More financial, human capital needs to be invested to reduce burden of high myopia

In the early 1980s, I became interested in the surgical treatment of myopia as a surgeon in the Prospective Evaluation of Radial Keratotomy study. In this study, we were treating patients with low to moderate myopia. While there is room for disagreement, I categorize –0.125 D to –3 D as low myopia, –3.125 D to –6 D as moderate myopia and over –6 D as high myopia. Going all the way back to Sir Stewart Duke-Elder, myopia over –6 D has been considered “pathologic myopia,” and these are the patients who have significant visual disability as well as increased risk for many other comorbidities, including early-onset cataract, retinal tear, retinal detachment and glaucoma.While any imbalance between the refractive power of the cornea and/or lens and the axial length of the eye can result in myopia, high myopia is usually axial myopia with an axial length longer than 25 mm. When I was doing my literature research on myopia in 1980, several studies, including the National Health and Nutrition Examination Survey, found the prevalence of myopia to be approximately 25% in the U.S. Another 25% were hyperopic and 50% emmetropic. Approximately 30% had 1 D or more of astigmatism and 35% were presbyopic. Over the ensuing 35 years, the number of myopes and presbyopes has increased to more than 40%. Europe has noted a similar increase in myopia. Most impressive is the increase in myopia in Asia, where in some countries, such as Singapore and China, it has risen to more than 80% in the younger population.