Progression of Myopia - which Preventive Measures Can be Recommended?

Abstract

The prevalence of myopia shows a worldwide increase with large regional differences. Especially high myopia enhances the risk of irreversible vision loss due to myopic maculopathy or other secondary effects. Reducing the prevalence and progression of myopia in schoolchildren is therefore a main goal in ophthalmology. Spending at least two hours a day outdoors is the easiest way to reduce myopia progression. Another modifiable factor is to reduce continuous near work with distances of less than 30 cm. Low-dose atropine eye drops administered once daily over two or more years have been shown to reduce myopia progression. Optical interventions which have been effective are multifocal contact lenses or orthokeratology contact lenses, but these have the risk of microbial keratitis. Whereas neither under- nor overcorrection of myopia have been proven effective, new so-called multisegment glasses have reduced myopia progression. Most of the studies concerning atropine and optic interventions have been performed in groups of Asian children, which are known to have more severe myopia progression, although actually there are many studies being conducted on Caucasian children. Still, there is also a lack of studies contrasting pharmacologic against optic interventions and comparing these with a combination of methods. The decision to start optic or pharmacologic measures can therefore only be an individual decision and is mainly based on age, refraction and progression in the past, while environmental factors should be assessed first.