The recent change in government presents a unique opportunity to transform eye care services in the United Kingdom. With the Labour Party now at the helm, there's potential for significant reforms that could address pressing issues in ophthalmology and optometry, particularly the growing myopia epidemic among children. This blog post explores how the new administration could reshape eye care policies to benefit all UK residents, with a special focus on making myopia management more accessible and affordable.
The Myopia Crisis
Myopia, or short-sightedness, has reached epidemic proportions globally, with the UK being no exception. Recent studies indicate that myopia rates among British children have more than doubled over the past 50 years [1]. This trend is alarming, as severe myopia can lead to sight-threatening conditions later in life, including retinal detachment, glaucoma, and myopic maculopathy [2].
Key Policy Proposals
1. Increased Funding for Eye Care Services
To address the growing demand for eye care services, the new Labour government needs to allocate substantial additional funding to the NHS and GOS (General Ophthalmic Services). This investment could help reduce waiting times, improve infrastructure, and ensure that everyone has access to timely eye examinations and treatments.
2. National Myopia Management Program
Implementing a comprehensive national program for myopia management could significantly impact children's eye health. This initiative should include:
Regular eye screenings in schools
Subsidised myopia control treatments (e.g., atropine eye drops, orthokeratology, multifocal contact lenses)
Public awareness campaigns about the importance of outdoor time and reducing screen time
3. Research and Development Support
Allocating funds for research into myopia prevention and treatment could lead to innovative solutions. Collaborations between universities, eye care professionals, major manufacturers, and the NHS could drive advancements in this field.
4. Workforce Development
Investing in the training and recruitment of more eye care professionals, including optometrists and ophthalmologists, would help meet the growing demand for services.
Making Myopia Management Affordable
One of the most significant barriers to effective myopia management is the cost of treatments. To make these interventions accessible to all, regardless of income, the government could consider:
Expanding NHS Coverage: Include myopia control treatments under NHS/GOS coverage, ensuring that children from all backgrounds can access these vital interventions.
Means-Tested Subsidies: Implement a sliding scale of subsidies based on family income, making expensive therapies like orthokeratology more affordable for low-income families.
Public-Private Partnerships: Collaborate with eyewear and contact lens manufacturers to reduce costs and increase availability of myopia control products.
Freeing Up Resources
To fund these ambitious plans, the Labour government will need to identify new sources of revenue and optimise existing resources. Some potential strategies include:
Reallocating Funds: Review current healthcare spending and redistribute resources to prioritise preventive eye care, which could lead to long-term cost savings.
Increasing Taxes on Unhealthy Products: Consider implementing or raising taxes on products that contribute to poor eye health, such as excessive sugar in processed foods, which has been linked to increased myopia risk [3].
Efficiency Improvements: Invest in digital health technologies and telemedicine to streamline eye care services and reduce operational costs.
International Collaborations: Partner with other countries facing similar challenges to share resources, research findings, and best practices in myopia management.
Myopia Therapies: Types, Costs, and Efficacies
Efficacy: Low-dose atropine (0.01%) has shown significant efficacy in slowing myopia progression, with studies demonstrating a reduction in myopia progression by 50-60% over 2-5 years [1].
Cost: Relatively low-cost option. In the UK, the annual cost can range from £100 to £300, depending on the formulation and frequency of use [2]. At present, there is no licenced option for optometrists in the UK.
Efficacy: Ortho-K lenses have been shown to slow myopia progression by 30-50% in children [3].
Cost: Higher initial cost, typically ranging from £500 to £1000 for the initial fitting and lenses, with ongoing costs for replacement lenses and check-ups [4]. Ortho-K means children can be glasses or contact lens free during the day increasing their confidence and the likelihood they will engage in sports and outdoor activities.
Efficacy: Studies have shown that multifocal contact lenses can slow myopia progression by 30-50% compared to single vision lenses [5].
Cost: Moderate, with annual costs ranging from £200 to £500, depending on the brand and replacement schedule [6].
Efficacy: Specially designed spectacle lenses (e.g., MiYOSMART) have shown to slow myopia progression by up to 60% in some studies [7].
Cost: Moderate, with prices ranging from £200 to £500 per pair, typically replaced annually [8].
5. Increased Outdoor Time
Efficacy: While not a direct therapy, increased outdoor time has been shown to reduce the risk of myopia onset and slow its progression by 10-20% [9].
Cost: Free but may require lifestyle changes and education programs.
Comparative Efficacy and Cost-Effectiveness
When comparing these therapies, it's important to consider both efficacy and cost-effectiveness:
Atropine eye drops generally show the highest efficacy and are relatively low-cost, making them one of the most cost-effective options [10].
Ortho-K lenses, while having a higher initial cost, can be cost-effective in the long term, especially for children with rapidly progressing myopia [11].
Multifocal contact lenses and spectacle lenses for myopia control offer moderate efficacy at a moderate cost, providing a balance between effectiveness and affordability [12].
Increased outdoor time, while showing lower efficacy compared to other interventions, is highly cost-effective due to its lack of direct costs [13].
A comprehensive approach often combines multiple therapies for optimal results. For instance, combining atropine with orthokeratology has shown promising results in recent studies [14].
Considerations for Policy Makers
When developing policies to make myopia therapies more accessible, policymakers should consider:
The long-term cost savings of effective myopia control, which can reduce the future burden on healthcare systems from myopia-related complications [15].
The need for personalized treatment plans, as the most effective therapy may vary between individuals [16].
The importance of regular monitoring and adjustments to treatment plans, which should be factored into ongoing costs [17].
The potential for bulk purchasing agreements or national contracts to reduce costs of therapies like atropine eye drops or specialized lenses [18].
By considering these factors, the new Labour government could develop a comprehensive and cost-effective strategy to address the myopia epidemic, ensuring that effective treatments are available to all children, regardless of their family's financial situation.
Conclusion
The new Labour government has a unique opportunity to make lasting improvements to eye care in the UK. By prioritizing the myopia epidemic and ensuring affordable access to treatments, they can safeguard the vision of future generations. These changes will require significant investment and policy shifts, but the long-term benefits to public health and the economy could be substantial.
As we move forward, it's crucial for policymakers, healthcare professionals, and the public to work together in implementing these changes. With concerted effort and the right policies in place, we can create a future where quality eye care is accessible to all, regardless of socioeconomic status.
References:
[1] Yam, J. C., et al. (2019). Low-Concentration Atropine for Myopia Progression (LAMP) Study. Ophthalmology, 126(1), 113-124.
[2] Morgan, I. G., et al. (2018). IMI - Interventions for Controlling Myopia Onset and Progression Report. Investigative Ophthalmology & Visual Science, 59(7), 4.
[3] Sun, Y., et al. (2015). Orthokeratology to Control Myopia Progression: A Meta-Analysis. PLoS One, 10(4), e0124535.
[4] Bullimore, M. A., et al. (2015). The Risk of Microbial Keratitis with Overnight Corneal Reshaping Lenses. Optometry and Vision Science, 92(3), 286-295.
[5] Walline, J. J., et al. (2020). Effect of High Add Power, Medium Add Power, or Single-Vision Contact Lenses on Myopia Progression in Children: The BLINK Randomized Clinical Trial. JAMA, 324(6), 571-580.
[6] Huang, J., et al. (2016). Efficacy Comparison of 16 Interventions for Myopia Control in Children: A Network Meta-analysis. Ophthalmology, 123(4), 697-708.
[7] Lam, C. S., et al. (2020). Defocus Incorporated Multiple Segments (DIMS) spectacle lenses slow myopia progression: a 2-year randomised clinical trial. British Journal of Ophthalmology, 104(3), 363-368.
[8] Sankaridurg, P., et al. (2019). Spectacle Lenses Designed to Reduce Progression of Myopia: 12-Month Results. Optometry and Vision Science, 96(11), 869-877.
[9] He, M., et al. (2015). Effect of Time Spent Outdoors at School on the Development of Myopia Among Children in China: A Randomized Clinical Trial. JAMA, 314(11), 1142-1148.
[10] Pineles, S. L., et al. (2017). Atropine for the Prevention of Myopia Progression in Children: A Report by the American Academy of Ophthalmology. Ophthalmology, 124(12), 1857-1866.
[11] Charm, J., & Cho, P. (2013). High Myopia-Partial Reduction Ortho-k: A 2-Year Randomized Study. Optometry and Vision Science, 90(6), 530-539.
[12] Walline, J. J., et al. (2011). Multifocal Contact Lens Myopia Control. Optometry and Vision Science, 88(11), 1349-1354.
[13] Wu, P. C., et al. (2013). Outdoor Activity during Class Recess Reduces Myopia Onset and Progression in School Children. Ophthalmology, 120(5), 1080-1085.
[14] Kinoshita, N., et al. (2018). Additive effects of orthokeratology and atropine 0.01% ophthalmic solution in slowing axial elongation in children with myopia: first year results. Japanese Journal of Ophthalmology, 62(5), 544-553.
[15] Fricke, T. R., et al. (2012). Global Cost of Correcting Vision Impairment from Uncorrected Refractive Error. Bulletin of the World Health Organization, 90(10), 728-738.
[16] Gifford, K. L., et al. (2019). IMI - Clinical Management Guidelines Report. Investigative Ophthalmology & Visual Science, 60(3), M184-M203.
[17] Wolffsohn, J. S., et al. (2016). Global Trends in Myopia Management Attitudes and Strategies in Clinical Practice. Contact Lens and Anterior Eye, 39(2), 106-116.
[18] Holden, B. A., et al. (2015). Global Prevalence of Myopia and High Myopia and Temporal Trends from 2000 through 2050. Ophthalmology, 123(5), 1036-1042.
[1] McCullough, S. J., O'Donoghue, L., & Saunders, K. J. (2016). Six Year Refractive Change among White Children and Young Adults: Evidence for Significant Increase in Myopia among White UK Children. PloS one, 11(1), e0146332.
[2] Holden, B. A., Fricke, T. R., Wilson, D. A., Jong, M., Naidoo, K. S., Sankaridurg, P., ... & Resnikoff, S. (2016). Global Prevalence of Myopia and High Myopia and Temporal Trends from 2000 through 2050. Ophthalmology, 123(5), 1036-1042.
[3] Cordain, L., Eaton, S. B., Brand Miller, J., Lindeberg, S., & Jensen, C. (2002). An evolutionary analysis of the aetiology and pathogenesis of juvenile-onset myopia. Acta Ophthalmologica Scandinavica, 80(2), 125-135.
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