Letters to the Editor

The Role of Family Medicine in Reducing the Risk of Myopia


Am Fam Physician. 2021 Apr 1;103(7):394.

To the Editor: The myopia epidemic represents an insidious public health challenge. The prevalence of myopia has been increasing in many countries, especially in East Asia, where young adults in some communities have a prevalence of greater than 90%.13 It has been estimated that myopia will increase globally from 1.4 billion people in 2000 to 4.8 billion people by 2050.4 Several environmental and behavioral factors are known to increase the risk of myopia. Importantly, children who spend less time outdoors have a higher risk, which is why extensive public health efforts have been made to encourage more outdoor time.5 Although optical correction can address the refractive aspects, the underlying anatomic changes that cause it (principally, increased axial length) heighten the risk of uncorrectable visual impairment from associated optic nerve and retinal damage. Additionally, individuals with myopia incur costs related to optical correction and can have a reduced quality of life.

The American Academy of Ophthalmology's Task Force on Myopia, which included representatives from the American Academy of Family Physicians and the American Academy of Pediatrics, recently outlined the need for a comprehensive public health strategy for myopia that relies on contributions from family physicians.6 Visual acuity testing is critical to detect early forms of eye disease and should be a routine part of well-child examinations. Pharmacologic interventions (e.g., low-dose atropine eye drops) and certain specialized contact lenses have been shown to reduce the progression of myopia. Family physicians and pediatricians can educate children and their families about this condition and strategies for controlling it while also referring them to eye care professionals for additional management.6 Encouraging outdoor time is important to reducing the risk of myopia and can play a role in more extensive discussions about healthy lifestyles. It is anticipated that continued virtual learning during the COVID-19 pandemic will reduce time outdoors for children and will therefore cause an increase in the risk of myopia. By educating children and their parents about myopia and the benefits of outdoor time, family physicians and pediatricians can play an important role in mitigating the public health burden of this condition.

Author disclosure: Dr. Fong reports receiving research grant support from Santen, Inc., and serving as a consultant for Eyenovia. The other authors have no relevant financial affiliations.


show all references

1. Jung SK, Lee JH, Kakizaki H, et al. Prevalence of myopia and its association with body stature and educational level in 19-year-old male conscripts in Seoul, South Korea. Invest Ophthalmol Vis Sci. 2012;53(9):5579–5583....

2. Rudnicka AR, Kapetanakis VV, Wathern AK, et al. Global variations and time trends in the prevalence of childhood myopia, a systematic review and quantitative meta-analysis: implications for aetiology and early prevention. Br J Ophthalmol. 2016;100(7):882–890.

3. Tsai TH, Liu YL, Ma IH, et al. Evolution of the prevalence of myopia among Taiwanese schoolchildren: a review of survey data from 1983 through 2017. Ophthalmology. 2021;128(2):290–301.

4. Holden BA, Fricke TR, Wilson DA, et al. Global prevalence of myopia and high myopia and temporal trends from 2000 through 2050. Ophthalmology. 2016;123(5):1036–1042.

5. Wu PC, Chen CT, Chang LC, et al. Increased time outdoors is followed by reversal of the long-term trend to reduced visual acuity in Taiwan primary school students. Ophthalmology. 2020;127(11):1462–1469.

6. Modjtahedi BS, Abbott RL, Fong DS, et al.; Task Force on Myopia. Reducing the global burden of myopia by delaying the onset of myopia and reducing myopic progression in children. Ophthalmology. 2020;S0161-6420(20)31043-5. Accessed February 3, 2021. https://www.aaojournal.org/article/S0161-6420(20)31043-5/fulltext

Send letters to afplet@aafp.org, or 11400 Tomahawk Creek Pkwy., Leawood, KS 66211-2680. Include your complete address, e-mail address, and telephone number. Letters should be fewer than 400 words and limited to six references, one table or figure, and three authors.

Letters submitted for publication in AFP must not be submitted to any other publication. Possible conflicts of interest must be disclosed at time of submission. Submission of a letter will be construed as granting the AAFP permission to publish the letter in any of its publications in any form. The editors may edit letters to meet style and space requirements.

This series is coordinated by Kenny Lin, MD, MPH, Associate Deputy Editor for AFP Online.



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