AOA report: Doctors of optometry leaders in fight against myopia’s threat

Amid the rapid rise of myopia around the world—the prevalence among people in the U.S. ages 12-54 jumped from 25% in 1971-72 to 41.6% in 1999-2004—the AOA has issued a new clinical report citing optometry’s leading role in its diagnosis, management and treatment of the public health threat.

Half the world’s population will be myopic by 2050, based on projections, noted the AOA’s just-released Myopia Management Clinical Report produced by its Evidence-Based Myopia Management Clinical Report Task Force.

“Doctors of optometry continue to play a primary role in diagnosis, clinical management and treatment of this increasing public health threat,” the report’s authors write. “Expanded myopia management services will be needed beyond the correction of myopic refractive error with current commonly prescribed spectacles or contact lenses for distance vision correction only. This report presents the current clinical evidence from published studies on the efficacy and application of myopia management procedures. It reviews evidence and provides guidance on the use of several currently available options for controlling myopia development in children: atropine, multi-focal soft contact lenses, orthokeratology with rigid gas permeable contact lenses, multifocal spectacle lenses, and behavioral modifications.”

Adds Carl Urbanski, O.D., chair of the AOA Evidence-Based Optometry Committee: “We hope this report will not only serve pure clinical needs but also serve as a call to action for doctors of optometry to fully serve the many patients with myopia within our practices. The opportunity to slow the rate of progression and lower the risk for the development of sight-threatening conditions later in life should not be understated.”

The clinical report builds on the AOA’s heightened focus in 2021 on children’s eye health and vision care, especially during the pandemic, which has created greater leisure time and schooling online for young people, raising concerns over extended screen time and its impact on their eye and vision health. Among its contents are sections on classification of myopia, complications associated with myopia, risk factors for development and progression of myopia, tests and equipment/instrumentation needed for myopia management and elements of follow-up care.

The easily digestible, 24-page report, considerably shorter than the committee’s extended clinical guidelines, covers other important ground for doctors of optometry and other clinicians: 

• Factors influencing the development of myopia: “The risk of developing myopia increases significantly in children who have two parents with myopia compared with those whose parents do not have myopia,” the report says. “Additionally, ethnic background appears to play a role in myopia susceptibility. Asian children are more likely to be myopic than their Caucasian counterparts. The visual environment also appears to be a contributor to school-age myopia. Children who become myopic tend to spend less time outdoors. Myopia development and progression may also be related to reading and computer screen viewing for long periods of time. Additionally, many studies have shown that myopia has a higher prevalence in urban areas vs. rural areas, which is likely to be based on differences in near work and time outdoors.”

• When should myopia control treatment be used: “The most appropriate time to begin treatment should be based on the age of onset of myopia, refractive status, and a careful risk assessment,” the report says. “The age of myopia onset or duration of myopia progression has been found to be the most important predictor of high myopia in later childhood in myopic children. The decreased risk of complications later in life provided by even modest reduction in progression suggest treatment is advised for all young children with myopia. In addition, a child’s binocular vision status may influence the efficacy of treatment (e.g., lag of accommodation and near esophoria).”

• Treatment options: A considerable amount of content is devoted to treatment options: pharmacologic, multifocal soft contact lenses, orthokeratology, spectacle lenses for progression and behavior modification. The authors further discuss keeping patients and caregivers informed. “Although heredity and ethnicity play an undeniable role in myopia development, it is also significantly influenced by the visual environment,” the report says. “Discussion with patients/parents/caregivers should include a comprehensive review of the causes of myopia, the risks and consequences of the development and progression of myopia in children, and the treatment options currently available. Emphasis should be on the long-term benefits of reducing myopia progression and related ocular complications.”

A fighting chance against myopia

The production of the report was requested by the AOA Board of Trustees to address the growing public health threat posed by progressive myopia, Dr. Urbanski says, citing the growing urgency brought on by environmental, educational and vocational disruptions due to the pandemic.

“Since doctors of optometry remain the primary source of vision care for children, teens and young adults in the country, we are already caring for these patients during the critical time to impact the development and progression of myopia and its potential long-term consequences,” Dr. Urbanski says.

“The EBO Committee will continue to work to produce both full, evidence-based guidelines and clinical reports to serve the needs of our clinicians,” he adds. “We hope our work can continue to make an impact, beginning with optometric education all the way through a clinician’s practice career.”

Resources doctors can use

To support doctors of optometry and raise public awareness, the AOA provides numerous resources:

AOA member-exclusive  AOA’s Children’s Vision Toolkit.

View the AOA Emergency Children’s Vision Summit on EyeLearn Professional Development Hub (members only).

Review the  AOA Evidence-based Clinical Practice Guideline: Comprehensive Pediatric Eye and Vision Examination.