President's Calling - Life in the Time of Myopia

Published July 16, 2019

Life in the Time of Myopia

Dear Academy Membership,
Myopia. There was a time when it seemed such a simple concept. “Myopia, also known as nearsightedness: a condition in which the visual images come to a focus in front of the retina of the eye resulting in defective vision of distant objects.” It was a pleasure to correct all of those young patients, to allow them to see the blackboard, to sit back from the television.
The refractive term also works beautifully as an adjective, “myopic,” describing short-sighted folks who lack imagination, narrow thinkers, those who are unable to understand a situation or the way actions will affect the future.
Times have changed. Now we live in the Time of Myopia as a worldwide problem. We live with the knowledge of a clear and present danger. Can you smell the smoke, feel the calm before the storm, see the darkening clouds? We go about our lives while the prevalence of myopia grows and spreads, while the age of onset drops from grade 3 to 2 to 1. We are witnessing an epidemic, one that will bring tragedy, morbidity, depression. Surely we will not be known as the myopic ones, the ones that missed the obvious.
What is an epidemic? Historically, the word was applied to infectious diseases that spread quickly through populations. Today we use the adjective “epidemic” to describe behaviors or conditions that are growing in populations at a rate that appears to be out of control. For example “Myopia, or nearsightedness, has reached epidemic proportions in parts of Asia.”
Yes, here we are, the experts in myopia, the mavens of myopia, the managers of myopia. And the question remains, what are we, as a profession, going to do about it?
Ophthalmology has taken the lead with the following statement.
"Myopia is an increasing cause of visual impairment around the globe. In 2010, myopia affected approximately 28% of the world's population. By 2020, myopia is expected to affect 34% of the global population and to rise to nearly 50% by 2050. In some countries in Asia, the proportion of the population 17 years and older with myopia is 70% and above. High myopia increases the risks of sight-threatening conditions, such as retinal detachment, cataract, and glaucoma, as well as pathologic myopia and myopic choroidal neovascularization, which is becoming a leading cause of blindness in some parts of the world. Therefore, the burden is significant today, not only including the costs of refractive error correction but also the costs of visual impairment of conditions associated with high myopia and will increase substantially in the future. As a first step, the Academy will convene a task force of experts in myopia progression and prevention from around the world to develop an evidence-based white paper on the rationale for protection and early intervention and available approaches to control myopia progression, and to outline next steps to ameliorate this public health problem."
The American Academy of Ophthalmology presents a clear goal: "To reduce the onset age and progression of myopia worldwide." It is powerful, precise, and concrete.
Much has been contributed by our profession to the understanding of myopia. Animal studies tell us that peripheral retinal focus determines the rate of the lengthening of the eyeball. Lack of time outdoors in natural light has proven to be an associated factor. The genetics, under great scrutiny, remain murky and complicated. Treatments are unfolding: contact lenses, special glasses, sunlight, low dose atropine. The American Optometric Association has prepared clinical guidelines for myopia control that are soon to be published.
But where is our collective voice? Where is our global initiative? Where do we stand? We, the very community that is uniquely placed to diagnose, observe, and treat myopia. Have we become myopic?
Gabriel Garcia Marquez, the Nobel prize winner who wrote the brilliant novel Love in the Time of Cholera, opined that "wisdom comes to us when it can no longer do any good." Surely we, as a profession, can prove him wrong.
Barbara Caffery, OD, PhD, FAAO