a positive effect on children’s quality of life, with increased self-confidence and par-ticipation in extracurricular activities reported.17 Similar results were found in a randomized study comparing the quality of life of pediatric contact lens wearers with spectacle wearers; pedi-atric contact lens wearers reported improved activity, appearance, and satisfaction with correction compared with spectacle wearers.18

THE PRACTICE MANAGEMENT PERSPECTIVE

Patient education is the most important component of building a myopia control practice. Given that health illiteracy is a common problem in the United States,19 it is important to clearly define myopia and its potential future complica-tions for patients. One study showed that a limited ability to correctly define myopia was not associated with sex, income, or education.20 Therefore, our clinic attempts to explain diagnosis and treatment to patients in simple ways to improve their understanding. To further this goal, our clinic has created consent forms in Spanish and English, bro-chures, and a user-friendly website.

It is also important to explain to patients why myopia progression occurs. Development of myopia is linked to genetics. Patients have a 2.08 times greater chance of becom-ing myopic with one myopic parent and a 5.07 times greater chance with two myopic parents.21 Research

s

The rising prevalence of myopia necessitates greater emphasis on prescribing myopia control.

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Building a myopia control practice will help practitioners provide the highest quality care to young patients.

AT A GLANCE

MYOPIA AFFECTS 27% OF PEOPLE WORLDWIDE,and that prevalence is projected to double by 2050.1

IN SOME ASIAN COUNTRIES, THE PREVALENCE OF MYOPIA CAN BE AS HIGH AS 84%.2

high myopes worldwide by 2050.1

~1 BILLION

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68 | MARCH 2019

also suggests that an increase in myopia prevalence is associated with spending less time outdoors, and not necessarily with near work.21-23

We explain to patients that myopia is likely due to a mixture of environ-mental and genetic factors.24 Our patients always receive a brochure and fact sheet that includes citations of important myopia publications, so they have the opportunity to review the data for themselves.

A TOP PUBLIC HEALTH PRIORITYThe increase in myopia prevalence

has become a major public health concern. It is estimated that there will be almost 1 billion high myopes worldwide by 2050.1 The time to act is now. It is important for practitio-ners to view myopia as a genetic and environmental condition with clear visual and economic effects.

The increase in worldwide urban-ization, which appears to promote myopia development, combined with the increase in economic burden associated with myopia, makes com-

bating myopia a top public health priority.1,25 Providing myopia control education to patients is now consid-ered a standard of care. Building a myopia control practice can help you provide the highest quality care to your young patients. n

1. Holden BA, Fricke TR, Wilson DA, et al. Global prevalence of myopia and high myopia and temporal trends from 2000 through 2050. Ophthalmology. 2016;123(5):1036-1042.2. Lin LL, Shih YF, Hsiao CK, Chen CJ. Prevalence of myopia in Taiwanese schoolchildren: 1983 to 2000. Ann Acad Med Singapore. 2004;33(1):27-33.3. Vongphanit J, Mitchell P, Wang JJ. Prevalence and progression of myopic retinopathy in an older population. Ophthalmology. 2002;109(4):704-711.4. Lim R, Mitchell P, Cumming RG. Refractive associations with cataract: the Blue Mountains Eye study. Invest Ophthalmol Vis Sci. 1999;40(12):3021-3026.5. Younan C, Mitchell P, Cumming RG, Rochtchina E, Wang JJ. Myopia and incident cataract and cataract surgery: the Blue Mountains Eye study. Invest Ophthalmol Vis Sci. 2002;43(12):3625-3632.6. Chang MA, Congdon NG, Bykhovskaya I, Munoz B, West SK. The association between myopia and various subtypes of lens opacity: SEE (Salisbury Eye Evaluation) project. Ophthalmology. 2005;112(8):1395-1401.7. [No authors listed]. Risk factors for idiopathic rhegmatogenous retinal detachment. The Eye Disease Case-Control Study Group. Am J Epidemiol. 1993;137(7):749-757.8. Qiu M, Wang SY, Singh K, Lin SC. Association between myopia and glaucoma in the United States population. Invest Ophthalmol Vis Sci. 2013;54(1):830-835.9. Marcus MW, de Vries MM, Junoy Montolio FG, Jansonius NM. Myopia as a risk factor for open-angle glaucoma: a systematic review and meta-analysis. Ophthalmology. 2011;118(10):1989-1994.10. Preventing blindness in children: report of a WHO/IAPB scientific meeting. Geneva: World Health Organization; 2000.11. Ogawa A, Tanaka M. The relationship between refractive errors and retinal detachment: analysis of 1,166 retinal detachment cases. Jpn J Ophthalmol. 1988;32:310-315.12. Flitcroft DI. The complex interactions of retinal, optical and environmental

factors in myopia aetiology. Prog Retin Eye Res. 2012;31(6):622-660.13. Du X, Cruickshank K, McNamee R, et al. Case-control study of stroke and the quality of hypertension control in north west England. BMJ. 1997;314(7076):272-276.14. Wolffsohn JS, Calossi A, Cho P, et al. Global trends in myopia manage-ment: attitudes and strategies in clinical practice. Cont Lens Anterior Eye. 2016;39(2):106-116.15. Lim MC, Gazzard G, Sim EL, Tong L, Saw SM. Direct costs of myopia in Singapore. Eye (Lond). 2009;23(5):1086-1089.16. Vitale S, Ellwein L, Cotch MF, Ferris FL, Sperduto R. Prevalence of refractive er-ror in the United States, 1999-2004. Arch Ophthalmol. 2008;126(8):1111-1119.17. Zhao F, Zhao G, Zhao Z. Investigation of the effect of orthokeratology lenses on quality of life and behaviors of children. Eye Contact Lens. 2018;44(5):335-338.18. Rah MJ, Walline JJ, Jones-Jordan LA, et al. Vision specific quality of life of pediatric contact lens wearers. Optom Vis Sci. 2010;87(8):560-566.19. Williams MV, Parker RM, Baker DW, et al. Inadequate functional health literacy among patients at two public hospitals. JAMA. 1995;274(21):1677-1682.20. Pucker AD, McBride R, Cox S. Patient understanding of nearsightedness. Poster presented at: American Academy of Optometry Annual Meeting; October 11-14, 2017; Chicago, IL. 21. Jones LA, Sinnott LT, Mutti DO, Mitchell GL, Moeschberger ML, Zadnik K. Parental history of myopia, sports and outdoor activities, and future myopia. Invest Ophthalmol Vis Sci. 2007;48(8):3524-3532.22. Rose KA, Morgan IG, Ip J, et al. Outdoor activity reduces the prevalence of myopia in children. Ophthalmology. 2008;115(8):1279-1285.23. Parssinen O, Lyyra AL. Myopia and myopic progression among schoolchildren: a three-year follow-up study. Invest Ophthalmol Vis Sci. 1993;34(9):2794-2802.24. Goldschmidt E, Jacobsen N. Genetic and environmental effects on myopia development and progression. Eye (Lond). 2014;28(2):126-133.25. Ip JM, Rose KA, Morgan IG, Burlutsky G, Mitchell P. Myopia and the urban environment: findings in a sample of 12-year-old Australian school children. Invest Ophthalmol Vis Sci. 2008;49(9):3858-3863.

KIM S. DUONG, OD, MS, FAAOn Clinical Assistant Professor, The University of

Alabama, Birmingham, Alabaman kduong@uab.edun Financial disclosure: None acknowledged

“ THE INCREASE IN WORLDWIDE URBANIZATION, WHICH APPEARS TO PROMOTE MYOPIA DEVELOPMENT, COMBINED WITH THE INCREASE IN ECONOMIC BURDEN ASSOCIATED WITH MYOPIA, MAKES COMBATING MYOPIA A TOP PUBLIC HEALTH PRIORITY.”