More than half of the population globally will be myopic by 2050, said Eric Donnenfeld, MD, the moderator of “Myopia Management: The Business of Ophthalmology or Optometry” at SightLine at ASCRS, calling it a “silent epidemic” that’s taking place right now.
There is significant morbidity associated with myopia, and myopia management and prevention as a new category makes sense economically, Dr. Donnenfeld said. However, the number of ophthalmologists in the U.S. continues to decline (Dr. Donnenfeld noted that there are three times more optometrists, a growing field, than ophthalmologists). In addition, refractive surgery, which has “never been more vital, more vibrant, more effective, safer than it is today,” has been decreasing.
Source: ASCRS
“Myopia represents an enormous opportunity for our doctors and our industry,” Dr. Donnenfeld said, setting the stage for discussion among Gary Gerber, OD, Treehouse Eyes, Patrick Johnson, PhD, Sydnexis, Nancy Sabin, STAAR Surgical, and Kerry Solomon, MD.
Dr. Donnenfeld asked Dr. Gerber why the field isn’t spending more time on myopia management at this point. “I wish I had an answer,” Dr. Gerber said, speculating that perhaps ophthalmology traditionally has thought of pediatric myopia as outside of its scope. However, if an ophthalmologist has a happy refractive surgery patient postop and that patient has children, at least a third of those patients’ children are likely myopic. There is an opportunity with these patient-parents to educate them about myopia management for their children. Dr. Gerber said this is building the refractive surgery pipeline because in the future, years after helping this pediatric patient manage their myopia, they could be a refractive surgery candidate and with a lower degree of treatment necessary. “Would you rather operate on a –2 or –7 D patient?” he questioned, alluding to that with proper myopia management earlier in life, the patient could be a –2 myope, instead of a –7.
“The tidal wave is not coming, the tidal wave is here,” Dr. Gerber said calling myopia management “the biggest opportunity in our industry.”
Dr. Johnson, president of Sydnexis, which has submitted a low-dose atropine drug to the FDA and is awaiting an approval decision later this year, was asked about the economic model that should make industry, ophthalmology, and optometry interested in pursuing myopia management.
Like Dr. Gerber, Dr. Johnson saw a synergy between the myopic pediatric patient needing to prevent progression and their parents who could be candidates for refractive surgery or presbyopia management. “We are handing you 27–30 million kids about 15–20 years before you normally would see them for LASIK. The question is, how do you want to handle them? We have a traditional pharmaceutical model … it’s a matter of what does the industry want to do with this massive influx of patients,” Dr. Johnson said. “We’re in a time right now in the world where we have drugs available for presbyopia and drugs that will be available soon for myopia. … [Myopia] is a huge business opportunity to create space and bring patients in and keep those patients for a long time.”
Dr. Donnenfeld asked Dr. Johnson later about who Sydnexis plans to target if its drop to stem myopia progression is approved. Dr. Johnson said they plan to target myopia management practices, which cover about 25% of the pediatric myopia population. “We have a very focused group we’re going to go after in the beginning,” Dr. Johnson said.
“The bottom line is what a lot of people in this room are talking about: It’s about the patient,” Dr. Johnson said. “We have the ability to take the kid about to lose vision, identify the kid, and prevent them from losing their vision, helping them be instead of a moderate myope, a mild myope, instead of a severe myope, a moderate myope.”
Dr. Donnenfeld ask why refractive surgery is declining. Ms. Sabin said there are three main barriers: financial, fear, and awareness.
Refractive surgery is a significant out-of-pocket expense for patients. Ms. Sabin said the industry needs to think differently about innovative payment models.
Addressing fear, Ms. Sabin said social media has had a significant influence in this area, and there is an opportunity for awareness about all of the refractive surgery options that are available now and to have authentic dialogue about the pros and other considerations. Ms. Sabin said there is an overall lack of awareness among younger patients about refractive surgery options. “The opportunity there is to continue to make sure that consumers have an awareness of what options are available to them to be free of contact lenses and glasses as well.”
Dr. Solomon said that we have great refractive procedures, but the reason that numbers are down is complex. He said that with the attention given to younger people about myopia, why it should be prevented, and how it relates to the longer-term health of the eye, it will be a boon for refractive surgery.
“As people become accustomed to treating myopia at an earlier age, it will be natural as myopia stabilizes that they will be willing to look at refractive surgery,” Dr. Solomon said.
