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62 October 2016 by Vanessa Caceres EyeWorld Contributing Writer world where myopia is on the rise will require better trained eyecare professionals, Dr. Leasher said. Ophthalmic-focused compa- nies and providers must gear up for increased demands in products such as eyeglasses, contact lenses, and re- fractive surgery, said Roy S. Chuck, MD, PhD, chairman, Department of Ophthalmology and Visual Sciences, Albert Einstein College of Medicine, Montefiore Health System, Bronx, New York. The discussion of myopia projections is timely as the Ameri- can Academy of Ophthalmology's Preferred Practice Pattern (PPP) for Refractive Management and Therapy is being updated for publication in 2017, said Dr. Chuck, who chairs the panel and is part of the PPP govern- ing committee. Working ahead Some parts of the world, like Asia, have recognized the epidemic and have begun to implement myo- pia control. This includes the use of contact lens, orthokeratology, spectacles, low-dose atropine, and increased time outdoors, Prof. Naidoo said. These same countries even have used media campaigns to encourage children to spend more Catching myopia early in life may also be an issue. In countries like the U.S., state-by-state varia- tions in childhood vision screening requirements have likely allowed for increasing levels of myopia to go undetected as children and teen- agers progress through school, Dr. Modi said. The prevalence of refractive error in countries like the U.S. is sometimes taken for granted because it is so common, even in school- aged children, Dr. Leasher said. However, not all insurance covers routine eyecare—a fact that works against ensuring everyone has good visual health, she thinks. The projections should have a large implication on eyecare plan- ning, Prof. Naidoo said. "There will be many more people in the world who will require spectacle correction who may not be able to afford it or access it in the future," he said. There also may be lost produc- tivity when people cannot see to work or study, Prof. Naidoo added. Governments and organizations should prepare for the added finan- cial burden of providing eyecare services as well as for optical correc- tion and surgeries for complications such as retinal detachment, Dr. Tan said. Certain developing areas of the "Assuming a constant rate of myopic macular degeneration, this would catapult myopia up the ranks as a leading cause of permanent worldwide blindness," said Yasha Modi, MD, assistant professor, De- partment of Ophthalmology, NYU Langone Medical Center, New York. "This study was a tremendous undertaking with a model that should be a five-alarm alert for policy makers in health and devel- opment," said Janet Leasher, OD, professor and director of community outreach, Nova Southeastern Uni- versity, College of Optometry, Fort Lauderdale, Florida. Causes and implications Environmental factors, such as life- style changes that include decreased time outdoors and increased near work activities, are likely a big cause of the upswing in myopia, according to study authors. "Among environ- mental factors, so-called high-pres- sure educational systems, especially at very young ages in countries such as Singapore, Korea, Taiwan, and China, may be a causative lifestyle change, as may the excessive use of near electronic devices," they wrote. Although genetic predisposi- tion may play a role, it cannot fully explain the trend, they added. Eyecare experts call for global campaign per myopia study projections "S taggering." "Frightening." "Should be a five- alarm alert." Those are just some of the reactions to a study published earlier this year that suggests almost half of the world population will have myopia by the year 2050—and that nearly 1 billion people will have high myopia. That would be a seven-fold increase in high myopia compared with the year 2000. 1 Those predictions were from the systematic review and meta-analysis "Global prevalence of myopia and high myopia and temporal trends from 2000 through 2050," published in the June issue of Ophthalmology. The numbers were a surprise even for the study authors. "We expected an increase, but we did not think that the prevalence will reach 50%," said study author Kovin Naidoo, PhD, CEO of Brien Holden Vision Institute, University of New South Wales, Sydney, Australia. The study's finding regarding the prevalence of high myopia is especially important because this subset of the population is at a great- er risk for vision impairment and blindness from conditions such as glaucoma, cataracts, retinal detach- ment, and myopic macular degener- ation, Prof. Naidoo said. The impact of uncorrected dis- tance refractive error—often caused by myopia—is estimated to be $202 billion annually, according to the authors. Myopia experts from around the globe were taken aback by the results. "While it is well-known that the prevalence rates of myopia were increasing in almost all populations globally, the sheer scale and magni- tude of the problem is still surpris- ing. However, their study methodol- ogy is strong and represents the best data we have to date," said Donald Tan, FRCSE, Arthur Lim Professor in Ophthalmology, ophthalmology and visual sciences academic clinical program, Duke-NUS Graduate Med- ical School, and Singapore National Eye Centre, Singapore. EW REFRACTIVE Myopia growth will have a domino effect worldwide