Strategies to Prevent the Progression of Myopia

AAPOS & SNEC Joint Meeting 2013

Monte D. Mills, MD


August 15, 2013

Editorial Collaboration

Medscape &

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Hello. I am Monte Mills, Director of Ophthalmology at the Children's Hospital of Philadelphia. I have just returned from the joint meeting of the American Association for Pediatric Ophthalmology and Strabismus and the Singapore National Eye Centre in Singapore, which was titled, "An Intercontinental Perspective of Pediatric Ophthalmology and Strabismus." I would like to share some of the highlights from this meeting.

First, this was a fabulous meeting; it was perhaps the largest gathering of pediatric ophthalmology and strabismus experts outside of North America, with more than 800 people registered. Symposia and workshops were sponsored by several international organizations, including ORBIS, the Royal College of Australia and New Zealand, and the International Strabismological Association. The meeting had a truly international flavor with many perspectives from around the world.

One of the most interesting presentations was given by keynote speaker Donald Tan,[1] who is from the Singapore National Eye Centre and is well-known around the world for his work on developmental myopia in childhood. Dr. Tan presented their latest findings about the use of atropine in the prevention of progression of myopia. As we have known for many years, 1% atropine used on a daily basis in childhood can slow the progression of myopia. However, there are many problems with this treatment, including intolerability, the cycloplegic effect, and the rebound progression of myopia that occurs after stopping the medication. Dr. Tan and his colleagues, in interesting and path-setting research, have demonstrated the effectiveness of 0.1% and 0.01% atropine as a daily eyedrop in retarding the progression of myopia, demonstrating a strong effect with the 0.01% concentration of atropine, which has much less cycloplegic effect and, as you would expect, better tolerability. Furthermore, the use of 0.01% atropine is associated with much less rebound effect than we have seen with 1% atropine. This research demonstrated the potential for 0.01% atropine as a medical therapy to prevent the progression of myopia.

In related talks, Kathryn Rose from Australia[2] presented a review and new information about other factors related to the progression of myopia and the strong correlation between time spent out-of-doors and reduced risk for myopia. Time spent out-of-doors in early childhood has a strong effect on lowering the risk for myopia. Currently, both cohorts and cross-sectional studies have demonstrated this strong effect, which is not mediated by activity, per se, but is actually mediated by outdoor time. Several ongoing studies should provide information very soon about the effectiveness of interventions to increase outdoor activity on the progression of myopia.

A truly unique symposium on the effects of error and poor outcomes on the surgeon and the family and the social, ethical, and medicolegal aspects of error and poor outcomes was presented by the Royal Australian and New Zealand College of Ophthalmology.[3]

The ORBIS symposium[4] on blindness revealed that blindness in childhood continues to be a significant worldwide problem. Many of the world's blind children are in Asia, and this symposium had a significant international contribution about prevention and treatment of childhood blindness from cataract, trachoma, refractive error, and other significant worldwide issues.

From the Children's Hospital of Philadelphia, this is Monte Mills.