The Myopia Epidemic - What it Means for Asia
Updated: Nov 23, 2022
In the next five years, a minimum standard of care is expected to be implemented around the globe for myopia, a condition which is projected to affect more than 50% of the world's population by 2050.
The World Health Organisation (WHO) recently designated myopia as a global public health issue, estimating annual global costs of productivity losses associated with vision impairment from uncorrected myopia at US$244 billion in 2015. This follows a landmark study by the Brien Holden Vision Institute, which predicted that nearly 50% of the world’s population - about 5 billion people - will be myopic by 2050 if myopia remains unaddressed. Almost 10% of the global population is predicted to have high myopia by 2050, which is 7.5 times more than in 2000.
A growing epidemic
Myopia, or short-sightedness, is the most common ocular disorder worldwide and a leading cause of visual impairment in children, according to an article published in Retina Today
Individuals with high myopia of -5.00 diopters or more face a greater risk of sight-threatening disorders later in life including glaucoma, cataract, retinal detachment, and myopic macular degeneration, which is an irreversible condition that can cause severe vision impairment or permanent blindness.
In one study, the risk of visual impairment is said to increase 3.4 times for individuals with myopia between 6.00 diopters and 10.00 diopters, and 22 times when above 10.00 diopters.
Research shows that even a 1.00 diopter increase in myopia has been associated with a 67% increase in the prevalence of myopic maculopathy. Conversely, slowing myopia by just 1.00 diopter should reduce the individual’s likelihood of myopic maculopathy by 40% (1).
Myopia in the Asia-Pacific
In many East Asian countries, myopia is a major public health concern that affects 80% to 90% of high school graduates, of which about 10 to 20% have sight-threatening pathologic myopia.
The rapid rise of myopia in countries like Hong Kong, South Korea, Singapore and Taiwan has been linked with increased pressures in young children to excel academically. This has only been exacerbated by the COVID-19 pandemic. Prolonged social-distancing restrictions and home-based learning are causing children to spend less time outdoors, and even more time on 'near work' such as reading, homework, and playing or working on electronic devices, all of which can accelerate myopia progression.
According to one 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-olds respectively, compared to 17%, 15%, and 15% before the pandemic. Despite these numbers, most parents in Hong Kong do not consider their child’s myopia a serious concern.
According to Herman Chan, Registered Optometrist (Part 1) at the Children Eye Care Centre in Hong Kong, “Many parents incorrectly assume their child’s myopia is being adequately managed when they reduce screen time. They don’t realise myopia will continue to progress with any kind of ‘near work’ including reading, writing, or playing card games, especially if they don’t practice good visual hygiene habits and have not been prescribed with a myopia control treatment.”
However, as myopia is a progressive disease, the survey revealed that although only about 15% of five- and six-year-olds had low myopia, by the time these children were 18 years old, a whopping 80% were myopic, and 20% had high myopia.
Taiwan is one of the ‘myopia capitals of the world’, where the prevalence of myopia is 63.3% in 2018, a 2.4-fold increase from the 26.5% recorded in 1986 (3).
Dr Lee Yang-Ming, Director of Yang-Ming Eye Clinic says, “One of the most common myths about myopia in Taiwan is that spectacles are sufficient for the treatment of myopia when children are still young, and when they get older, laser treatments. But spectacles are not sufficient for managing myopia, and to date there are no laser treatments that are able to stop, reduce or reverse the elongation of the eyeball, which causes myopia.”
“Based on recent studies, we know that the earlier myopia is detected and treated, the better the chances are for the child to preserve his or her eye health in the long run. I would recommend immediate intervention and treatment even if the child’s myopia is at -0.7 diopters, because the child’s vision will begin to deteriorate even at this stage,” adds Dr Wu Yu Kai, Director of Health Eye Clinic.
Not only does Singapore have one of the highest rates of myopia in the world, the condition is presenting in younger and younger children, and with greater severity. Studies by the National Eye Centre (SNEC) show 10% of Singaporean children will be myopic by age five, increasing up to 60% and 80% by the time they are 12 and 18 years old respectively.
According to a 2009 study, the costs of correcting myopia in teenagers is estimated to be S$37.5 million (US$27 million) annually.
“You might ask, why worry if the myopia is low? Early intervention is key. Take for example high blood pressure. The moment someone has borderline high or high blood pressure, you intervene immediately with lifestyle changes and medication. You don’t wait till the person gets a stroke to intervene,” says Dr Cheryl Lee, Medical Director and Ophthalmic Surgeon, The EyeClinic.
“One of the simplest ways to slow down myopia progression is spending more time outdoors. UVB rays have been shown to stimulate dopamine from the retina, which slows down the growth of the eye. According to the World Health Organisation (WHO), children who spend more than two hours a day outdoors have a lower risk of myopia than children who spend less than two hours, even if they continue to do 'near work' or have two myopic parents.” says Dr Cheryl Ngo, Ophthalmologist & Eye Specialist, Adult & Child Eye (ACE) Clinic.
Myopia prevalence in Malaysia is slightly lower than its Southeast Asian counterparts, although there have not been any recent or comprehensive studies carried out in the population. The most recent study published in the International Journal of Allied Health Sciences showed about 9.8 to10% of children are myopic by the time they are seven years old, and up to 35% by the time they are 15.
Mr Woon Pak Seong, Optometrist and Managing Director, Vision Space (Petaling Jaya) says, “Parents think LASIK surgery can resolve myopia, and allow their children's myopia to progress. The reality is: the higher the myopia, the smaller the LASIK treatment zone, and the less favourable the results. So we should keep myopia as low as possible early, so when the children opt for LASIK surgery when they are older, the outcomes are better.”
“You know that myopia has a strong genetic component when you see a two-year-old with -9.00 diopters on both eyes. But this is not the norm. What we usually see are four- or five-year-olds with a myopia of -3.00 diopters, which is highly likely caused by environmental and lifestyle factors,” says Mr Tan Thok Chuan, Optometrist and Director, TC Tan Optometrist and Tan & Ho Child Clinic (Butterworth, Penang).
Pivotal seven-year findings on myopia management
The latest findings from CooperVision’s seven-year clinical trial demonstrate that in addition to reducing 'near work' and increasing outdoor time, myopia management contact lenses can help slow down the rate of myopia progression (4).
The study found that myopia progression was cut by approximately half in children between the ages of eight and 17 years who wore myopia management dual-focus contact lenses for the first six years of the study (5).
“Because of advancements in research and technology, eye care professionals (ECPs) now have new tools to manage myopia, such as dual-focus contact lenses that have been proven to provide clear vision as well as slow down the progression of the disease. This enables ECPs to address vision impairment issues caused by myopia very early on,” says Hamish Thrum, Senior Director Myopia Asia-Pacific, CooperVision.
Global Standard of Myopia Management in the Next Five Years
Following WHO's clarion call, governments are realising they will be facing an enormous burden on public healthcare systems in future decades if they do not address myopia during childhood. Millions of adults with much higher complication rates and more serious eye conditions will have to be treated in the future, which could have potentially been avoided had their myopia been managed at an earlier age or stage.
Other organisations have also called for more coordinated action on myopia. The Asia Optometric Management Academy (AOMA) and Asia Optometric Congress (AOC) recently collaborated to create a single region-wide 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 (WCO) has made a similar resolution, and in Australia and New Zealand, a white paper has been written by the Child Myopia Working Group advocates adopting a standard of care.
“Within the next five years, it is likely most countries will implement a minimum standard of care requirement for the treatment of children with myopia. This means regardless of whether or not eye care and healthcare practitioners (ECPs and HCPs) are ready for myopia management, at some stage in the near future, it will be the standard of care. Now is the time for ECPs who have yet to incorporate myopia management into their practice to prepare for this important shift in how the profession manages myopia,” says Thrum.
CooperVision and WCO recently amplified their dedication to advancing myopia management as a standard of care worldwide for a second year by jointly launching an online learning resource that provides multilingual assets and approaches which enable ECPs anywhere in the world to apply a myopia management standard of care. In 2021, the WCO board of directors unanimously approved a standard of care resolution, advising optometrists to incorporate myopia management in their practices.
“By increasing awareness of myopia management tools and enlisting the support of ECPs and HCPs, we hope to help children see well now and as they grow and age,” says Thrum.
Article is written by Bridges M&C Account Director Hyma Haridas
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