Lifetime cost of myopia and the impact of anti-myopia treatments in Australia
| Sunday, November 3, 2024 |
| 9:20 AM - 9:40 AM |
| Panorama Rooms 2 & 3 |
Overview
Tim Fricke - Invited Speaker
Speaker
Tim Fricke
Australian College of Optometry
Lifetime cost of myopia and the impact of anti-myopia treatments in Australia
Abstract
PURPOSE: To inform decisions on myopia management in Australia by estimating lifetime myopia costs with comparisons across management options.
METHODS: We modelled lifetime costs of traditional myopia management (TMM = full, single-vision spectacle correction) and active myopia management (AMM) options starting from an 8-year-old child presenting with -0.75DS in both eyes. The AMM options included were low-dose atropine, anti-myopia spectacles, anti-myopia soft contact lenses and orthokeratology. Evidence-based progression data were used to determine the likelihood of all possible refractive outcomes under two circumstances: 1) Those predicted to experience faster myopia progression based on a combination of familial and lifestyle reasons, and 2) Those predicted to experience slower myopia progression. Myopia control effectivities were averaged across published sources for each AMM, with low-dose atropine averaged across 0.01% - 0.05% concentrations. Myopia care costs were collected from published sources, key informants, and informal practice surveys. Refractive and ocular health decisions were based on customary clinical protocols that respond to the speed of progression, level of myopia and associated risks of pathology and vision impairment. The predicted progression rates, costs, protocols and risks were used to estimate and compare lifetime cost of myopia under each scenario. Costs were based on 2024 values without discounting. Cost ratios compared treatments by dividing a specific AMM cost by the relevant TMM cost.
RESULTS: Estimated lifetime cost of myopia using TMM was AU$61,442/$43,426 for those predicted to experience faster/slower myopia progression. AMM/TMM lifetime cost ratios for low-dose atropine, anti-myopia spectacles, anti-myopia soft contact lenses and orthokeratology, were 0.68, 0.59, 0.71 and 0.66 respectively for faster progressors, and 0.85, 0.74, 0.89, 0.83 respectively for slower progressors. Different contact lens wear rates (major effect) and pathological complication rates (minor effect) mean that myopia has higher lifetime costs in females than males. Effective anti-myopia spectacles provided the largest reduction in lifetime cost of myopia; however, all AMMs reduced lifetime cost for both progression speeds under zero discounting.
CONCLUSIONS: Financial investment in AMM during childhood in Australia is likely to reduce the total lifetime cost of myopia compared to TMM via reduced refractive progression, simpler lenses, and reduced risk of pathology and vision loss. Children predicted to be at higher risk of faster myopia progression derive the greatest economic advantage from AMM.
Conflicts of interest: NT – Brien Holden Vision Institute. SR – Vyluma, Hoya, EssilorLuxottica, Johnson and Johnson, Thea, SightGlass Vision, Brien Holden Vision Institute
Funding: Thea and BHVI, who have interests in myopia control
METHODS: We modelled lifetime costs of traditional myopia management (TMM = full, single-vision spectacle correction) and active myopia management (AMM) options starting from an 8-year-old child presenting with -0.75DS in both eyes. The AMM options included were low-dose atropine, anti-myopia spectacles, anti-myopia soft contact lenses and orthokeratology. Evidence-based progression data were used to determine the likelihood of all possible refractive outcomes under two circumstances: 1) Those predicted to experience faster myopia progression based on a combination of familial and lifestyle reasons, and 2) Those predicted to experience slower myopia progression. Myopia control effectivities were averaged across published sources for each AMM, with low-dose atropine averaged across 0.01% - 0.05% concentrations. Myopia care costs were collected from published sources, key informants, and informal practice surveys. Refractive and ocular health decisions were based on customary clinical protocols that respond to the speed of progression, level of myopia and associated risks of pathology and vision impairment. The predicted progression rates, costs, protocols and risks were used to estimate and compare lifetime cost of myopia under each scenario. Costs were based on 2024 values without discounting. Cost ratios compared treatments by dividing a specific AMM cost by the relevant TMM cost.
RESULTS: Estimated lifetime cost of myopia using TMM was AU$61,442/$43,426 for those predicted to experience faster/slower myopia progression. AMM/TMM lifetime cost ratios for low-dose atropine, anti-myopia spectacles, anti-myopia soft contact lenses and orthokeratology, were 0.68, 0.59, 0.71 and 0.66 respectively for faster progressors, and 0.85, 0.74, 0.89, 0.83 respectively for slower progressors. Different contact lens wear rates (major effect) and pathological complication rates (minor effect) mean that myopia has higher lifetime costs in females than males. Effective anti-myopia spectacles provided the largest reduction in lifetime cost of myopia; however, all AMMs reduced lifetime cost for both progression speeds under zero discounting.
CONCLUSIONS: Financial investment in AMM during childhood in Australia is likely to reduce the total lifetime cost of myopia compared to TMM via reduced refractive progression, simpler lenses, and reduced risk of pathology and vision loss. Children predicted to be at higher risk of faster myopia progression derive the greatest economic advantage from AMM.
Conflicts of interest: NT – Brien Holden Vision Institute. SR – Vyluma, Hoya, EssilorLuxottica, Johnson and Johnson, Thea, SightGlass Vision, Brien Holden Vision Institute
Funding: Thea and BHVI, who have interests in myopia control
Biography
Tim Fricke is an optometrist, researcher and international development practitioner, and is currently Director Research and Education at the Australian College of Optometry and National Vision Research Institute. He has held clinical, teaching, research, management and leadership roles in private, public, community health, hospital and refugee camp settings, including Director of the Brien Holden Foundation. His research has covered paediatric eye care, epidemiology, quality of life, access to eye care, and health economics. He is an honorary senior fellow at the University of Melbourne, and is completing a PhD in ophthalmic epidemiology at UNSW Sydney.
