The prevalence of
myopia has markedly increased in East and Southeast Asia, and pathologic consequences of
myopia, including myopic
maculopathy and high
myopia-associated
optic neuropathy, are now some of the most common causes of irreversible
blindness. Hence, strategies are warranted to reduce the prevalence of
myopia and the progression to high
myopia because this is the main modifiable risk factor for pathologic
myopia. On the basis of published population-based and interventional studies, an important strategy to reduce the development of
myopia is encouraging schoolchildren to spend more time outdoors. As compared with other measures, spending more time outdoors is the safest strategy and aligns with other existing health initiatives, such as
obesity prevention, by promoting a healthier lifestyle for children and adolescents. Useful clinical measures to reduce or slow the progression of
myopia include the daily application of low-dose
atropine eye drops, in concentrations ranging between 0.01% and 0.05%, despite the side effects of a slightly reduced amplitude of accommodation, slight
mydriasis, and risk of an
allergic reaction; multifocal spectacle design;
contact lenses that have power profiles that produce peripheral myopic defocus; and orthokeratology using corneal gas-permeable
contact lenses that are designed to flatten the central cornea, leading to midperipheral steeping and peripheral myopic defocus, during overnight wear to eliminate daytime
myopia. The risk-to-benefit ratio needs to be weighed up for the individual on the basis of their age, health, and lifestyle. The measures listed above are not mutually exclusive and are beginning to be examined in combination.