Kritika Gautam, B. Optom

Paediatric Fellow Optometrist, Dr. Shroff’s Charity Eye Hospital, New Delhi, India

Myopia, an old age term has now gained the priorities due to public health concern regarding myopia progression. Worldwide 30% population is currently myopic, and as per reported studies 50% of the world population will be myopic by the year 2050 and 10% will be highly myopic.⁽¹⁾ Rohit Saxena et.al., reported that 13% of the Delhi NCR population are myopic and 17% of children or 1 out of 6 children aged between 5 – 15 years are suffering from myopia. ⁽²⁾

Reported studies are advocating that hyperopic defocus is responsible for the elongation of the eyeball resulting in myopia progression. Nowadays reducing myopia progression is the global goal. For that, we need to be concerned even before the eyes become myopic.

Myopia progression and the associated axial elongation led to visually debilitating pathologic retinal conditions. The rise of the pandemic in the year 2019 (COVID-19), is the more aggravated factor for even higher myopia progression rates than what is noted in the pre-COVID era. This could be possibly due to a combination of a more indoor-centric lifestyle (digital-ecosystem, involvement in intensive near-work activities) and limited outdoor time.

The current rapid rate of myopia progression in children emphasizes the need for a more aggressive approach to controlling axial elongation.

As there are many factors that can be considered as responsible factors for developing myopia.  Here comes the term “Premyopia”. A condition of non-myopic refraction with a family history of myopia and a combination of other risk factors give rise to “Premyopia”. IMI (International Myopia Institute) defines the Pre-Myopia as the refractive state of an eye having <-0.75D and > -0.50D in children where a combination of baseline refraction, age, and other quantifiable risk factors provide a sufficient likelihood of the future development of myopia to merit preventive intervention.⁽³⁾

Factors affecting premyopia:

1. Family History: One myopic parent increases the risk by 3 times and two myopic parents increase the risk by 6 times.
2. Reduce outdoor time is associated with an increased risk of myopia less than 80 min outdoors increase risk of myopia.
3. Binocular Vision: Children with high AC/A ratio seem to have an increased risk of myopia development within 1 year over 20 times. ⁽⁴⁾
4.  Refractive State: If the child is less hyperopic according to age, there is a higher chance of developing future myopia.

Managing Premyopia

Management of pre myopia is important before they become myopic but if the child does not develop myopia yet it’s quite challenging to manage this. Few lifestyle modifications such as increased outdoor times of approximately 80 minutes/day and decreasing the near time of 2-5hrs per day can reduce the risk of myopia. Studies demonstrating that regular topical administration of 0.025% atropine eye drops can also prevent myopia onset and reduce rate of myopia sift in pre-myopic children.⁽⁵⁾

Proper counselling of the parents is important to make them understand the condition and preventable measures for better results. It is important for identifying and managing premyopes to reach the goal of preventing myopia progression.

References:

1. How to identify and manage Pre-Myopes. Myopia Profile. (2020, October 23). Retrieved October 18, 2022, from https://www.myopiaprofile.com/identify-manage-pre-myopes/
2. Monica Jong, B. O. (2021, February 25). Should we be identifying and managing pre-myopia? Review of Myopia Management. Retrieved October 18, 2022, from https://reviewofmm.com/should-we-be-identifying-and-managing-pre-myopia/
3. Myopia hitting India’s youth. BioSpectrum India. (n.d.). Retrieved October 18, 2022, from https://www.biospectrumindia.com/views/70/13698/myopia-hitting-indias-youth.html

4. Loughman, J. (2019, November 20). Defining pre-myopia: A new term for an age-old condition. Ocuco. Retrieved October 18, 2022, from https://www.ocuco.com/ie/defining-pre-myopia-a-new-term-for-an-age-old-condition/
5. Flitcroft, D. I., He, M., Jonas, J. B., Jong, M., Naidoo, K., Ohno-Matsui, K., … & Yannuzzi, L. (2019). IMI–Defining and classifying myopia: a proposed set of standards for clinical and epidemiologic studies. Investigative ophthalmology & visual science, 60(3), M20-M30.