Myopia Profile

Clinical

Upper age for myopia management

 Posted on March 1st 2020 by Connie Gan

The question on the upper age for commencing myopia management, and when to cease myopia management, was raised in this post. The links referenced in the post are discussed below.

NL A dumb question maybe ( I am still trying to catch myself up on the myopia control research) but is there an upper age where you dont worry too much? Would you be thinking myopia control in an 18yr old? How about a 30 yr old that seems to be progressing? Do you give the same advice etc?BE This graph, from COMET study, gives a good indication about when myopia progression is likely to finish (early 20s) which is my best estimate for when myopia control may not be needed any more. But I accept the point that you make and there will always be exceptions to the normal...so if in an individual myopia appears to be progressing then it is worth attempting to control it!MH *past tense. more devices now than 2013...LB The upper age limit was more defined in previous years, but I am finding more changes later than 20's, especially for those on devices for extended hours. I'm not sure in regards to studies, but to me the trends are changing.DK If the myopic power is - 8.00 D and -2.00D Cyl then myopia progression can prevent by Ortho-KMB Here's a paper mentioned by Bruce Evans. The soundbite I use from the paper is: 50% stabilize by 15 years 75% stabilize by 18 yearsMB Adult progression is rare but happens. We found a lot in this retrospective study but in a 5-year prospective study of 260 adults (mean age at baseline 30.7 ± 3.5 years), only 43 (16.5%) had a five-year progression of-0.50 D or more.COMET STUDU GRAPH.jpeg

What the research shows

COMET study - reported results from the overall study cohort

  • 48% had stable myopia by age 15 years;
  • 77% by age 18 years;
  • 90% by age 21 years;
  • By age 24 years, the curves of almost all of the participants, 96% had achieved the curve-based definition of myopia stabilization.

A retrospective study of myopia progression in adult contact lens wearers - (Bullimore et al 2002)

  • Showed that the frequency of myopia progression decreases with age, being common in their 20s but less frequent in their 30s
  • Over 5 years of study, 21.3% of the participants show myopia progression of at least 1D
  • There were no differences in risk factors between those who progressed in adulthood and those who didn't - hours per day spent reading and writing, computer use, education level, family history of myopia, age of onset of myopia, and contact lens wear were similar.

Take home messages

  • The above studies show that myopia can progress slowly and steadily during adulthood for a small portion of the population.
  • While half of myopes will stabilize by age 16, this means that half don't! Myopia management should continue until myopia stabilization is demonstrated, at which point you could consider discontinuing the myopia control treatment and reviewing again in 6 months. Young adult myopes wearing contact lens treatments may be happy enough to continue them even once myopia is stable.
  • Continue to emphasise the importance of visual hygiene to our adult patients. Heavy near work can promote myopia progression, even in young adults.
  • Regardless of the age of myopia stabilization, we need to take special care of higher myopes, especially those with axial length over 26mm or more than 5-6D of myopia as they have a high risk for macular and retinal disease. In these patients, we should consistently monitor their eye health throughout adulthood.

Meet the Authors:

About Connie Gan

Connie is a clinical optometrist from Kedah, Malaysia, who provides comprehensive vision care for children and runs the myopia management service in her clinical practice.

Read Connie's work in many of the case studies published on MyopiaProfile.com. Connie also manages our Myopia Profile and My Kids Vision Instagram and My Kids Vision Facebook platforms.

About Kimberley Ngu

Kimberley is a clinical optometrist from Perth, Australia, with experience in patient education programs, having practiced in both Australia and Singapore.

Read Kimberley's work in many of the case studies published on MyopiaProfile.com. Kimberley also manages our Myopia Profile and My Kids Vision Instagram and My Kids Vision Facebook platforms.

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