Burden of uncorrected myopia on APAC health systems
Uncorrected myopia remains the leading cause of distance vision impairment worldwide, and its growing prevalence could cost billions of dollars in lost productivity over the coming decades. A landmark study by the Brien Holden Vision Institute (BHVI) in Australia predicts that by 2050 more than half of the world’s population, or 52%, will be nearsighted. In addition, the management and control of myopia is a relatively new concept in many countries. Let’s explore what possible steps can be taken to treat this affliction.
The World Health Organization (WHO) recently flagged myopia as a global public health problem, estimating the annual global costs of lost productivity associated with visual impairment due to uncorrected myopia at $244 billion in 2015 This will increase significantly in the future if this issue is not resolved.
People with high myopia (-5.00 diopters or more) are at greater risk for vision problems later in life, including glaucoma, cataracts, retinal detachment, and myopic macular degeneration, which is an irreversible condition that can lead to severe visual impairment or permanent blindness. The risk of visual impairment increases 3.4 times with myopia between 6.00 diopters and 10.00 diopters, and 22 times above 10.00 diopters.
Myopia in Asia-Pacific
Studies have shown that the increased intensity of educational pressures in young children has coincided with the rapid increase in cases of myopia in Asian countries in recent decades. In many East Asian countries, myopia is a major public health problem affecting between 80-90% of high school graduates, of whom approximately 10-20% suffer from sight-threatening pathological myopia.
The early onset and rapid progression of myopia in Asia has been linked to increased time spent on work-like activities and classroom work, coupled with limited time spent outdoors; both of which have been exacerbated by the Covid-19 pandemic. According to a Hong Kong study, during the COVID-19 pandemic, the estimated one-year incidence of myopia is 28%, 27%, and 26% for six-, seven-, and eight-year-old children respectively, compared to 17 for percent, 15 percent and 15 percent before the pandemic.
A higher prevalence of myopia tends to occur in high-income countries that place a high priority on academic performance, such as South Korea, Singapore, China, and Japan. Elsewhere in East and Southeast Asia, the numbers are lower but rising rapidly.
Global myopia management standard in the next five years
With the publication of the BHVI research paper and the clarion call of the WHO, governments are realizing that if they do not tackle myopia in childhood, they will face a huge burden for public health systems in the decades to come. They will have to treat millions of adults with much higher complication rates and more serious eye conditions that could have been prevented if their myopia had been managed in childhood.
Other organizations have also called for more coordinated action on myopia. The Aasia Optometric Management Academy (AOMA) and the Asia Optometric Congress (AOC) recently collaborated to create a unique regional consensus on myopia management. The Standard Practice Model provides a systematic approach for practitioners to treat myopic patients, using a holistic approach in the myopia management process. The World Council of Optometry has made a similar announcement, and in Australia a white paper by the Child Myopia Working Group is also advocating for a standard of care.
It is likely that over the next five years most countries will implement a minimum standard of care for the treatment of children with myopia. This means that whether or not ophthalmologists and healthcare professionals (ECP and HCP) are ready for myopia management, at some point in the near future, it will be the standard of care. Now is the time for ECPs who have not yet incorporated myopia management into their practice to prepare for this significant change in the way the profession manages myopia.
Cutting myopia in the bud
Low levels of myopia may not ring alarm bells for many parents. However, since myopia is a progressive disease, the younger the child when myopia sets in, the greater the risk of serious sight-related complications later in life if myopia is left untreated. Even a 1.00 diopter increase in myopia was associated with a 67% increase in the prevalence of myopic maculopathy. Conversely, slowing myopia by just 1.00 diopter is expected to reduce the risk of myopic maculopathy by 40%.
Several studies suggest that the progression of myopia can be controlled and slowed through a combination of lifestyle modifications and therapeutic approaches. A randomized clinical trial on children aged 6 to 12 in Guangzhou, China, showed that children who spent more time outdoors than 40 minutes to an hour a day had a reduced rate of myopia
Besides lifestyle modifications, some of the tools and treatments used in the management of myopia include atropine eye drops, glasses, orthokeratological or “ortho-k” lenses, and soft bifocal contact lenses.
In East Asia in particular, children requiring vision correction by contact lenses or glasses are not a serious problem. Many parents don’t realize that nearsightedness, like high blood pressure or diabetes, if left unchecked and untreated, can lead to more serious problems later on.
The good news is that ECPs now have new tools in their artillery for managing myopia, such as myopia management lenses which have been proven to not only provide clear vision but also slow the progression of myopia. disease. They allow ECPs to treat visual impairment problems caused by myopia at an early stage. Early treatment reduces the risk of visual impairment associated with myopia and helps maintain eye health in children as they age.
Early intervention is crucial in controlling myopia, and the latest findings from CooperVision’s seven-year clinical trial demonstrate that myopia management contact lenses can help slow the rate of myopia progression. The pivotal MiSight 1-day contact lens clinical trial demonstrated that 12 months after stopping treatment, mean axial elongation data, which is used to measure myopia, showed no evidence of effect rebound; Only MiSight 1 Day is proven to retain the benefits of myopia control after treatment ends. The study is the longest running study of soft contact lenses in children for myopia control.
Previously, CooperVision reported that MiSight 1 Day cut myopia progression by half over several years of treatment. This was seen in children who wore MiSight 1 day for the first six years of the study as well as in children who wore the Proclear 1 day single vision lens for the first three years and were then readjusted to MiSight 1 day.
Results from the first three years of the same seven-year trial show that despite 52 children wearing myopia management contact lenses for an average number of around 13 hours per day, there were no serious ocular adverse events. or significant.
Since myopia management and control is a relatively new concept in many countries, it is the responsibility of ECPs to detect, report and manage childhood myopia. By increasing awareness of myopia management tools, gaining support from ECPs and other healthcare professionals, and equipping them with myopia management tools, we hope to help children see well now and as they grow and age.
Hamish Thrum, Senior Manager, Myopia Asia Pacific (APAC), CooperVision