Predicting Myopia

myopia management - optometrist diagnosis

The goal of myopia management is to control myopia progression by suppressing axial elongation yielding the lowest level of myopia in the long-term.

There are two ways to cause the final myopia level to be lower.
1. Intervene earlier.
2. Prescribe more effective treatments.1

Early Intervention

The earliest intervention would be at or before onset. Infants of all species almost always have hyperopia, and the process of emmetropization results in gradually reducing hyperopia leading to either low hyperopia or emmetropia at maturity.2 While this is the intended effect of emmetropization in humans, it often fails to stop at emmetropia and myopia results.

A future myope can be predicted from several characteristics:

  • First, lower hyperopia than expected for the age. If there is 0.75D or less hyperopia at the age of 6, myopia is likely in the future.3,4 In the normal emmetropization process hyperopia reduces at slower rates with age, so if an acceleration in hyperopia reduction is seen, myopia may be more likely.
  • Secondly, myopia may be more likely with high accommodative lag, high AC/A ratios, and esophoria at near, though evidence is lacking at correcting these factors result in better outcomes.5
  • Third, parental myopia, myopic siblings, Asian ancestry, rigorous academic pursuits particularly at younger ages, and limited outdoor play all can be used to predict myopia and to predict early onset and high myopia.6-11

Prescribe More Effective Treatments Early

Practitioners, parents, and patients tend to be less concerned or willing to treat myopia when the prescription is still low. Especially the younger the patient.

While there are good reasons, it is virtually guaranteed to reduce the chance of limiting the final level of myopia the later one starts myopia management.

The following chart illustrates the possible outcomes for five hypothetical siblings undergoing myopia treatments with varying approaches and outcomes. The best outcome is most easily achieved by starting early, and by using the most effective method as early as possible.1

Myopia Control Scenarios

1. Aller TA. Clinical management of progressive myopia. Eye (Lond). 2014;28(2):147-153.
2. Morgan IG, Rose KA, Ellwein LB, Group RESiCS. Is emmetropia the natural endpoint for human refractive development? An analysis of population-based data from the refractive error study in children (RESC). Acta Ophthalmol. 2010;88(8):877-884.
3. Zadnik K, Sinnott LT, Cotter SA, et al. Prediction of Juvenile-Onset Myopia. JAMA Ophthalmol. 2015;133(6):683-689.
4. Jones-Jordan LA, Sinnott LT, Manny RE, et al. Early childhood refractive error and parental history of myopia as predictors of myopia. Invest Ophthalmol Vis Sci. 2010;51(1):115-121.
5. Berntsen DA, Sinnott LT, Mutti DO, Zadnik K. A randomized trial using progressive addition lenses to evaluate theories of myopia progression in children with a high lag of accommodation. Invest Ophthalmol Vis Sci. 2012;53(2):640-649.
6. Zadnik K, Satariano WA, Mutti DO, Sholtz RI, Adams AJ. The effect of parental history of myopia on children’s eye size. JAMA. 1994;271(17):1323-1327.
7. Zadnik K. The Glenn A. Fry Award Lecture (1995). Myopia development in childhood. Optom Vis Sci. 1997;74(8):603-608.
8. Morgan I, Rose K. How genetic is school myopia? Prog Retin Eye Res. 2005;24(1):1-38.
9. Ip JM, Huynh SC, Robaei D, et al. Ethnic differences in refraction and ocular biometry in a population-based sample of 11-15-year-old Australian children. Eye (Lond). 2008;22(5):649-656.
10. Rose KA, Morgan IG, Ip J, et al. Outdoor activity reduces the prevalence of myopia in children. Ophthalmology. 2008;115(8):1279-1285.
11. Ip JM, Saw SM, Rose KA, et al. Role of near work in myopia: findings in a sample of Australian school children. Invest Ophthalmol Vis Sci. 2008;49(7):2903-2910.