Myopia progression may continue into adulthood
Key takeaways:
- Three studies showed that adults aged 20 to 50 years with myopia experienced about –1 D of progression.
- Most progression occurred between 20 and 30 years of age.
Myopes may undergo about –1 D of progression between the ages of 20 and 50 years, according to an analysis of three large studies published in Investigative Ophthalmology & Visual Science.
Previous research has led to the commonly held belief that primary myopia stabilizes during late teenage years or early adulthood, Noel A. Brennan, MScOptom, PhD, FAAO, and colleagues wrote. However, a long-term comprehensive examination of myopia progression in adults aged 20 to 50 years is lacking.
To fill this knowledge gap, Brennan and colleagues performed an analysis of datasets from three studies to explore evidence of a myopic shift in this age group.
The first dataset included U.S. population-based prevalence data from the National Health and Nutrition Examination Survey and focused on degrees of myopia in individuals at 18 to 24 years old (1971 to 1972) and 45 to 57 years old (1999 to 2004) using a logit transformation of prevalence values at different refractive error thresholds to estimate myopic progression.
The second dataset included myopic progression data from a large regional ophthalmic clinic in Germany. Brennan and colleagues estimated aggregate progression in adults aged 20 to 49 years old grouped by refractive error and 5-year age groups.
Finally, myopic shift was calculated in a large sample of Japanese clinical patients aged 20 to 49 years whose refractive changes were recorded every 5 years.
In the U.S. population, the 30-year myopic shift was approximately –1.1 D in individuals with a baseline refractive error of –1 D, –1.4 D with a baseline refractive error of –3 D and –1.9 D with a baseline refractive error of –6 D.
In the German population, the total progression estimates ranged from –1 D to –2.9 D for myopia of –0.5 D or less. As degree of baseline myopia increased, so did myopic progression.
Finally, in the Japanese population, mean 30-year progression weighted by sample size was –1 D for men and –0.9 D for women across all refractive groups. As myopia increased in the cohort, myopic progression decreased.
Notably, in all three populations, average myopic progression rates decreased as age increased, and most progression occurred between 20 and 30 years of age.
The researchers noted several limitations with this analysis, including that none of the patients in the studies were examined under cycloplegia. Also, because two of the datasets were from clinical practices, patients with progressive myopia may have been overrepresented.
“Anecdotally, clinicians often report myopia progression in adults, and our analysis substantiates this impression against the general doctrine that myopia stabilizes in late teenage years,” Brennan and colleagues wrote. “This work also suggests that providing interventions to slow progression might be an appropriate strategy in young adults, as well as children.”
Perspective
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This article describes novel information that may change the way we as optometrists think about the progression of myopia. Traditionally we think of myopia as progressing in children and early adulthood but then leveling off. New insights indicate that when examining myopia over decades, small changes do occur and can be significant.
The investigation encompassed three distinct datasets: U.S. population-based prevalence data, German clinical data and Japanese clinical data. These datasets collectively pointed toward an approximate progression of –1 D between 20 and 50 years of age.
This has significant implications for how we approach myopia management and inform our patients about potential long-term changes in their vision. We understand the need for myopia management in children and teens, but what about adults? What new therapies will we be able to provide?
A few challenges existed in this study: Patients were not examined with cycloplegia, nor was axial length measured. Future research, including large numbers of individuals, absolutely needs to consider these variables to draw more valid conclusions.
Among the first studies of its kind, the conclusion of this paper opens the possibility of new research and investigation into adult myopic progression. Additionally, it may lead to a new follow-up frequency recommendation for adults with myopia.
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