Truth: Age of stabilization varies considerably

Welcome to “Myopia Mythbusters.” In each column, April Jasper, O.D., presents a myth, and Mark Bullimore, MCOptom, Ph.D., busts it.

This month’s myth: Myopia stabilizes at age 15.

THE FACTS

The benefits of myopia control should, in theory, continue to accrue as long as myopia is progressing, although there are limited long-term studies.^1,2,3 So when does myopia stabilize, such that myopia management can be concluded?

Data are scarce and for decades, the only comprehensive estimates were courtesy of Goss and Winkler who analyzed the records of 299 myopes from three optometry practices. These myopes had at least four examinations between the ages of 6 and 24.⁴ Their results suggest that myopia stabilizes earlier in females, with cessation ranging from ages 14.4 to 15.3, and cessation in males ranging from ages 15.0 to 16.7. The authors note, however, considerable variability.

The COMET Group estimated the age and the amount of myopia at stabilization in their original cohort — an ethnically diverse group of 469 myopic children.⁵ The data were fitted with curves to describe the age, 15.6 ± 4.2 years, and myopia at stabilization, –4.87 ± 2.01 D. Thus, the mean age at stabilization was similar to the previous estimate, but contrary to Goss and Winkler, there was no significant difference between the sexes.⁴

The COMET authors noted a large variation in age of stabilization of refractive error:

48% of the cohort had stable myopia by age 15;

77% of the cohort had stable myopia by age 18;

90% of the cohort had stable myopia by age 21; and

96% of the cohort had stable myopia by age 24.⁵

In a subsequent paper, the COMET group reported on the stabilization of axial elongation in the same cohort.⁶ Axial stabilization occurred on average eight months later than myopia, but the two ages were well correlated.

These values are useful when considering how long to continue myopia control and in discussions with parents, but remember this cohort was recruited at a relatively young age. Given the eligibility criteria for the study, the mean age of onset was age 7 or 8. Thus, it is unclear whether the age of stabilization in this cohort of early onset myopes can be generalized to myopia of later onset. Intuitively, myopia emerging during the teenage years would progress, on average, beyond the age of 15.

Other studies have demonstrated that myopia progression occurs well into adulthood. Parssinen et al. reported that 45% of myopes progressed by at least –0.50 D from 23 to 31 years.⁷ Likewise, Bullimore et al. reported that 16% of 219 myopes (mean age = 31 years) progressed by at least –0.50 D over five years.⁸

THE SOLUTION

Dr. Jasper says: Based on research, it is best to monitor refractive error and, if possible, axial length to inform your decisions. My goal for my patients is to continue treatment through college. The negative effects of discontinuing treatment too soon are significant, so it is best to err on the side of remaining in treatment until stable. As a parent, this makes sense to me. As a doctor, I know I have given my patients their best chance of success. OM

REFERENCES
1. Brennan NA, Toubouti YM, Cheng X, Bullimore MA. Efficacy in Myopia Control. Prog Retin Eye Res 2020: https://doi.org/10.1016/j.preteyeres.2020.100923.
2. Hiraoka T, Kakita T, Okamoto F, et al. Long-Term Effect of Overnight Orthokeratology on Axial Length Elongation in Childhood Myopia: A 5-Year Follow-up Study. Invest Ophthalmol Vis Sci 2012;53:3913-9.
3. Santodomingo-Rubido J, Villa-Collar C, Gilmartin B, et al. Long-Term Efficacy of Orthokeratology Contact Lens Wear in Controlling the Progression of Childhood Myopia. Curr Eye Res 2017;42:713-20.
4. Goss DA, Winkler RL. Progression of Myopia in Youth: Age of Cessation. Am J Optom Physiol Opt 1983;60:651-8.
5. COMET Group. Myopia Stabilization and Associated Factors among Participants in the Correction of Myopia Evaluation Trial (Comet). Invest Ophthalmol Vis Sci 2013;54:7871-84.
6. Hou W, Norton TT, Hyman L, et al. Axial Elongation in Myopic Children and Its Association with Myopia Progression in the Correction of Myopia Evaluation Trial. Eye Contact Lens 2018;44:248-59.
7. Parssinen O, Kauppinen M, Viljanen A. The Progression of Myopia from Its Onset at Age 8-12 to Adulthood and the Influence of Heredity and External Factors on Myopic Progression. A 23-Year Follow-up Study. Acta Ophthalmol 2014;92:730-9.
8. Bullimore MA, Mitchell GL, Jones LA, Reuter KS. Progression of Myopia in an Adult Population. Invest Ophthalmol Vis Sci 2008;49:2606.
 

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.