The global rise in myopia (near-sightedness or short-sightedness) is not just a vision issue - it's a pressing global public health concern. Recent studies predict that by 2050, nearly half of the world's population could be myopic (1). In response to this alarming trend, a new Delphi consensus (2) has been established to guide eye care practitioners (ECPs) and inform the public about the best practices in myopia management.
In this blog post, we'll explore the potential value of this consensus to the public, outline actionable steps for ECPs, delve into the reasons behind its creation, highlight the most intriguing points, and discuss the future research it advocates.
Delphi exercises to explore agreement and disagreement have been used elsewhere in clinical research, but also in eyecare, such as when would be best to prescribe spectacles after cataract surgery. Because of the expanding field of myopia, and the vast amount of new information coming out regularly, this provided an ideal purpose to bring experts together to identify areas of agreement and disagreement. Dr Neema Ghorbani Mojarrad and Dr Annegret Dahlmann-Noor both had the idea of organising a Delphi to discuss myopia management in the UK for some time, and thus, they both collaborated with other colleagues to progress this work forward. It is hoped that it helps ECPs understand the current thoughts of leading myopia specialists around the UK, grounded in scientific evidence and clinical experience.
The Potential Value to the Public
Empowering Informed Decisions
The Delphi consensus provides evidence-based guidelines that empower individuals and families to make informed decisions about eye health. By standardising myopia management approaches, it ensures that patients receive the most effective interventions regardless of where they live.
For UK ECPs this work defines the largest myopia expert panel group exercise. It included a range of experienced clinical practitioners and top scientists and researchers across the UK to ensure that we obtained a range of opinions in the ever-changing field of myopia management and helps identify the areas of myopia that we aren’t sure about, and the aspects of myopia that experts agree on. Many of the panel are part of our advisory committee and contributor group. An example of a key finding is that experts believe that we should be discussing myopia and myopia management with every child that becomes myopic (and their parents) before the age of 13 years old.
Reducing Long-term Risks
Myopia isn't just about blurry distance vision; it's associated with serious ocular complications like retinal detachment, glaucoma, and myopic maculopathy (3). Early intervention guided by the consensus can slow myopia progression, reducing these long-term risks.
What Should Eye Care Professionals Do?
1. Adopt Evidence-Based Practices
ECPs should integrate the consensus guidelines into their clinical practice. This includes staying updated on the latest myopia control methods such as:
Atropine Eye Drops: Utilising low-dose atropine to slow progression (4)
There appears we still need large amounts of research! Atropine is an area many UK ECPs and scientists did not appear fully confident about. Areas where we need more evidence include when to consider stopping myopia management interventions, and how to determine or confirm what counts as success in myopia management i.e. how much progression is acceptable, and how to clinically quantify this. The statements that achieved agreement are just as interesting as those that didn’t achieve agreement, as they show areas that experts aren’t sure about.
Orthokeratology (Ortho-K): Fitting patients with specially designed contact lenses worn overnight.
Peripheral Defocus Contact Lenses and Spectacles: Prescribing lenses that reduce eye strain and control myopia progression.
2. Emphasise Early Detection
Regular comprehensive eye exams for children are crucial. Early detection allows for timely intervention, which is more effective in controlling myopia progression.
3. Educate Patients and Families
Provide resources and counselling on:
Lifestyle Modifications: Encouraging outdoor activities and managing near work.
Understanding Myopia: Explaining the condition, its risks, and management options.
4. Collaborate and Refer
Work collaboratively with other healthcare providers when necessary and refer patients to specialists for advanced interventions.
Why Was the Delphi Consensus Carried out?
Addressing the Myopia Epidemic
The consensus was developed in response to the rapid increase in myopia prevalence worldwide. It aims to:
Standardise Care: Reduce variability in myopia management across different regions.
Incorporate Multidisciplinary Insights: Combine expertise from ophthalmologists, optometrists, researchers, and public health professionals.
Guide Future Research: Identify gaps in current knowledge and prioritize areas for further investigation.
Most Interesting Points from the Consensus
1. Combination Therapies Show Promise
The consensus highlights that combining treatments (e.g., atropine with optical interventions) may enhance efficacy in controlling myopia progression (5).
2. Environmental Factors Play a Significant Role
Increased outdoor time has been affirmed as a protective factor against the onset of myopia. The consensus emphasizes lifestyle modifications as a key component of management. This means getting children outdoors at very young ages is essential.
3. Individualised Treatment Plans Are Essential
Recognizing that myopia progression varies among individuals, the consensus advocates for personalized management strategies based on risk factors such as age, family history, and rate of progression.
4. Technological Advancements in Myopia Control
Emerging technologies, including novel contact lens designs and spectacle lenses with peripheral defocus capabilities, are acknowledged for their potential benefits. Night lenses seem to be one of the more effective options and children can be free of glasses or contact lenses during the day, increasing their confidence and ability to engage in sports and outdoor activities.
Suggestions for Further Research
1. Long-term Safety and Efficacy Studies
There's a need for extended research on the long-term effects of interventions like low-dose atropine and Ortho-K, particularly regarding safety and sustained efficacy.
2. Genetic and Biomolecular Studies
Understanding the genetic predispositions and molecular mechanisms underlying myopia can lead to more targeted therapies.
3. Socioeconomic Impact Assessments
Investigating the economic burden of myopia and the cost-effectiveness of various interventions can inform public health policies.
4. Public Health Strategies
Research into large-scale prevention programs and educational campaigns to raise awareness about myopia is encouraged.
Conclusion
The recent Delphi consensus on myopia is a significant milestone in combating the global myopia epidemic. It offers a comprehensive framework for ECPs to deliver consistent, effective care and provides the public with valuable information to take proactive steps in managing eye health.
By embracing these guidelines and supporting ongoing research, we can work towards a future where myopia is effectively controlled, reducing the burden on individuals and healthcare systems worldwide.
Stay informed about myopia and its management by siginig up to the Myopia Focus Newsletter. Together, we can see a clearer future.
References
1) Holden, B. A., et al. (2016). Global Prevalence of Myopia and High Myopia and Temporal Trends from 2000 through 2050. Ophthalmology, 123(5), 1036-1042. https://www.aaojournal.org/article/S0161-6420(16)00025-7/fulltext
2) Dahlmann-Noor AH, Ghorbani-Mojarrad N, Williams KM, Ghoneim A, Allen PM, Beach ML, Bruce G, Buckhurst HD, Buckhurst PJ, Cruickshank FE, Cufflin MP, Day MD, Doyle L, Evans BJW, Flitcroft DI, Gray LS, Grewal I, Guggenheim JA, Hammond CJ, Higginbotham JC, Jawaid I, Kearney S, Lawrenson JG, Logan NS, Loughman J, Mallen EAH, McCullough SJ, Nagra M, Saunders KJ, Seidel D, Shah T, Strang NC, Webber KJ, Wolffsohn JS, Young AL. 2024 UK and Ireland modified Delphi consensus on myopia management in children and young people. Ophthalmic Physiol Opt. 2024 Sep 18 doi: 10.1111/opo.13381. Epub ahead of print. PMID: 39295273.
3) Flitcroft, D. I. (2012). The complex interactions of retinal, optical and environmental factors in myopia aetiology. Progress in Retinal and Eye Research, 31(6), 622-660. https://www.sciencedirect.com/science/article/abs/pii/S1350946212000610
4) Chia, A., et al. (2012). Atropine for the treatment of childhood myopia: safety and efficacy of 0.5%, 0.1%, and 0.01% doses (ATOM2). Ophthalmology, 119(2), 347-354. https://www.aaojournal.org/article/S0161-6420(11)00878-5/fulltext
5) Walline, J. J., et al. (2011). Multifocal contact lens myopia control. Optometry and Vision Science, 88(8), 895-903. https://journals.lww.com/optvissci/Fulltext/2011/08000/Multifocal_Contact_Lens_Myopia_Control.8.aspx
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