Uniting on the Future of Myopia Care 2025 APMMS

The symposium – the fifth in the series, brought together leading minds in optometry and ophthalmology from across the globe to Hong Kong to explore the latest developments in myopia management. Themed ‘Myopia control in children: meeting the challenge together’, the event – supported by CooperVision – put the spotlight on the importance of evidence, early intervention, and global collaboration. Approximately 200 delegates attended the June event in person, while around 1,000 joined virtually, reflecting strong regional and international engagement.

APMMS began with a keynote address by Dr Dora Lui, General Manager and Vice President of Asia Pacific Strategy at CooperVision. She shared the story of Venus, an eight-year-old girl from Hong Kong who had already developed high myopia at -4.00D. Her mother, who had experienced a retinal detachment due to her own myopia, was determined to find more suitable options than glasses – especially given Hong Kong’s intense academic pressures and Venus’ passion for dance. Under the care of her optometrist, Venus was fitted with MiSight 1 day contact lenses, which helped support both her vision and her lifestyle. The case was a strong reminder that personalised myopia management can profoundly impact a child’s visual outcomes, confidence, and overall wellbeing.

Dr Sandra Block from the World Council of Optometry (WCO) and Dr Ken Nischal from the World Society of Paediatric Ophthalmology and Strabismus (WSPOS) joined forces to address the growing global impact of myopia. Drawing on the Holden et al. 2016 projections,1 Dr Block highlighted the significant increase in myopia expected across all age groups by 2050, framing it as a global pandemic rather than a regional epidemic. She spoke about the need for evidence-based, accessible interventions, early detection through appropriate screening, and the importance of upskilling eye care providers. Family engagement and treatment adherence were also identified as critical to long-term success.

Dr Nischal expanded on the behavioural and environmental influences on myopia prevalence, particularly the role of near work in more developed countries. He illustrated the clinical importance of axial length as a more reliable indicator than refractive error, especially in atypical presentations or when corneal curvature is flatter. Using imaging from a five-year-old patient with unilateral high myopia (right eye +0.50D, left eye -5.50D), he demonstrated striking interocular differences: magnetic resonance imaging (MRI) scans showed size asymmetry between the eyes, and optical coherence tomography (OCT) imaging revealed clear structural changes in the myopic eye. This case highlighted how significant myopia can go undetected without axial length measurement. He also noted that males tend to have longer axial lengths than females across all ethnicities, an important consideration in monitoring and interpreting growth patterns. Ultimately, Dr Nischal emphasised that successful myopia management is not about halting growth entirely but about guiding axial length toward emmetropic norms appropriate for the child’s age and ethnicity.

Dr Vincent Ng from the Hong Kong Polytechnic University reviewed the comparative effectiveness of current myopia management approaches. With over half of children aged 11–12 in Hong Kong already myopic, he highlighted the importance of early action. Interventions including defocus incorporated multiple segments (DIMS), highly aspherical lenslet target (HALT), diffusion optics technology (DOT), and cylindrical annual refractive element (CARE) spectacle lenses, as well as dual focus contact lenses, orthokeratology (OK), and 0.05% atropine, have all shown similar efficacy; reducing myopia progression by approximately 50%.2-8Treatment selection, he noted, should be guided by each child’s clinical needs, lifestyle, and likelihood of adherence.

At age five, May presented with a refraction of R +0.25 and L plano, prompting a six-month review. Dr Gifford spoke of recent evidence suggesting Asian children may require a higher hyperopic reserve of around +1.50D to minimise future myopia risk,9 highlighting the need to adapt our understanding of premyopia thresholds for different populations. Environmental advice, such as increasing outdoor time and reducing near work10 was discussed, alongside emerging interventions including low-dose atropine,11 repeated lowlevel red light (RLRL) therapy,12 and HALT spectacle lenses.13

By age eight, May was myopic and started myopia control spectacles. Within six months, her progression of R -0.75D and L -0.50D prompted consideration of combination therapy or a switch in modality. Ms Lumb stressed that compliance is critical – HALT spectacle lenses showed nearly double the effect in children wearing them full-time (12+ hours/day).3 At age nine, May transitioned to MiSight 1 day contact lenses for gymnastics and by age 13, her progression aligned with MiSight 1 day trial outcomes.6 Again, Ms Lumb emphasised compliance, with MiSight 1 day studies reporting high compliance, with average wear times of 12.8 hours/day at six months and 13.9 hours/day at six years exceeding recommended wear times.6

Dr Niall Crosby from the International Eye Cataract Retina Centre in Singapore examined whether the rising prevalence of myopia could trigger a corresponding surge in rhegmatogenous retinal detachment (RRD). Using artificial intelligence-supported modelling, he projected that RRD cases could triple between 2025 and 2045, especially in Southeast Asia, as today’s myopic youth reach higher-risk decades. However, he concluded that retinal detachment will not reach epidemic proportions due to its low overall prevalence (0.03%). Still, the anticipated rise in cases represents a significant public health concern requiring proactive planning around prevention, education, and surgical capacity.

Dr Maria Liu from the University of California Berkeley School of Optometry in the United States moderated a panel discussion featuring Dr Gifford, Dr Nischal, Dr Ng, Dr Crosby and Dr Foo, with Dr Pei-Ying Lin (University of Melbourne). The panel examined four diverse clinical cases in paediatric myopia, highlighting practical considerations in applying evidencebased care. Across all scenarios, early intervention was encouraged where risk factors were present, with spectacle lenses considered a safe and accessible starting point for premyopes. The importance of tailoring treatment to each child’s clinical profile, family context, and lifestyle was a consistent theme.