Myopia: Still a widespread deviation from the norm or already a pandemic?

Ophthalmologists from all over the world have been experiencing a dramatic increase of myopic patients. In 2010, over a quarter of the world’s population was estimated to be affected by so-called nearsightedness. It is predicted that in the next 20 years, the diagnoses of high myopia (≥−6.00 D) will double, and triple for moderate myopia (−3.00 to −5.99 D), from the incidences recorded in 2010. This prevalence is expected to especially affect more Europeans and South Africans, meaning the people of these areas are expected to suffer from visual impairment resulting either from a too large axial length of the bulbus or from a distorted cornea.1–3 Although this ocular disorder can be seemingly easily remedied by compensating vision with spectacles or classic contact lenses, researchers and clinicians have begun to systematically explore environmental backgrounds, underlying causes, and treatment options of this widespread deviation from the norm.4–11 To start with, several studies have proven that next to genetic predisposition, sufficiently long exposure to natural daylight during school-age development plays a decisive role in the development of the eye.4,5 Thus, adapting the balance between outdoor activities and close distance work shows great potential for preventing myopia from occurring at all for individuals without a genetic disposition. For children and middle-school students already affected by myopia, administering low-dose atropine drops have proven a beneficial treatment and show great promise for reducing the progression of myopia in the young eye.6,7 Furthermore, special contact lenses and spectacles have been designed to simultaneously correct blurry vision and decelerate eye growth or myopia progression.8–10 Last, but not least, a wide range of surgical options are available today to correct myopia with favorable outcomes. Corneal refractive procedures, such as PRK or TransPRK, LASIK or femto-LASIK, and KLEx, are most commonly performed and provide reliable visual results.11 In cases of higher myopia or contraindications to corneal surgery, phakic IOLs represent an effective alternative with good patient satisfaction.12 For older patients with presbyopia or cataract, refractive lens exchange or cataract surgery with implantation of multifocal or EDOF IOLs can further reduce spectacle dependence.13 However, it is important to emphasize that these procedures correct the refractive error but do not address the underlying causes. Potential risks remain, sometimes even caused by the correction, including corneal ectasia after laser vision correction, endothelial cell loss with phakic IOLs, and an increased risk of retinal detachment after lens extraction.14–16 The myopia treatment endeavors being explored demonstrate the versatility of our field and our goals as medical professionals. We are striving to not only correct myopia as a permanent short-term treatment for symptoms, but to get to the root causes of the imminent pandemic. In other words, to cure or even prevent myopia before it is diagnosed.