Strategies for Slowing Myopia Progression in Kids Differ Widely Between Ophthalmologists

By Will Boggs MD

September 21, 2019

NEW YORK (Reuters Health) - The strategies for slowing myopia progression differ widely among pediatric ophthalmologists around the world and include both effective and ineffective approaches, according to an online survey.

Myopia is the most common visual disorder worldwide. Various pharmacological, optical and behavioral treatments appear to slow progression, but there is no consensus regarding the best treatment approach.

Dr. Eedy Mezer from Ruth Rappaport Children's Hospital, in Haifa, Israel, and colleagues compared practice patterns used by pediatric ophthalmologists to counter the progression of myopia using an online survey of 794 pediatric ophthalmologists worldwide, including 455 who employed such treatments.

A mean myopia-progression rate of 1.1 diopters/year was used as the cutoff for initiation of treatment, with minor deviations across geographical regions, and the overall mean age cutoff for beginning treatment was 5.33 years.

Pharmacological treatment was the most popular modality in most regions, but optical treatment was preferred in Europe and Central Asia, the researchers report in the British Journal of Ophthalmology, online August 13.

The prevalence of physicians prescribing effective pharmacological treatments, which the authors defined as either atropine or pirenzepine, was 97% overall and was 93% or higher in most regions, but only 85% in Europe.

Optical treatment was popular in Europe, Central Asia, Central-South America and the Far East, where 92% or more respondents used it, but it was less popular in North America, Australia and the Middle East. Still, only 38.8% of respondents used an optical treatment that has been proved effective for reducing myopia progression.

The prevalence of ophthalmologists using behavioral treatment ranged from 86% in North America to 98% in the Far East and 100% in Central Asia.

More than a third of respondents used a combination of two modalities, and 56% of respondents used a combination of three modalities of treatment. The prevalence of ophthalmologists using an effective pharmacological or optical treatment did not differ significantly according to how many treatment modalities they employed.

"In order to alter the expanding myopia epidemic, we advocate that treatment recommendation criteria and guidelines be made by national as well as supranational medical organizations," the authors conclude. "Many more national public health programs should advance and disseminate this information to practicing pediatric ophthalmologists by different means such as continuing medical education (CME)."

Dr. Ian G. Morgan from Australian National University, in Canberra, and Sun Yatsen University, in Guangzhou, China, who studies myopia prevention, told Reuters Health by email, "There are now effective methods for controlling the progression of myopia, and these should be considered if there is a risk that the child would end up highly myopic, with the increased risk of sight-threatening myopic pathologies."

"Practice patterns need to be evidence-based, and hence, some uniformity would be expected to emerge," he said. "But awareness of the importance of controlling myopia progression and of the effective methods now available is still emerging, and more professional education would be useful."

"This is an area of active research and considerable progress," Dr. Morgan said. "Clinicians interested in using these approaches should keep a close eye on the emerging literature, to assess the efficacy and safety of all techniques."

Dr. Mezer did not respond to a request for comments.


Br J Ophthalmol 2019.