Nation’s largest physician organization adopts policy calling for insurance coverage for treatments that can slow its progression in children
SAN FRANCISCO — In the latest sign that consensus is building toward reframing how the country treats a condition long dismissed as a routine inconvenience solved with a trip to the eyeglass counter, the American Medical Association recently passed a resolution backing formal classification of nearsightedness as a disease — including by the Centers for Medicare and Medicaid Services — to ensure children and adolescents have access to appropriate treatments and insurance coverage. The resolution also calls for increased public health education and improved screening in children.
This new policy direction mirrors a global effort the American Academy of Ophthalmology launched back in 2021. The Academy alerted the world to the rising global public health crisis of nearsightedness, or myopia, with the publication of a white paper, Reducing the Global Burden of Myopia by Delaying the Onset of Myopia and Reducing Myopic Progression in Children.1 It was the first effort to coordinate a global health initiative to spread education and foster collaboration to improve treatments.
The numbers behind the push are stark. In America, the number of nearsighted people has nearly doubled over the last 50 years to about 41.6 percent of the population, according to the National Eye Institute. The World Health Organization predicts that, if the current trend continues, half of the world’s population will be nearsighted by 2050 — with up to one-fifth at an increased risk of blindness due to complications of high myopia (severe nearsightedness).
That matters because high myopia is not merely a matter of thicker glasses. It carries a meaningfully elevated risk of retinal detachment, glaucoma, cataracts and myopic maculopathy — complications that can cause permanent vision loss.
A body of peer-reviewed research now points to several approaches that can measurably slow myopia's advance in children and teenagers. The goal of treatment is to delay the onset of myopia in children and slow it down so the most devastating consequences of high myopia can be avoided. These new treatments include:
· Essilor Stellest Eyeglasses – FDA-approved special eyeglasses that can slow the development of myopia in children between 6 to 12 years old.
· Soft Contact Lenses – FDA-approved “multifocal” contact lenses for children with myopia, worn from 8 to 12 years old. These lenses are worn during the day and discarded at night. When worn consistently over several years, they may slow the development of myopia.
· Orthokeratology (Ortho-K) – Hard contact lenses worn overnight for children aged 6 and older. Wearing Ortho-K lenses only improves vision for a short time. Once you stop wearing the lenses, the cornea slowly goes back to its normal shape and myopia comes back. Still, ortho-K may provide some permanent reduction in myopia progression. It’s important to note that overnight wear of any type of contact lens is associated with a higher risk of infection than daily wear.
· Low-Dose Atropine Eye Drops – Eye drops for children between 5 and 18 years old. Given for two to three years, the drops are placed in the eye each night at bedtime. Evidence supports its use in East Asian children, while its effectiveness in children in Western regions is less certain and requires further study.
· Behavioral Shifts – Spending more time outdoors. Studies show that spending at least two hours a day outdoors can help slow down nearsightedness.
The trouble is that almost none of these treatments reaches the families who need it. Awareness that progressing nearsightedness is an urgent health issue remains limited among parents, teachers, and policymakers alike. And even when families do learn about newer interventions, many find that insurance will not pay for them, because myopia is not consistently treated as a disease requiring treatment.
“I’m a pediatric ophthalmologist and a mom of three,” said Rupa Wong, MD, spokesperson for the American Academy of Ophthalmology. “I believe all children with progressing nearsightedness should have the same access to these treatments, just like my kids. But most parents aren’t even told that treatments exist. We hope that increasing attention on this issue will help shift the national conversation on children’s eye health. Kids’ eye health is a public health issue; it’s not a parenting issue.”
The Academy has also been working to expand access to vision screening and early intervention for children through our support for H.R. 2527, the Early Detection of Vision Impairments for Children Act. This would be the first national program to address children’s vision and eye health.
The Academy applauds these important steps towards turning a slow-moving epidemic into a national priority before another generation of children grows up seeing the world less clearly than they should.
Parents interested in learning more about these treatments should discuss them with their child’s ophthalmologist.
1. Modjtahedi, B. S. (2021). Reducing the global burden of myopia by delaying the onset of myopia and reducing myopic progression in children. Ophthalmology, 128(6), 816–826. doi.org
About the American Academy of Ophthalmology
The American Academy of Ophthalmology is the world’s largest association of eye physicians and surgeons. A global community of 32,000 medical doctors, we protect sight and empower lives by setting the standards for ophthalmic education and advocating for our patients and the public. We innovate and support research to advance our profession and to ensure the delivery of the highest-quality eye care. Our EyeSmart® program provides the public with the most trusted information about eye health. For more information, visit aao.org.