Beatnik Picnic

Myopia - The Near Horizon

Nico Bea -
[!info] This is the seventh in a series of posts about the epidemic of myopia (nearsightedness), my personal experience with it, and what people are doing about it. The sixth part is *"Myopia - Doing Something About It"

the near horizon of myopia management

It's fortunate that researchers continue to work to expand the myopia treatment arsenal. Southeast asia seems especially active in also exploring causes, perhaps given that the problem is most acute there. A few of the most interesting treatments that are being explored include repeated low-level red light therapy (RLRL) and scleral cross-linking, and perhaps even off-label intra-ocular pressure reduction.

RLRL

RLRL involves targeting a red light toward the retina for a small amount of time each day, and the mechanism of its therapeutic action is thought to involve increasing bloodflow to tissues that support the retina (the choroid), which then make elongation less likely. So far commercial devices have used lasers to generate and target this red light. RLRL has some controversy, as US-based researchers have safety concerns with it, though the main thrust of interest comes from a device called eyerising which has been responding to these concerns and stands by its device's safety. The eyerising device, in contrast to many other myopia management treatments, also has a clinical trial for adults with pathological myopia. The trial is run by the noted specialist Kyoko Ohno-Matsu. Notably, this is one of a very small number of myopia therapies that displays an axial length reduction in a few patients, something almost never observed in other trials. There is also a new professional society devoted to red light therapies. It is also just hitting the mainstream, as evidenced by this Economist article featuring red light and ophthalmology researcher Glen Jeffery

photo from Eyerising International

Scleral cross-linking compounds

Scleral cross-linking involves a use of a compound or molecule that stiffens and strengthens the sclera, a hard outer layer of the eye. I believe this technique is established for a similar disorder to myopia called keratoconus that instead affects the front of the eye. The idea is to stop elongation or irregular protrusions from the front of the eye. The treatment currently being studied was created by an ophthalmologist who holds records for youngest to ever become a physician. The company formed is called IVEENA, and there is currently a safety trial, which will be followed by a clinical trial in children.

The above and other items are discussed more from this end of 2025 article: https://www.optometrytimes.com/view/what-s-on-the-horizon-for-myopia-management-

And very recently, the phase 1 safety study has successfully concluded.

off-label SLT and IOP reduction

There is also another approach. I spoke a few times with one very helpful optometrist and contact lens company officer, himself very highly myopic. He has had a Selective Laser Trabeculoplasty (SLT). This is an outpatient laser procedure usually performed in glaucoma patients to reduce their intra-ocular pressure. But some optometrists speculate that reduction of pressure in the eye will reduce mechanical strain on the rear of the eye, meaning less elongation. It sounds to me like emptying a balloon a little so that it doesn't stretch out so much. This was the anecdotal experience of that optometrist, whose eye length stabilized and who even had a shift for the better in his corrective lens prescription. However there is at least one trial that has been either conceived or maybe even started using glaucoma eyedrops for the same purpose. Primary completion is estimated in november of this year, and full completion in 2028. Notably, the trial implicitlky acknowledges what many in the US are unwilling to recognize: "Previous studies have shown that adult patients with HM [high myopia] have sustained growth of the axial length (AL), which is a risk factor for the progression of pathological myopia and thus may further affect the visual function , so how to slow down the sustained growth of the AL in adult patients with HM has become an urgent clinical problem."

trabecular meshwork

another cutting edge: southeast asia

A special mention should also be made of the extra attention put on this issue by researchers and practitioners in Southeast Asia. As this article describes, Chinese organizations are investing heavily in reducing myopia incidence and burden. There is even a special district devoted to eye research, the China Eye Valley. Advanced research in eyes and myopia is also happening in organizations in Singapore, Japan, Australia, and elsewhere.

RLRL and Scleral cross-linking are especially interesting, because they suggest that they may be able to even (very slightly) reverse the elongation caused by myopia, not merely cease it. In contrast to decades of merely prescribing corrective lenses, these treatments address the roots of the issue, they don't simply try to cope with the ill effects.

the genetic map is not the territory but it's a start

A small amount of research also continues to be done on genetic factors contributing to myopia and high myopia susceptibility. The hope being that by identifying gene loci or regions, additional drug or treatment targets can be identified. So far it seems there is overlap with regions of the genome addressing circadian rhythms and collagen formation. sources on that which may be a little above my pay grade to interpret:

The collagen formation aligns with using scleral collagen cross-linking as a treatment. It also has some ties to known disorders where myopia or high myopia are more common, such as ehlers-danlos.

radical futures in regeneration

These may be more in the territory of sci-fi, but perhaps in a future post I'll discuss more about long-shot, long timeline explorations along these lines, which could help people suffering from many kinds of vision disorders and impairments:

Science Corporation's and Dr. Daniel Palanker's work on regrowth of neural tissue and prosthetic devices to support retinal function

source: https://www.nei.nih.gov/about/our-impact/nei-research-initiatives/audacious-goals-initiative

In the next and final (for now) part, I'll recap and summarize, and also list some resources for further investigation.