Mysterious Myopia

A PERSPECTIVE ON
“MYSTERIOUS”
MYOPIA

Dr. Pavan K Verkicharla

Scientist - Myopia Research,
Prof. Brien Holden Eye Research Centre,
Head & Consultant Optometrist - The Myopia Centre,

L V Prasad Eye Institute

Talking about the awesome, fascinating yet frustrating
myopia has always been and will be an exciting subject
matter for me. As I have been told to express my
perspective on myopia, I felt it would be wise to call this
write-up as “MY- OPIA” and thus views here should be
interpreted with caution.

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Myopia, according to me is an ignored area in India among parents
(ignoring their child to have their eyes examined regularly),
children (ignoring the need to have the best vision), eye care
professionals (ignoring to practice, research, and preach about
myopia and its management), industries (ignoring the Indian
myopia scenario by not getting anti-myopia strategies to India
or/and ignoring the poor/middle class with their high costs for their
anti-myopia lenses). I could call myopia fascinating as it gives
employment to thousands of diverse eye care professionals ranging
from optometrists, researchers, personnel in the optical industry,
and ophthalmologists. Or frustrating as it is a complex ocular
refractive condition with multifactorial aetiology with its cause still
remaining unclear (even after conducting centuries of research).
There are many unanswered questions such as why only a few
children develop myopia? Of them why only a few progress to
high/pathologic myopia and others don’t? How to counteract the
progression? What anti-myopia strategy should be prescribed and
when/how, etc.?

2

Myopia Boom in India: The combination of the current digital-

ecosystem, more indoor-centric lifestyle, involvement in intense near

work activities (for entertainment and in strive for academic excellence),

and limited outdoor time may result in an epidemic of high myopia in

India similar to what was seen in China or Singapore a few decades ago.

Various research studies conducted in China and Singapore showed that

80-90 children out of 100 have myopia. Therefore, it is high time for the

eyecare fraternity in India to start practicing and preaching myopia

before the prevalence of myopia surges to uncontrollable levels as seen

in East Asian countries. India is already on the verge of seeing a peak in

myopia prevalence. Our current prediction model indicates that 1 out of

2 children living in urban regions of India will have myopia by 2050 if no

anti-myopia measures are initiated soon. Our work in the Myopia

Research Lab at L V Prasad Eye Institute (LVPEI) also showed that about

17% of Indian children show a myopic progression of at least 1D every

year, which according to me is quite a rapid progression. We also

reported that the pathologic complications do not just happen only in

cases with high myopia and the elderly, but also in milder forms of

myopia and are seen even in children. This means, Indians are no lesser

than anyone (pun intended) and we might soon see a myopia boom.

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As an optometrist, it is absolutely our responsibility to tackle this awesome,
intriguing, fascinating yet frustrating myopia. Note that myopia is more than
“parallel rays of light coming from infinity focused in front of the retina with
relaxed ocular accommodation” and beyond the routinely performed on-axis
refraction. Given the growing evidence on the efficacy of various anti-myopia
strategies and also its availability in India, one has to understand that prescribing
single vision lenses to a child with myopia progression is nothing less than a
“sin”.

“It is time to act now and
optometrists should be in the
frontline to combat this myopia
battle,” said Prof. Brien Holden in
his write-up about myopia in 2015.
I would like to add to that by saying

“If not now, when?”

The goal of any anti-myopia strategy (in the form of optical,
environmental/behavioral, and pharmacological) should not aim to just stop the
progression, but also target a) myopia prevention (think of children with
emmetropes but with other risk factors like parental myopia), b) delay the onset
so that they may not develop high myopia in adulthood and c) slow the
progression irrespective of age. Having said that, I do understand that majority of
the specially-designed spectacles and contact lenses for myopia management
are not manufactured in India and are thus very expensive for our patients.
Hopefully, we will soon have Indian manufactured spectacles/contact lenses
designed for controlling myopia, so that we can cater to all those in need instead
of just to the ones who can afford them. Sometimes simple recommendations
such as a change in lifestyle and increasing the time spent in outdoors serve
efficiently in myopia prevention and control in children.

4

A holistic approach is a way to go if
we want to ensure that the child
does not have myopia progression.
Before we jump on the anti-myopia
bandwagon or blindly follow what is
in the market, I think it is imperative
to understand the causation by
getting as much information as
possible about the children’s daily-
lifestyle from their parents and from
the children themselves, understand
their family history of myopia and
measure ocular parameters as much
as you can (optics sand structures).
Otherwise, we will be shooting in
the dark.

Myopia management should stem from research as we need to first
understand why the child has myopia or is undergoing progression. With the
evidence piling up every day (11,000+ papers published in the last decade on
myopia, 342 in 2021 already), unless we are up to speed (with the literature
about myopia) it will become a challenge for us to tackle this future pandemic.
Our work in the myopia research lab concentrates more on investigations
related to the pathophysiology of myopia and one of our experiments in
understanding near work indicated that reading on paper is equally
myopiogenic and thus the blame game on just smartphones to cause myopia
may not be right. Note that the smart phones entered the market only after the
2000s, but the myopia prevalence was already at peak (80%), ten years before
that. Clearly, the recommendation to children to just read on paper may not be
correct. I want to highlight that we should not blindly follow prescribing one
type of anti-myopia strategy without understanding the actual cause.
Understand the mechanisms such as when and why ortho-keratology, center
distance multi-focal, bi-focal spectacle lenses, and atropine eye drops are good
treatment options. The evidence about the efficacy of all these strategies varies
from approximately 40-70%. Monitor all the “X” factors related to myopia
(environment, central and peripheral optics, biometry at least) and then decide
the suitable anti-myopia strategy the child should get to counteract myopia
progression.

The 4 M's of myopia Let’s be the change
mantra I want to that we want to see in
highlight to all the this mysterious world.
optometrists

Multi-factorial nature of myopia I wish all the proud
Understand that there are many optometrists
factors and a holistic approach is the
way to go a happy

Measure the 'X' factors related to World Optometry Day.
myopia
Whatever you can with your
instruments/awesome brain

Monitor the progression closely Wishing you all the
3-6 month time will help us identify possible success inyour
changes in axial length
myopia management.
Manage with appropriate anti-
myopia strategy Happy to get
Varies from case to case and providing connected
them with nothing can be considered anytime for myopia.
a sin

[email protected]

Dr Pavan Verkicharla is a Scientist researching on both basic and transnational aspects of myopia at the Myopia
research lab in L V Prasad Eye Institute, India. Pavan pursued his Ph.D from the Queensland University of
Technology, Australia and post-doctoral research from Singapore Eye Research Institute, Singapore. He has
numerous publications in international peer-reviewed journals and is passionate about myopia research. He also
serves as a reviewer for international peer-reviewed journals and is a recipient of the prestigious "Bernard
Gilmartin Award" for his research. Dr Verkicharla holds research grants from both private organizations and the
government of India (Department of Science and Technology, and Science and Engineering Board) for
researching and understanding the various aspects of myopia with a holistic approach. Apart from research, Dr
Pavan also heads “The Myopia Centre’ at LVPEI

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