Are we doing enough for the patient with myopia? A literature review

Abstract

Aim: Myopia is one of the most common eye conditions and often has a progressive nature. With higher degrees come greater risks of visual disability; however, typically no treatment is offered clinically to tackle myopic progression. This review aims to determine whether it is possible to predict future high myopia, review the available treatments to slow myopic progression and consider their role in clinical practice. Methods: A literature search was undertaken using the Web of Knowledge and PubMed databases. Results: Progressive addition lenses (PALs) are effective in slowing myopic progression in those with larger accommodative lag, and bifocals with base-in prisms have been found effective in progressing myopia with both high and low accommodative lag. However, the reduced progression gained from these treatments is small (treatment effects: 0.28–0.33D/3 years, 0.61D/18 months and 0.85D/2 years). Atropine and pirenzepine instillation are consistent in slowing myopic progression in most cases (treatment effect 0.14–1.25D/year); however, accelerated myopic progression in treated eyes has been observed after atropine treatment. Conclusions: None of the discussed treatments warrant widespread use. Atropine and pirenzepine appear to be the most effective options at present for slowing myopic progression. However, there is doubt as to whether their effects are maintained post-treatment. As it stands PALs have little effect clinically, though they may be beneficial for susceptible groups. Further research is required before clinicians can create evidence-based guidleines for these treatments, if their use is recommended at all.

Keywords

• Accommodative lag
• Aetiology
• Atropine
• Bifocals
• Myopia
• Pirenzepine
• Progression
• Progressive addition lenses
• Treatment