Update on the Epidemiology and Genetics of Myopic Refractive Error

Justin C Sherwin; David A Mackey


Expert Rev Ophthalmol. 2013;8(1):63-87. 

In This Article

Management of Myopia

Myopia may be corrected with spectacles, contact lenses, orthokeratology or surgical means including laser refractive surgery and intraocular lens implantation. Correction of myopia can result in ocular morbidity, including keratitis secondary to contact lens wear and corneal scarring and persistent corneal haze following refractive surgery. At present, there is no widely used intervention to prevent myopia from occurring or progressing. Randomized controlled trials (RCTs) of several interventions to prevent myopic progression, including bifocal lenses, progressive additional lenses and contact lenses have failed to show major promise.[18] The use of atropine drops for controlling myopic progression is hopeful and has been shown to be superior to placebo for children with mild-to-moderate myopia in several recent meta-analyses.[19–21] However, owing to several common adverse effects (including near blur, light sensitivity, dermatitis and allergic conjunctivitis), the uptake of this intervention has been sluggish. This may change, as a recent RCT demonstrated doses as low as 0.01% may be better tolerated without limiting clinical efficacy.[22] Increasing time outdoors may be a suitable intervention to prevent myopia and its progression[23] but ongoing RCTs must first be assessed and prescribing a lifestyle intervention has inherent challenges.

It is important to acknowledge that correction of refractive error by means of spectacles, refractive surgery or otherwise does not negate the elevated risk of pathology associated with severe myopia. In the majority of affected individuals with early-onset nonsyndromic high myopia, loss of vision during working life is minimal.[24] Nevertheless, high myopia remains a major cause of blindness and visual impairment in older adults.[25,26] Novel treatments that may improve the visual outcome of those affected with myopic sequalae such as choroidal neovascularization, a major cause of visual loss in high myopia, are being developed.[15]