Advances in myopia prevention strategies for school-aged children: a comprehensive review

Abstract

Myopia has significantly risen in East and Southeast Asia, and the pathological outcomes of this condition, such as myopic maculopathy and optic neuropathy linked to high myopia, have emerged as leading causes of irreversible vision loss. Addressing this issue requires strategies to reduce myopia prevalence and prevent progression to high myopia. Encouraging outdoor activities for schoolchildren and reducing near-work and screen time can effectively prevent myopia development, offering a safe intervention that promotes healthier habits. Several clinical approaches can be employed to decelerate myopia progression, such as administering low-dose atropine eye drops (0.05%), utilizing orthokeratology lenses, implementing soft contact lenses equipped with myopia control features, and incorporating spectacle lenses with aspherical lenslets. When choosing an appropriate strategy, factors such as age, ethnicity, and the rate of myopia progression should be considered. However, some treatments may encounter obstacles such as adverse side effects, high costs, complex procedures, or limited effectiveness. Presently, low-dose atropine (0.05%), soft contact lenses with myopia control features, and orthokeratology lenses appear as promising options for managing myopia. The measures mentioned above are not necessarily mutually exclusive, and researchers are increasingly exploring their combined effects. By advocating for a personalized approach based on individual risk factors and the unique needs of each child, this review aims to contribute to the development of targeted and effective myopia prevention strategies, thereby minimizing the impact of myopia and its related complications among school-aged children in affected regions.

Myopia Control: Are We Ready for an Evidence Based Approach?

“…Of these, 41 RCTs were included in the final analysis and summarized in tabular form (Supplementary Tables 2 – 7 ). Of the 140 review publications found, 18 reviews [ 9 , 12 , 19 , 45 , 54 – 67 ] published in the years 2019 to 2023, and retrieved via multiple searches, were considered, and included. In addition, some new myopia interventions, e.g., the cylindrical annular refractive element (CARE) lenses, were added later.…”

“…Although spending time outdoors seems generally safe, it is nonetheless important to consider the potential risks linked to outdoor activities, which necessitates appropriate application of sun protection for both the eyes and skin [ 19 ]. Increased outdoor time is accessible to all individuals but may be constrained by social factors such as academic expectations, weather conditions, and seasonal variations [ 87 ].…”

“…Similarly, Wong et al suggested that more time spent on digital screens is associated with a higher risk of myopia [ 91 ]. Hence behavioral approaches to reduce prolonged near work are gaining more attention [ 19 , 20 , 92 ]. Interventions restricting screen time in schools have been implemented in mainland China to mitigate myopia [ 19 ].…”

“…Hence behavioral approaches to reduce prolonged near work are gaining more attention [ 19 , 20 , 92 ]. Interventions restricting screen time in schools have been implemented in mainland China to mitigate myopia [ 19 ]. Tools like the Clouclip® are promoted in China to notify children and parents about detrimental viewing habits [ 93 , 94 ].…”

“…Over the last decades, the rise in myopia prevalence coincided with urbanization, an intensified focus on education, and reduced time outdoors [ 13 , 14 ]. As a consequence, the prevalence of myopia varies depending on geographical and ethnic factors, with rates reaching as high as 90% for myopia and up to 30% for high myopia in schoolchildren from East and Southeast Asia [ 15 – 19 ]. Population studies in 12-year-old children employing cycloplegic refraction report myopia rates that range from 6.0% in Cambodia, to 7.4% in New Delhi, to 17.7% in Northern Ireland, and 20.0% in the USA.…”