Reducing the Global Burden of Myopia by Delaying the Onset of Myopia and Reducing Myopic Progression in Children

In 2019, the American Academy of Ophthalmology (AAO) created Task Force on Myopia in recognition substantial global increases myopia prevalence and its associated complications. The Force, led by Richard L. Abbott, MD, Donald Tan, comprised recognized experts prevention treatment, public health from around world, organization representatives Family Physicians, Optometry, Pediatrics. Academy’s Board Trustees believes that is a high-priority cause visual impairment, warranting timely evaluation synthesis scientific literature formulation an action plan to address issue different perspectives. This includes education physicians other care providers, patients their families, schools, local national agencies; defining policies ameliorate patients’ access appropriate therapy promote effective interventions; fostering promising avenues research. common ocular condition increasing impairment globally. has been rising over past several decades, especially East Asia, with projections even greater growth next 50 years. Holden et al1Holden B.A. Fricke T.R. Wilson D.A. al.Global high temporal trends 2000 through 2050.Ophthalmology. 2016; 123: 1036-1042Abstract Full Text PDF PubMed Scopus (1538) Google Scholar estimated number myopic individuals (–0.50 diopter [D] or more myopia) would grow 1406 million people (22.9% population; 95% confidence interval [CI], 932–1932 [15.2%–31.5%]) 4758 (49.8% CI, 3620–6056 [43.4%–55.7%]) 2050 (Fig 1). Similar was predicted for those (?–5.00 D myopia): 163 (2.7% 86–387 [1.4%–6.3%]) 938 (9.8% 479–2104 [5.7%–19.4%]). Although vision loss resulting refractive error can usually be addressed spectacles contact lenses, anatomic changes (i.e., longer axial length) increase patient’s risk uncorrectable developing throughout life, advanced age.2Tideman J.W. Snabel M.C. Tedja M.S. al.Association length Europeans myopia.JAMA Ophthalmol. 134: 1355-1363Crossref (123) Higher degrees are risks complications subsequent loss.2Tideman By 75 years age, 3.8% (0.50 –6.00 39% (–6.00 among Dutch have impairment.2Tideman retinal detachment, cataract, glaucoma, staphyloma, macular degeneration, choroidal neovascularization. It projected will 7 13 times high-risk areas 2055.2Tideman burden posed extends beyond direct costs optical correction socioeconomic impacts3Ang M. Flanagan J.L. Wong C.W. al.Review: control strategies recommendations 2018 WHO/IAPB/BHVI meeting myopia.Br J 2020; 104: 1482-1487PubMed diminished qualify life4Rose K. Harper R. Tromans C. al.Quality life 2000; 84: 1031-1034Crossref (103) Scholar, 5Takashima T. Yokoyama Futagami S. al.The quality pathologic myopia.Jpn 2001; 45: 84-92Crossref (35) 6Queiros A. Villa-Collar Gutierrez A.R. subjects methods using NEI RQL-42 questionnaire.Eye Contact Lens. 2012; 38: 116-121Crossref (37) impairment. corresponding clinical societal impacts necessitate coordinated response. February this concern, Ophthalmology’s determined take leading role addressing need combat development progression basis. As first step, comprising world develop evidence-based white paper rationale early intervention, including approaches outline steps problem. organized spring reviewed summer met person October held online discussions idea exchanges 2020. primary aim explore how could serve best as resource slow myopia. Force’s intent report not duplicate recent rigorous reviews genetics, prevalence, economic costs, epidemiologic features effectiveness safety various interventions reducing progression. Instead, goals provide broad-based overview current evidence focus initiation support important thoughtful, concerted, systematic manner. goal reduce delaying onset children adolescents, hopes preventing severe consequences higher levels objectives help define problem by:1.Educating community, policy makers, general about imposed myopia.2.Assisting broad initiatives prevent myopia, working parents educational authorities create school-based programs incorporate maintain standards while leveraging benefit outdoor time.3.Fostering collaboration researchers, organizations, industry internationally novel control. multifactorial both genetic environmental components. points toward influences such urbanization reduced exposure keys development. Certain populations, within seem particularly at myopia.7Foster P.J. Jiang Y. Epidemiology myopia.Eye (Lond). 2014; 28: 202-208Crossref (228) 8Rahi J.S. Cumberland P.M. Peckham C.S. lifecourse: 1958 British birth cohort.Ophthalmology. 2011; 118: 797-804Abstract (119) 9Park D.J. Congdon N.G. Evidence “epidemic” myopia.Ann Acad Med Singapore. 2004; 33: 21-26PubMed 10Morgan I. Rose How school myopia?.Prog Retin Eye Res. 2005; 24: 1-38Crossref (481) marked rise Asia seems driven primarily exposures (e.g., pressures combined less time).11Wong T.Y. Ferreira Hughes al.Epidemiology disease neovascularization: review.Am 157: 9-25 e12Abstract (360) Several factors studied, gender, race ethnicity, time, near-work activity, status, level, body mass index, exercise activity diet, varying supporting evidence.12Grzybowski Kanclerz P. Tsubota al.A review epidemiology worldwide.BMC 20: 27Crossref (85) Studies examining near work produced inconsistent results, whereas relationship between increased time established firmly.12Grzybowski 13French A.N. Morgan I.G. Mitchell K.A. Risk incident Australian schoolchildren: Sydney Adolescent Vascular Study.Ophthalmology. 2013; 120: 2100-2108Abstract (197) 14Jones L.A. Sinnott L.T. Mutti D.O. al.Parental history sports activities, future myopia.Invest Ophthalmol Vis Sci. 2007; 48: 3524-3532Crossref (477) An association long observed anecdotally, observational studies.15Nickels Hopf Pfeiffer N. Schuster A.K. education: results NHANES 1999–2008.PLoS One. 2019; 14e0211196Crossref (20) 16Mountjoy E. Davies N.M. Plotnikov D. al.Education myopia: assessing direction causality mendelian randomisation.BMJ. 2018; 361k2022Crossref (110) 17Morgan French Ashby R.S. epidemics aetiology prevention.Prog 62: 134-149Crossref (366) 18Cuellar-Partida G. Lu Kho P.F. al.Assessing predisposition Mendelian randomization study.Genet Epidemiol. 40: 66-72Crossref (42) 19Williams K.M. Bertelsen al.Increasing Europe impact education.Ophthalmology. 2015; 122: 1489-1497Abstract (233) 20Han S.B. Jang J. Yang H.K. al.Prevalence adult Korean population: Korea nutrition examination survey 2013–2014 (KNHANES VI).PLoS 14e0211204Crossref bidirectional, 2-sample study Mountjoy al16Mountjoy provided strong causal contributes myopia.16Mountjoy authors found each additional year 0.18-D error. Important factors, degree urbanization, significantly incidence Children urban environments 2.6 likely compared rural when controlling factors.21Rudnicka Kapetanakis V.V. Wathern variations childhood quantitative meta-analysis: implications prevention.Br 100: 882-890Crossref (247) Parental another factor although it modifiable, may identify which require closer monitoring.22Zadnik Satariano W.A. effect parental children’s eye size.JAMA. 1994; 271: 1323-1327Crossref (260) Scholar,23Liao Ding X. Han al.Role status progression: 12-year annual observation Guangzhou Twin Study.Invest 60: 3499-3506Crossref (17) A Liao al23Liao China highly had being adulthood. Additionally, exhibited faster elongation earlier age. Understanding highest allow targeted intervention. Pärssinen Kauppinen24Pärssinen O. Kauppinen 22-year follow-up adulthood.Acta 97: 510-518Crossref (39) approximately 32% who received 8.8 12.8 age progressed least They adulthood baseline spent reading, fewer activities childhood, during onset. Chen al25Chen Zhang He Identifying population centile curves refraction.PLoS 11e0167642Crossref (23) proposed curve, derived population-based data, age-specific severity scale Luong al26Luong L.Q. Shu Y.H. Modjtahedi B.S. al.Racial ethnic differences large, diverse cohort pediatric patients.Invest 61 (Available at: https://arvojournals.org/solr/searchresults.aspx?q=modjtahedi&restypeid=1.): 20Crossref retrospectively evaluated trajectory refractions racially ethnically Southern Californian (n = 11 595) 4 initial refraction –1 –6 After adjusting Southeast Asian showed than White children. simple regression model data Study able predict 12- 13-year-old go experience area under curve 95.27Chen Guo al.Contribution genome-wide significant single nucleotide polymorphisms prediction: findings 10-year Chinese twin children.Ophthalmology. 126: 1607-1614Abstract (10) Additional modeling efforts needed expand our understanding stratification populations. Epidemiologic studies typically spherical equivalent –0.50 –5.00 D28Lin L.L. Shih Y.F. Hsiao C.K. C.J. Prevalence Taiwanese 1983 2000.Ann 27-33PubMed Scholar,29Jung S.K. Lee J.H. Kakizaki H. Jee stature level 19-year-old male conscripts Seoul, South Korea.Invest 53: 5579-5583Crossref (271) Scholar; however, note use noncycloplegic overestimate young adults.12Grzybowski Data 1999–2004 National Health Nutrition Examination Survey (NHANES) suggested 44.7% adults older 20 were (defined D), 6.5% D).30Vitale Ellwein Cotch M.F. United States, 1999–2004.Arch 2008; 1111-1119Crossref (357) Comparison 1971–1972 data31Vitale Sperduto R.D. Ferris 3rd, F.L. Increased States 2009; 127: 1632-1639Crossref (578) indicated 12 54 period two surveys (25.0% vs. 41.6%; P < 0.001). overall overestimated analysis, same methodology used cohorts.31Vitale Willis al’s32Willis J.R. Vitale Morse neovascularization States: analysis IRIS® Registry NHANES.Ophthalmology. 1771-1782Abstract (31) analyses (2005–2008) Intelligent Research Sight 3.92% Theophanous al33Theophanous Batech al.Myopia children.Clin 12: 1581-1587Crossref (41) contemporary estimates California 5 19 broadly representative state’s demographics. reported 41.9% younger (at –1.00 D) 2.7% demonstrated D). However, because these values undergoing routine examinations, they population. Pacific Islander (odds ratio, 1.64; 1.58–1.70) Black 1.08; 1.03–1.13) children.33Theophanous 6 72 months based cycloplegic autorefraction, Los Angeles shown vary race, rates seen (6.6%), followed (3.98%), Hispanic (3.7%), non-Hispanic (1.20%).34Multi-Ethnic Pediatric Disease GroupPrevalence hyperopia 6- 72-month-old African children: Multi-Ethnic 2010; 117: 140-147 e143Abstract (83) Scholar,35Wen Tarczy-Hornoch McKean-Cowdin hyperopia, astigmatism 2109-2116Abstract (124) parallel Baltimore (5.5%) (0.7%).36Giordano Friedman D.S. Repka M.X. preschool 116 (746 e731–e734): 739-746Abstract (132) Among school-aged children, Americans autorefraction 2003:37Kleinstein R.N. Jones Hullett al.Refractive ethnicity children.Arch 2003; 121: 1141-1147Crossref (320) 18.5% 13.2% 6.6% 4.4% lack large-scale nationwide teenagers, limits true Reed al38Reed L.M. Santamaria newly enlisted airmen Joint Base San Antonio.Clin 14: 133-137Crossref (7) enlistees Air (69% men; mean 20.59 years), 45% (more 2% 2004 meta-analysis crude 40 Western Australia 26.6% 16.4%, 4.6% 2.8% having respectively.39Kempen K.E. errors Europe, Australia.Arch 495-505Crossref (491) similarly prevalences 25.4% 4.5%, European Consortium homogenous (?25 <90 age) 98% ancestry. –0.75 present 30.6% (95% 30.4%–30.9%) 2.69%–2.73%) Europeans, respectively.40Williams Verhoeven V.J. Europe: (E(3)) Consortium.Eur 30: 305-315Crossref (217) 2019 India 27.7% adults.41Sheeladevi Seelam B. Nukella P.B. errors, uncorrected error, presbyopia India: review.Indian 67: 583-592Crossref detection rate 31 provinces 57.2% (122 965/215 160) 18 age.42Dong Liu H.B. Wang Z.H. al.[The epidemic secular adolescents aged 7–18 2005 2014].Zhonghua Yu Fang Yi Xue Za Zhi. 2017; 51: 285-289PubMed Significant regional exist myopia,12Grzybowski Scholar,21Rudnicka Asians 15 (69%; credible intervals, 61%–77%) Africans (5.5%; 3%–9%).21Rudnicka Rudnicka al21Rudnicka 23% preceding decade contrast smaller persons pronounced persons. most striking where grown 80% 90% children.43Pan Ramamurthy Saw S.M. Worldwide myopia.Ophthalmic Physiol Opt. 32: 3-16Crossref (520) Scholar,44Ding B.Y. Lin L.L.K. schoolchildren Singapore.Surv 677-697Abstract (73) 96.5%, 21.61% myopia.29Jung comparison, men 83.3% 6.8% respectively.45Lee Kwon W.K. population.Invest 54: 5466-5471Crossref (80) population, cohorts noteworthy. 1.5 Austrian military 2017 13.8% 24.4% 35 years.46Yang Vass Smith al.Thirty-five-year trend participants.Br 1338-1344Crossref (5) Interestingly, consistently lower larger (11.4%–21.7%) (24.5%–29.6%) period.46Yang Taiwan individu