Outdoor activity may lower myopia rate in East Asian children
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A greater need for treatment and awareness of visual impairment issues such as myopia among the population in East Asian countries exists, according to findings published in the British Journal of Ophthalmology.
Marcus Ang, MBBS, M Med(Ophth), MCI, FRCS(Ed), FAMS, PhD, of the Singapore National Eye Centre, and colleagues evaluated results from the WHO Regional Office for the Western Pacific, International Agency for the Prevention of Blindness and the Brien Holden Vision Institute on best practices in myopia management in East Asia.
“This region faces challenges that are very applicable to the rest of the world, for example, the lack of awareness of myopia and the need for myopia management by practitioners, families and policymakers,” Monica Jong, BOptom, PhD, a senior project manager at the Brien Holden Vision Institute in Australia, told Primary Care Optometry News. “For myopia to be tackled, health departments and education departments need to work together, as environmental risk factors such as time outdoors and near work intensity are largely responsible for the majority of myopia we see today.”
Ang and colleagues identified that an increase in outdoor activity was beneficial in lowering myopia incidence while the correlation between near work activity and risk factors for myopia prevalence and progression have been undetermined.
The researchers wrote that the use of eyeglasses, such as bifocals and multifocal lenses, may impede progression of myopia, but further research must be done.
Ang and colleagues discovered that the use of overnight orthokeratology contact lenses had a greater efficacy of slowing down myopia progression with a rate of axial elongation reduction ranging between 32% and 63% during a 5-year period in East Asian children between 7 and 16 years old. A combination of the orthokeratology lenses and atropine (0.01%) eye drops could be more effective in decreasing axial elongation than the use of the lenses alone.
Higher doses of atropine — such as 0.5% or 1% — slowed myopia progression in excess of 70% among children between 6 and 12 years old during a 1- to 2-year period. But the investigators reported that side effects included dilated pupils, glare and blurred vision. Lower doses of the drug at 0.1% or less yielded fewer side effects and had a lower myopia progression, between 30% and 60%.
Ang and colleagues wrote that although atropine showed beneficial effects at stifling myopia growth, the FDA has not granted regulatory approval for any pharmacological agents to treat myopia progression.
The researchers found that in recording information regarding myopia prevalence in Western Pacific countries, there was a lack of accurate data to analyze. Countries such as Australia and Laos did not have a national myopia screening program, while other barriers included a lack of awareness, limited resources and resistance to wearing glasses.
In China, where many studies are reporting myopia rates of 50% and rates in an excess of 20% of students living in urban areas, there is no nationally driven program for myopia control despite it being recognized as a major public health issue.
Singapore, which has spent the better part of 4 decades trying to control myopia progression through the implementation of health policies, is estimated to have a majority of its population above the age of 80 years to be myopic by the year 2050, Ang and colleagues wrote. The country issued recommendations to increase outdoor family time for children to lower myopia risk as well as childhood obesity while improving mental health.
“The recommendations of the meeting to address ways to tackle these challenges and implement myopia and high myopia management also apply to the rest of the world, including recognizing that myopia is a problem, training eye care personnel in myopia detection and management, policy changes for integrating eye health within existing school health programs and developing more approved treatments,” Jong told Healio. “There is still a lot more to do in this space, but we have made great progress in having myopia recognized as a serious ocular health condition and keeping it on the global health agenda.”
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