With the prevalence of myopia increasing at what some experts call an “epidemic rate,” a new report from the National Academies of Sciences, Engineering and Medicine (NASEM), titled “Myopia: Causes, Prevention, and Treatment of an Increasingly Common Disease,” has recommended that myopia be classified as a disease. The report calls for the Centers for Medicare & Medicaid Services (CMS) to make the classification, which would require a medical diagnosis. In addition, the report recommends that children spend between one to two hours a day outdoors, stemming from studies that show that being outdoors stimulates the eye with light that is brighter, more varied and requires different eye movements and focus compared with light indoors.

According to several recent studies, the prevalence of myopia is growing around the world, with one study estimating that on average, 30 percent of the world is currently myopic and by 2050, almost 50 percent, or 5 billion people, will be myopic. The hot spots of myopia are East and South East Asia, where countries such as South Korea, Taiwan, Singapore, China and Japan have a myopia prevalence of 80 percent to 90 percent. But myopia is also rising in the U.S., which has reported a prevalence of 42 percent, almost doubling in three decades.

“Disease is a very emotive word. From an ECP and patient perspective, I suspect that even with the classification, it will be a word that is not used readily,” said Dr. Debbie Jones, clinical professor, School of Optometry and Vision Science and lead clinical scientist at the Centre for Ocular Research & Education (CORE), University of Waterloo. “With that said, if classifying myopia as a disease leads to government initiatives/policies to address the myopia epidemic, then it is a valuable change in language and will pave the way to a better future for many. If classification as a disease were to be adopted globally, and in any way hinders the provision of care by ECPs in certain jurisdictions, this would need to be addressed."

 
 Dr. Debbie Jones, clinical professor, school of optometry and vision science and lead clinical scientist, CORE.
  
Dr. Jones continued, “There is good evidence that time outdoors can delay the onset of myopia and potentially slow down progression. Delaying onset may ultimately result in a lower final myopic prescription and less risk of vision impairment in later life. The time to act is when children are young—implementation of mandatory time outside incorporated into school curricula has been shown to have a positive impact in areas of Asia. This should be carried forward to all schools worldwide. We are not looking to just encourage time outside—we need it to be mandated.”

The report recommends that CMS produce evidence-based guidelines, supported by federal and state departments of education and health care providers, promoting more time outdoors (at least one hour per day) for children. Further, the National Institutes of Health and other funding agencies should solicit and fund research to investigate the genetic and environmental mechanisms in the development of myopia, and funding agencies should support innovative, multidisciplinary research to identify mechanisms and novel treatments for myopia.

“I agree with the report that myopia should be classified as a disease,” said Justin Kwan, OD, FAAO, head of myopia management—Americas, CooperVision. “Merriam-Webster defines a disease as a condition of the living animal or plant body or of one of its parts that impairs normal functioning and is typically manifested by distinguishing signs and symptoms. If you showed me pictures of 100 retinas, I could tell you with almost 100 percent certainty which ones have myopia because of the anatomical changes.

“Policy changes in response to concerning rates and levels of myopia have already been instituted in Asia,” added Dr. Kwan. “The U.S. would just be catching up to the right thing to do—getting children outside for at least 80 minutes a day.”

 

 
Last month, Change Agents from across the U.S. convened in Chicago for The Myopia Collective’s inaugural Change Agent Workshop. The three-day event offered presentations on scientific advancements, educational seminars on community engagement and networking opportunities, empowering participants with the knowledge and tools to enhance myopia management in their practices and strengthen their advocacy efforts. A collaboration between the American Optometric Association (AOA) and CooperVision, The Myopia Collective unites eyecare professionals, researchers and advocates to shift the focus from merely correcting myopia to providing comprehensive, evidence-based treatment for children.

The Myopia Collective’s inaugural Change Agents gathered in Chicago last month.


“Prevent Blindness congratulates the NASEM Committee on Focus on Myopia: Pathogenesis and Rising Incidence, and for issuing this new report on myopia highlighting the broad impact it has on health, education and the lifelong potential of an individual,” Prevent Blindness said in a statement on the NASEM report. “Prevent Blindness is proud to have been invited to provide input and guidance to the committee for the development of the report.”

 
 Justin Kwan, OD, FAAO, head of Myopia Management—Americas for CooperVision.
  
“Myopia is the most prevalent disease optometrists will treat in their careers, more than dry eye,” said Dr. Kwan. “My top recommendations are for early detection and treatment before the age of 8. We need at least 30,000 ODs out of the 49,000 practicing in the U.S. to not wait for progression and consistently treat all growing children with myopia. The sooner we start, the sooner we finish treatment. This saves the health care system significant dollars and increases the chance these children have a lifetime of healthy and clear vision.”

Of course, stressing the importance of annual eye examinations as well as increasing public awareness and offering education about myopia management, all play essential roles in potentially halting the epidemic.

“The first recommendation has to be increased awareness on the importance of routine eye examinations for children so that those at risk can be identified and managed with evidence-based options prior to the onset of myopia with the aim of, at the very least, delaying the onset but hopefully preventing myopia,” said Dr. Jones. “Increased awareness for the public on the necessity to have all myopic children in a myopia control option is also essential as well as, of course, continuing to educate ECPs on the importance of myopia control.

“Government/insurance funding for myopia control needs to be considered,” Dr. Jones continued. “This is already happening in Europe with coverage for optical devices and pharmaceuticals. Providing coverage for treatment options that should be standard of care would open up opportunities for those patients who face financial barriers.”

 
The CooperVision booth at Optometry’s Meeting in Nashville was built around the importance of addressing childhood myopia. 
  
Continued collaboration among all parties and at all levels is also a must, according to Dr. Jones.

“Great things happen when the right people are at the same table. It is imperative that there is a collaborative effort to combat childhood myopia and to continue to find the best way to manage those patients who already have myopia,” said Dr. Jones. “Policy makers need to find a pathway to make all evidence-based myopia control options available to all patients worldwide. This is guided by the work of researchers within the optical industry as well as independent researchers. Funding agencies need to look for opportunities to support research into managing myopia and managing patients who are at risk of developing myopia.”

And of course, ODs are in a favorable position to take the lead in this battle against childhood myopia, doctors advise.

“Optometrists are well distributed throughout the 50 states to serve children with myopia—something that has the potential to do immense good for patients and practices alike,” Dr. Kwan concluded.