This is how Barcelona prepares for the vision problem that will affect half the population in 2050

BarcelonaXavier Pàmies, a 66-year-old translator, suffered a retinal detachment in 2007 while on holiday in Northern Europe. "These things always happen in the summer," he explains with a laugh. But the incident was serious and required emergency intervention at the Vall d'Hebron Hospital. After two retinal operations, two cataract operations, and a late diagnosis of glaucoma, this patient is now stabilized and maintains "reasonably good vision between both eyes." He is one of the more than 200 patients who have passed through the new Myopia Unit at Vall d'Hebron, integrated into the Ophthalmology Service and located at the Pere Virgili Health Park; a service that aims to respond to a condition estimated to affect half the population by 2050.

Since September 2024, this unit has been treating complex cases of this visual defect, such as Xavier's. He suffers from high myopia, a vision problem exceeding six diopters, which, unlike mild myopia (0.5 to 3 diopters) or moderate myopia (3 to 6 diopters), requires strict monitoring due to the risk of developing complications and vision loss over the years. The new unit is pioneering because it concentrates all tests and specialist evaluations "with a multidisciplinary approach." Everything is done in the same space, allowing for more accurate diagnoses and better assessments, according to the hospital's Ophthalmology team.

The unit is not designed for just anyone with myopia. The profile it seeks is very specific: patients with high myopia, meaning an axial length of the eye greater than 26 millimeters or more than six diopters. "They are the ones who, especially at older ages and with higher diopters, present more retinal complications and a higher incidence of glaucoma," explains Dr. Anna Boixadera, a vitreoretinal specialist. The risk increases especially from the age of 50, when "the incidence of complications rises," although the progression is not the same for everyone. "You might have many diopters and not develop complications," admits the expert, adding that the factors explaining this progression are not yet fully understood.

The main novelty of Vall d'Hebron's care model is that retina and glaucoma will no longer function as two separate circuits. Patients are evaluated jointly by specialists from both areas, who share tests and reach a consensus on diagnosis, prognosis, and treatment. "Instead of coming one day to one specialist and one day to another, the patient comes with both," summarizes Boixadera. The reorganization also takes advantage of the new equipment in the Ophthalmology Service, with ultra-wide field retinographies and optical coherence tomography (OCT), which help to study with greater precision the deformities typical of eyes with high myopia and to anticipate possible complications.

The challenge of glaucoma

One of the priorities is to prevent glaucoma – optic nerve damage that can lead to vision loss – from going unnoticed. Specialist Marta Castany explains that highly myopic individuals often arrive with already identified retinal lesions, but with undiagnosed glaucoma. The reason for the delay is that, unlike retinal problems, "it doesn't cause symptoms." In fact, many patients develop low-pressure glaucoma, which "isn't even detected at the optician's" because the intraocular pressure appears normal. When the first signs appear, the disease is usually advanced, and there has already been a loss of peripheral visual field.

Xavier's case is an example. After years of monitoring for complications from retinal detachments, in 2020 he began to notice that his vision was worsening. He thought the problem was the artificial lens implant after cataract surgery. "But they told me I had advanced glaucoma," he recalls. Treatment with drains in both eyes has helped stabilize the disease, although he still lives with a different degree of impairment in each eye and has practically stopped driving. "I work translating in front of the computer, and I continue to do so," he explains, satisfied with having retained functional vision.

The need for these types of units also responds to a demographic trend. According to Boixadera, the prevalence of myopia will continue to increase in the coming decades, affecting half of the population by 2050. "The issue of screens is what's increasing the incidence of people who will be myopic," he points out. Although there are strategies for children to slow its progression, such as encouraging outdoor activities or some specific treatments, he warns that "once myopia is established in an adult, we have no prevention." Therefore, early detection of complications is the main area for action.