Reframing Myopia as a disease demanding urgent treatment: Asia-Pacific Myopia Management Symposium Recap #1

Both the biological underpinnings of progressive myopia and its significant impact on eye health necessitate a proactive and preventative approach to its detection and management.¹ The Asia-Pacific Myopia Management Symposium (APMMS) 2023, powered by CooperVision, brought global experts on myopia together to discuss the many facets of myopia and its management at the individual and national levels. The three key themes that emerged were:

1. Reframing Myopia as a disease demanding urgent treatment.
2. Empowering myopia control through technology, research and evidence.
3. Building a future-proof practice with myopia management.  

This article is the first of a three-part series exploring these key themes of the symposium. 

It is commonly acknowledged that myopia is not simply a case of vision correction, but a lifelong, chronic condition that comes with significant ocular risks.² The shift from viewing myopia as a disease rather than a refractive state of the eye allows for the health, social and economic consequences of myopia to be more fully appreciated and understood. The symposium emphasized four major factors leading to this shift:

• Biological changes and risks of myopia: The development and progression of myopia involve significant biological changes, such as the flattening of the cornea after birth and the importance of axial length as a key factor for myopia progression.³ Particularly, in elongated myopic eyes, changes like the thinning of the choroid and decreased choroidal blood flow can lead to scleral hypoxia, highlighting the disease's biological basis.⁴
• Impact on eye health: Myopia significantly increases the risk of serious eye conditions, including myopic maculopathy, open-angle glaucoma, posterior subcapsular cataract, and retinal detachment. No amount of myopia is safe: even a 1 dioptre increase in myopia can substantially raise the risk of these conditions, thus portraying myopia as far more than a benign refractive error.⁵
• Need for early and effective management: The emphasis on early examination, identification of at-risk individuals, and the application of the best evidence-based interventions for young myopes underlines the critical approach needed in treating myopia as a serious health concern.⁶ Moreover, discussions on the use of atropine in myopia management, including considerations around its efficacy, potential rebound effects, and the importance of individualized treatment plans, further demonstrate the complexity of managing myopia effectively and the necessity of viewing it through the lens of disease management rather than simple refractive correction.
• Combination therapies: The exploration of combination therapies, such as MiSight 1 day contact lenses with atropine⁷ and orthokeratology with atropine,⁸ reflects the evolving strategies in myopia management aimed at maximizing treatment outcomes. This approach acknowledges the multifactorial nature of myopia progression and the need for comprehensive strategies that can address various aspects of the condition.

Overall, these points pivot around the recognition of myopia as a complex, progressive condition with significant health implications, warranting timely and tailored management strategies akin to those used in other chronic diseases. This shift towards understanding myopia as a disease is critical for advancing public health initiatives, research, and clinical practices aimed at mitigating the growing global burden of myopia.

There is still a lot about myopia and myopia control that we are still learning. Recent studies on myopia have suggested that scleral hypoxia can contribute to myopia by increasing activities like glycolysis and levels of lactate.⁹ Additionally, analysis of aqueous humor in myopic patients suggests multiple factors including scleral matrix degradation and chronic inflammation are linked to myopia progression.¹⁰ This research helps highlight the complex biological underpinnings that we are still learning regarding myopia as a disease, and can further explore as future treatment targets. 

The seminal Holden et al study was hugely influential: by projecting a substantial increase in myopia prevalence by 2050, the study demonstrated the potential for myopia to become a leading cause of uncorrectable visual impairment.¹¹ A study by Bullimore et al published 2024 that looked at myopia prevalence in the US used comparatively conservative myopia prevalence estimates (compared to the Holden et al study) but still finds a notable contribution of myopia to future visual impairment,¹² emphasizing the need for treatment across all levels of myopia to reduce its public health impact.

Treating myopia as a disease means recognizing it as a significant and progressive eye condition that requires a comprehensive management strategy, rather than just prescribing corrective lenses. This approach emphasizes the importance of early detection, intervention, and continuous monitoring to slow progression and prevent complications. It also should signify a shift towards a more preventive approach in clinical practice, with proactive advice on preventative measures such as spending more time outdoors and good visual habits for near work, and a close look at risk profile for everyone.