Myopia Management PERSPECTIVES

NASEM report on myopia: key takeaways for practicing eye care professionals.

Introduction and Overview

The National Academies of Sciences, Engineering, and Medicine (NASEM) 2024 report, Myopia: Causes, Prevention, and Treatment of an Increasingly Common Disease, is a comprehensive, 375 pages document building on decades of research, exploring advances in genetics, ocular imaging, and environmental factors contributing to myopia as a disease.

What the Report Says

Watch NASEM report contributor and Navigator Ambassador, Dr. Síofra Harrington give her take on the report here.

Challenges in tracking prevalence

The NASEM report on myopia notes that while myopia is rising globally, tracking its true prevalence is complicated by inconsistent data collection and varying definitions of the condition. For example, evidence in the United States is limited by irregular screening practices, differing diagnostic criteria using 20 year old data, and varied assessment methods.

Environmental factors

The report highlights the significant role of environmental factors, (such as outdoor time during daylight) in potentially reducing the risk of myopia progression by stimulating retinal pathways. The significance of near work, including the use of electronic devices, remains uncertain and requires further study.

Diagnostic technologies & pathogenesis

Advances in diagnostic technologies and evidence on use of cycloplegics in refractions are improving our ability to assess myopia, though there is no consensus on standardised clinical protocols. The report underscores the importance of understanding the mechanisms behind myopia pathogenesis, with recent research showing that the entire retina, not just the fovea, regulates eye growth through retinal image signalling. While refractive surgery, which does not affect ocular elongation, can improve vision as measured by distance visual acuities, it does not reduce the risk of long term ocular complications associated with myopia.h. Thus, patients are still at increased risk for retinal thinning, holes, detachments and other eye health complications of myopia, highlighting the need for continued monitoring of ocular health.

Socioeconomic barriers

Socioeconomic barriers hinder access to care, particularly for children, underscoring the need for improved vision screening and follow-up systems. These barriers include uneven awareness of the importance of vision issues, assessing children’s eye health, challenges for parents in accessing eye care professionals, and difficulties with patient compliance to prescribed treatments. Furthermore, socioeconomic factors such as income inequality, lack of health insurance, and geographic disparities contribute to reduced access to eye care services in underserved communities. These findings call for coordinated research and clinical efforts to better understand and manage this growing public health concern.

Key Takeaways for Practising Eye Care Professionals

Myopia as a Disease: The increasing prevalence of myopia and its potential ocular complications necessitate treating myopia as a serious disease, rather than a simple refractive error. Reclassifying myopia as a medical condition can promote better management and prevention efforts.
Outdoor Time and Visual Activity: Time spent outdoors during daylight, focusing on distant objects, is crucial for slowing myopia progression. The quality of outdoor activities plays a significant role in maintaining a healthy ‘visual diet’ – the variety of visual stimuli from the environment. Exposure to natural sunlight and focusing on distant objects stimulate retinal pathways, offering a protective effect against myopia. While near work activities, such as reading or screen time, seem to be associated with myopia, important gaps in knowledge remain regarding their precise impact on eye growth.
Comprehensive Management: Eye Care Professionals should consider conducting cycloplegic refraction examinations of children to ensure accurate refractive assessment, where possible. Technological advancements in diagnostics may enhance future care.
Limitation of Refractive Surgery: Refractive surgery can improve vision but does not address the key concern of axial elongation in myopia. The eye remains physically stretched, leaving patients at risk for long-term complications such as retinal thinning, holes, and detachments, even after successful vision correction. Such management is also generally performed at a stage in life where a patient is too old for effective myopia control.

Three Action Items

1. Promote Outdoor Time: Advocate for at least one hour of outdoor activity daily, particularly for children, as a preventive measure against myopia.
2. Stay Updated on Best Practices for Myopia Measurement: As new technologies emerge and other forms of intervention that are proven to assist in preventing or controlling progression, optometrists should stay informed about advances in myopia diagnostics and incorporate evidence-based practices into routine care.
3. Participate in Clinical Trials: Eye Care Professionals can contribute to the development of more effective myopia treatments by participating in and promoting both pre-market and post-market clinical trials aimed at better understanding myopia’s progression and potential interventions

To access the complete NASEM report, please visit this link.