Eyeworld

74 | EYEWORLD | SPRING 2025 R EFRACTIVE About the physician Michael Repka, MD Division Director, Pediatric Ophthalmology and Adult Strabismus Wilmer Eye Institute Johns Hopkins School of Medicine Baltimore, Maryland References 1. Morgan IG, et al. The epi- demics of myopia: etiology and prevention. Prog Retin Eye Res. 2018;62:134–149. 2. Wong YL, Saw SM. Epidemiol- ogy of pathologic myopia in Asia and worldwide. Asia-Pacific J Ophthalmol. 2016;5:394–402. 3. Martinez-Albert N, et al. Risk factors for myopia: a review. J Clin Med. 2023;12:6062. 4. Manoharan MK, et al. Myopia progression risk assessment score (MPRAS): a promising new tool for risk stratification. Sci Rep. 2023;13:8858. 5. Chua WH, et al. Atropine for the treatment of childhood myopia. Ophthalmology. 2006;113:2285–2291. 6. Chia A, et al. Atropine for the treatment of childhood myopia: safety and efficacy of 0.5%, 0.1%, and 0.01% doses (Atropine for the Treatment of Myopia 2). Oph- thalmology. 2012;119:347–354. by Liz Hillman Editorial Co-Director P rogressive pediatric myopia, its increas- ing prevalence, and possible treat- ments are important topics for eyecare providers, even if their primary patient population isn't pediatric. Regardless of specialty within ophthalmolo- gy, Michael Repka, MD, who is a pediatric oph- thalmologist, said it's important to understand the research that's going on in this area because it affects a large percentage of the population globally and is associated with long-term vision- threatening complications. "I think that the more we talk about it, the better off we are. Having ophthalmologists understand that myopia should not be viewed as a fact of life, that it's something that could be adjusted, may help them in their day-to- day conversations with their patients who are parents," he said. "But first and foremost, it's knowing what's going on in the field and the interest in an area that hasn't been traditionally mainstream." Dr. Repka shared his perspectives regarding myopia, especially in the West, and his thoughts on recent research and treatments for myopia control in an interview with EyeWorld. Myopia status While it's well documented that pediatric myo- pia has been on the rise in East Asia and some of Southwest Asia, the dramatic increase in prevalence is (at least not yet) mirrored in the West. The prevalence of myopia in East Asia can be as high as 80–90% among young adults, compared to 20–40% in Western countries. 1 High myopia among the Asian population rang- es from 6.8–21.6%, compared to 2.0–2.3% in non-Asian populations. 2 Dr. Repka said that myopia and factors associated with progression in the West are not perfectly understood. "In much of Asia there's clearly been a dramatic increase in the prevalence of amblyo- pia. … It's not as clear that the prevalence in the U.S. has increased dramatically over the same period of 30–40 years," he said. "Part of that is we don't have the kind of surveillance and uni- versal collection of data that they have in other parts of the world or in smaller countries. … There are some data that suggest prevalence is increasing, but I do think more of that evidence is supportive elsewhere in the world, not nec- essarily reflecting what is happening in the U.S. There are places or pockets where it seems to be anecdotally increasing, but I do want to caution that it's not perfectly clear." Dr. Repka said that the difference in myopia prevalence between the East and West could be due to incomplete data, a lag of increase in prevalence, or it could be due to differences in environmental risk factors. "There's no ques- tion that people are trying to understand and determine what are the predictors of myopia progression." The most mentioned risk factors for myo- pia onset and progression are long periods of reading, reading at a close distance, and limited exposure to sunlight. 3 Work is being done to create tools to assess risk of multiple factors re- lated to myopia development and progression. 4 Myopia control efforts Atropine is among the most publicized and researched treatments for stemming progressive myopia. A 2006 study in an Asian population found 1% atropine to be well tolerated and effective, and later research evaluated lower doses, finding 0.1% and 0.5% to be safe and effective. 5,6 Research into even lower concen- trations found 0.05% atropine to be "most effective in controlling [spherical equivalent] progression and [axial length] elongation" over 1 year. 7 Dr. Repka said that low-dose atropine has been a "game changer in East Asia." However, in Western populations, low-dose atropine had "less than exciting results," Dr. Repka said. A study published in 2023, of which Dr. Repka was the lead investigator, found that, among school-age children in the U.S., 0.01% atropine "did not slow myopia progression or axial elongation" compared to placebo. 8 "We don't know what 0.05% would do in the West," Dr. Repka added, explaining that 0.05% is the concentration that many Asian countries have begun to use. Dr. Repka said "it's not the end of the day for atropine research" in the West. He said that it's time to pursue ad- ditional studies to evaluate higher doses. "The problem with higher dosages is they may work, Perspective on the current state of myopia and its control in the West

• Cover