Advancing clear vision: Collaborating to address the escalating myopia epidemic
By: Ashley John, Mei Chee Lim, Catherine Kuah and Sarah Jegasothy
Myopia is a leading cause of blindness in South Asia, with increasing prevalence globally.
Myopia, a prevalent refractive error, is not merely a vision issue corrected by glasses or surgery, but an ocular disease that can lead to blindness (0.2–1.4% prevalence in Asians) [1]. The World Health Organization forecasts by 2050, almost half the global population will have myopia, a staggering 20% increase from current prevalence [2]. This rising prevalence, particularly in East Asia, presents a significant threat to eye health and public welfare, with high rates (42.7–59.1%) among school-aged children and a rapid progression rate of nearly minus one diopter per year [3].
Complications like myopia maculopathy (degeneration, stretching of the retinal layers and bleeding in the macula) have emerged as leading causes of untreatable visual loss in various regions. The socioeconomic impact of myopia is substantial, with the likelihood of experiencing myopic maculopathy, retinal detachment, posterior subcapsular cataract and open-angle glaucoma rising with every additional one diopter of myopia. Furthermore, children with myopia face an elevated risk of developing depression compared to their peers with normal vision [4]. Therefore, efforts to control myopia progression through public policies and interventions are essential to alleviate the burden on individuals, families and society.
Currently, there are no successful therapies that stop or slow the development of myopia without side effects.
Years of research have led to the emergence of multiple treatment options that control myopia progression, each with its own limitations.
Briefly:
· Specialized eyewear: Spectacle correction studies have explored innovations like progressive addition spectacle lenses (PALs) and defocus incorporated multiple segments (DIMS) to inhibit or delay myopia progression. However, results comparing the efficacy of the two approaches remain highly variable.
· Contact lenses: Contact lenses such as orthokeratology show promise but have barriers like cost and specialized fitting.
· Surgery: Surgical interventions like photorefractive keratectomy (PRK), laser-assisted in situ keratomileusis (LASIK) and small incision lenticule extraction (SMILE) improve visual acuity, but these may come with postoperative complications such as dry eye and corneal irritation.
· Atropine drops: Low-dose atropine is effective but lacks long-term ocular toxicity data and may be costly.
· Environmental modifications: Environmental modifications such as spending time outdoors have a modest effect on myopia progression, but challenges hinder implementation [5] [6].
Overall, treatments for myopia control are currently limited. Further studies are needed to assess the long-term impact and feasibility of these interventions across diverse populations.
Innovations enabling early detection and monitoring of myopia progression
Several innovations focused on earlier intervention and tracking have emerged in recent years which can help better control myopia progression. For example, risk-monitoring mobile applications, peripheral refraction measurement technology, optical coherence tomography (OCT), artificial intelligence (AI) and AI-powered virtual assistants and chatbots have enabled earlier, more precise detection and better management of myopia [7] [8] [9].
What manufacturers can do to address the myopia epidemic
Alongside the current treatments and innovative solutions mentioned above, manufacturers can take two key steps to further address the myopia epidemic.
Step 1: Improve early detection and long-term monitoring of myopia and develop myopia control solutions through collaborative partnerships
Early detection and monitoring of myopia are crucial for risk stratification and implementation of appropriate interventions. Ultimately, timely diagnosis and tracking improve long-term eye health and quality of life while reducing strain on healthcare resources. Industry leaders can collaborate with lens manufacturers, pharmaceutical companies, digital app players and AI companies to provide a more multi-pronged holistic solution. By combining their expertise and resources, these stakeholders can develop innovative approaches to early detection, personalized interventions and comprehensive monitoring to manage the rising myopia epidemic.
For instance, lens manufacturers can partner with pharmaceutical companies to provide myopia control solutions such as low-dose atropine as a combined offering with specialized eyewear, which together help to slow the progression of myopia. These lenses can help slow the progression of myopia in children and adolescents. Meanwhile, digital app players can team up with AI companies to develop mobile applications that analyze smartphone usage patterns, light exposure and other relevant data to provide personalized myopia management recommendations. These apps can also integrate with wearable devices to track eye movements and provide real-time feedback on visual habits.
Furthermore, AI companies and pharmaceutical companies can leverage AI algorithms to analyze large datasets and flag patterns associated with myopia progression. They can then develop predictive models that help identify individuals at high risk of severe myopia and guide personalized interventions. Additionally, lens manufacturers, pharmaceutical companies and digital app players could collaborate and integrate data from wearable devices, mobile apps and clinical measurements, providing a comprehensive and holistic approach to myopia management.
Step 2: Improve access to treatments by emphasizing the public health impact of myopia with governments, healthcare providers (HCPs) and the public
Many countries lack access to treatment for moderate to severe myopia, despite its rising prevalence and potential financial burden on healthcare systems. Severe myopia can create vision-threatening complications, impacting quality of life and consuming significant healthcare resources. Improving access and reimbursement for myopia treatments, particularly for high-risk individuals, can reduce the burden for patients and health systems and mitigate future complications.
To better improve access, industry stakeholders should learn from the obesity space. Manufacturers have implemented successful strategies to address the obesity epidemic, working closely with non-profit organizations, scientific leaders and patient advocacy groups to create public awareness campaigns and scientific research studies educating populations on the complications of obesity [10] [11]. By shifting the narrative around myopia to emphasize its importance in children’s eye health, stakeholders can similarly shift the perspective of myopia from a “lifestyle problem” to a “chronic illness.” Leaders must also advocate for improved coverage and support from governments and healthcare professionals. While the financial burden of myopia treatment — similar to obesity — will likely be massive, viewing myopia as a disease can begin to reveal its health and social burden, especially for those with severe myopia in need of better coverage.
Our journey to treat myopia and prevent blindness must begin now.
Overall, by legitimizing myopia as a disease and forming collaborative partnerships that enable technological innovations, myopia industry stakeholders must revolutionize myopia management by improving early detection, monitoring and access to care, ultimately helping address the myopia epidemic and improve eye health outcomes.
References
[1] S. A. University of New South Wales, “The Impact of Myopia and High Myopia, Report of the Joint World Health Organization–Brien Holden Vision Institute Global Scientific Meeting on Myopia,” World Health Organization, 2015.
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[3] P.-C. M. P. Wu, H.-M. M. M. Huang, H.-J. M. Yu, P.-C. M. Fang and C.-T. M. Chen, “Epidemiology of Myopia,” Asia-Pacific Journal of Ophthalmology, pp. 386–393, 2016.
[4] C. P. P. A. G. Carla Lanca, “Effectiveness of myopia control interventions: A systematic review of 12 randomized control trials published between 2019 and 2021,” Frontiers in Public Health, 2023.
[5] J. Tian, “A review of myopia treatment methods and their research progress,” Highlights in Science Engineering and Technology, pp. 348–355, 2022.
[6] M. T. F. O. a. N. R. M. O. F. Barry N. Wasserman, “A Review of Advances in Myopia Management,” Review of Ophthalmology, 2020.
[7] V. Koh, “Myopia app works as the parent’s private eye,” HealthXchange.sg, Singapore, 2018.
[8] S. G. Honavar, “Eye of the AI storm: Exploring the impact of AI tools in ophthalmology,” Indian Journal of Ophthalmology, p. 2328–2340, 2023.
[9] K. P. S. M. E. Y. Y. L. C.-H. S. J. S. H. L. D. Z. C. J. H. L. G. M. C. J. T. B. S. C.-Y. C. V. T. C. Zhi Wei Lim, “Benchmarking large language models’ performances for myopia care: a comparative analysis of ChatGPT-3.5, ChatGPT-4.0, and Google Bard,” eBioMedicine, p. 104770, 2023.
[10] “Driving Change in Obesity,” Novo Nordisk, December 2022. [Online]. Available: https://www.novonordisk-us.com/about/driving-change-in-obesity.html.
[11] “Obesity,” Eli Lilly, 2024. [Online]. Available: https://www.lilly.com/disease-areas/obesity.
