This document provides an overview of myopia, including its prevalence, causes, and current management strategies for controlling its progression. It highlights increasing rates of myopia globally, particularly in East Asia, and discusses various interventions such as optical, pharmaceutical, and surgical methods. The conclusion emphasizes the urgent need for further research and collaboration to address the growing myopia epidemic.

1. Journal :- International journal of ophthalmology
Impact factor :- 1.33
Published on :- April 2021
Presenter - Yashu Chaudhary
Moderator – Ms. Uzma Rafeeq

2. Aim
• This paper presents a current overview on the concepts of
myopia, and is expected to summarize updated on myopia
control strategies

3. Objective
• To summarize the current management options for halting
down the myopia progress
• To determine the prevalence of global myopia

4. Introduction
• Myopia , an error of visual focusing that makes distant objects
appear blurred , not just imposes refractive ramifications but
poses a serious risk for threatening ocular complications
• World health organization defines (WHO) defines high myopia
as -5.00 D or greater , and is associated with irreversible
blindness
• Myopia has become a global public health and socio-
economic problems predominantly in east Asia
• Global efforts to study myopia and the race to find out the
most effective methods to control myopia is ongoing
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5. Myopia prevalence
• East Asia , have high prevalence of Myopia & it continues to
increase
• Highest in China, Japan , Republic of Korea and Singapore
reporting a prevalence of 50%
• Relatively lower prevalence in Australia, Europe and North and
South America
• Prevalent in 36.4% children of 8 years in Taiwan in 2016 & 2.4%
in the Netherlands among 6 years old children in 2018
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7. Cont.
• High myopia is estimated to range between 2%-5% in white
population & between 5% - 10% in Asian population
• Prevalence of pathologic myopia is estimated to be 1% in
whites & 1% - 3% in Asians
• Myopia prevalence has significantly from 79.5% to 87.7%
Moderate myopia (38.8% to 45.7%)
Severe myopia (7.9% to 16.6%)
Terminal myopia (0.08% - 0.92%)
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8. Classification
• Myopia
Based on
degree
Anatomical
features
Age of onset
Progression
rate Pathological
low
Medium
High
Axial
Refractive
Congenital
Youth onset
Early adult onset
Late adult onset
Stationary
Temporary progressive
Permanently progressive
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9. Etiology and risk factors
• Age ( an important determinant factor )
• Gender (predilection is conflicting )
• Race (predominance among Asian population )
• Heredity (more risk of developing myopia if parents were myopic )
• Environmental factors (near work ,socioeconomic status etc. )
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10. Pathologic myopia & Pathophysiology
• Pathologic myopia is generally high myopia accompanied by
visual dysfunctions & describes the situation of pathologic
consequences
• These myopias are rapidly progressive ,with early onset
resulting in high myopia in adulthood
• Pathophysiology of myopia is multifactorial and still poorly
understood
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11. Conti…
Form
deprivation
Lens induced
defocus
Hyperopic
defocus
Abnormal eye
growth
Choroidal
thinning
Low degree of
scleral thinning
Axial
elongation

12. Myopic Maculopathy
• Most common cause of visual impairment
• Signs
Posterior staphyloma
Patchy or diffuse chorioretinal atrophy
Lacquer cracks
Myopic macular retinoschisis
Dome shaped macula & choroidal neovascularization
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14. META –PM classification

15. High myopia & cataract surgery
• High myopia posses a significant challenges during cataract
surgery
• Biometry becomes extremely important.
• Inaccuracy of axial length measurements and incorrect choice
of lens formula can lead to unpredicted refractive outcome
• Patient with high myopia , adequate counseling , preoperative
planning and appropriate IOL choice are important
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16. Methods of myopia control
• Myopia control strategies can be divided into following :-
1. Optical intervention
2. Pharmaceutical intervention
3. Surgical intervention
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17. Optical intervention
1. Bifocals and multifocal lenses
• Near prescription of these lenses halt myopia progression
• RCT showed that with bifocals myopia progression during
study of 2.5 y slowed by 20 %
• COMET – 2 study showed sought that PALs of 2.00 D resulted
in reduction of myopia progression by 24% in 3y study
2. Peripheral defocusing lenses
• Reduction of peripheral hyperopia
• Peripheral defocus modifying contact lenses are more effective
than tested spectacle designs
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18. Cont.
3. Defocus incorporated multiple segments(DIMS)
• DIMS comprises a central optic zone & multiple segment of
constant myopic defocus (+3.50)
• DIMS showed 52% lesser myopia & 62% lesser axial
elongation
4. Orthokeratology
• Ortho k lenses changes corneal shape to an oblate shape
which results in a peripheral refraction that has less hyperopic
defocus
• Overall treatment effect around 50%
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20. Pharmaceutical intervention
• Includes daily application of low dose atropine
• Plausible mechanism is thought to be through modulation of
atropine
• ATOM -1 study by Chua et al concluded that 1% atropine
shows 77% efficacy following 2 year treatment
• ATOM -2 study determine efficacy of 0.5%, 0.1% , 0.01%
atropine with mean myopia progression is to be :-
Concentration of atropine Mean axial elongation Mean myopia progression
0.5% 0.27 mm -0.30 D
0.1% 0.28 mm -0.38 D
0.01% 0.41 mm -0.49 D
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21. Cont..
• Recently the LAMP study also evaluated the efficacy and safety
of low concentration atropine
• 7- methyl xanthine also entered human trials .
• No serious side were noted but drug cessation leads to axial
lengthening normally
• Siatkowski et al and team, received that 2% pirenzepine group
has mean myopia progression of -0.26 D following 1 year
instillation.
Concentration of atropine Mean axial elongation Mean myopia progression
0.05% 0.20 mm -0.27 D
0.025% 0.29 mm -0.46 D
0.01% 0.36 mm -0.59 D
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22. Surgical intervention
• Surgical intervention like Laser corneal refractive surgery , IOL
implantation and implantable collamer lens can are
established to treat myopia
• But these surgical methods don't halt progression
• Sub scleral injection of mesenchymal stem cells and dopamine
are latest surgical strategies
• Posterior scleral reinforcement to halt axial elongation
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23. Environmental measures
• Outdoor activities in low level of illumination results in
pupillary dilation ultimately results in more hyperopic defocus
in the periphery
• But sunlight and activities offering high level of illumination
are known to help in halting down the progression
• Excessive near work & reduced outdoor activities also act as
risk factor for myopia progression
• Myopia is also related with introvert personality and higher
level of intelligence

25. Conclusion
• Myopia is an emerging health issue with high prevalence
• Despite global efforts the most effective treatment strategy is
yet to be identified
• Need to scale up researches , engage public health experts and
enhance multidisciplinary collaboration to tackle the ever
increasing prevalence of Myopia