Myopia Boom Linked to Environmental Factors

Hot Topic

An Intergenerational Myopia Boom

The long-term Guangzhou Twin Eye Study, conducted from 2006 to 2018, revealed a significant intergenerational increase in myopia prevalence and severity among Chinese children compared with their parents, highlighting environmental factors as the primary drivers of this myopia boom. The study tracked 686 children (between 7 and 15 years of age at baseline) and their parents, measuring cycloplegic refractions and biometric data annually. By young adulthood, 78% of the children were myopic, compared with 42.1% of their parents. High myopia (< -6.0 D) affected 9.6% of children compared with 5.2% of parents, and moderate myopia (-3.0 D to -6.0 D) increased to 38.8% from 9.9%. Mild hyperopia and emmetropia declined in the younger generation, whereas extreme myopia (< -9.0 D) and severe hyperopia (≥ +2.0 D) showed no significant change. The refractive shift was primarily attributed to an increase in axial length in children, with minimal changes in lens power, corneal curvature, and corneal power. The children’s refraction distribution was broader and flatter (-6.0 D to -0.5 D) compared with the parents’ refraction distribution, with a narrower peak around -1.0 D. A low correlation (approximately 0.30) between parent and child refractive percentiles suggested a weak genetic influence, pointing instead to environmental factors.

The study linked the rapid doubling of myopia prevalence within one generation to increased educational pressure, prolonged near work, reduced outdoor time, and urban lifestyles, as supported by supplemental questionnaires on residential patterns, outdoor activities, and educational attainment.

The authors emphasized that genetic changes occur too slowly to explain this trend, advocating for further research into effective environmental interventions, such as adjusting school schedules and increasing outdoor breaks, to address the rising prevalence of moderate and high myopia in China.

My Two Cents

Well, duh. We knew myopia was getting worse. However, none of us could have imagined that the progression of myopia would be this fast—78% of this generation is myopic compared with 42.1% of parents, while high myopia doubled and moderate myopia nearly quadrupled. Astounding numbers.

If you’re one of those doom-and-gloom optometrists who loves to poo-poo over the future of the profession, I challenge you to read this study and try not to see the future opportunities for us in the primary eye care field to manage and treat this growing patient demographic that desperately needs doctors who care and know what they’re doing!

OUTSIDE THE LANE

Medical Debt Remains in Credit Reports

A federal judge in Texas has overturned a Consumer Financial Protection Bureau (CFPB) rule that aimed to remove medical debt from Americans’ credit reports, allowing such debt to continue influencing credit scores. The CFPB, under the Biden administration, introduced the rule in January to prevent medical bills from affecting lending decisions, arguing that medical debt is not a reliable indicator of a borrower’s likelihood to default, based on its 2014 research. The rule sought to alleviate the financial burden on nearly 100 million Americans with health care debt, which can affect their ability to secure housing, car loans, and other economic opportunities. However, the Cornerstone Credit Union League challenged the CFPB, claiming the agency exceeded its authority. The judge agreed, stating that the rule breached the CFPB’s jurisdiction. The decision was criticized by advocacy groups, such as Community Catalyst, which called it a setback for those burdened by medical debt.

In contrast, the Consumer Data Industry Association supported the ruling, arguing that unpaid medical debt is crucial for assessing creditworthiness. This ruling highlights the ongoing debate over the role of medical debt in credit reporting, with more than a dozen states enacting laws to limit its effect. The issue remains contentious, as medical debt continues to pose significant financial risks, including homelessness, for millions of Americans.

My Two Cents

According to a 2022 study published by Kaiser Health and NPR, 100 million Americans supposedly have medical debt.

Although this article was full of fascinating information, that number is sobering. It would be intriguing to take an even deeper look at that number to determine precisely what comprises the debt of that many Americans (the United States has approximately 331 million citizens, according to the 2020 census). This is where the gray lines of politics really do come into play regarding whether that medical debt should play a role in lending decisions. On one side, it makes sense that financial institutions should know if someone is drowning in medical debt before approving a loan; however, it’s also incredibly easy to see the patients’ point of view in that the medical issues are likely not their fault and shouldn’t be an impediment to their pursuit of happiness and well-being. Talk about a tricky situation! That’s why I can’t ever imagine going into politics. For me, it would be impossible to feel like you’re making the right decision in situations like this.

CAN YOU RELATE

While at Vision Expo West a few weeks ago, I was stopped by several of you to chat about the newsletter, and we discussed eye care, its future, and (most importantly) my dog and my son.

One question came up from at least 10 of you, and I realized that I never did a follow-up. Many wanted to know about my EVO ICL (Staar Surgical/Alcon) surgery results. A little backstory: In May 2024, I underwent binocular EVO ICL surgery performed by my friend and partner, Blake Williamson, MD, MPH, MS, at our practice. We even livestreamed the surgery! Although the livestream no longer exists on our social media, here is a video of me getting people ready to tune in.

The surgery took approximately 5 minutes per eye, and, personally, I chose not to undergo general anesthesia and instead just had proparacaine routinely placed into my eyes. Not because I’m that brave or wanted to prove my mental fortitude; rather, I didn’t want to pay for anesthesia services or say anything dumb live on social media.

I saw approximately 20 patients at my dry eye center that morning. Then I dilated myself, drove to the surgery center (about 15 minutes away), did a few social media videos, chatted with Dr. Williamson, and underwent the presurgical workup. We did the procedure on one eye, walked out of the surgery suite, cleaned up, and chatted while the surgical team prepped for the next eye. We entered a different suite with a different surgical team (same Dr. Williamson), and then I emerged 5 minutes later with totally new eyes!

I relaxed at the surgery center for a few hours, got my IOP checked, and (don’t tell anyone) drove myself home and went to sleep. The next day, I had a very light clinic and was already seeing 20/20 with little to no side effects. Unreal!

Regarding the side effects, I experienced halos around lights for about 3 months. Since then, my eyes have become less dry, and my vision has improved to 20/15 monocularly and 20/10++ binocularly. It was a fantastic decision. I’m excited to see what Alcon has up its sleeve, following the big purchase of Staar Surgical.

If you’re curious about the surgery, here is an excellent video on the subject, and, no surprise, the face of our profession, Joseph Allen, OD, is featured. Yet again, great job, Dr. Allen!

QUOTE OF THE WEEK

“[LASIK] will change your life for the better...[The procedure was] painless, straightforward, and quick.”

— Dennis Quaid