Q&A: Myopia Awareness Week draws attention to ‘largest eye threat of the 21st century’
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Key takeaways:
- Myopia is a disease caused by excessive elongation of the eye that poses a high risk for blinding conditions.
- Two hours of outdoor time daily and breaks during near work can help prevent myopia in children.
Myopia Awareness Week is May 13-19 and serves to bring awareness to the “significant problem” of myopia, the danger of which is often underestimated, according to Fuensanta A. Vera-Diaz, OD, PhD, FAAO.
Vera-Diaz, director of research and associate professor at New England College of Optometry (NECO), said optometrists should discuss the importance of myopia with families to help with prevention and promote early diagnosis.
“If you see a parent, tell them to bring their kids in,” Vera-Diaz told Healio. “If you see an older sibling, ask them to bring the younger siblings in and educate them on the importance of having regular eye exams from an early age.”
Healio spoke with Vera-Diaz about the significance of Myopia Awareness Week and how it can be used as an opportunity to overcome misunderstandings, learn about best treatment options and promote preventive behaviors.
Healio: What is the significance of Myopia Awareness Week?
Vera-Diaz: Myopia Awareness Week was an initiative started by the Brien Holden Vision Institute in 2019 to raise awareness on the significant problem of myopia. I personally join the campaign each year as a supporter and so does my institution, NECO. This is one of many initiatives that clinicians, scientists and other stakeholders are undertaking to bring this global issue to the attention of the public.
Stakeholders include eye care professionals in general, but also other health care providers, including pediatricians and school nurses, as well as parents and teachers. It is crucial that we all work together to bring awareness to this highly significant problem, because in the past it is not something that people have realized is important.
Healio: How can clinicians work toward early diagnosis of myopia?
Vera-Diaz: The early diagnosis of myopia is not as much of a problem, assuming the child can see an eye care provider, as the long-term consequences of myopia. Children with myopia tend not to go unnoticed too long because they may complain of blurry vision or squint when looking far away, so parents bring them to the eye care provider more often than for other problems. Once they come to the office, it is also very easy to diagnose myopia.
However, many children are still not getting eye care. States have different initiatives and rules as to requirements for vision screenings and eye exam scheduling.
The American Optometric Association recommends that all babies have an eye exam when aged 6 months to 12 months and then at least one exam between ages 3 years to 5 years, and every year after that, and obviously more frequently if needed. Eye care providers can convey this message to families to help educate them on the importance of regular eye exams, even for healthy young children.
Healio: Could you discuss some of the long-term effects of myopia?
Vera-Diaz: The complications associated with myopia that are potentially blinding include myopic maculopathy, retinal detachment, open-angle glaucoma and certain types of cataracts, as well as increased risk for complications after cataract surgery. All individuals with myopia are at higher risk for these complications compared with individuals without myopia. Even those with low myopia are at risk for these complications, although the higher the myopia and the longer the eye, the higher the risk. The risk for these complications also increases with age.
Healio: What are the most common aspects of myopia that people don’t understand?
Vera-Diaz: What parents and many other health care providers often don’t know is that myopia is a significant health concern because it poses a very high risk for complications. In fact, myopia is now considered the largest eye threat of the 21st century.
The prevalence of myopia is increasing very rapidly, and children are getting myopia earlier, which means that they end up having higher amounts of myopia and therefore higher risk for complications.
We should think of myopia as a disease, not just a refractive error. Myopia is not just that we cannot see well from far away unless we put glasses on. Myopia is a disease of the eye that is caused because of excessive elongation of the eye. Myopia happens because the eyes grow excessively long at the back, and this is the cause of the complications associated with myopia.
Healio: So, it is not only about not seeing well far away?
Vera-Diaz: Correct. That’s why it’s good to call the condition myopia and not near-sightedness. Near-sightedness implies that you do not see well far away; this problem can be corrected with glasses, contact lenses or refractive surgery. However, in myopia, the excessive elongation of the eye is permanent, regardless of the correction given to the patient. Even when you correct myopia with refractive surgery, the eye is still excessively long, and the risks for these complications remain.
Healio: What options are available for myopia management?
Vera-Diaz: Fortunately, we have treatments we can offer to children that can help control the progression of myopia. As I said earlier, the higher the myopia, the higher the risk for complications. If a child already has myopia, our goal as optometrists should be to control it as much as possible so they end up with the lowest amount of myopia.
The pharmacological treatment option currently used in clinic is low-dose atropine drops that are instilled every evening. Other pharmacological treatments are being investigated, and clinicians should be on the lookout for those. There are also a number of optical treatments that can help slow the progression of myopia. These include both specially designed contact lenses and glasses.
The two types of contacts lenses used for myopia control are those with multizone areas of optical power and orthokeratology lenses.
Specially designed spectacle lenses are not yet available in the U.S. We are currently conducting FDA-regulated clinical trials and hope that these will be approved and available soon.
Healio: What role do parents play in myopia identification and treatment?
Vera-Diaz: Parents’ involvement in the process of myopia management is very important with any of the available treatments. Whether the treatment is successful will depend on the child’s interest as well as the parents’ involvement. Young children may be good candidates for all myopia control treatments, but whether they can handle contact lenses or instill drops depends on their maturity level. There are young children who can put the drops in themselves. There are also very young children who can put the contact lenses in themselves.
Parents need to be educated and need to be on board, which is why it is important to explain to parents that myopia management is preventive medicine. We are helping prevent their child from developing a potentially blinding condition in the future. That is what you are doing when practicing myopia management.
Healio: What role do optometrists play in expanding access to myopia care?
Vera-Diaz: Eye care providers have a responsibility to educate themselves on the importance of the problem of myopia and what options are available to patients. The minimum eye care providers should do is educate their patients and their families on the problem of myopia and their options. Even if the provider is not able to offer those options for their patients, they should refer them to someone who can.
We can also do more work outside the clinic. For example, NECO held its inaugural Vision Health Equity Summit last December. We gathered a group of politicians and health care providers to bring awareness to health inequity and the importance of eye health equity, and we discussed myopia as an example of a problem where there is no equity.
Healio: What strategies can be implemented to prevent the development of myopia?
Vera-Diaz: One thing that we can do to help prevent myopia is to educate families, children and caregivers on the importance of the visual environment. The reason so many children have myopia today is because they are spending much less time outdoors and too much time looking up-close.
I spend a lot of time in the clinic talking directly with the children, because that way they listen a lot more. I tell them that they should go outside at least 2 hours outside every day — and they do not have to be continuous hours — to reduce the risk for myopia and myopia progression. We discuss specific activities they can do outdoors.
When they are indoors and doing near work — for example using a computer, reading tablets or anything they do at arm’s length — it is important that they do not bring the material too close to their eyes and that they have frequent breaks, even if it is a short break, every 15 or 20 minutes. During the break they should look far away, even for just a few seconds, before returning to the near activity.
At the myopia control clinic at NECO, we spend a lot of time educating families on the importance of modifying these behaviors, of spending more time outdoors and considerations when doing near work.
Educating families on this is something that every eye care provider can do. You do not have to be an expert in myopia. You do not need to know how to fit specialty contact lenses. We can all do our part by educating children and families.
Healio: What is the take-home message for optometrists who read this article?
Vera-Diaz: Myopia is not just a refractive error. It is a disease caused by excessive elongation of the eye that poses a high risk for potentially blinding conditions.
On the plus side, we can lower the risk for complications by using myopia control treatments. The lower the amount of myopia, the lower the risk for complications.
Our ultimate goal should be preventing myopia. Many of us are working on that from a scientific perspective. And if myopia is already present, we should use myopia control treatments to slow down its progression.
For more information:
Fuensanta A. Vera-Diaz, OD, PhD, FAAO, is director of research and associate professor at New England College of Optometry. She can be reached at vera_diazf@neco.edu; X (Twitter): @neco_cvl; Instagram: @neco.childrensvisionlab; Facebook: Children's Vision Lab at NECO.
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