REFRACTIVE 36 EWAP MARCH 2022 Contact information Tan: dtJers.clinic Walsh: ewalsh@nyee.edu Myopia, a condition that for decades has been described in some regions as an epidemic, is well on its way to reaching pandemic proportions. A systematic review and meta-analysis published by Holden et al. in 201È estimated that in 2000, 22.9% of the world’s population would be myopic and 2.Ç% highly myopic.1 The authors predicted that by 20x0, nearly x0% of the global population would be myopic and nearly 10% highly myopic. A more recent paper looking at myopia in school-age children noted “exceptionally high myopia prevalence rates in school children in East Asia (ÇÎ%), and high rates in North America (42%).”2 Though considered easily correctable with glasses, myopia and high myopia are associated with a risk of developing cataracts sooner and a higher risk for glaucoma and retinal issues, said Erin Walsh, MD. It’s been documented that myopia rates and myopia progression increase with more near work being performed, such as reading, homework, and screen time, Dr. Walsh said. “I tell my patients that the more reading we do, the higher rates of myopia we’re going to see. Countries where children are Stemming myopia progression by Liz Hillman Editorial Co-Director spending considerable time doing near work are seeing higher rates of increasing progressive myopia.” Myopia, its progression, and the long-term issues that can be associated with it have been a topic for a while, Dr. Walsh said, with the conversation shifting toward how to slow down progression in recent years as trends of high population rates of myopia emerged. Options to stall progression There are many options to treat the optical problem of myopia, but they do not necessarily address the complications associated with myopia, which could still occur. Progression of myopia can, however, be mitigated in some cases. The most common and well-researched therapies to try to prevent progression of myopia are low-dose atropine and orthokeratology. Donald Tan, MD, said there have been many studies on reducing myopia progression over the years that have begun to come to fruition. Low-dose atropine has the best evidence for stalling myopia progression, he said. Certain contact lenses, some spectacles, and orthokeratology also have produced evidence that they help reduce progression, but Dr. This article originally appeared in the December 2021 issue of EyeWorld. It has been slightly modified and appears here with permission from the ASCRS Ophthalmic Services Corp. Tan said it’s not as robust as the evidence supporting low-dose atropine, and some of these options have potential risks. "rthokeratology and contact lens use, Dr. Tan said, is associated with a risk for infection and corneal ulcers. These risks are higher in the pediatric population than adults, he thinks, due to less attention to hygiene. A closer look at atropine Dr. Tan called low-dose atropine a paradigm shift. When in training, he was taught awareness with regard to the potentially sight-threatening complications associated with high or pathological myopia. Now, “we’re at the prevention stage, since it is a reasonable assumption that if we can reduce myopia progression so that less children ultimately develop high or pathological myopia, the percentage of subseµuent complications associated with high myopia should also be less,” he said. The Atropine in the Treatment of Myopia (AT"M) studies first enrolled 400 children aged È–12 who had –1 D to –È D of myopia. The patients were randomiâed to receive either 1% atropine or placebo.3 The researchers found significantly less progression of myopia in the atropine group. At 1 year,
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