There is a critical need for early myopia intervention in young children. DR JOSEPH PAUL discusses the prevalence of child myopia in Australia and New Zealand from one of the most up-to-date datasets and the role optometrists play in recommending lifestyle-led management options, proven to slow progression and minimise the risk of more serious conditions.
In recent years, there has been a concerning prevalence of short-sightedness in Australian and New Zealand children. A Specsavers 2022 retrospective review of more than three million deidentified patient records aged 18 and under showed child myopia detection rates had increased to 28.8% in Australia and remained as high as 29.8% in New Zealand.1 This review also found that the age at which patients were being diagnosed with myopia was decreasing. In the UK, studies have found similar results and show that the typical onset of myopia occurs in children aged between six and nine, and its progression is most rapid under 10 years of age.2
When a child’s distance vision is blurry, it affects their ability to focus at school and engage in classroom lessons. This condition can prevent them from seeing the teacher or front of the room clearly and fully participating in activities requiring medium to long-range vision. Myopia can impact the child’s learning and have short- and long-term effects on quality of life. In addition to visual impacts, if not detected early and managed with proven therapeutic interventions, progressive myopia greatly increases the lifetime risk of potentially blinding eye disease.3,4
Regular eye examinations are crucial for the early detection of myopia in children, and as accessible eye health professionals, optometrists play a central role in myopia management in the community. A range of evidence-based management options are available that have been clinically proven to provide clear vision and slow the progression of myopia into severe nearsightedness or high myopia. However, these interventions must be implemented early to have the most effect.
Therapeutic myopia management options
Research and technology into new strategies for myopia control continue to advance. Therapeutic interventions in the form of spectacle lenses, MiSight contact lenses, and low-dose atropine eyedrops provide a range of proven methods for proactively managing myopia in children while slowing the rate of progression.
The spectacle lens uses non-invasive technology to correct vision and manage myopia simultaneously. Studies have shown that MiYOSMART lenses can effectively slow myopia progression by up to 60%,5 making it a valuable tool in preventative eyecare for children. Contact lenses may be preferable over spectacles when a child has an overtly active lifestyle.
Suitable for kids as young as eight,6 MiSight contact lenses are fitting for those playing contact sports or energetic activities and provide a convenient and effective solution for improved sight. The daily disposable lenses are specifically designed to correct vision while slowing the progression of myopia by more than half.7 MiSight lenses encourage normal eye growth and reduce the elongation associated with myopia development, effectively mitigating the risks associated with high myopia as an adult.
Likewise, atropine eye drops are another useful management option for the control of child myopia. In an Australian clinical trial, they were shown to be a safe and effective myopia-control approach, with a 35% effect in slowing down myopia progression and 33% in slowing down eye growth after 18 months of treatment.8
Barriers to patient uptake
According to Specsavers national optometry data, between 20-25% of myopic kids in Australia and New Zealand are in a form of myopia management, whether that is therapeutic spectacle lenses, contact lenses or low-dose atropine eyedrops.9 Many factors play into a patient’s decision to adopt or delay the use of a therapeutic myopia intervention. It is likely a mix of financial, lifestyle, and awareness aspects that contribute to myopic children leaving optometry practices without a management solution.
While all myopia management options require some level of investment, the costs can be managed effectively. Eye drops and contact lenses are spread across ongoing orders, while spectacle lenses often have a higher initial expense but offer an effective cost-per-wear option. Each solution boasts unique lifestyle benefits, and it is therefore essential for optometrists to discuss the pros and cons with families to help them select the right intervention, with personalised recommendations tailored to the child’s hobbies and lifestyle.
A parent’s awareness and understanding of myopia and its progression are fundamental to how receptive they are to early vision intervention. To ensure informed decisions, optometrists must take the time to thoroughly explain the condition, its impact on the child’s vision, and, if not managed appropriately, the potential eye health risks in the future.
Ensuring the patient and their family are informed about the right therapy for the child’s lifestyle is crucial. In this way, optometrists play a pivotal role in tackling the growing prevalence of myopia in Australia and New Zealand.
The proactive adoption of myopia management strategies will enhance the patient’s immediate visual acuity and enable other associated social and health benefits, including improved quality-of-life. Offering patient-centric, lifestyle-led management recommendations now has the power to reduce instances of more severe vision-impacting conditions in the future.
About the author: Dr Joseph Paul is the head of professional services at Specsavers ANZ where he provides clinical and professional support to optometrists across Australia and New Zealand. He holds a PhD in glaucoma research and has extensive experience as a postdoctoral researcher at the Centre for Eye Research Australia. During the past decade, he has also practised as an optometrist at Specsavers and in private practice.
More reading
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References:
1.Specsavers ANZ Patient Outcomes Database. [Data file]. Specsavers, Melbourne, 2024. [accessed 15 June 2024]
2.McCullough SJ, O’Donoghue L, Saunders KJ. Six year refractive change among white children and young adults: evidence for significant increase in myopia among white UK children. PLoS One. 2016;11(1):e0146332. doi:10.1371/journal.pone.0146332
3.Optometry Australia. The Australia and New Zealand Child Myopia Report 2022/23. Reducing the Risk to Vision. Available https://www.optometry.org.au/wp-content/uploads/National_news_images/2022/November/Reducing-the-Risk-to-Vision_Myopia-Report-202223.pdf [Accessed 15 July]
4.Tiedeman et al. Association of Axial Length With Risk of Uncorrectable Visual Impairment for Europeans With Myopia JAMA Ophthalmol. 2016 Dec 1;134(12):1355-1363.
5.Lam CSY, Tang WC, Tse DY, et al. Defocus Incorporated Multiple Segments (DIMS) spectacle lenses slow myopia progression: a 2-year randomised clinical trial. Br J Ophthalmol. 2020;104(3):363-8. DOI: 10.1136/bjophthalmol-2018-313739.
6.Chamberlain P, et al. A 3-year randomized clinical trial of MiSight® lenses for myopia control. Optom Vis Sci. 2019; 96(8):556-567.
7.Back A, Chamberlain P, et al. Clinical Evaluation of a Dual-Focus Myopia Control 1 Day Soft Contact Lens – 2-Year Results. Paper presented at the annual meeting of The American Academy of Optometry. November 9, 2016; Anaheim, California USA.
8.Samantha Sze-Yee Lee PhD, Gareth Lingham PhD, Low-concentration atropine eye drops for myopia control in a multi-racial cohort of Australian children: A randomised clinical trial. Clinical & Experimental Ophthalmology. Volume 50, Issue 9. P 1001-1012
9.Specsavers ANZ Patient Outcomes Database. [Data file]. Specsavers, Melbourne, 2024. [accessed 15 June 2024]
