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COLUMNS
The Growing Burden of Uncorrected Myopia in Asia
Eye care practitioners (ECPs) must incorporate myopia management into their practice right now to help reduce the burden of sight-threatening conditions in the future.
by Hamish Thrum

Myopia, or nearsightedness, is the most common ocular disorder worldwide and a leading cause of visual impairment in children.1 A hallmark study published recently predicted that by 2050, over half of the world’s population will be myopic.2

Left unchecked or uncorrected, myopia can progressively worsen. Even individuals with low to moderate myopia (below -6.00 diopters) face a greater risk of sight-threatening disorders later in life including glaucoma, cataract, retinal detachment, and myopic macular degeneration, which can cause severe vision impairment or permanent blindness. The risk of visual impairment increases 3.4 times with myopia between 6.00 diopters and 10.00 diopters, and 22 times when above 10.00 diopters.3

Alarming Rise of Myopia in Asia

The World Health Organization (WHO) has recently designated myopia as a global public health issue, estimating the annual global costs of productivity losses associated with vision impairment from uncorrected myopia at US$244 billion in 2015.5

In East Asian and Southeast Asian countries such as China, Taiwan, Hong Kong, and Singapore, the incidence of myopia is especially high. The annual direct cost of myopia correction for Asian adults has been estimated at US$328 billion per annum with the cost of care also increasing significantly with high myopia.6 These costs can be reduced if myopia is corrected at an earlier stage.

Myopia affects between 80 to 90 per cent of high school graduates in many East Asian countries, of which about 10 to 20 per cent are said to have sight-threatening pathologic myopia.1 Studies have shown the rapid rise of myopia in Asian countries coincides with the increased intensity of pressures in young children to excel academically.7

The COVID-19 pandemic has only exacerbated these issues over the past two years, with children spending more time on near-work activities and classwork with little to no time spent outdoors. According to one Hong Kong study, the estimated one-year incidence of myopia was 28, 26, and 26 per cent for six, seven and eight-year-olds during the pandemic, compared to 17, 15, and 15 per cent pre-pandemic.8

Call for Minimum Standard of Care in Myopia Management

WHO’s recognition of myopia as a global pandemic and the publication of several landmark papers are making governments realise they will be facing an enormous burden to public healthcare systems in future decades if they do not address myopia in childhood. Millions of adults will need treatment for higher complication rates and more serious eye conditions, something that could have been potentially avoided had their myopia been managed in childhood.9

Other organisations have also called for more coordinated action on myopia. The Asia Optometric Management Academy (AOMA) and Asia Optometric Congress (AOC) recently collaborated to create a single region-wide consensus on myopia management.10 The standard practice model provides a systematic approach for practitioners to treat myopic patients, using a holistic approach in the myopia management process. The World Council of Optometry have made a similar resolution,11 and in Australia and New Zealand, a white paper written by the Child Myopia Working Group advocates adopting a standard of care.12

In the next five years, most countries will implement a minimum standard of care requirement for the treatment of children with myopia. This means regardless of whether or not eye care and healthcare practitioners (ECPs and HCPs) are ready for myopia management, it will be the standard of care. So now is the time for ECPs who have yet to incorporate myopia management into their practice to prepare for this important shift in how the profession will manage myopia.

Early Intervention is Crucial

Low levels of myopia may not ring alarm bells, but if left untreated in the early stages, it can worsen and increase the risk of severe sight-related complications later in life. It has been found that even a 1.00 diopter increase in myopia can increase the possibility of myopic maculopathy by 67 per cent. Conversely, slowing myopia by just 1.00 diopter should reduce the individual’s likelihood of myopic maculopathy by 40 per cent.13

Worryingly, despite the risks, many people don’t consider a child requiring vision correction through contact lenses or spectacles a serious concern, especially in East Asia. Parents don’t realise that myopia is much like high blood pressure or diabetes – leaving it unchecked and untreated could lead to serious sight-threatening conditions later in life.

Fortunately, myopia progression can be controlled and slowed down with a combination of lifestyle and treatment approaches, as shown by research. A randomised clinical trial of children aged six to 12 years old in Guangzhou, China showed that children who spent additional time outdoors from 40 minutes to an hour each day had a reduced rate of myopia.14

In addition to spending more time outdoors, some of the tools and treatments we can use to manage myopia include atropine eye drops, spectacles, orthokeratology or “ortho-k” lenses, multifocal contact lenses, and dual-focus contact lenses.15

Pivotal 7-year Study on Dual-focus Contact Lenses on Myopia

Thanks to advancements in research and technology, ECPs now have new tools in their toolkit to manage myopia, such as dual-focus soft contact lenses that have been proven to slow down the progression of the disease while enabling clear vision.

The findings from CooperVision’s pivotal MiSight® 1 day contact lens clinical trial show that myopia progression has been cut by approximately half in children between the ages of eight and 17 years who wore the contact lenses for the first six years of the study.16 This was observed in a cohort that wore MiSight® 1 day for six years as well as the original control group who were switched to MiSight® 1 day after three years.17

The latest findings from the seven-year study demonstrate that myopia control gains were retained and eye growth reverted to the expected age-average myopic progression rates 12 months following treatment cessation.18,19 This is the longest-running soft contact lens study among children for myopia control.

ECPs can now address vision impairment issues caused by myopia at a very early stage. Early intervention reduces the risk of myopia-associated vision impairment and helps retain the eye health of children as they age. Additionally, the study proved that while early intervention and treatment offer the best outcomes, even older children fitted with MiSight® 1 day contact lenses had their myopia progression cut by half.20

As myopia management and control is a relatively new concept in many countries, it is the responsibility of ECPs to detect, report, and manage childhood myopia. By increasing awareness of myopia management and enlisting the support of and equipping ECPs and other healthcare professionals, we hope to help children see well now, and as they grow and age.

§ The products mentioned are not CooperVision products and the data presented is not intended to imply the safety or effectiveness of CooperVision’s multifocal/orthokeratology lenses for myopia control. CooperVision does not endorse the use of off-label prescriptions for myopia management. Centre-distance multifocal contact lenses are widely available in a monthly replacement modality and are not currently approved for myopia control.

References

  1. Mehta, N., & Wen, A. (2019, September). Myopia: A Global Epidemic. Retina Today. Retrieved from https://retinatoday.com/articles/2019-sept/myopia-a-global-epidemic
  2. Holden, B. A., Fricke, T. R., Wilson, D. A., Jong, M., Naidoo, K. S., Sankaridurg, P., ... & Resnikoff, S. (2016). Global prevalence of myopia and high myopia and temporal trends from 2000 through 2050. Ophthalmology, 123(5), 1036-1042.
  3. Holden, B. A., Jong, M., Davis, S., Wilson, D., Fricke, T., & Resnikoff, S. (2015). Nearly 1 billion myopes at risk of myopia-related sight-threatening conditions by 2050–time to act now. Clinical and Experimental Optometry, 98(6), 491-493.
  4. Flitcroft, D. I. (2012). The complex interactions of retinal, optical and environmental factors in myopia aetiology. Progress in retinal and eye research, 31(6), 622-660.
  5. Blindness and vision impairment. World Health Organization. (2021, October 14). Retrieved from https://www.who.int/news-room/fact-sheets/detail/blindness-and-visual-impairment
  6. Chua, S. Y. L., & Foster, P. J. (2020). The Economic and Societal Impact of Myopia and High Myopia. In Updates on Myopia (pp. ٥٣-٦٣). Springer, Singapore.
  7. Morgan, I. G., & Rose, K. A. (2013). Myopia and international educational performance. Ophthalmic and Physiological Optics, 33(3), 329-338.
  8. Zhang, X., Cheung, S. S., Chan, H. N., Zhang, Y., Wang, Y. M., Yip, B. H., ... & Yam, J. C. (2021). Myopia incidence and lifestyle changes among school children during the COVID-19 pandemic: a population-based prospective study. British Journal of Ophthalmology.
  9. Tideman, J. W. L., Snabel, M. C., Tedja, M. S., Van Rijn, G. A., Wong, K. T., Kuijpers, R. W., ... & Klaver, C. C. (2016). Association of axial length with risk of uncorrectable visual impairment for Europeans with myopia. JAMA ophthalmology, 134(12), 1355-1363.
  10. AOMA and AOC Release Consensus on Myopia Management. Review of Myopia Management. (2021, November 29). Retrieved from https://reviewofmm.com/aoma-and-aoc-release-consensus-on-myopia-management/
  11. Resolution: The Standard of Care For Myopia Management by Optometrists. World Council of Optometry . (n.d.). Retrieved from https://worldcouncilofoptometry.info/resolution-the-standard-of-care-for-myopia-management-by-optometrists/
  12. Investigative ophthalmology & visual science, 62(5), 1-7.
  13. Bullimore, M. A., & Brennan, N. A. (2019). Myopia control: why each diopter matters. Optometry and Vision Science, 96(6), 463-465.
  14. He, M., Xiang, F., Zeng, Y., Mai, J., Chen, Q., Zhang, J., ... & Morgan, I. G. (2015). Effect of time spent outdoors at school on the development of myopia among children in China: a randomized clinical trial. Jama, 314(11), 1142-1148.
  15. Ruiz-Pomeda, A., & Villa-Collar, C. (2020). Slowing the progression of myopia in children with the MiSight contact lens: a narrative review of the evidence. Ophthalmology and Therapy, 9(4), 783-795.
  16. Chamberlain, P., Arumugam, B., & Jones, D. (2020). Myopia progression in children wearing dual-focus contact lenses: 6-year findings. Optom Vis Sci, 97, 200038.
  17. Arumugam B, Chamberlain P, Bradley A et al. The Effects of Age on Myopia Progression with Dual-Focus and Single Vision Daily Disposable Contact Lenses. OptomVis Sci 2020;97(E-abstract):205340, AAO 2020 Poster
  18. Chamberlain P, Arumugam B, et al. Myopia progression on cessation of Dual-Focus contact lens wear: MiSight 1 day 7 year findings. OptomVis Sci 2021;98:E-abstract 210049.
  19. Hammond D, Arumugam B, et al. Myopia Control Treatment Gains are Retained after Termination of Dual-focus Contact Lens Wear with no Evidence of a Rebound Effect. OptomVis Sci 2021;98:E-abstract 215130.
  20. Arumugam, B., Bradley, A., Hammond, D., & Chamberlain, P. (2021). Modelling Age Effects of Myopia Progression for the MiSight 1 day Clinical Trial. Investigative Ophthalmology & Visual Science, 62(8), 2333-2333.

About the Author

Dr Galileo Violini

Hamish Thrum, Senior Director of Myopia Asia Pacific (APAC) at CooperVision, has specialised in healthcare for over 20 years. With success in education and business management roles across the medical devices industry, he takes pride in connecting patients with innovative technologies and healthcare providers to create a positive impact in the APAC region and beyond.

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