A Look Back at a Pivotal Moment in Eye Research
The global conversation about saving our children's vision was already gaining momentum over a decade ago.
In the world of vision science, the International Myopia Conference (IMC) stands as the premier gathering where groundbreaking research is shared and future directions are charted. While detailed records of the 13th conference are limited in public archives, its role in the continuum of myopia research is undeniable3 .
Leading myopia researchers worldwide
Foundation for modern myopia management
Addressing a WHO public health issue
Held over a decade ago, this conference occurred at a critical juncture when researchers were solidifying our understanding of myopia as a complex, multifactorial disease—not merely a refractive error to be corrected with glasses. These regular conferences have served as incubators for ideas that have since evolved into today's effective myopia management strategies, helping to address what the World Health Organization has classified as a global public health issue.
Myopia, commonly known as nearsightedness, has reached epidemic proportions in many parts of the world, particularly in East and Southeast Asia. The condition affects more than 52% of children in some populations, with high myopia affecting nearly 18% of high school students in China1 .
Each additional diopter of myopia increases the risk of serious ocular complications later in life, including myopic maculopathy, retinal detachment, glaucoma, and cataracts9 .
The development of myopia involves both genetic and environmental factors:
Children with myopic parents have a significantly higher risk of developing myopia themselves.
Extensive near work (reading, screen time) and limited time outdoors have been strongly correlated with myopia development.
The eye's growth appears to be influenced by the quality of focus in peripheral vision, even when central vision is clear.
Over years of investigation, several key theories have emerged to explain myopia development and progression, each supported by various lines of evidence from human studies and animal models.
The defocus theory suggests that the eye's growth is guided by visual cues, particularly relative hyperopic defocus in the peripheral retina. When the eye elongates, images that are not focused directly on the fovea (central vision) fall behind the retina, creating a signal for the eye to grow even longer. This theory has led to the development of specialized optical interventions like multifocal contact lenses and spectacles with special optical designs that manipulate peripheral defocus to slow eye growth.
A more recent hypothesis proposes that retinal contrast may play a crucial role in eye growth regulation. Modern urban environments and high-contrast activities like reading black text on white paper may provide different contrast signals than natural environments. This theory has led to the development of Diffusion Optics Technology (DOT) spectacles that use light-scattering elements to reduce retinal contrast while maintaining clear central vision7 .
This theory focuses on the role of retinal neurotransmitters, particularly dopamine, in regulating eye growth. Dopamine release, which is stimulated by bright light exposure, appears to inhibit axial elongation. This explains the protective effect of time outdoors against myopia onset and progression and has inspired research into light-based therapies.
While the 13th IMC featured many important studies, subsequent conferences have revealed increasingly sophisticated research methodologies. The following representative experiment illustrates the type of rigorous clinical trial that has shaped our current understanding of myopia control.
To evaluate the efficacy and safety of MiSight® 1 day soft contact lenses for controlling myopia progression in children over a 12-month period1 .
This randomized controlled trial followed a robust scientific protocol:
The MiSight® lenses feature a unique dual-focus design with alternating distance correction zones and treatment zones that create myopic defocus, theoretically reducing the stimulus for eye elongation.
The interim results demonstrated impressive efficacy for the MiSight® lenses:
| Group | Axial Elongation (mm) | Reduction vs Control | Myopia Progression (D) | Reduction vs Control |
|---|---|---|---|---|
| MiSight® | 0.24 mm | 51% | 0.51 D | 57% |
| Control | 0.49 mm | - | 1.19 D | - |
The findings were statistically significant and clinically meaningful. No serious ocular adverse events were reported, supporting the safety of soft contact lens wear in children1 .
| Time Point | Axial Elongation Reduction | Myopia Progression Reduction |
|---|---|---|
| 6 months | 52% (0.13 mm) | N/A |
| 12 months | 51% (0.24 mm) | 57% (0.51 D) |
This study was particularly notable because the results in Chinese children surpassed those observed in the original randomized controlled trial which primarily involved a non-Asian cohort. This highlighted the potential for even greater treatment effects in populations at higher risk for myopia progression1 .
| Parameter | Contact Lens Group | Control Group | Significance |
|---|---|---|---|
| Endothelial Cell Density | 2,865 cells/mm² | 2,901 cells/mm² | No significant difference |
| Central Corneal Thickness | 543 μm | 546 μm | No significant difference |
| Percentage of Hexagonal Cells | 65.2% | 66.1% | No significant difference |
The long-term safety data gathered over 10 years of daily wear showed no significant differences in critical corneal health measures between the contact lens and control groups, affirming the safety of soft contact lenses for childhood myopia management1 .
Myopia research employs a diverse array of specialized tools and substances to investigate the underlying mechanisms and potential treatments for this complex condition.
| Tool/Reagent | Function in Myopia Research |
|---|---|
| Low-Dose Atropine | A non-selective muscarinic antagonist used to slow myopia progression, though its exact mechanism remains debated. |
| Cycloplegic Agents | Eye drops that temporarily paralyze accommodation, allowing accurate measurement of refractive error without the influence of focusing. |
| Optical Coherence Tomography (OCT) | Advanced imaging technology that provides high-resolution cross-sectional images of the retina and choroid. |
| Ocular Biometers | Instruments that precisely measure axial length, a critical parameter for monitoring myopia progression. |
| Animal Models (chicks, tree shrews, monkeys) | Used to study myopia mechanisms and test interventions under controlled conditions. |
| 7-Methylxanthine (7-MX) | A caffeine derivative investigated as an oral treatment for myopia, showing dose-dependent reduction in progression. |
| Specialized Spectacle Lenses (DIMS, DOT, HALT) | Optical interventions designed to manipulate visual signals to slow eye growth. |
| Repeated Low-Level Red Light Devices | Emerging therapy that uses specific light wavelengths to potentially influence choroidal thickness and blood flow. |
The journey from the 13th International Myopia Conference to today has witnessed remarkable advances in our understanding and management of this complex condition. What began as basic research into the mechanisms of eye growth has blossomed into a robust clinical arsenal including specialized spectacles, contact lenses, pharmaceutical agents, and light-based therapies.
Basic mechanisms of eye growth and development
Transition to understanding myopia as a multifactorial disease
Multiple intervention strategies including optical, pharmaceutical, and environmental approaches
Personalized interventions based on genetic and environmental risk factors
The upcoming 2025 International Myopia Institute white papers promise to further refine clinical guidelines and introduce updated definitions, including the concept of "low hyperopic reserve" as a marker for pre-myopia1 .
As we look to the future, the field continues to evolve toward more personalized, targeted interventions based on individual risk factors, genetic predispositions, and environmental exposures.
The foundational work presented at conferences like the 13th IMC has paved the way for a future where effective myopia management may preserve vision for generations to come. The progression of this research demonstrates how scientific inquiry, when sustained through international collaboration and regular knowledge-sharing at forums like the International Myopia Conference, can transform our approach to global health challenges.