The Risks and Benefits of Myopia Control

Purpose- The prevalence of myopia is increasing around the world, stimulating interest in methods to slow its progression. The primary justification for slowing myopia progression is to reduce the risk of vision loss through sight-threatening ocular pathologic features in later life. The article analyzes whether the potential benefits of slowing myopia progression by 1 diopter (D) justify the potential risks associated with treatments. Methods- First, the known risks associated with various methods of myopia control are summarized, with emphasis on contact lens wear. Based on available data, the risk of visual impairment and predicted years of visual impairment are estimated for a range of incidence levels. Next, the increased risk of potentially sight-threatening conditions associated with different levels of myopia are reviewed. Finally, a model of the risk of visual impairment as a function of myopia level is developed, and the years of visual impairment associated with various levels of myopia and the years of visual impairment that could be prevented with achievable levels of myopia control are estimated. Results- Assuming an incidence of microbial keratitis between 1 and 25 per 10 000 patient-years and that 15% of cases result in vision loss leads to the conclusion that between 38 and 945 patients need to be exposed to 5 years of wear to produce 5 years of vision loss. Each additional 1 D of myopia is associated with a 58%, 20%, 21%, and 30% increase in the risk of myopic maculopathy, open-angle glaucoma, posterior subcapsular cataract, and retinal detachment, respectively. The predicted mean years of visual impairment ranges from 4.42 in a person with myopia of –3 D to 9.56 in a person with myopia of –8 D, and a 1-D reduction would lower these by 0.74 and 1.21 years, respectively. Conclusions- The potential benefits of myopia control outweigh the risks: the number needed to treat to prevent 5 years of visual impairment is between 4.1 and 6.8, whereas fewer than 1 in 38 will experience a loss of vision as a result of myopia control

Ocular effects and impact of myopia and astigmatism in an older population

Purpose To assess the relationship between corrected refractive errors and the degree of visual impairment, and determine the prevalence of myopic retinopathy and tilted discs in subjects attending the Blue Mountains Eye Study. Methods The Blue Mountains Eye Study is a population—based cohort of urban Australians aged 49 or older. Of the 4433 eligible persons, 3654 (82.4%) participated in the study between 1992—4 (BMES I). Of the 3114 living eligible participants from BMES I, 2334 (75.0%) were reexamined between 1997—9 (BMES H). The ocular examination included logMAR visual acuity, standardised refraction, applanation tonometry, cover testing, stereoscopic retinal photographs and Humphrey visual field testing. Retinal signs adjudicated included posterior staphyloma, lacquer cracks, Fuchs’ spot, myopic chorioretinal thinning and atrophy, Bperipapillary atrophy and tilted optic discs. Visual impairment was defined as best-corrected visual acuity of 20/40 or worse