ARVO 2015 Annual Meeting Abstracts
364 Bringing myopia into focus - Minisymposium
Tuesday, May 05, 2015 3:45 PM–5:30 PM
1CD Mile High Blrm Minisymposium
Program #/Board # Range: 3519–3525
Organizing Section: Clinical/Epidemiologic Research
Program Number: 3519
Presentation Time: 3:45 PM–4:00 PM
Epidemiology of myopia in adults and children
Leslie Hyman. Preventive Medicine, Stony Brook Medicine, Stony
Brook, NY.
Presentation Description: Myopia is the most common type
of refractive error worldwide. Over the past 30+ years a number
of population- and school-based studies in adults and children
conducted in the United States, Europe, Asia and elsewhere have
provided insights into myopia prevalence, patterns of occurrence,
risk factors and changes over time. Data on myopia incidence are
more limited as are population- based longitudinal data evaluating
refractive changes over time.
Prevalence estimates in adults range from 9%-51%, depending on
definition and location, with the highest rates generally occurring
in Asian populations. Estimated rates of pathological myopia, an
important cause of visual impairment and blindness found in a
subset of persons with myopia, range from 0.9%-3.1%. Over the
latter part of the 20th century, myopia prevalence appears to have
increased in younger birth cohorts with highest increases seen in
Asia. Consistent with this observation is that prevalence of myopia
is highest in children, varying by ethnicity with rates as high as 40%
by age nine years in Chinese children in Singapore and 70% by age
15 in urban China. Although comparisons across studies are limited
by differences in definitions, data collection methods and age ranges,
myopia prevalence is consistently highest in East Asian children from
Singapore, Hong Kong, Malaysia and China and lowest in children
in India, Australia and rural Mongolia. In all studies, prevalence
increases with increasing age.
In adults, myopia prevalence varies with age, with a shift toward
hyperopia observed in middle age adults younger than 70 years and
a myopic shift in adults 70 years and older, likely due to lenticular
nuclear sclerosis. No consistent patterns in myopia prevalence by
gender have been observed.
The recent epidemiologic studies have documented the high
frequency of myopia particularly in Asian populations in which
rates are high and continuing to increase, drawing attention to the
importance of myopia as a public health concern, including its
diverse medical, economic and social impact. These studies also have
evaluated various environmental and genetic factors, to help explain
the observed patterns. Their results lend support to the suggestion
that myopia results from a complex interaction between genetic
predisposition and environmental exposures and lay a framework
for further investigation into understanding causes and control of
myopia.
Commercial Relationships: Leslie Hyman, None
Support: NIH, NEI Grant U10 EY11805, NIH NIDCR Grant
U10DE018886
Program Number: 3520
Presentation Time: 4:00 PM–4:15 PM
Environmental risk factors for onset and progression of myopia
Donald O. Mutti. Ohio State University College of Optometry,
Columbus, OH.
Presentation Description: Recent advances have more sharply
defined the specific contributions of environmental risk factors
for myopia development. The traditional emphasis on reading
and other forms of close work being associated with myopia has
shifted towards a greater understanding of time outdoors being
protective against myopia. Rather than simply not being near work,
time outdoors appears to have its own independent effects. The
presentation will discuss these effects and the questions yet to be
answered: does time outdoors affect both risk of myopia onset and
the rate of progression, is the benefit from brighter visible light
and dopamine release, from ultraviolet exposure and vitamin D
production, from more exercise, from some combination of these
factors, and what is the potential for harnessing these effects toward
some therapeutic benefit.
Commercial Relationships: Donald O. Mutti, None
Support: NIH Grant EY023210, UL1RR025755
Program Number: 3521
Presentation Time: 4:15 PM–4:30 PM
Genetic factors, parental history, and gene-environment
interactions
Christopher J. Hammond. King’s College, London, London, United
Kingdom.
Presentation Description: Parental myopia still remains the
strongest risk factor for myopia, and large-scale genome-wide
association studies of ever-increasing size such as the Consortium
on Refractive Error and Myopia (CREAM) are reporting more and
more common genetic risk polymorphisms, which have increased
the proportion of heritability that can be explained, although they
are still not useful for personal prediction. Rare variants can be
identified using sequencing technology and are now being identified.
Pathway analyses may help us to decide potential therapeutic targets,
to be taken forward in animal experiments. Given the importance
of environment in the development of myopia, understanding
how this happens is important, and studies are underway looking
at the interactions between genes and environment, and studying
epigenetics, to further understand the complex genetics of refractive
error.
Commercial Relationships: Christopher J. Hammond, None
Program Number: 3522
Presentation Time: 4:30 PM–4:45 PM
Treatment of myopia: Prevention, slowing of progression, and
refractive surgery
Jane E. Gwiazda. New England College of Optometry, Boston, MA.
Presentation Description: The main treatments for myopia include
single vision spectacle lenses, contact lenses, and refractive surgery,
all of which correct the refractive error but do nothing to slow
the underlying eye growth which may lead to sight-threatening
conditions such as retinal detachment and myopic retinopathy.
Lens interventions that have been investigated for slowing the
progression of myopia in children include bifocals, progressive
addition spectacles, lenses to reduce relative hyperopic defocus in
the peripheral retina, and contact lenses of various designs to be
worn either during the day or at night (orthokeratology). Most of the
experimental lens designs, when compared to conventional single
vision lenses, have shown small, statistically significant treatment
benefits that last for relatively short periods of time, though some
of the newer contact lens designs have shown more promise. Larger
treatment effects have been observed in subgroups of children,
including those with fast progressing myopia, myopic parents, large
accommodative lags, and/or near esophoria. With respect to drug
treatments, atropine, a muscarinic receptor antagonist, has been
found to be more effective than lenses in slowing the progression of
myopia. However, there are side effects (e.g., light sensitivity, blurry
near vision) and a rebound (increased progression and eye growth)
©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2015 Annual Meeting Abstracts
after treatment is stopped. A risk-free recommendation to control
myopia is to increase outdoor activity, although preliminary data
from clinical trials show only small benefits similar in magnitude to
some of the lens therapies.
The challenge is to find treatments that are safe, cost-effective, and
provide long-lasting, clinically significant slowing of myopia. Once
this happens, the next step will be to evaluate them in children at
risk for myopia. However, because at this time it is not possible to
predict with certainty which individuals will become myopic, many
non-myopic children might be subjected to unnecessary treatment.
In addition, treatments that slow the progression of myopia may not
be the same as those that prevent its onset because risk factors for
progression and onset have been found to differ. The availability
of customized treatment based on an individual’s family history of
myopia, visual environment and habits, oculomotor performance, and
other relevant factors, is an ultimate goal.
Commercial Relationships: Jane E. Gwiazda, None
Support: NIH Grant EY 11756
Clinical Trial: NCT00000113
Program Number: 3523
Presentation Time: 4:45 PM–5:00 PM
Public health significance of myopia
Kathryn A. Rose. 1University of Sydney, Lidcombe, NSW, Australia;
2
Graduate School of Health, University of Technology, Sydney,
Sydney, NSW, Australia.
Presentation Description: The public health costs related to
myopic refractive error are multi-layered. They range from those
associated with failure to provide adequate correction of refraction
errors to the costs both to the individual and their community that
are caused by permanent visual impairment and blindness as a
consequence of the maculopathies associated with high myopia.
Unfortunately the public health costs associated with the latter are
the least well established. They are also of potentially great concern.
While historically high myopia (≤ -6.0D) has occurred in 2-3% of
populations, there is emerging evidence that as the prevalence of
myopia rises in a location, the prevalence of high myopia increases,
rising exponentially when the overall prevalence reaches 60-70%
of the population. With each increasing dioptre of high myopia the
proportion of maculopathy also increases, raising the likelihood
of untreatable visual impairment and blindness. As many diverse
populations are showing an increase in myopia prevalence, this is a
new and looming epidemic with high public health cost, to add to
those already well documented for correctable forms of myopia.
Commercial Relationships: Kathryn A. Rose, None
Support: Australian NHMRC Grants 253732, 402425, 512530
Program Number: 3524
Presentation Time: 5:00 PM–5:15 PM
Epidemiology of pathological myopia
Seang-Mei Saw. 1National University of Singapore, Singapore,
Singapore; 2Singapore Eye Research Institute, Singapore, Singapore.
Presentation Description: Pathologic myopia is a leading cause
of visual impairment especially in Asian cities such as Beijing and
Singapore. In Singapore epidemiologic studies of children (SCORM),
young adults and adults (SEED) with high myopia, we have defined
the prevalence of pathologic myopia at various ages. Early signs
of pathologic myopia including optic disc tilt and peripapillary
atrophy were present even in teenage children, while young male
adults also had chorioretinal atrophy which lowered best-corrected
visual acuity. In adults, other common lesions were staphyloma and
chorioretinal atrophy. More precise delineations of peripapillary
atrophy and optic disc tilt have been performed by computed-assisted
detection methods. An epidemic of pathologic myopia is expected
in Singapore and other parts of Asia in the next few decades due to
the generational effect of higher myopia prevalence in the young
(82%) versus older adults (36%) and the rapidly aging population. In
Singapore and other Asian countries, there will be a high prevalence
of myopia and high myopia with associated visually disabling
complications in adults of all ages in the near future.
Commercial Relationships: Seang-Mei Saw, None
Support: Supported by the National Medical Research Council
(NMRC) 0695/2003 grant.
Program Number: 3525
Presentation Time: 5:15 PM–5:30 PM
Recent findings on myopia control methods
Brien A. Holden. Vision Cooperative Research Centre, Sydney, NSW,
Australia.
Presentation Description: Myopia has traditionally been considered
an East Asian health issue1 but the incidence and prevalence of
myopia is increasing globally,2 e.g. the USA has seen a rise from
26% to 42% between 1971 to 1999.3 High myopia which predisposes
the eye to an increased risk of developing cataract, glaucoma and
myopic macular degeneration is also increasing at an alarming
rate .4-7 Myopic macular degeneration is now the major cause of
blindness in Shanghai and Tajimi, Japan.4,5 Myopia control methods
have been tested that could reduce the incidence of high myopia
including increased outdoor activity, atropine, 7-methylxanthine,
orthokeratology, novel myopia control spectacles and contact lenses.2
The myopic eye shows significant peripheral hyperopia which
promotes axial elongation.8, 9 Conventional single vision spectacles
and contact lenses do not address this and possibly even exacerbate
the problem. Novel lenses designed to shift the peripheral image in
front of the retina have been shown to slow progression by 37% to
50%.10-12 Also, other lens designs that shift parts of the retinal image
forward also slow the progress of myopia.13 The experimental drugs
0.01% atropine and 7-methylxanthine also slow myopia progression
substantially but their long term effects are as yet unknown.14, 15
1. Jung SK, Lee JH, Kakizaki H et al. IOVS. 2012;53:5579-83.
2. Holden B, Sankaridurg P, Smith E et al. Eye. 2014;28:142-6.
3. Vitale S, Sperduto RD, Ferris FL, 3rd. Arch Ophthalmol.
2009;127:1632-35
4. Iwase A, Araie M, Tomidokoro A, et al. Ophthalmol.
2006;113:1354-62.
5. Wu L, Sun X, Zhou X, et al. BMC ophthalmol. 2011;11:10.
6. Wong TY, Ferreira A, Hughes R et al. Am J Ophthalmol.
2014;157:9-25 e12.77
7. Spaide R, Ohno-Matsui K, Yannuzzi L. Pathologic Myopia. 2014
8. Smith EL, 3rd, Kee CS, Ramamirtham R et al. IOVS.
2005;46:3965-72.
9. Smith EL, 3rd, Hung LF, Huang J et al. IOVS. 2010;51:3864-73.
10. Walline JJ, Greiner KL, McVey ME et al. OVS. 2013;90:1207-14.
11. Sankaridurg P, Holden B, Smith E, 3rd, et al. IVOS.
2011;52:9362-7.
12. Anstice NS, Phillips JR. Ophthalmol. 2011;118:1152-61.
13. Cheng D, Woo GC, Drobe B et al. 2014. JAMA Ophthalmol.
14. Chia A, Chua WH, Cheung YB, et al. Ophthalmol. 2012;119:34754.
15. Trier K, Munk Ribel-Madsen S, Cui D, et al. J Ocul Biol Dis
Infor. 2008;1:85-93.
Commercial Relationships: Brien A. Holden, Brien Holden Vision
Institute (E), US 7025460 (P), US 8240847 (P), WO2011/106838A1
(P)
Support: Australian Government CRC Grant
©2015, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].