Public Health and Epidemiology Insights from IMC 2024

The International Myopia Conference (IMC) 2024 held in Sanya, China on the 25th to 28th of September convened researchers and eyecare practitioners worldwide to discuss the rising prevalence of myopia and its significant public health implications. With presentations from experts across various regions, the conference highlighted a range of public health strategies, regional trends, and critical factors influencing myopia progression, stressing the urgent need for effective policies and preventive interventions to address this growing issue. Here, we summarise the latest updates we gathered from the conference.

The first IMC symposium highlighted the intersection of myopia and public health, featuring impactful presentations by Ian Morgan and Seang Mei Saw. They emphasized the importance of evidence-based, collaborative approaches to curb rising myopia rates. Morgan discussed public health strategies, noting that early intervention from preschool to Grade 3 is critical. Policies promoting outdoor time and managing educational pressures—such as Taiwan’s national school break policy and a play-based preschool initiative in Zhejiang, China—are already showing positive outcomes.

Seang Mei Saw outlined a three-tiered approach to myopia prevention: primary (environmental modifications to prevent onset), secondary (early detection and treatment), and tertiary (managing risks of complications). She highlighted the potential of precision medicine, leveraging gene identification and AI imaging for targeted interventions in high-risk individuals.

Another significant topic at IMC 2024 was the stark differences in myopia prevalence across global populations, emphasizing how cultural, environmental, and lifestyle factors shape the myopia landscape. A session moderated by Ian Flitcroft and Jian Ge featured data from studies conducted worldwide, revealing varied myopia trajectories across different populations.

Jing Zhao’s study on Chinese children aged 3-9 identified parental myopia, excessive homework, and near-work as risk factors for younger children (ages 3-6), while baseline myopia, female gender, and overweight status were risk factors for older children (ages 7-9). Outdoor activity emerged as protective across both age groups. Miriam Conway’s research on Scottish children aged 3.5-5.5 years found that refractive error was more hyperopic pre-COVID, with post-COVID data indicating a rise in myopia in children living in urban environments, especially those in apartment settings.

Sayantan Biswas examined how lighting impacts myopia, finding that dim lighting led to greater axial length changes and choroidal thickness in emmetropes, suggesting light exposure could help prevent myopia in young adults without impacting progression in those already myopic. Rachel Langan discussed the contrast theory, positing that high-contrast near work overstimulates peripheral retinal cells, thus driving myopia. Wei Zhang emphasized the correlation between urbanization and increased myopia prevalence, highlighting the need to understand underlying mechanisms. 

IMC 2024 underscored the importance of robust public health frameworks that incorporate preventive strategies, community outreach, and targeted policies. Presentations advocated for increased awareness campaigns and educational programs that inform communities about the risks associated with prolonged near work and screen use. Experts at the conference also encouraged collaboration between schools, healthcare providers, and policymakers to implement policies that promote visual health in young children, particularly by increasing outdoor play and reducing screen exposure.

One of the more ambitious recommendations discussed was the creation of centralized data repositories, both regionally and internationally, to enable researchers and policymakers to track myopia trends more effectively. In the U.S., for example, Dr. Machelle Pardue emphasized the lack of comprehensive national data on myopia prevalence, which hinders effective policymaking and intervention. Establishing a central repository would support data-driven decisions, allowing for more accurate predictions of myopia trends and the development of effective preventive strategies.

The Chew Sek-Jin Memorial Lecture, a highlight of the IMC, was awarded to Professor Ian Flitcroft, a Dublin-based pediatric ophthalmologist whose research has greatly influenced myopia management. Ian’s journey in myopia research began in the 1980s, exploring retinal responses and spatial frequency effects on eye growth, attending his first IMC in 1998. His influential 2012 paper challenged the notion of a "safe" level of myopia, sparking a shift in modern myopia management.

In his lecture, titled “Are we there yet?” Ian argued that while single vision correction remains predominant, myopia management must be simplified without oversimplifying the condition. He noted that urban environments, with their blurred-image-like spatial frequency, might interfere with the eye’s growth signals, highlighting a need for outdoor time. Ian also discussed the anatomical contributors to myopia—particularly axial length—as essential for targeted treatment, citing the MOSAIC study, which shows axial myopes respond well to atropine treatment. He likened myopia levels to IOP in glaucoma as a marker of retinal risk. Ian’s vision for the future includes preventing myopia onset, slowing its progression, and ensuring lifelong visual health for myopes. While progress is strongest in slowing myopia, much work remains. He closed by inspiring the next generation to continue bridging research and clinical practice for better patient outcomes. 

As the prevalence of myopia continues to rise, IMC 2024 highlighted the critical role of public health in myopia management. By addressing the unique environmental and lifestyle factors contributing to myopia onset, public health initiatives can support early intervention and help reduce the societal burden of myopia. Through region-specific strategies, educational campaigns, and policy-driven interventions, the conference speakers emphasized the potential for comprehensive myopia prevention that prioritizes the well-being of future generations.

The IMC 2024 presentations serve as a call to action, urging governments, healthcare providers, and communities to implement preventive measures that align with the diverse needs of global populations. As evidenced by successful case studies from Taiwan and New Zealand, such public health initiatives could provide a powerful defense against the growing myopia epidemic, ultimately contributing to a healthier future for children worldwide.