Commentary: Curbing myopia progression: The way forward.

Abstract

Myopia, why the sudden hullabaloo around it? As we all know myopia is an eye disease that has become more prevalent in recent years and is expected to affect nearly half of the world’s population in the future.[12] The authors of the article have very well summarized the older and newer concepts of this soaring disease, the knowledge of which each and every ophthalmologist must have in order to treat his/her patients better. Gone are the days when myopia was treated with just spectacles and its complications were managed as and when it occurred. It’s now time to detect the disease early, slow down the progression and thereby reduce the occurrence of its sight-threatening complications. We all know that myopia is a heritable disease. It must be kept in mind that if one of the parents is a myope, it doubles the risk of myopia in the child and if both parents are myopes there is six-fold increased risk of myopia in the child. Parental myopia[3] is not only a risk factor for developing myopia but is also a risk factor for progressive myopia. Hence, children born to myopes should be screened at regular intervals and watched for any progression. The other important consideration is of pre-myopes who have an increased likelihood of developing myopia, more commonly if there is parental myopia. Pre-myopia,[4] as defined by the IMI, is a refractive state of the eye of ≤ +0.75 D and > −0.5 D in children after cycloplegic refraction with a combination of risk factors. Keeping a closer watch, frequent follow-up and early intervention in pre-myopes may be the need of the hour as well. As rightly said by the authors, there is no fixed guideline for management of myopia and its progression. We have been following this algorithm at our institute. This algorithm was designed based on the recent studies that have investigated the effectiveness of the various treatment modalities for different grades of myopia. In addition to these treatment options, emphasis should be laid on lifestyle changes as most of the children nowadays are indoors due to which there has been an increase in screen time, lack of exposure to sunlight and excessive near activity in many other forms like reading, etc. Supporting this statement is the study by Muthu et al.[5] which stated that during the phase of COVID-19 pandemic lockdown, wherein children were confined to their houses, there was a significant increase in the number of myopes. Hence, children must be encouraged a few hours of outdoor activity (≥2 hours daily) and maintain appropriate distance of 14 inches and posture while doing any near activity. Also, in those children who are voracious readers, constant near activity can also be a risk factor to progression, and hence, they need to follow the 20–20–20 rule (to take regular breaks after 20 minutes of continuous reading by looking at a distance of 20 feet for 20 seconds, which means to look as far as possible after opening a window). Currently research on myopia is extensive. Dopamine and its deficiency has been associated with the development and progression of myopia.[67] We are aware of the role of sunlight exposure and myopia. Also, Dopamine is directly proportional to the amount of playtime and sunlight exposure time, thereby linking itself to myopia. In addition, many pharmacological agents that have been clinically tried in the management of myopia are, in one way or the other, linked to the basic research of dopamine. We have previously shown and reported the detection of dopamine levels from the tear fluid of humans via ELISA.[8] In our unpublished data, we observed lower dopamine levels in the tears of the myopic patients as compared to normal controls. However, there is a need to validate the relationship between myopia, dopamine and various pharmacological and non-pharmacological options in myopic progression, which can provide more promising treatment options in the future. With the rise in myopia and myopia progression, one can expect an increase in the incidence of its complications like glaucoma, cataract, retinal degenerations, etc. Therefore, ophthalmologists must monitor myopes at regular intervals and watch out for these sight-threatening complications. To conclude, the management of myopia will always be a customized approach, depending on the risk factors and the features at the time of presentation. We hope future studies and newer treatment options provide an apt solution to prevent progression in this myopia pandemic.