Opinion Piece: The Big Question: Is Myopia Management Reducing Myopia on a Macro Level?

In 2016, the Brien Holden Institute (BHVI) and the World Health Organisation (WHO) published a hugely influential document. It stated that by 2050, nearly 50% of the world’ population would be myopic and 10% of the global population would have high myopia. High myopia, in particular, can lead to many sight threatening secondary eye conditions in later life.  

Is Myopia Management Really Making a Difference?

This is because, in most cases of myopia, the eyeball stretches in size and length. This leads to a range of stresses on parts of the eye and can lead to an increased risk of cataracts, glaucoma, myopic macular degeneration and retinal detachment, for example. 

There are already signs that this significant increase in prevalence of myopia and high myopia is leading to many new cases of sight impairment and severe sight impairment, often at earlier ages. Southeast Asia has the highest concentrations of such cases, but all over the world, these increases in prevalence are apparent. 

Lifestyle changes over the past 50-60 years are significantly to blame, though genetics does play a role. 

There are numerous ways of potentially slowing the progression of myopia and, increasingly, such therapies and methods are being provided to children and teenagers across the globe. 

This led me to wonder. Has the introduction of these new therapies led to any discernible change in the prevalence of myopia, or, at least, any reduction in the average rate of change in levels of myopia? 

It is interesting to first consider a paper from 2021(1), which showed that pre-school myopia levels were showing an increase in prevalence, but once interventions began, the rates of progression and the prevalence of myopia declined. The study also showed how significant the effect of Covid was on increasing the progression of myopia, due to less outdoor time and much more time on smartphones, computers, close work and using artificial light on being in dark surroundings. 

One paper from 2022 (2) showed that practitioners were increasingly concerned about progressive myopia in children and a larger proportion were practicing myopia management. To quote the paper directly: ‘Practitioners reported that embracing myopia control enhanced patient loyalty, increasing practice revenue and improving job satisfaction.’. This paper also showed, at the time, that specialised spectacle lenses were the primary myopia management option in use. 

The impact of myopia and high myopia is significant, according to the IMI (International Myopia Institute). Their paper of 2021 (3) demonstrated the long-term effects of the condition physically, mentally and economically. As mentioned, highly myopia adults are much more likely to suffer from sight threatening conditions. However, because of poor vision without glasses, the need to wear glasses (often thick and heavy) or contact lenses all the time, there is an emotional impact on sufferers. There is the increased worry about the cost of eyecare, as well as the worry about potential vision loss in the future. Added to this is the wider impact on national economies with reduced productivity and an increase in the cost of providing for a larger number of people with severe sight impairment.  

A meta-analysis by Liang, et al (4) in September 2024 was more specific about the prevalence of myopia. It suggested that the pooled prevalence of myopia has risen, but the projections for 2050 suggest roughly 40% of the global population will be myopic. It is not specific about the reasons for this apparent drop in predicted prevalence. The figures from the 2016 BHVI/WHO paper may have been an over estimation, or there is a real effect already due to a change in public and professional understanding of myopia. It could be that people are making lifestyle changes (or helping their children to) and are engaging in myopia management via eye care professionals.  

One is hopeful that there is a real and measurable reduction in the rate of progression of myopia in many children and a reduction in the overall prevalence of high myopia. It’s clear that studies are underway and groups like the IMI regularly look into the statistics and data on myopia and high myopia globally.  

There are many active longer-term studies underway, which hope to shed more light on the definitive figures for existing and predicted myopia prevalence and rates of progression, for example. 

Many of these studies are taking place in Southeast Asia, such as the SCORM (Singapore Cohort of Risk Factors for Myopia) study (5) and the MEIS (Myopia Epidemiology and Intervention) study in China (6). 

Other longitudinal studies are ongoing, such as in France, where a significant number of children and teenagers are being investigated (7,8). 

With an increasing number of modern myopia management options becoming available, more children and their parents taking advice about lifestyle changes and more governments taking the condition seriously, we're hopeful that the prevalence and predicted levels of myopia and high myopia will fall and that the predictions for 2050 may not come true.

That said, modern technology still seems to be demanding more and more of our, and our childrens, time via screen based interfaces. Predicting the future is of course uncertain, so we'll continue to campaign and work towards better eye health outcomes for our children.  

References 

1. Yang, Yu-Chieh et al. Prevalence Trend of Myopia after Promoting Eye Care in Preschoolers. Ophthalmology, Volume 129, Issue 2, 181 – 190. 

2. James S. Wolffsohn, Yasmin Whayeb, Nicola S. Logan, Rebecca Weng, the International Myopia Institute Ambassador Group*; IMI—Global Trends in Myopia Management Attitudes and Strategies in Clinical Practice—2022 Update. Invest. Ophthalmol. Vis. Sci. 2023;64(6):6. 

3. Padmaja Sankaridurg, Nina Tahhan, Himal Kandel, Thomas Naduvilath, Haidong Zou, Kevin D. Frick, Srinivas Marmamula, David S. Friedman, Ecosse Lamoureux, Jill Keeffe, Jeffrey J. Walline, Timothy R. Fricke, Vilas Kovai, Serge Resnikoff; IMI Impact of Myopia. Invest. Ophthalmol. Vis. Sci. 2021;62(5):2. 

4. Liang, J., Pu, Y., Chen, J., Liu, M., Ouyang, B., Jin, Z., Ge, W., Wu, Z., Yang, X., Qin, C., Wang, C., Huang, S., Jiang, N., Hu, L., Zhang, Y., Gui, Z., Pu, X., Huang, S., & Chen, Y. (2024). Global prevalence, trend and projection of myopia in children and adolescents from 1990 to 2050: a comprehensive systematic review and meta-analysis. The British journal of ophthalmology.  

5. Saw, S., Awodele, A., Cheng, C., Cheung, Y., Tan, D., & Wong, T. (2016). Changing prevalence, and incidence and progression of myopia in Singapore teenagers: the SCORM cohort. Investigative Ophthalmology & Visual Science, 57. 

6. Xu, L., , Y., Yuan, J., Zhang, Y., Wang, H., Zhang, G., Tu, C., Lu, X., Li, J., Xiong, Y., Chen, F., Liu, X., Xue, Z., Zhou, M., Li, W., Wu, N., Chen, H., Chen, J., Lu, F., Su, J., & Qu, J. (2020). COVID-19 Quarantine Reveals Grade-specific Behavioural Modification of Myopia: One-Million Chinese Schoolchildren Study. medRxiv.  

7. Tricard, D., Marillet, S., Ingrand, P., Bullimore, M., Bourne, R., & Leveziel, N. (2021). Progression of myopia in children and teenagers: a nationwide longitudinal study. The British Journal of Ophthalmology, 106, 1104 - 1109.  

8. Ducloux, A., Marillet, S., Ingrand, P., Bullimore, M., Bourne, R., & Leveziel, N. (2021). Progression of myopia in teenagers and adults: a nationwide longitudinal study of a prevalent cohort. The British Journal of Ophthalmology, 107, 644 - 649.