Myopia Care Highlights – From Lenses To Atropine

The session opened with Dr. Nicola Logan (United Kingdom), who presented a survey of global trends in treating myopia, reflecting the growing concern about the disease’s increasing prevalence in children throughout the world. “We are all here today because we have that special interest in myopia, but are we all doing something about it in our clinical practice? Regional differences are affected by scope of practice and availability of options,” said Dr. Logan.

Her presentation identified a number of key takeaways from a global trends survey in myopia management. While contact lenses are growing in popularity, single-vision spectacles remain the most popular myopia correction method.

This is especially true among young myopes. Additionally, she pointed out that eye care professionals have begun to prescribe myopia management contact lenses much more frequently than soft single-vision lenses, which she said is certainly a step in the right direction.

Currently, according to Dr. Logan, eye care professionals consider a patient’s age to be the most important factor when deciding what intervention to use. “I would like to encourage you to consider lifestyle factors to be equally important in terms of choosing your intervention to use in every individual child you see in your practice. “I encourage everyone to be on board in making a difference in terms of what we are doing for young children with myopia and move away from that typical single vision correction to something that’s much more appropriate,” she concluded.

Following Dr. Logan’s lecture, Dr. Seung-Hee Baek (South Korea) spoke about the evolution of myopia treatment in South Korea in the past decade. She noted that myopia development is especially high among young Korean patients, and appears to be advancing at a higher rate of progression in recent years.

Dr. Baek reported on the growing use of low-dose atropine as a myopia treatment, which has shown encouraging results. She presented the results of several studies involving low-dose atropine in Korean children. “Results showed that treatment with 0.01%, 0.025% and 0.05% atropine solution inhibits myopia progression in Korean children in a dose-dependent manner,” she shared. Based on these results, it is hoped that higher low-dose atropine may soon be available, as they may prove more effective. “The burden of myopia in Korea is substantial. Clinically, 0.01% atropine may not suffice in many cases. We are eager to have higher low-dose commercial atropine eye drops soon,” she concluded.

Early Intervention is Key –
The Axial Length and Genetic Connection

Dr. Tzu Hsun Tsai (Taiwan) took the podium next, presenting findings from the first comprehensive study of axial length among children in Taiwan. “We established the first Taiwanese population-based percentile curves of axial length in children, which may help in assessing an individual’s health status and predicting the probability of myopia,” said Dr. Tsai. Specifically referencing change of axial length percentile as an indicator of myopia progression, Dr. Tsai reported that these factors can be useful in charting myopia progression throughout the young population. She noted, however, that these data points are population - and time specific, and their use may not prove useful when applied generally. “The region-specific characteristics served as reference and helped in tailoring anti-myopia strategies,” she explained. Furthermore, Dr. Tsai added that in a cohort of orthokeratology lens users, axial length percentile change rate in addition to baseline spherical equivalent, best estimate myopia progression.

Dr. Ninomiya Sayuri (Japan) and Dr. Pei Chang Wu (Taiwan), each focused on different aspects of childhood myopia development. Dr. Sayuri focused on the pathogenesis and mechanism of the condition, while Dr. Wu’s lecture was primarily concerned with risk factors and potential preventions. Dr. Sayuri posited that genetic components may underlie childhood myopia – pathological myopia—and that this may one day hold the key to finding a cure for the condition. Dr. Sayuri walked the audience through the three main areas for myopia control: optical, pharmacological and environmental control. Also, she brought some good news — that MiSight® [CooperVision’s 1 day soft contact lenses for myopia control] is finally undergoing clinical trials in Japan—the first on-label trial for myopia control in the country. “So, for me, prescribing single-vision glasses to myopic kids is like giving a poisonous apple to them. I feel guilty when I know there is a better option,” shared Dr. Sayuri.

Dr. Wu spoke on the great importance of outdoor time for children as a preventative measure, as well as the correlation between other factors like physical activity and living environment, and myopia development. He also highlighted the prevalence of “quarantine myopia” during the COVID-19 pandemic, which was exacerbated by increase of screen time and lack of outdoor time. He went far back to the concept of pre-myopia – a state of low hyperopia reserve in children—to serve a poignant reminder to the audience regarding the critical role of the environment in influencing myopia progression.

All of these speakers brought together one central theme — the critical importance of myopia care and prevention among young patients in order to control the condition.

Clear Signs Of Correlation

The relationship between myopia and severe comorbidities became increasingly evident as Dr. Bullimore proceeded—along with myopia, and in proportion to its extent, other ocular conditions emerged.

But what about myopia itself and the loss of vision that occurs directly as a result of the condition? Left unchecked, myopia often advances throughout a patient’s lifetime. The ongoing deformation in the eye’s axial length can frequently lead to diminished vision and, in some cases, to vision loss. While we have more preventative options for myopia than ever before, vision loss due to myopia remains irreversible. And this threat is one that needs to be understood more thoroughly.