Understanding Myopia Progression

What is Myopia?

Myopia, commonly referred to as nearsightedness, is a prevalent vision condition where distant objects
appear blurry while close objects can be seen clearly. This occurs due to the elongation of the eyeball or
an overly curved cornea, causing light rays to focus in front of the retina rather than directly on it. As a
result, individuals with myopia experience difficulty seeing things at a distance.

What are the causes of Myopia?

Myopia is influenced by a combination of genetic and environmental factors. Key contributors include:

  • Genetics: A family history of myopia increases the likelihood of developing the condition.
  • Prolonged Near Work: Activities such as reading, using digital devices, or any task requiring close focus can contribute to the onset and progression of myopia.
  • Lack of Outdoor Time: Insufficient exposure to natural light has been linked to the development of myopia in children.

How Myopia progresses?

Myopia progression typically occurs during childhood and adolescence as the eye continues to grow. Without intervention, myopia can worsen over time, leading to higher degrees of nearsightedness. The axial length of the eye increases, which can result in complications such as retinal detachment, glaucoma, and cataracts later in life.

What are the disadvantages of Myopia

While myopia is easily corrected with glasses or contact lenses, high myopia (severe nearsightedness) can have significant disadvantages:

  • Increased risk of eye diseases: Higher degrees of myopia are associated with a greater risk of retinal detachment, glaucoma, and myopic maculopathy.
  • Dependence on corrective lenses: Individuals with myopia often rely on glasses or contact lenses for clear vision, which can be inconvenient.
  • Impact on Quality of Life: Severe myopia can limit activities and overall quality of life, especially if left unmanaged.

How to prevent Myopia progression?

Preventing or slowing the progression of myopia is crucial for long-term eye health. Strategies include:

    • Regular eye exams: Early detection through routine eye exams is key to managing myopia effectively.
    • Lifestyle modifications: Encouraging outdoor activities and reducing screen time can help lower the risk of myopia development in children.
    • Specialized lenses: Advanced lens designs, such as the Essilor Stellest lenses, have shown promise in slowing myopia progression.
    • Pharmacological interventions: Low-dose atropine eye drops are gaining recognition as a viable option for reducing the rate of myopia progression.

 

 

What are the key research and developments

  1. Essilor Stellest Lenses: The four-year clinical trial results of the Essilor Stellest lens, presented at the 2023 Annual Meeting of the Association for Research in Vision and Ophthalmology (ARVO), demonstrated sustained myopia control efficacy. The trial, conducted at the Eye Hospital of Wenzhou Medical University in China, showed that these lenses reduced myopia progression by more than one and a quarter diopter on average over four years. Additionally, the lenses effectively slowed axial eye elongation in children, even in older age groups (11-16 years). The study also highlighted that myopia progression and axial elongation were slower in children wearing these lenses compared to a control group wearing single vision lenses. (Luxottica, 2023)
  2. Pharmacological interventions: Low-dose atropine (0.01%-0.05%) has emerged as a key pharmacological agent in slowing myopia progression. Recent studies have shown that atropine can effectively reduce the annual rate of myopic progression, particularly when combined with other methods such as Ortho-K lenses​ (Management, 2024)​. This treatment offers a minimally invasive option with a growing body of evidence supporting its safety and efficacy.
  3. Corneal Collagen Cross-Linking (CXL): Although primarily used for keratoconus, CXL with riboflavin and UVA is being investigated as a potential treatment for myopia. Animal studies have shown promising results, indicating that CXL can enhance scleral rigidity and inhibit axial elongation, potentially slowing myopia progression​ (Optometry, 2021). However, further clinical trials are needed to establish its application in humans.
  4. Lifestyle factors and early intervention: Research underscores the importance of early intervention and lifestyle modifications in managing myopia. Increased screen time has been linked to higher myopia rates, making it essential to counsel patients on reducing digital device usage and encouraging outdoor activities​ (Optometry, 2023)​. Optometrists are encouraged to incorporate these discussions into routine paediatric eye exams, as early detection and management can significantly impact the course of the disease.

Managing myopia progression requires a multi-disciplinary approach, combining clinical expertise with the latest research and technological innovations. As optometrists, it is important to educate patients and their families about the available treatments and the importance of early intervention. Optometrists can provide comprehensive care that not only corrects vision but also addresses the underlying progression of myopia by staying informed about the latest advancements. Implementing these advancements will help reduce the long-term complications associated with high myopia and lead to better outcomes for patients.  Staying updated on the latest developments in myopia management will help you provide the best care for their patients.

 

References

Luxottica, E., 2023. EssilorLuxottica unveils four-year clinical trial results of its Essilor Stellest lens at the 2023 Annual Meeting of the Association for Research in Vision and Ophthalmology (ARVO). [Online]
Available at: https://www.essilorluxottica.com/en/newsroom/press-releases/trial-results-essilor-stellest/

Management, R. o. M., 2024. Latest Myopia NewsEssilorLuxottica Shares Five-Year Stellest Data at ARVO 2024. [Online]
Available at: https://reviewofmm.com/essilorluxottica-shares-five-year-stellest-data-at-arvo-2024/

Optometry, R. o., 2021. CXL May Also Help Halt Myopia Progression. [Online]
Available at: https://www.reviewofoptometry.com/article/cxl-may-also-help-halt-myopia-progression

Optometry, W. i., 2023. When it Comes to Myopia Progression, Earlier Intervention is Better. [Online]
Available at: https://www.womeninoptometry.com/luxottica-branded-pracices/article/when-it-comes-to-myopia-progression-earlier-intervention-is-better/