Strategies in myopia prevention and management

Abstract

It has been estimated that more than half of the population residing in the Eastern Mediterranean region (EMR) will have myopia by 2050. With recent evidence from the EMR revealing that myopia is becoming more prevalent in children and presenting at a younger age than seen before, it is of importance to investigate the strategies employed in myopia control. Various intervention strategies have been investigated in the last few years including optical, pharmacological, and environmental modification methods. Spectacle-based strategies including use of bifocal lenses and progressive addition lenses (PALs) have been shown to be the least successful in reducing the progression of myopia. However, the use of such lenses provides better myopia control than prescribing single-vision lenses or under-correcting, which may increase myopia progression. Since many practitioners in the region are only allowed to prescribe and fit spectacles, the use of bifocals and PALs should not be neglected. Multifocal contact lenses and orthokeratology have proven to be successful clinically in the management of myopia. However, cost and limited availability of these lenses in the region are barriers for the use of these lenses by EMR practitioners. Use of atropine has been shown to be effective in controlling myopia progression. With the limited scope of practice regarding the use of diagnostic drugs by optometrists, there is need for advocating to allow optometrists to use ocular diagnostics such as atropine. In addition, limited availability of low-dose atropine limits the use of atropine as a myopia control strategy. It has been shown that spending more time outdoors acts as a preventive mechanism against the development of myopia. With evidence from studies on children from the region indicating more near work and reduced outdoor time as risk factors for myopia, it is imperative to educate parents and teachers for the need to increase time outdoors.