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Myopia Risks to Eye Health

RISKS

ASSOCIATED RISKS OF MYOPIA

Myopia is associated with increased risks to eye health in adulthood.
  • Myopic macular degeneration (MMD)1
  • Staphyloma2
  • Retinal detachment3
  • Primary open-angle glaucoma4
  • Cataracts5
Of these diseases, MMD and retinal detachment have the strongest relationship to myopia and longer axial lengths (Table 1).6 Among people aged 75 years or older, cumulative risk of visual impairment (decimal VA 0.30 to 0.05 [approx. 20/60 to 20/400]) or blindness (decimal VA worse than 0.05 [20/400]) from all causes increases from 3.8% in eyes with an axial length less than 26 mm to 25% in eyes with an axial length of 26 mm or greater and more than 90% in eyes with an axial length of 30 mm or greater.7

Table 1

Table showing eye disease risks by level of myopia measured in diopters.
Table 1: The increased likelihood (odds ratio) of a myopic person > 60 years developing eye disease versus an emmetrope by degree of myopia6

Table 1 Tips

*Applies to only Myopia of -6.00 to -10.00 D. Odds ratios are 7.8 for myopia of -10.00 to -15.00 D and 88 for myopia more than -15.00 D.
+Decimal visual acuity of 0.30 to 0.05 (approx 20/60 to 20/400).

THREATS

MYOPIA IS THE BIGGEST THREAT TO EYE HEALTH OF THE 21ST CENTURY7

Eye care professionals should embrace new therapies treating children as soon as signs of myopia appear in order to reduce the risk of sight-threatening complications in later life7.

Prevalence of myopia

Graphic symbol showing “2x” with arrow directed upwards, representing doubling of population with myopia in recent years.
The number of people worldwide with myopia has nearly doubled in the past 7 years8.

Both Eastern and Western populations

Graphic symbol of globe representing worldwide prevalence of myopia.
Both Eastern and Western populations exhibit the same troubling trend of increasing myopia.8

No safe level of myopia,

Graphic symbol showing an exclamation mark to emphasize there is no safe level of myopia.
No safe level of myopia,26 with over 30% of Myopic Macular Degeneration occurring in people less myopic than -6.00 D.9

Every additional diopter

Graphic symbol showing arrow pointing diagonally upwards representing increasing myopia risk the greater the refractive error.
Every additional diopter of myopia increases the risk of MMD by 67%.10

25% of people

Graphic symbol displaying 25%.
25% of people with axial length ≥26 mm will develop visual impariment by age 75.11

Reduce the risk of sight-threatening complications in later life.

Prevalence of myopia

Graphic symbol showing “2x” with arrow directed upwards, representing doubling of population with myopia in recent years.
The number of people worldwide with myopia has nearly doubled in the past 7 years8.

Both Eastern and Western populations

Graphic symbol of globe representing worldwide prevalence of myopia.
Both Eastern and Western populations exhibit the same troubling trend of increasing myopia.8

No safe level of myopia,

Graphic symbol showing an exclamation mark to emphasize there is no safe level of myopia.
No safe level of myopia,26 with over 30% of Myopic Macular Degeneration occurring in people less myopic than -6.00 D.9

Every additional diopter

Graphic symbol showing arrow pointing diagonally upwards representing increasing myopia risk the greater the refractive error.
Every additional diopter of myopia increases the risk of MMD by 67%.10

25% of people

Graphic symbol displaying 25%.
25% of people with axial length ≥26 mm will develop visual impariment by age 75.11

MANAGING MYOPIA IN CHILDREN:
THE NEED FOR A NEW APPROACH

Myopia is a continuum of disease stages which should be assessed as early as possible. Myopia may continue to progress beyond the teenage years17 and the associated disease risk increases exponentially with severity of myopia,6,10 making early diagnosis and treatment crucial to lifetime eye health.

Children image

Boy wearing glasses who may have myopia, climbing a jungle gym outside.

EARLY MYOPIA ONSET INCREASES RISK OF HIGH MYOPIA

Myopia progresses more quickly in younger children.14 Because early onset implies more years of progression, myopes younger than 12 are at greater risk of developing high myopia15. This is why it’s essential to:
  • Examine all children at least once between the ages of 3-5 years to establish baseline measurements16
  • Examine all children at least annually until they reach 18 years of age16

Table 2

Table showing different degrees of myopia based on the level of refractive error.
Table 2: Classification of myopia by spherical equivalent refractive error16
EARLY MYOPIA ONSET INCREASES RISK OF HIGH MYOPIA

EARLY MYOPIA ONSET INCREASES RISK OF HIGH MYOPIA

Myopia progresses more quickly in younger children.14 Because early onset implies more years of progression, myopes younger than 12 are at greater risk of developing high myopia15. This is why it’s essential to:
  • Examine all children at least once between the ages of 3-5 years to establish baseline measurements16
  • Examine all children at least annually until they reach 18 years of age16

Table 2

Table showing different degrees of myopia based on the level of refractive error.
Table 2: Classification of myopia by spherical equivalent refractive error16

REFRACTIVE ERROR PREDICTS MYOPIA ONSET

Numerous risk factors can help predict myopia’s onset, but the best predictor is cycloplegic spherical equivalent refractive error at a given age. A child with low hypermetropic refraction for a given age (Table 3) has greater than an 80% likelihood of myopia onset by age 13.18 This approach provides a simple clinical method to evaluate risk of myopia onset that is just as accurate as more complex algorithms.

Table 3

Table showing levels of refractive error from ages 6 to 11 that contribute to risk of high myopia by 8th grade.
Table 3: Cycloplegic spherical equivalent autorefraction threshold by age, for children at high risk of becoming myopic by 8th grade18
REFRACTIVE ERROR PREDICTS MYOPIA ONSET

REFRACTIVE ERROR PREDICTS MYOPIA ONSET

Numerous risk factors can help predict myopia’s onset, but the best predictor is cycloplegic spherical equivalent refractive error at a given age. A child with low hypermetropic refraction for a given age (Table 3) has greater than an 80% likelihood of myopia onset by age 13.18 This approach provides a simple clinical method to evaluate risk of myopia onset that is just as accurate as more complex algorithms.

Table 3

Table showing levels of refractive error from ages 6 to 11 that contribute to risk of high myopia by 8th grade.
Table 3: Cycloplegic spherical equivalent autorefraction threshold by age, for children at high risk of becoming myopic by 8th grade18

Every additional diopter image

Graphic symbol illustrating eye in front of eye chart, representing the important of measuring refractive error.

IMPORTANCE OF EARLY TREATMENT: EVERY DIOPTER MATTERS

  • Progression is highly likely once a child is identified as pre-myopic or myopic.19
  • Reducing myopia by 1.00 D reduces the likelihood of a patient developing myopic macular degeneration by about 40%.10
  • Begin clinical treatment for all myopic children 12 years of age or less and offer lifestyle guidance at a minimum for pre-myopic children.
IMPORTANCE OF EARLY TREATMENT: EVERY DIOPTER MATTERS

Every additional diopter image

Graphic symbol illustrating eye in front of eye chart, representing the important of measuring refractive error.

IMPORTANCE OF EARLY TREATMENT: EVERY DIOPTER MATTERS

  • Progression is highly likely once a child is identified as pre-myopic or myopic.19
  • Reducing myopia by 1.00 D reduces the likelihood of a patient developing myopic macular degeneration by about 40%.10
  • Begin clinical treatment for all myopic children 12 years of age or less and offer lifestyle guidance at a minimum for pre-myopic children.

RISK FACTORS FOR MYOPIA

  • Younger age12
  • Refractive error (see Table 3)18
  • Minimal time outdoors (< 2 hrs/day)20
  • Near work for longer duration or at a shorter working distance21,22
  • Myopic parents23

Table 4

Table showing myopia risk by age and recommended clinical response.
Table 4: Likelihood of myopia progression or onset and recommended clinical action by age and refractive status

Table 4 tips

†Lifestyle guidance is a suggested component of all myopia control therapy
‡Treatment of pre-myopia is at discretion of the parent/patient and clinician
RISK FACTORS FOR MYOPIA

RISK FACTORS FOR MYOPIA

  • Younger age12
  • Refractive error (see Table 3)18
  • Minimal time outdoors (< 2 hrs/day)20
  • Near work for longer duration or at a shorter working distance21,22
  • Myopic parents23

Table 4

Table showing myopia risk by age and recommended clinical response.
Table 4: Likelihood of myopia progression or onset and recommended clinical action by age and refractive status

Table 4 tips

†Lifestyle guidance is a suggested component of all myopia control therapy
‡Treatment of pre-myopia is at discretion of the parent/patient and clinician
Graphic symbol of trees and sun on hill illustrating the importance of outdoor time to delay onset of myopia in children.

LIFESTYLE GUIDANCE

One evidence-based method to delay the onset of myopia in children is spending time outdoors.24 Growing evidence supports that more time outdoors may also slow the progression of myopia.25 Increased outdoor time may benefit all children.
LIFESTYLE GUIDANCE
Graphic symbol of trees and sun on hill illustrating the importance of outdoor time to delay onset of myopia in children.

LIFESTYLE GUIDANCE

One evidence-based method to delay the onset of myopia in children is spending time outdoors.24 Growing evidence supports that more time outdoors may also slow the progression of myopia.25 Increased outdoor time may benefit all children.

REFERENCES

1. Ohno-Matsui K et al. Updates of Pathologic Myopia. Prog Retin Eye Res 2016;52:156-87.
2. Ohno-Matsui K, Jonas JB. Posterior staphyloma in pathologic myopia. Prog Retin Eye Res 2019;70:99-109.
3. Mitry D et al. The Epidemiology of Rhegmatogenous Retinal Detachment: Geographical Variation and Clinical Associations. Br J Ophthalmol 2010;94:678-84.
4. Marcus MW et al. Myopia as a Risk Factor for Open-Angle Glaucoma: A Systematic Review and Meta-Analysis. Ophthalmol 2011;118:1989-94.
5. Pan CW et al. Myopia and Age-Related Cataract: A Systematic Review and Meta-Analysis. American Journal of Ophthalmology 156.5 (2013): 1021-1033.
6. Haarman AE et al. The Complications of Myopia: A Review and Meta-Analysis. Investigative Ophthalmology & Visual Science. 2020 Apr 9;61:49.
7. Holy C, Kulkarni K, Brennan NA. Predicting Costs and Disability from the Myopia Epidemic – A Worldwide Economic and Social Model. Investigative ophthalmology & visual science. 2019;60(9):5466-5466.
8. Holden BA et al. Global Prevalence of Myopia and High Myopia and Temporal Trends from 2000 through 2050. Ophthalmol 2016;123:1036-42.
9. Wong, Yee-Ling, et al. "Prevalence, risk factors, and impact of myopic macular degeneration on visual impairment and functioning among adults in Singapore." Investigative Ophthalmology & Visual Science 59.11 (2018): 4603-4613.
10. Bullimore MA, Brennan NA. Myopia Control: Why Each Diopter Matters. Optom Vis Sci 2019;96:463-5.
11. Tideman JW et al. Association of axial length with risk of uncorrectable visual impairment for Europeans with myopia. JAMA Ophthalmol 2016;134:1355-63.
12. Chua SY et al. Age of Onset of Myopia Predicts Risk of High Myopia in Later Childhood in Myopic Singapore Children. Opthal Physiol Opt 2016;36:388-94.
13. Bullimore MA, Brennan NA. Myopia Control: Why Each Diopter Matters. Optom Vis Sci 2019;96:463-5.
14. Donovan L, Sankaridurg P, Ho A, Naduvilath T, Smith EL 3rd, Holden BA. Myopia progression rates in urban children wearing single-vision spectacles. Optom Vis Sci. 2012 Jan;89(1):27-32.
15. Hu Y, Ding X, Guo X, Chen Y, Zhang J, He M. Association of Age at Myopia Onset With Risk of High Myopia in Adulthood in a 12-Year Follow-up of a Chinese Cohort. JAMA Ophthalmol. 2020;138(11):1129–1134.
16. AOA reference: “Comprehensive Pediatric Eye and Vision Examination” https://www.aoa.org/AOA/Documents/Practice%20Management/Clinical%20Guidelines/EBO%20Guidelines/Comprehensive%20Pediatric%20Eye%20and%20Vision%20Exam.pdf
17. Parssinen, Olavi, and Markku Kauppinen. "Risk factors for high myopia: a 22-year follow-up study from childhood to adulthood." Acta Ophthalmologica 97.5(2019):510-518.
18. Zadnik K et al. Prediction of Juvenile Onset Myopia. JAMA Opthalmol 2015;133:683-9.
19. Mutti DO et al. Refractive error, axial length, and relative peripheral refractive error before and after the onset of myopia. Invest Ophthalmol Vis Sci. 2007;48:2510-9.
20. Wu PC et al. Increased Time Outdoors Is Followed by Reversal of the Long-Term Trend to Reduced Visual Acuity in Taiwan Primary School Students. Ophthalmology. 2020 Feb 8:S0161-6420(20)30139-1.
21. Huang et al. The Association between Near Work Activities and Myopia in Children: A Systematic Review and Meta-Analysis. PloS One 2015;10:e0140419.
22. Wen L et al. Objectively measured near work, outdoor exposure and myopia in children. British Journal of Ophthalmology Published Online First: 19 February 2020. Doi: 10.1136/bjophthalmol-2019-315258.
23. Tedja MS et al. IMI – Myopia Genetics Report. Invest Ophthalmol Vis Sci 2019;60:M89-M105.
24. He M et al. Effect of time spent outdoors at school on the development of myopia among children in China: a randomized clinical trial. JAMA. 2015;314:1142-8.
25. Wu PC et al. Myopia prevention and outdoor light intensity in a school-based cluster randomized trial. Ophthalmol. 2018;125:1239-50.
26. Flitcroft Dl. The complex interactions of retinal, optical and environmental factors in myopia aetiology. Prog Ret in Eye Res. 2012;31(6):622-660.

PP2021ABLM4065
REFERENCES

REFERENCES

1. Ohno-Matsui K et al. Updates of Pathologic Myopia. Prog Retin Eye Res 2016;52:156-87.
2. Ohno-Matsui K, Jonas JB. Posterior staphyloma in pathologic myopia. Prog Retin Eye Res 2019;70:99-109.
3. Mitry D et al. The Epidemiology of Rhegmatogenous Retinal Detachment: Geographical Variation and Clinical Associations. Br J Ophthalmol 2010;94:678-84.
4. Marcus MW et al. Myopia as a Risk Factor for Open-Angle Glaucoma: A Systematic Review and Meta-Analysis. Ophthalmol 2011;118:1989-94.
5. Pan CW et al. Myopia and Age-Related Cataract: A Systematic Review and Meta-Analysis. American Journal of Ophthalmology 156.5 (2013): 1021-1033.
6. Haarman AE et al. The Complications of Myopia: A Review and Meta-Analysis. Investigative Ophthalmology & Visual Science. 2020 Apr 9;61:49.
7. Holy C, Kulkarni K, Brennan NA. Predicting Costs and Disability from the Myopia Epidemic – A Worldwide Economic and Social Model. Investigative ophthalmology & visual science. 2019;60(9):5466-5466.
8. Holden BA et al. Global Prevalence of Myopia and High Myopia and Temporal Trends from 2000 through 2050. Ophthalmol 2016;123:1036-42.
9. Wong, Yee-Ling, et al. "Prevalence, risk factors, and impact of myopic macular degeneration on visual impairment and functioning among adults in Singapore." Investigative Ophthalmology & Visual Science 59.11 (2018): 4603-4613.
10. Bullimore MA, Brennan NA. Myopia Control: Why Each Diopter Matters. Optom Vis Sci 2019;96:463-5.
11. Tideman JW et al. Association of axial length with risk of uncorrectable visual impairment for Europeans with myopia. JAMA Ophthalmol 2016;134:1355-63.
12. Chua SY et al. Age of Onset of Myopia Predicts Risk of High Myopia in Later Childhood in Myopic Singapore Children. Opthal Physiol Opt 2016;36:388-94.
13. Bullimore MA, Brennan NA. Myopia Control: Why Each Diopter Matters. Optom Vis Sci 2019;96:463-5.
14. Donovan L, Sankaridurg P, Ho A, Naduvilath T, Smith EL 3rd, Holden BA. Myopia progression rates in urban children wearing single-vision spectacles. Optom Vis Sci. 2012 Jan;89(1):27-32.
15. Hu Y, Ding X, Guo X, Chen Y, Zhang J, He M. Association of Age at Myopia Onset With Risk of High Myopia in Adulthood in a 12-Year Follow-up of a Chinese Cohort. JAMA Ophthalmol. 2020;138(11):1129–1134.
16. AOA reference: “Comprehensive Pediatric Eye and Vision Examination” https://www.aoa.org/AOA/Documents/Practice%20Management/Clinical%20Guidelines/EBO%20Guidelines/Comprehensive%20Pediatric%20Eye%20and%20Vision%20Exam.pdf
17. Parssinen, Olavi, and Markku Kauppinen. "Risk factors for high myopia: a 22-year follow-up study from childhood to adulthood." Acta Ophthalmologica 97.5(2019):510-518.
18. Zadnik K et al. Prediction of Juvenile Onset Myopia. JAMA Opthalmol 2015;133:683-9.
19. Mutti DO et al. Refractive error, axial length, and relative peripheral refractive error before and after the onset of myopia. Invest Ophthalmol Vis Sci. 2007;48:2510-9.
20. Wu PC et al. Increased Time Outdoors Is Followed by Reversal of the Long-Term Trend to Reduced Visual Acuity in Taiwan Primary School Students. Ophthalmology. 2020 Feb 8:S0161-6420(20)30139-1.
21. Huang et al. The Association between Near Work Activities and Myopia in Children: A Systematic Review and Meta-Analysis. PloS One 2015;10:e0140419.
22. Wen L et al. Objectively measured near work, outdoor exposure and myopia in children. British Journal of Ophthalmology Published Online First: 19 February 2020. Doi: 10.1136/bjophthalmol-2019-315258.
23. Tedja MS et al. IMI – Myopia Genetics Report. Invest Ophthalmol Vis Sci 2019;60:M89-M105.
24. He M et al. Effect of time spent outdoors at school on the development of myopia among children in China: a randomized clinical trial. JAMA. 2015;314:1142-8.
25. Wu PC et al. Myopia prevention and outdoor light intensity in a school-based cluster randomized trial. Ophthalmol. 2018;125:1239-50.
26. Flitcroft Dl. The complex interactions of retinal, optical and environmental factors in myopia aetiology. Prog Ret in Eye Res. 2012;31(6):622-660.

PP2021ABLM4065