Commentary on: A growing concern: Addressing rapid myopia progression in children

Childhood myopia is increasing at a pandemic rate and has gained renewed interest among ophthalmologists worldwide in the past decade. The global prevalence of myopia has increased from 24.3% in 1990 to 35.8% in 2023.[1] It is predicted to affect 39.8% of the world’s population by 2050.[1] The prevalence of myopia is highest in developed Asian countries, suggesting that ethnicity and lifestyle factors play a crucial role in its onset.[1] With an annual increase in myopia prevalence of 0.8%, predictions for the Indian population by 2050 indicate a prevalence of up to 48%.[2] The concerns with myopia are not limited to the rising incidence and prevalence of this disease. Once it occurs, progression of myopia is inevitable. A study conducted on school children aged 5–15 years in North India revealed that 49% of the children showed progression of myopia within one year of onset, with a mean increase of −0.27 ± 0.42 D.[3] More recently, a hospital-based study has shown a higher progression rate of −0.45 ± 0.01 D per year among children under 15 years.[4] Among them, a subset of children showed rapid progression, defined as >0.75 D or >1 D per year. This subset constitutes approximately 18% of children with myopia in India.[4] A younger age and more severe myopia predispose individuals to a higher rate of progression.[4] Such statistics raise alarms for an imminent boom in the number of high myopes and associated retinal complications in the future. In recent times, most myopia research has revolved around retardation of its progression. The commonly used modalities include: Low-dose and high-dose atropine. Peripheral myopic defocus-inducing spectacles. Contact lenses. Around 13% to 20% of children continue to progress by 0.75 D or more despite monotherapy with these modalities.[5–7] The effect of treatment is known to be affected by the age and severity of myopia, with younger and more severe myopes showing a lesser response.[5–7] The association between the initial rate of progression and response to treatment requires further study. In a recent study, the authors assessed the effect of 0.05% atropine in retarding the progression of myopia in rapid progressors (>0.75D/year) and found it to reduce progression by 62%, with only 7.5% continuing to progress >0.75/D/year with treatment.[8] Forty percent children still showed myopia progression of ≥0.5 D in one year. The follow-up in this study was for only one year. Further longitudinal data are needed to determine whether this effect increases over time in rapid progressors, as seen with low-dose (0.01%) atropine therapy.[5] Although a higher concentration of atropine may be considered the first line of therapy for rapid progressors, there is a need to evaluate other modalities and combination therapies in these patients. In a comparative study, a combination of 0.05% atropine with multifocal contact lenses was more effective than multifocal contact lenses alone.[9] Additionally, the role of prophylactic treatment in children predisposed to rapid progression, such as younger children with severe myopia at onset, warrants further investigation. Continued research and innovations in the field of myopia are necessary to enable informed decision-making regarding the most effective strategies to retard the progression of myopia in children, especially the rapid progressors.