Updates on Myopia A Clinical Perspective Marcus Ang Tien Y. Wong Editors Updates on Myopia Marcus Ang • Tien Y. Wong Editors Updates on Myopia A Clinical Perspective Editors Marcus Ang Tien Y. Wong Singapore National Eye Center Singapore National Eye Center Duke-NUS Medical School Duke-NUS Medical School National University of Singapore National University of Singapore Singapore Singapore This book is an open access publication. 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The registered company address is: 152 Beach Road, #21-01/04 Gateway East, Singapore 189721, Singapore Preface Myopia is now being recognized as a signifcant global public health problem that will affect billions of people in the next decades, especially in Asia. Currently, pathologic myopia is already a major cause of visual impairment in both Asian and Western populations. As the prevalence of myopia and pathological myopia increases around the world, there is increasing need for active prevention of myopia progression and management of its potential complications. The purpose of this book is to provide updates on current understanding of myo- pia, new methods of evaluation of the myopic eye, and a focus on clinical manage- ment of myopia and its complications. This book will provide a unique perspective from the current world experts on the subject, with a focus on clinical aspects of understanding, evaluation, and management of myopia. Chapter 1 provides a concise summary of all the key points from the book for busy readers who want a quick overview on clinical myopia. The rest of the book is comprehensive and provides updates on almost all aspects with regard to myopia. Chapters 2 and 3 describe epidemiology and economic burden; Chaps. 4 and 5 dis- cuss genetic and pathogenetic mechanisms; Chaps. 6 to 8 describe risk factors and ways to prevent myopia development or progression. Next, Chaps. 9 and 10 discuss pathological myopia and advances (and challenges) in imaging myopic eyes. Finally, Chaps. 11 to 14 provide clinical pearls of managing myopia complications, i.e., glaucoma, retina, and choroidal neovascularization in adults. As new data is constantly emerging, this book was generated with the inputs of all authors within 6 months to ensure that the evidence shared is as current as pos- sible. Thus, it is important to keep updated with online material and literature review. Nonetheless, we hope you will fnd this book as a useful reference for optometry students, ophthalmology residents, and eye care professionals to have a comprehensive update on myopia with a clinical perspective. Singapore, Singapore Marcus Ang Singapore, Singapore Tien Y. Wong v Acknowledgments Singapore National Eye Centre, Singapore Singapore Eye Research Institute, Singapore Duke National University of Singapore (DUKE NUS), Singapore Singapore National Eye Centre Myopia Centre, Singapore PANTONE 300C PANTONE Neutral Black C vii Contents 1 Introduction and Overview on Myopia: A Clinical Perspective ������������ 1 Chee Wai Wong, Noel Brennan, and Marcus Ang 2 Global Epidemiology of Myopia . 27 Saiko Matsumura, Cheng Ching-Yu, and Seang-Mei Saw 3 The Economic and Societal Impact of Myopia and High Myopia . 53 Sharon Yu Lin Chua and Paul J. Foster 4 Understanding Myopia: Pathogenesis and Mechanisms ������������������������ 65 Ranjay Chakraborty, Scott A. Read, and Stephen J. Vincent 5 The Genetics of Myopia . 95 Milly S. Tedja, Annechien E. G. Haarman, Magda A. Meester-Smoor, Virginie J. M. Verhoeven, Caroline C. W. Klaver, and Stuart MacGregor 6 Risk Factors for Myopia: Putting Causal Pathways into a Social Context �������������������������������������� 133 Ian G. Morgan, Amanda N. French, and Kathryn A. Rose 7 Prevention of Myopia Onset ���������������������������������������������������������������������� 171 Mingguang He, Yanxian Chen, and Yin Hu 8 Clinical Management and Control of Myopia in Children �������������������� 187 Audrey Chia and Su Ann Tay 9 Understanding Pathologic Myopia . 201 Kyoko Ohno-Matsui and Jost B. Jonas 10 Imaging in Myopia . 219 Quan V. Hoang, Jacqueline Chua, Marcus Ang, and Leopold Schmetterer 11 Glaucoma in High Myopia ������������������������������������������������������������������������ 241 Jost B. Jonas, Songhomitra Panda-Jonas, and Kyoko Ohno-Matsui ix x Contents 12 Clinical Management of Myopia in Adults: Treatment of Retinal Complications �������������������������������������������������������� 257 Jerry K. H. Lok, Raymond L. M. Wong, Lawrence P. L. Iu, and Ian Y. H. Wong 13 Clinical Management of Myopia in Adults: Treatment of Myopic CNV ������������������������������������������������������������������������ 271 Shaun Sim, Chee Wai Wong, and Gemmy C. M. Cheung 14 Optical Interventions for Myopia Control . 289 Wing Chun Tang, Myra Leung, Angel C. K. Wong, Chi-ho To, and Carly S. Y. Lam Correction to: Optical Interventions for Myopia Control. C1 About the Editors Marcus Ang is consultant ophthalmologist at the Corneal and External Eye Disease Department of the Singapore National Eye Center (SNEC) and Duke-NUS Medical School, National University of Singapore, as well as Clinical Director of the SNEC Myopia Centre. His clinical and research areas of expertise include the treatment, and prevention of visual impairment in adult myopia. He also has special research interests in corneal transplantation, such as Descemet membrane endothe- lial keratoplasty (DMEK) and anterior segment imaging including novel optical coherence tomography systems for the cornea. Dr. Ang has published over 120 peer-reviewed articles journals, coauthored several book chapters on corneal trans- plantation, and received numerous international awards. Tien Y. Wong is Arthur Lim Professor in Ophthalmology and Medical Director at the Singapore National Eye Center (SNEC). He is concurrently Academic Chair of Ophthalmology and Vice-Dean of Duke-NUS Medical School, National University of Singapore. Prior to his current appointments, Prof. Wong was Executive Director of the Singapore Eye Research Institute; Chairman of the Department of Ophthalmology, National University of Singapore; Chairman of the Department of Ophthalmology at the University of Melbourne; and Managing Director of the Centre for Eye Research Australia, Australia. Professor Wong is a retinal specialist, whose clinical practice focuses on major retinal diseases. His research covers epidemiologi- cal, clinical, and translational studies of eye diseases, including epidemiology and risk factors of myopia, imaging in myopic macular degeneration, and clinical trials on treatment of myopic choroidal neovascularization. He has published more than 1000 papers in peer-reviewed journals, including the New England Journal of Medicine and the Lancet. Prof. Wong has received a number of national and interna- tional awards. xi Introduction and Overview on Myopia: A Clinical Perspective 1 Chee Wai Wong, Noel Brennan, and Marcus Ang Key Points • Myopia is a signifcant global public health and socioeconomic problem. • Pathologic myopia has become a major cause of blindness or visual impair- ment in both Asian and Western populations. • Myopia may be a highly heritable trait, with environmental infuences such as outdoor activity playing important roles in its development and progression. • Control of myopia in children is important, and various strategies includ- ing pharmacologic and lens-related interventions have proven effcacy. • Imaging is important to detect complications of pathologic myopia, and both medical and surgical interventions may be useful for their management. C. W. Wong · M. Ang (*) Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore Duke-NUS Medical School, Singapore, Singapore e-mail: [email protected]