Discussion by

Abstract

The practice of medicine in the twentieth century will be remembered as the era of diagnostic discovery and therapeutic advances. While new treatment modalities will continue to emerge, the twenty-first century will most likely become an era of medicine known for disease prevention, as the knowledge of the genetic basis and predisposition of disease processes will lead to the manipulation of the pathophysiologic process at an early stage of disease. Ophthalmologists currently have important roles in the prevention of ocular disease. Regular ophthalmic surveillance and timely pharmacologic and surgical intervention can be used to treat complications of diabetic retinopathy and glaucoma. One of the greatest causes of visual disability is refractive error, with myopia being one of the top five leading causes of vision impairment and blindness throughout the world.1 All ophthalmologists are aware of the ocular pathology associated with moderate and high myopia. While myopic macular degeneration and rhegmatogenous retinal detachments are the most feared sequelae of high myopia, glaucoma, strabismus, and vitreous degeneration are also much more prevalent and cataract procedures have greater inherent risks in high myopes. While our journals are filled with articles and studies describing surgical procedures to “cure” myopia, none of these procedures prevent the above-mentioned complications of pathologic myopia. Little research has been conducted to address the possible prevention of the progression of myopia. In the article by Saw and colleagues, the authors conducted an evidence-based analysis of the current literature to examine studies that utilized interventions to prevent the progression of myopia. Specifically, in addressing the use of atropine eye drops, they concluded, “regarding the use of atropine eye drops was considered level B, moderately important outcome.” The question posed by this analysis is: Should we as ophthalmologists advocate the use of topical eye drops in an effort to prevent myopia? Based on the evidence of these few well-designed, controlled and conducted studies the answer is a qualified yes.