New center tackles rapidly growing myopia prevalence

The prevalence of myopia, or nearsightedness, continues to grow, affecting about 42% of the entire American population. Outside of the U.S., urban areas of Singapore, China, Taiwan, Hong Kong, Japan and Korea report upwards of 80 to 90% of high school graduates are myopic.

Myopia is a disorder where the eye grows longer than average, causing light to focus in front of the retina instead of on the retina, leading to blurred vision. Fortunately, most cases of myopia are considered mild or moderate and glasses, contacts, or refractive surgery can provide clear vision. More progressive or severe cases, however, carry significantly higher risk of retinal and optic nerve degeneration and vision loss that cannot be so easily managed.

Recognizing that myopia impacts people of all ages, a multidisciplinary faculty team at the Byers Eye Institute at Stanford established the groundbreaking Myopia Center of Excellence to address offering the latest therapies, opportunities for laboratory and clinical research, and new avenues of education outreach.

“While still in its early stages, this collaborative center already meets a great need, because myopia spans across multiple subspecialties within ophthalmology and optometry,” Tawna Roberts, OD, PhD, assistant professor of ophthalmology, said. “The goal is to slow the progression of myopia during childhood and also later in life, as patients with myopia are at a higher risk of developing glaucoma, cataracts, retinal detachments, and other problems that lead to vision loss.”

Roberts has played a key role in establishing the center along with Ann Shue, MD, clinical assistant professor of ophthalmology and a pediatric ophthalmology and glaucoma specialist, who said the specific cause for myopia is unclear.

“We know the shape of the eyeball and cornea, genetics, and environmental factors such as reduced sunlight and excessive screen time can all play a role, but there is still a lot to learn,” Shue said.

In addition to Roberts and Shue, Robert Chang, MD, associate professor of ophthalmology, and Steven Sanislo, MD,clinical professor of ophthalmology, treat adults with visual and ocular complications from myopia while Katie Warner, OD, clinical assistant professor of ophthalmology, joins Roberts in treating pediatric patients.

“As myopic eyes elongate it causes stretching to the retina and increases the risk for retinal tears,” Sanislo said. “Severely myopic eyes can also develop myopic macular degeneration which can lead to serious vision disability. Therapies that reduce the elongation of the eye will benefit myopia patients of all ages.”

Through a patient’s eyes

One of the first patients receiving treatment in the new Myopia Center is 11-year-old Annabelle Yao, who has been a lifelong patient at Stanford. A few months after Annabelle was born, her parents Weijing Shen and Frank Yao noticed her skin began developing an unhealthy pale color. Concerned, they took Annabelle to Lucile Packard Children’s Hospital Stanford, where she was quickly sent to the Pediatric Emergency Department at Stanford Hospital.

They discovered both of Annabelle’s kidneys had failed, causing toxins to build up in the body, leading to skin color changes and a higher risk of complications in her brain and eyes. Until Annabelle could receive a kidney transplant, she was put on dialysis, a process that takes over the function of the kidney by removing waste and extra fluid from the blood.

Annabelle’s health made tremendous improvement since birth and she started being seen every three months by a team of specialists. 

“Around the age of six, we began taking Annabelle to Byers to have her vision monitored when we noticed she had strabismus—her eyes were looking in different directions,” Weijing said.

After doing a year of school virtually during COVID-19, Annabelle’s parents also noticed that her nearsightedness was worsening at a much faster rate. Annabelle was previously given a glasses prescription, but the glasses did not slow down the progression of her myopia. Roberts recommended two new treatments to prevent Annabelle’s myopia from worsening so quickly: multifocal contact lenses, which provide clear vision while simultaneously slowing eye growth, and low-dose atropine eye drops. Annabelle’s parents opted for the latter.

“Atropine is a nervous system blocker often used for patients with slow heart rate or stomach complications,” Roberts said. “Historically, it has been used in the eyes primarily to treat eye pain from inflammation and to treat amblyopia. But recent research and clinical trials have shown that it can also significantly slow down the growth of the eye, so we use it for myopia.”

Roberts noted that while it is still unknown how to prevent myopia entirely, the drops can help keep Annabelle’s myopia from being as high in her adult years as it would be without any intervention.

Throughout all her health complications, Annabelle has remained as her parents describe “cheerful, positive, and independent.”

“We often joke that Annabelle’s favorite saying is ‘I can do that’ because she is very independent,” Frank said. “Even at a young age, she has a desire to continuously overcome any obstacle she faces, which has really been an encouragement to both us and her older sister, Sophia.”

Weijing and Frank relate Annabelle’s early years when she made a miraculous recovery from her kidney failure, to now making many friends at school and taking up her newest hobby of dancing.

“While this has been a long journey for Annabelle and our family, we have received tremendous support from the entire Stanford team,” Frank said. “We are grateful for the exceptional patient care that Dr. Roberts has provided Annabelle in this entire process and cannot thank her enough.”

By KATHRYN SILL

Kathryn Sill is a web and communications specialist for the Byers Eye Institute in the Department of Ophthalmology, at Stanford University School of Medicine. Email her at ksill@stanford.edu.