Myopia and public health

Liverpool, UK-The British Contact Lens Association (BCLA) opened the first day of its 2015 conference with a day-long focus on myopia management. Ian Flitcroft, MA DPHIL FRCOPHTH, calls myopia a public health time bomb.

Related: Evaluating myopic maculopathy

Physiological vs. pathological myopia

Myopia isn’t just an Asian problem, according to Dr. Flitcroft, it’s a large proportion of the world’s population.

“It’s getting worse,” he says. “The change is happening very quickly, so we need to respond quickly.”

Unfortunately, no one, not even eyecare professionals, understands myopia.

“Patients and politicians don’t understand it,” he says. “It’s not even on the agenda, like obesity, and professionals haven’t looked at it in the correct way.”

Myopia has traditionally been seen as an optically correctable inconvenience; however, Dr. Flitcroft maintains that it is the consequence of an abnormal pattern of eye growth that has significant health implications. In addition, fewer than 6.00 D of myopia is perceived to be inconsequential.

“There’s nothing magical about 6.00 D of myopia,” he says. “It’s an arbitrary figure that came from I’m not sure where.”

According to Dr. Flitcroft, myopia has traditionally been divided into two categories: physiological or pathological.

Physiological myopia is low (up to 6.00 D), common, an optical inconvenience, and correctable by optical or surgical means.

Pathological myopia, on the other hand, is high (more than 6.00 D, rare, associated with a structurally abnormal eye, and potentially sight threatening.

Related: Experiencing retinal detachment as an OD

Public health implications

Myopic maculopathy is the only top five cause of vision loss without an accepted treatment. What’s more, the condition isn’t rare: it’s the fourth most common cause of visual impairment in the UK-ahead of diabetic eye disease.

Public health concerns of myopia include financial (“The loss of productivity is absolutely staggering,” he says) and quality of life (“Being more than 10.00 D myopic has as big an impact on quality of life as keratoconus”).

Myopia is associated with retinal detachment, myopic maculopathy, glaucoma, and cataract. As myopia increases, risk factors for these conditions increase.

“There is no safe threshold for myopia in terms of glaucoma, cataract, and retinal detachment,” says Dr. Flitcroft. “Myopia is as bad for your eyes as smoking is for your heart.”

A small myopic shift in the population increases the risk for the entire population. For example, a 1.00 D myopic shift will increase maculopathy by a third. If myopia is reduced myopia by 1.00 D, maculopathy will be reduced.

What’s next?

Dr. Flitcroft wants to know when myopia will become a priority and what will be done to address the problem.

As the current group of myopes age, they will get more eye disease, need more operations and lose more sight than their parents, he says. Doing nothing is no longer an option.

Says Dr. Flitcroft: “Is physiological myopia outside the scope of public health? Is the only problem pathological myopia? I say no.”

He posits more questions which require answers:

• Will treating/reducing levels of myopia have any impact on public heath?

• Will treating/reducing levels of myopia have any impact on costs of refractive correction?

• Will it be possible to convince most parents to treat their children?

• Will those who fund eye care be willing to pay for it?