It’s no surprise that in this day and age, with indoor screen time replacing outdoor playtime and more myopic parents passing their genes to their offspring, the number of myopes is increasing at an alarming rate.
In fact, it has become such a concern that it is now globally recognized as a “myopia epidemic.” Organizations, such as the World Health Organization (WHO), American Academy of Ophthalmology (AAO), and American Academy of Optometry (AAOpt), have come together to find a way to combat this epidemic through prevention strategies, patient/parent education, and public policy.
As practitioners, it is vital to understand and implement these global strategies in order to provide the best care for their patients. This article will review important statistics of the myopia epidemic, address at-home prevention strategies, and discuss future public policy measures being formed by national and global organizations.
Overview of myopia epidemic statistics
In 2010, uncorrected refractive error was deemed the most common cause of distance vision impairment (affecting approximately 108 million people) and the second most common cause of blindness globally.1 Uncorrected distance refractive error, mostly caused by myopia, is estimated to incur costs of approximately $202 billion per year and is rising.2 Myopia brings not only an economic burden but also further vision challenges.
Each diopter of myopia is associated with increased risk for other ocular conditions:3
- 58% for myopic maculopathy
- 20% for open-angle glaucoma
- 21% for posterior subcapsular cataracts
- 30% for retinal detachment
Understanding the growing myopia epidemic
Brien Holden and colleagues, a global leader in myopia research and trends, performed a systematic review and meta-analysis of the prevalence of myopia and high myopia, using data published since 1995. This information was used to estimate temporal trends of myopia from 2000 to 2050. The authors predicted that by 2050 the number of myopic people worldwide will nearly double, resulting in approximately 938 million myopes globally.
Further, the study authors also looked at the distribution of people estimated to have myopia across age groups in 2000 and 2050. They found that the bulk of myopia today is in age groups younger than 40 years. This is believed to be due to more of the lifestyle changes for children over the past 10 to 20 years than genetic factors; lifestyle changes include outdoor playtime being rapidly replaced by indoor screen time.
Ultimately, not only will there be more people with myopia by 2050, but they will also be older and more susceptible to pathological disorders of myopia.4,5
Recent myopia prevention strategy guidelines
In 2019, the WHO created guidelines on physical activity, sedentary behavior, and sleep for children under the age of 5. Although this is not directly related to the myopia epidemic, the organization discusses the amount of screen time recommended by age. For infants less than 2 years old, no screen time is recommended. For children between ages 2 to 4, no more than 1 hour of screen time each day is advocated.6
These guidelines are supported by Foreman et al., who examined over 3,000 studies related to screen time and myopia in children and young adults between the ages of 3 months and 33 years. They found the more time kids spent on digital devices, and the earlier they were introduced to such devices, the higher risk of developing myopia.7
Though even more evidence is needed to quantify the direct relationship between screen time and myopia, less screen time may encourage more outdoor play, which multiple studies have found a protective effect of outdoor time on myopia onset.8,9,10 Based on the International Myopia Institute, Jonas et al. recommend children spend at least 1.5 to 2 hours a day outside.11
Most children 6 and older spend the majority of their day indoors at school. With the support of the government and school district, outdoor time could be incorporated into the school curriculum or provided as a community program.12
The value of parental education in pediatric myopia management
Parents often ask how screen time may impact their child in the long run. As practitioners, it is important to understand the current knowledge surrounding this concern and proactively encourage less screen time and more outdoor play. If the child is already showing signs of myopia, it is important to provide resources and treatment options for myopia control. Unless the parent is a high myope themselves, it is hard for them to understand the visual problems related to myopia.
One great technique to show parents how myopia may impact their vision is holding up a +3.00D lens over their best-corrected vision. Furthermore, the Brien Holden Vision Institute created a “Myopia Calculator” that is accessible online to practitioners. Once imputed, the patient’s age, level of refractive error, and myopia control treatment option are used to create a graph mapping the child’s progression of myopia with and without intervention. Parents can then visualize the benefits of starting myopia control treatments early.
Explaining health risks associated with myopia to parents
It is also important for the parents to understand the health risks associated with increased myopia, such as maculopathy, and retinal holes/tears. Parents often take myopia more seriously when they understand the potential risk of their child becoming visually impaired with every increasing diopter of myopia.
There are many online resources available to parents, such as mymyopia.com, mykidsvision.org, and hootmyopiacare.com. This allows parents to further research on their own about myopia and feel more comfortable with the information you, as a practitioner, are providing. Testimonials from other parents and children in current myopia control treatments can also reassure new parents of the value of taking action early.
Public policy on myopia
As mentioned above, organizations such as the International Myopia Institute and WHO have gathered data to demonstrate global trends of myopia and recommendations to prevent myopia onset and slow progression. Although there are no standardized policies in place currently, in 2019, the AAO created an organization called the “Task Force on Myopia,” composed of key leaders from various fields of healthcare, including ophthalmology, optometry, and primary care.
Dr. Richard Abbott, MD, and Dr. Donald Tan, MD, created this task force in order to create an action plan to address this issue from various perspectives. The goal of the “Task Force on Myopia” is to reduce the global burden of myopia by delaying the onset and reducing the progression of myopia through advocacy, research, and public health policies.
This includes advocating for myopia as an important health concern in the US and internationally, seeking avenues to promote multicenter randomized controlled trials of medical and public health interventions, and aiding in the development of public health initiatives to lower the global economic burden of myopia.13
The future of myopia management
Now that myopia is recognized as a global health concern, it is our responsibility as practitioners, leading experts in the field, and public officials to work together to create a standardized action plan to slow the onset and progression of myopia.
Through public policy, strong parent education, and proper medical treatment, we can tackle this epidemic and envision a bright future for the next generation.
