New Consensus Report: Myopia Should Be Classified as a Disease

In a new consensus report, the National Academies of Sciences, Engineering, and Medicine said that myopia should be classified as a disease that requires a medical diagnosis, and that children should spend at least 1 hour outdoors each day to help prevent its development.

“We would love for third-party payers to see it as a disease so we can get coverage to evaluate the myopic eye in more detail and avoid creating healthcare disparity by only getting [care] to the kids who can afford it,” said co-author Katherine K. Weise, OD, MBA, of the University of Alabama at Birmingham, in a presentation about the report’s findings.

The 350-page report, written and reviewed by vision specialists, noted that rates of myopia in the U.S. grew from 25% in 1971-1972 to 42% in 2004, and are as high as 88% in Asian countries. “If current trends continue, there will be 5 billion nearsighted individuals globally by 2050,” the report authors wrote.

Reclassify Myopia as a Disease

The reclassification of myopia “is needed to ensure that efforts not only to treat blurry vision resulting from uncorrected or undercorrected refractive error, but also to prevent and manage the progression of myopia,” the authors explained.

David A. Berntsen, OD, PhD, of the University of Houston, who was not involved in the report, told MedPage Today that “myopia is currently considered a refractive error and considered ‘normal’ versus a disease that is an abnormal condition that has structural and functional consequences and carries risk of other complications or comorbidities.”

“Eye exams without a disease diagnosis are not generally covered by medical insurance because myopia is not considered a disease,” he added. “That means routine vision exams, even for a myopic child, are often only covered by a vision plan.”

In fact, “myopia causes stretching of ocular tissues,” he said. “The more myopic a person becomes, the greater the risk of other diseases later in life — e.g., myopic maculopathy, retinal detachment, glaucoma, etc. This is why it is important that myopia be recognized as a disease and not a ‘normal’ condition with no consequence.”

Focus on Sunlight Exposure as a Prevention Tool

The report authors recommended that the CDC create evidence-based guidelines supported by federal and state departments of education and healthcare providers that promote more time outdoors — at least 1 hour per day — for children.

In a press release, the National Academies noted that studies have shown that being outdoors “stimulates the eye with light that is brighter and more varied and requires different eye movements and focus compared to when indoors. More research is needed to pinpoint the most important factors, but there is unequivocal evidence that increased time outdoors slows excessive eye growth in children and therefore reduces the risk of developing myopia.”

Berntsen pointed out that “increasing outdoor time to an hour a day is a positive public health message not only for myopia, but for an overall healthy lifestyle.”

Begin Vision Screening Early

The report also recommended comprehensive eye exams from 6 and 12 months of age, then at least once from the ages of 3 and 5 years, then before first grade, and then every 1 to 2 years thereafter. The authors called on HHS and departments of education to ensure that children receive a vision screening before first grade and a comprehensive eye exam when needed.

The American Optometric Association also recommends that children undergo a thorough optometric eye examination from the ages of 3 and 5 years. “With today’s diagnostic equipment and tests,” the association said, “a child does not have to know the alphabet or how to read to have his or her eyes examined.”

Jeffrey J. Walline, OD, PhD, of the Ohio State University in Columbus, told MedPage Today that “most states require vision screenings during school, and vision screenings are pretty good at determining nearsighted children.”

“However, the biggest issue is getting children an examination if they fail a vision screening,” added Walline, president-elect of the American Academy of Optometry, which supports the report. “Estimates indicate that only about 20% of children who fail vision screenings actually get an eye examination.”

The report also recommended an integrated, national data surveillance system to collect “state-level data on vision screening, referrals to eye care providers, sociodemographics (age, race/ethnicity, sex, and geographic location) and outcomes of referrals.”

Other Prevention Strategies

The report also highlighted multifocal optical corrections and atropine eye drops as prevention tools. “We all agree that the preponderance of evidence suggests that myopia progression should be treated when the resources allow,” Weise said at the presentation. “It’s a treatable condition.”

Walline noted that “over the past 20 years, science has resulted in an explosion of new, effective treatments to slow the progression of myopia, and this document will share information about all of those treatments. Current treatments will not … prevent myopia from occurring, but they do slow progression and delay onset with few side effects, and that could ultimately reduce the risk of sight-threatening complications in adulthood.”

Berntsen said prevention therapy slows myopia progression by about 0.50 to 0.75 diopters. “The current treatments we have are better than no treatment, but there is still room for further improvement,” he added.

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