Truth: Progression varies based on age, race and parentage

Welcome to the inaugural “Myopia Mythbusters” column. In each, April Jasper, O.D., presents a myth and Mark Bullimore, M.C.Optom, PhD, tries to bust it. (Similar to the webinar series.) The myths originate from questions posed by eye care professionals and are relevant to myopia management.

This month’s myth: 0.50 D per year is normal myopic progression.

THE FACTS

The rate of myopia progression among patients is too varied to assign a single value. The most important factors that contribute to myopia progression are age and race; the number of myopic parents also plays a significant role.

Age. With respect to age, in the Correction of Myopia Evaluation Trial (COMET) — a 3-year clinical trial of progressive addition lenses (PALs) for myopia progression —children in the single vision lens group who were 6 or 7 years old at baseline progressed twice as fast as the 11-year-olds: –2.19 D vs. –1.04 D over three years.¹ Additionally, Donovan et al. published a review of the myopia progression rates.² “The estimated progression rates were dependent on baseline age, with decreasing progression as age increased,” the study says.

Race. Ethnicity is another significant factor, with myopic children in Asian countries progressing faster than those in western countries. Donovan et al. estimated annual myopia progression in 9-year-olds to be –0.55 D for populations of predominantly European extraction and –0.82 D for East Asians.² In other words, the East Asian children progressed 50% faster. This same ratio holds for axial elongation, as reported by Brennan et al, which shows corresponding data for axial elongation, another measurement used to monitor the progression of myopia.³ Regardless of the variations in progression rate, there is no evidence that treatment effect varies with ethnicity.^4,5

Parentage. Many studies report parental history of myopia increases the incidence and prevalence of myopia in children, but there are fewer studies on the effect of parental history of myopia on the progression of childhood myopia.^6-8 Among Singaporean myopic children aged 6 to 12, the mean progression rate for those with at least one myopic parent was –0.63 D/year compared to –0.42 D/year for those whose parents were not myopic.⁹ In a COMET subset, children who have two myopic parents progressed faster over five years than those who have zero or one myopic parent by –0.78 D and –0.55 D, respectively.⁸

THE SOLUTION

What Dr. Bullimore’s summary has taught me is that it is better to avoid talking about what is normal progression. I explain to parents and the patient that progression of myopia varies with factors of age, race, and family history. Acknowledge that managing these patients is challenging because we may never know what would have happened without our intervention.

TAKE-HOME MESSAGE

Remind all myopic children and their parents that regardless of age of onset, ethnicity, parental history and lifestyle, they will experience progression. Give these patients appropriate treatment options in an effort to reduce the individual’s myopia progression. OM

REFERENCES

1. Hyman L, Gwiazda J, Hussein M, et al. Relationship of Age, Sex, and Ethnicity with Myopia Progression and Axial Elongation in the Correction of Myopia Evaluation Trial. Arch Ophthalmol 2005;123:977-987. 

2. Donovan L, Sankaridurg P, Ho A, Naduvilath T, Smith EL, Holden B. Myopia Progression Rates in Urban Children Wearing Single-Vision Spectacles. Optom Vis Sci. 2012;89:27-32. doi: 10.1097/OPX.0b013e3182357f79

3. Brennan NA, Cheng X, Toubouti Y, Bullimore MA. Influence of Age and Race on Axial Elongation in Myopic Children. Optom Vis Sci. 2018;95:E-abstract 180072.

4. Berntsen DA, Sinnott LT, Mutti DO, Zadnik K. A Randomized Trial Using Progressive Addition Lenses to Evaluate Theories of Myopia Progression in Children with a High Lag of Accommodation. Invest Ophthalmol Vis Sci. 2012;53:640-649. 

5. Chamberlain P, Peixoto-de-Matos SC, Logan NS, Ngo C, Jones D, Young G. A 3-Year Randomized Clinical Trial of Misight Lenses for Myopia Control. Optom Vis Sci. 2019;96(8):556-567. 

6. Zadnik K, Satariano WA, Mutti DO, Sholtz RI, Adams AJ. The Effect of Parental History of Myopia on Children’s Eye Size. JAMA. 1994;271(17):1323-1327.

7. Lim DH, Han J, Chung TY, et al. The High Prevalence of Myopia in Korean Children with Influence of Parental Refractive Errors: The 2008-2012 Korean National Health and Nutrition Examination Survey. PLoS One. 2018;13:e0207690.

8. Kurtz D, Hyman L, Gwiazda JE, et al. Role of Parental Myopia in the Progression of Myopia and Its Interaction with Treatment in Comet Children. Invest Ophthalmol Vis Sci. 2007;48(2):562-570. 

9. Saw SM, Nieto FJ, Katz J, et al. Familial Clustering and Myopia Progression in Singapore School Children. Ophthalmic Epidemiol. 2001 Sept;8(4):227-236.

DR. BULLIMORE writes about myopia and other topics, is an adjunct professor at the University of Houston, a consultant for Alcon Research, Allergan, CooperVision, Essilor, Eyenovia, Genentech, Johnson & Johnson Vision, Novartis, Presbia and Wells Fargo Securities and owner of Ridgevue Publishing, Ridgevue Technologies and Ridgevue Vision.

DR. JASPER practices in West Palm Beach, Fla.. She is an American Academy of Optometry fellow and is chief optometric editor of Optometric Management. Email her at april.jasper@pentavisionmedia.com.