Myopia: Beyond the Blur – A Global Epidemic in Focus

Kashish Dineshbhai Mulani,

B. Optom Student, KD Institute of Optometry, Ahmedabad, India

 

Myopia, often known as near-sightedness, is no longer only a refractive problem that may be rectified with glasses or contacts. It has arisen as a global health concern, affecting about 30% of the world’s population in 2020 and projected to reach 50% by 2050. Among these, 10% will develop extreme myopia, increasing their risk of permanent visual disorders like Retinal Detachment, Glaucoma, and Myopic Maculopathy, a significant cause of blindness with no cure. ^(1–4)

What Drives the Myopia Epidemic?

Myopia has increased due to both genetic and environmental factors, particularly prolonged near labour and minimal time spent outside. A national cross-sectional study in China found a substantial link between economic development, scholastic pressures, and increasing myopia rates in youngsters. ⁽¹⁾  In many Asian countries, the desire to achieve academically in competitive systems appears to manifest as early onset and rapid progression of myopia.

Socio-economic Inequity in Access to Vision Care

Though refractive defects such as myopia are treatable, the expense of care whether in the form of spectacles, contact lenses, or refractive surgery can be prohibitively expensive for economically disadvantaged people. According to the report, many individuals cannot afford even the most basic eyesight treatment. ⁽²⁾ Low-cost surgical procedures can lead to poor post-operative results, raising concerns about quality and follow-up treatment. For low-income households, even regular spectacles, much alone myopia management treatments, are out of reach.

Myopia Control with Atropine: Balancing Efficacy and Visual Quality

Low-Dose Atropine, particularly 0.01%, has emerged as a game changer for reducing myopia progression in children. ⁽²⁾ Clinical trials, such as ATOM2 and LAMP, have demonstrated its usefulness with minimal side effects. ⁽²⁾ Higher doses, such as 0.05%, may modestly enhance outcomes, however, they can degrade visual quality, particularly in low-contrast settings, as proven by Optical Quality Analysis System (OQAS) testing. ⁽²⁾

Early intervention is critical. Regular cycloplegic refraction every 3-6 months, beginning with 0.01% Atropine at bedtime, and monitoring for mild side effects (e.g., pupil dilatation, photophobia) are recommended. ⁽²⁾ Using bifocal or tinted lenses can alleviate discomfort. Equally crucial is educating parents, teachers, and students about the long-term dangers of untreated myopia and the value of continuous therapy. ⁽²⁾

Figure 1: Atropine Drop Treatment Based on ATOM 2 Study

Addressing the Global Burden

Myopia currently affects up to 90% of individuals in urban Asian populations and roughly 33% in the United States. ⁽³⁾ The economic burden, compounded by the cost of eyesight loss from complications, needs immediate policy adjustments. There is a need in schools for low-cost interventions, insurance coverage, and myopia screening, particularly among high-risk populations. To reduce modifiable risk factors, eye care practitioners should promote outdoor activities and minimise screen use.

Conclusion

Vision Care is a Right, not a Luxury!

The evidence is unequivocal: Myopia is not innocuous. This condition necessitates extra treatment, from children suffering with untreated blurry vision to adults at risk of permanent visual loss. ⁽⁴⁾ 0.01% Atropine stands out as a practical, safe, and affordable treatment. However, unless equal access is secured, millions will continue to fall through the cracks. It is time to shift from correction to comprehensive prevention, with an emphasis on science and social justice.

 

References

1. Ma Y, Lin S, Li L, Jia Y, Zou H. Socioeconomic mechanisms of myopia boom in China: A nationwide cross-sectional study. BMJ Open. 2021 Jun 16;11(6).
2. Sankaridurg P, Tahhan N, Kandel H, Naduvilath T, Zou H, Frick KD, et al. IMI impact of myopia. Vol. 62, Investigative Ophthalmology and Visual Science. Association for Research in Vision and Ophthalmology Inc.; 2021.
3. Leo SW, Young TL. An evidence-based update on myopia and interventions to retard its progression. In: Journal of AAPOS. 2011. p. 181–9.
4. Bourke CM, Loughman J, Flitcroft DI, Loskutova E, O’Brien C. We can’t afford to turn a blind eye to myopia. QJM: An International Journal of Medicine . 2023 Aug 1;116(8):635–9.