By Dwight Akerman, OD, MBA, FAAO
Chief Medical Editor, Review of Myopia Management
Myopia is a significant cause of visual impairment. Its prevalence is growing steadily. In the United States, the prevalence of myopia in children ages 5-19 years is estimated to be a shocking 42%.1 Despite the immense disease and economic burden, there are currently no Food and Drug Administration-approved drugs for myopia. This review aims to summarize pharmaceutical interventions of myopia at clinical and preclinical stages in the past decade and discuss challenges for preclinical myopia drugs to progress to clinical trials.
The authors have summarized the current and emerging pharmaceutical interventions in myopia treatment. Presently, only atropine, pirenzepine, and 7-methylxanthine are shown to reduce myopia progression in human trials. Drugs such as ketorolac tromethamine, oral riboflavin, and an experimental drug are being tested in clinical trials. In the past decade, there have been several promising pharmaceutical agents that successfully suppress myopia in animal models. However, they are predominantly administered via an injection, making their progression towards clinical trials unlikely. Nonetheless, these results still add to our knowledge of the pathophysiology of myopia, which is vital to the overall process of drug development.
The researchers suggest that based on the successes of low-dose combination therapy in other fields of medicine, this approach should be considered in the future treatment of myopia. However, since there is already substantial evidence to support the effectiveness of low-dose atropine as a monotherapy to manage myopia, it seems appropriate for countries with lower income and a high prevalence of myopia to consider its usage while more research is conducted.
1 Theophanous, C., Modjtahedi, B. S., Batech, M., Marlin, D. S., Luong, T. Q., & Fong, D. S. (2018). Myopia prevalence and risk factors in children. Clinical ophthalmology (Auckland, NZ), 12, 1581.
Current and emerging pharmaceutical interventions for myopia
Vutipongsatorn, K., Yokoi, T., & Ohno-Matsui, K.
Myopia is a major cause of visual impairment. Its prevalence is growing steadily, especially in East Asia. Despite the immense disease and economic burden, there are currently no Food and Drug Administration-approved drugs for myopia. This review aims to summarise pharmaceutical interventions of myopia at clinical and preclinical stages in the last decade and discuss challenges for preclinical myopia drugs to progress to clinical trials. Atropine and oral 7-methylxanthine are shown to reduce myopia progression in human studies. The former has been extensively studied and is arguably the most successful medication. However, it has side effects; trials on low-dose atropine are ongoing. Other pharmaceutical agents being investigated at a clinical trial level include ketorolac tromethamine, oral riboflavin, and BHVI2 (an experimental drug). Since the pathophysiology of myopia is not fully elucidated, numerous drugs have been tested at the preclinical stage and can be broadly categorised based on the proposed mechanisms of myopisation, namely antimuscarinic, dopaminergic, anti-inflammatory and more. However, several agents were injected intravitreally or subconjunctivally, hindering their progress to human trials. Furthermore, with atropine being the most successful medication available, future preclinical interventions should be studied in combination with atropine to optimise the treatment of myopia.
Vutipongsatorn, K., Yokoi, T., & Ohno-Matsui, K. (2019). Current and emerging pharmaceutical interventions for myopia. British Journal of Ophthalmology, bjophthalmol-2018