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In 2019, the American Academy of Ophthalmology (AAO) created a Global Myopia Task Force partnering with the American Academy of Family Physicians (AAFP), the American Academy of Optometry (also the AAO), and the American Academy of Pediatricians (AAP). The task force released a mission statement in late 2020 stating their goal is to reduce the global burden of myopia by delaying the onset of myopia and reducing myopic progression in children, with the hopes of preventing more severe consequences of higher levels of myopia1
Myopia is a leading cause of avoidable vision loss, especially in children. Myopia is estimated to affect 52% (4949 million) of the world population, respectively in 2050 (see Fig 1)2. It estimates that pediatric Myopia in East Asians has the highest prevalence at 15 years of age (69%) compared with Africans (5.5%)3. During the last 3 decades, the prevalence of Myopia has increased by 8-fold in United States4 . The Figure 2 shows prevalence of childhood Myopia in selected countries5 . The fact that younger eyes experience more rapid progression of Myopia leading to greater levels of high Myopia than that being reported is a matter of concern3
Myopia, also commonly referred to as ‘near-sightedness’ or ‘short-sightedness’, is a common eye condition which causes blurred distance vision. In myopic eyes, the eyeball is either longer than normal, or the cornea is too curved, both causing some images to be blurry6
The word Myopia is derived from a Greek term “muopia” which means to close the eyes. Myopia manifests itself as blurred distance vision, hence it is popularly known as “near-sightedness”7
People suffering from Myopia often have trouble-seeing whiteboard, movie screen, television set or other distant objects.
The most common symptoms of Myopia include:
The various ways adopted to classify are based on etiological dichotomies such as hereditary vs. environmental, physiological vs. pathological, structural vs. functional, or axial vs. refractive. Paradoxically, such a classification, being devoid of etiological assumptions, may help to make possible a better understanding of the etiology of the various categories of Myopia12. Several classifications have been postulated13:
Axial, benign, component, correlational, curvature, index, lenticular, physiologic, physiological, refractive, school, simple, syndromic.
Childhood, congenital, acquired, juvenile onset, youth onset, school, adult, early adult onset, late adult onset.
Permanently progressive, progressive, progressive high, progressive high degenerative, stationary, temporarily progressive.
Low, medium, intermediate, moderate, high, pathologic, pathological, physiologic, physiological, severe, simple.
Degenerative, degenerative high, malignant, pathologic, pathological, pernicious, progressive, progressive high, progressive high degenerative.
The evidence suggests that Myopia is more likely to result from the combined and interacting effects of hereditary and environmental factors14. Some of these risk factors include:
The incidence of Myopia is higher in children with myopic parents. As per the results of a published study, the proportions of Myopia were 6.3% in schoolchildren aged 13.7±0.5 years whose both parents are emmetropic, 18.2% in children with one myopic parent, and 32.9% in children who’s both parents are myopic.
Myopic children were also found to have a stronger parental history of Myopia in families with higher parental level of education, higher income, and white collar or professional occupations.
Higher odds of Myopia were found in children of East Asian than those of European Caucasians in the same population.
The level of education is suggested to cause Myopia. A very significant study showed that higher levels of school and post-school professional education are associated with a more myopic refraction. The epidemiological surveys have consistently found a higher prevalence of Myopia in well-educated population thus proving the workload from formal education system. Studies conclude that Myopia typically developed in children of younger age are gradually increased both in prevalence and in severity from grade school throughout graduation.
As per the results of a study from China, Myopia was twice as prevalent in middle class students than poor students. According to the data from the American Academy of Ophthalmology (AAO), Myopia afflicts an 80 to 90% of people in Asia and about 40% in the US.
Near-work such as reading, writing, using mobile phones, compute use, and playing video games, have been suggested to be possibly responsible for the remarkable increase in the prevalence of Myopia.
Available evidence suggests that genetic and environment factors play a crucial role in the development of juvenile-onset Myopia. Though the manners in which both these factors interact and lead to the pathogenesis of Myopia remain inconclusive, several studies report that near work plays a pivotal role in the development of Myopia. In addition, experimental studies suggest that refractive errors could be induced through form deprivation and lens-induced defocus. Every literate individual across the globe regularly does near work, however only a certain percentage of the population develops Myopia. This furthermore warrants the involvement of genetic factors in those individuals18.
Myopia usually develops at an early age in childhood. Myopia affects the children’s ability to learn in school and impacts their quality of life. A study involving parents, teachers, and students found poor vision or uncorrected visual deficits in children negatively impact their attention, perseverance, academic performance, and caused psychosocial stress, whereas receiving corrective spectacles improved the students’ academic performance and psychosocial wellbeing. There are also psycho-social barriers, such as fear of discrimination, bullying, and negative societal attitudes8,9.
“Myopia does not only affect educational outcomes; disadvantages arising from Myopia also extend to quality of life and personal and psychological well-being.”
Myopia not only affect education outcomes; but also, quality of life, personal, psychological well-being and development. Studies have identified that children with Myopia are experiencing low self-esteem8,9.
The study reported that children are being teased or discriminated when they have social pressure against spectacle wear. Parents are also sensitive to social pressures and hesitate to obtain spectacles for their children due to the stigma associated with this8,9.
Visual acuity testing, retinoscopy, autorefraction, or photorefraction during vision screening or clinical examination can all help detect Myopia. One of the most common vision screening batteries, the Modified Clinical Technique, includes visual acuity, ophthalmoscopy, retinoscopy and a cover test. Some screening programs include autorefraction or photorefraction rather than retinoscopy 20.
A correct evaluation of a patient with Myopia involves comprehensive eye and vision examination that should include several elements outlined below20–
A thorough patient history includes a review of the nature of presenting problem and chief complaint, visual, ocular and general health history, developmental and family history, use of medication, allergies and vocational and avocational vision requirements. The patient history could reveal the following types of Myopia
Could provide important information such as on
May be indicated for identifying associated conditions and documenting and monitoring retinal changes in patients with degenerative Myopia. Some of these supplemental testing include
The purpose of Myopia management is to slow the elongation of the eye, minimize the spectacle prescription, and reduce the risk of complications later in life. At a younger age, disease progression is faster with Myopia. Lowering Myopia by 1.00 D can have a clinically meaningful effect on the risk of eye disease (myopic macular degeneration by 40%, open-angle glaucoma by 20%, and visual impairment by 20%). Increase in Myopia by 1.00 D is associated with a 67% increase in the prevalence of myopic macular degeneration (MMD) <sup>21</sup>.
The corrections for nearsightedness mainly include corrective lenses or surgery. Eyeglasses and refractive surgery can correct the refractive error or refocus the image onto the retina23
These devices make up for the curve of cornea or the elongation of eye by shifting the focus of light as it enters an eye
Refractive surgery is a permanent form of correction for nearsightedness. Also called laser eye surgery, the procedure reshapes the cornea to focus light onto retina
Corneal reshaping therapy, also known as orthokeratology, involves using specific lenses to temporarily change the shape of the cornea. This therapy may help correct Myopia and prevent it from progression
Use of low-dose atropine helps to slow down the progression of Myopia
By balancing screen time with outdoor times when possible, may helps to limit child’s Myopia and protect their vision as they grow
Myopia prevention in first place is utmost important. It is certainly difficult to convince people, especially children to act before a problem appears. Prophylactic actions are essential for those who have a history of Myopia in their family. Some epidemiological studies suggest that children who spend more time outdoors are less likely to be or become myopic, irrespective of how much near work they do. Probably, the light-stimulated release of dopamine from retina that inhibits increased axial-elongation could account for protective effect of outdoor time spent by these children25
Some of the factors that could help in preventing progression of Myopia are as follows:25
