Dr. Brien Holden was an optometric giant. He was a renowned researcher, educator and humanitarian. Dr. Holden worked tirelessly toward advancing eye care and reducing visual impairment worldwide. A few months before he died, he brought together scientists, researchers and clinicians from around the world to address the rapidly increasing prevalence of myopia and the implications.
The prevalence of myopia is growing at an alarming rate, especially in Asia. In China, Taiwan and Singapore, between 70 and 80% of young adults are myopic. The prevalence is rising in western countries as well. If current trends continue, 2.5 billion people will be myopic by 2020 and 5 billion people will be myopic by 2050. Of these, almost 1 billion will be highly myopic (5.00 D. or greater). High myopia is associated with an increased risk of vision loss and blindness. For example, myopic macular degeneration is ranked as the first, second or third most frequent cause of blindness in studies performed on Asian populations.
In a recently published editorial, Dr. Holden called for a global collaboration (The Myopia Institute) to deliver information and knowledge about the global challenge of myopia, and investigate and report on evidence-based strategies for reducing myopia and its associated visual impairment.
One intervention currently receiving significant research attention for slowing the progression of myopia is the use of low dose atropine eye drops. Atropine causes the pupil to dilate and reduces accommodation (the ability of the eyes to focus at near). By reducing the concentration of atropine, these side effects can be minimized. Somewhat surprisingly, the lower dose is more effective at reducing myopia progression.
In a soon-to-be published article, researchers followed 400 Asian children with progressive myopia over 5 years (Clinical Trial on Atropine for Treatment of Myopia–ATOM1 and ATOM2). The study design was somewhat complex. It involved 3 different dosages of atropine, treatment for 2 years, a 1 year “washout” period (to determine what happened when atropine treatment was stopped), and retreatment for 2 years if the myopia progressed during the washout period. At the end of 5 years, the overall progression of myopia was lowest in the group that was treated with the lowest dosage of atropine. The authors concluded that low-dose atropine is a clinically viable myopia reduction therapy for children with documented myopic progression. Of course, there are more questions than answers: which children would benefit the most? What other interventions are effective? And why is atropine effective? The exact mechanism of action of atropine on actively growing myopic eyes is not known.
I recently discussed myopia reduction treatments with a young patient and her parents. It was a lengthy conversation! As soon as I mentioned atropine, dad took out his phone and began googling. I knew I was only 1 small step ahead of him and the knowledge gap was rapidly decreasing. Dr. Holden wrote, “Optometry should be at the frontline of this battle. It not only has a responsibility to provide the best care to patients, but to remain informed about epidemiological trends and understand the latest range of treatment options for progressive myopia.” I would like to think that Dr. Holden would be proud of me!
Learn more about myopia and myopia reduction treatment here!
Photo from National Eye Institute via Flickr.