Myopia: The Inside Story & New Treatment Options

myopia in school childMyopia, also called “nearsightedness,” is a common eye condition that requires correction with eye glasses. If severe, it can lead to serious eye conditions. Myopia is a refractive error in which close objects are clear, but distant objects are blurry. This is because the refracted image is in focus in front of the retina. Typically, the myopic eye is elongated; however, myopia can also be caused by a distorted cornea.

This disorder affects around 33% of the population of the United States. In some East Asian countries, over 90% of the population is myopic.[1] It is typically detected in children and teens, and it can worsen as the individual passes middle age.

The typical treatment for myopia is eyeglasses or contact lenses. Laser surgery can often repair myopia. Severe cases of myopia can lead to eye damage, including retinal holes or tears and retinal detachment.

How Myopia Is Diagnosed

Nearsightedness is usually detected during a routine eye exam. The eye doctor dilates (opens) the pupil using special eye drops and painlessly looks inside the eye. From childhood, an exam at least every two years is recommended and at least annually for people who wear glasses or have eye disease.

Myopia typically first appears in childhood and the teen years. Sometimes a patient complains of these symptoms, which can indicate myopia:[2]

  • Eyestrain and headaches
  • Squinting
  • Trouble reading signs or seeing distant objects such as the chalkboard at school

With myopia, distance vision is blurry. An individual can have more than one type of vision problem, such as myopia combined with astigmatism.

Causes

Technically, myopia means that images in the eye focus in front of the retina, making vision blurry. The eyeball is too long or the cornea or lens is misshapen. However, definition does not indicate the underlying cause of myopia.

The exact causes of myopia are not well established. Some possible factors may include hereditary, personality type, emotional issues, diet and nutrition, stress and close-up focusing (such as reading, sewing, smartphone, computer and tablet use).

Here are just a few studies that have looked at possible causes.

  • A study in England of 64 pairs of identical twin adults found that a higher occupational status, living in a city, and performing more close work were good indicators of having myopia. Twins who spend more time outdoors or played outdoor sports had less myopia than their genetically identical siblings.[3]
  • Myopia’s dramatic rise in the developed world may be linked to extra studying time, not enough time outdoors, and/or hand-held electronics (close-up work). A study in Asia in 2015 found an additional 40 minutes of outdoor activity at school was correlated with approximately a one-third decrease in the incidence rate of myopia (30.4% versus 39.5% in the control group) over three years.[4]
  • Genetics appeared to be a strong factor in developing myopia in childhood; more close-up work, higher achievement in school and less sports had a smaller effect in a 2002 study.[5]
  • Animal studies[6],[7] have indicated that lack of visual stimuli damaged the development of proper vision. Humans evolved in a variety of outdoor environments, and spending the majority of our time indoors under fluorescent lighting may be preventing the ideal development of vision.[8]

Prognosis

The prognosis for myopia depends on the severity of the condition. There are two classifications of nearsightedness.[9]

Simple Myopia is a low-to-moderate level of myopia, from -0.5 to -6.0 diopters. This is correctable using glasses or contact lenses. Some may elect refractive surgery to alter the shape of the cornea, thereby reducing or eliminating the need for glasses or contacts.

High Myopia is -6.0 diopters or worse. In addition to needing corrective lenses, the patient is at risk of structural damage to the eye because the eyeball stretches too much. Patients with high or pathological myopia are at risk of holes or tears in the retina, and retinal detachment. Additionally, abnormal blood vessels might grow beneath the retina, which can cause vision changes.[10]

Among school dropouts in Asia, 80-90% have myopia.[11] High myopia affects 10-20% of those completing high school in this part of the world. [12]

In nearsighted people, close-up vision is clearer. However, after approximately age 40, presbyopia may cause close-up vision to become blurry. This is due to lens changes with age, which appear to make the lens less flexible and thicker in nearly everyone. Magnifying bifocals may be needed, or magnifying reading glasses may be necessary for reading, sewing, texting, etc.

Standard Treatment

Currently, there are three standard treatments for nearsightedness[13]:

Eyeglasses are the standard treatment for myopia. Typically, a parent brings their child to the eye doctor complaining the youngster cannot read the board or gets eyestrain or headaches. Eyeglasses compensate by forcing the image entering the eye to focus on the retina, instead of in front of the retina.

In teens and adults, contact lenses may be more convenient. Contacts touch the eye, which allows for a more precise refraction. Vision with contact lenses is typically clearer, wider and more comfortable than glasses. Not everyone is a candidate for contact lenses, but recent advancements have allowed more patients than ever to adapt to contacts.

Refractive surgery may be an option for many myopic patients. There are several types of refractive surgery, including excimer lasers (LASIK).

If a secondary effect from high myopia occurs, support information is on the holes or tears page, and the retinal detachment page.

Other Approaches to Myopia Support and Prevention

Atropine Drops – Not Approved By USDA (Sept 2015)

Research is underway to determine if atropine drops can slow the progression of myopia. A treatment like this would be especially important in individuals at risk of developing high myopia and its associated eye damage. However, atropine eye drops have risks, including blurred vision, stinging and burning, sensitivity to sunlight, and/or swelling of the eyelids.[14]

In Asia, atropine eye drops are used extensively.[15] Using a low concentration of atropine seems to be beneficial with fewer side effects. Due to side effects, this medication is being used with caution in myopic patients. Using atropine drops to prevent myopia may not become a common practice, due to the side effects.

A meta-study found that anti-muscarinic medications such as atropine were best at slowing the progression of myopia versus under-correction, rigid gas permeable contact lenses, progressive additional lenses, and multifocal lenses.[16] However, the US Food and Drug Administration has not yet approved any of these modalities to slow down the progression of myopia (as of September 2015).

Daylight

Exposure to natural light may compensate for excessive close-up work and indoor lighting. Try getting access to natural light for at least two or three hours per day. Children should play outside as much as possible during the day, weather permitting. Instead of exercising inside, exercise outdoors by biking, taking long walks or hikes, and playing sports – from tossing a Frisbee to touch football to organized sports leagues.

Exercise and Reduce Stress

Whether done indoors or outdoors, exercise is key to good overall health. Swim, work out at the gym, and challenge yourself to progressively more difficult exercise. Try to get least 20 to 30 minutes of moderate to vigorous exercise each day. Exercise reduces stress. Stress is suspected to be one of several factors in the development of certain eye conditions. Considering that myopia is related to the muscles of the eyes, keep stress levels low and avoid excessive muscular tension.

Be Careful With Screen Time

If you are a heavy user of computers, tablets, or smartphones, visit our page on computer fatigue syndrome. Tablets and smartphones are usually held even closer to the face than computers, and often in dark rooms, increasing eye fatigue.

If you have myopia and spend a lot of time on the computer your are also more vulnerable to glaucoma.

Do Eye Exercises

Did you know that eye exercises can help reduce the effect of myopia? In some cases, they can even reduce the needed prescription strength! Eye exercises can help people of all ages. For seniors, they strengthen muscles that become weaker with age. Click to download Natural Eye Care’s free eye exercise e-book.

Nutritional Support

Learn about nutritional support that complements eye exercises.

If you experience symptoms of myopia, visit your eye doctor for a complete and painless dilated eye exam.

Next: Nutritional support, diet, & lifestyle tips for myopia.

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Sources/End Notes
[1] “Controlling myopia progression in children and adolescents: by Smith MJ, Walline JJ. Adolesc Health Med Ther. 2015 Aug 13;6:133-40. doi: 10.2147/AHMT.S55834. PMID: 26316834 http://www.ncbi.nlm.nih.gov/pubmed/26316834
[2] https://nei.nih.gov/health/errors/myopia
[3] “Risk factors for myopia in a discordant monozygotic twin study.” Ramessur R, Williams KM, Hammond CJ. Ophthalmic Physiol Opt. 2015 Sep 17. doi: 10.1111/opo.12246. http://www.ncbi.nlm.nih.gov/pubmed/26376775
[4] “Effect of Time Spent Outdoors at School on the Development of Myopia Among Children in China: A Randomized Clinical Trial.” He M et. al. JAMA. 2015 Sep 15;314(11):1142-8. doi: 10.1001/jama.2015.10803. http://www.ncbi.nlm.nih.gov/pubmed/26372583
[5] Sherwin, Justin (25 October 2011). “Lack of outdoor play linked to short-sighted children”. BBC News.
[6] Smith III, E.L., G.W. Maguire, and J.T. Watson (1980). Axial lengths and refractive errors in kittens reared with an optically induced anisometropia. Investigate Ophthalmology and Vision Science 19: 1250-55.
[7] Hubel D., T.N. Weisel (1985). “Myopia and eye enlargement after neonatal lid fusion in monkeys.” Nature 266: 485-88.
[8] Lieberman, Daniel E. The Story of the Human Body: Evolution, Health, and Disease. New York: Pantheon Books, 2013.
[9] “Myopia: a review of literature.” Maduka Okafor FC, Okoye OI, Eze BI. Niger J Med. 2009 Apr-Jun;18(2):134-8. http://www.ncbi.nlm.nih.gov/pubmed/19630316
[10] https://nei.nih.gov/health/errors/myopia
[11] “Myopia.” Morgan IG, Ohno-Matsui K, Saw SM. Lancet. 2012 May 5;379(9827):1739-48. doi: 10.1016/S0140-6736(12)60272-4. Review. PMID: 22559900  http://www.ncbi.nlm.nih.gov/pubmed/22559900
[12] ibid.
[13] https://nei.nih.gov/health/errors/myopia
[14] http://www.drugs.com/mtm/atropine-ophthalmic.html
[15] “The role of atropine eye drops in myopia control.” Grzybowski A, Armesto A, Szwajkowska M, Iribarren G, Iribarren R. Curr Pharm Des. 2015 Sep 8. PMID:26350533  http://www.ncbi.nlm.nih.gov/pubmed/26350533
[16] “Interventions to slow progression of myopia in children.” Walline JJ et. al. Cochrane Database Syst Rev. 2011 Dec 7;(12):CD004916. doi: 10.1002/14651858.CD004916.pub3. PMID:22161388 http://www.ncbi.nlm.nih.gov/pubmed/22161388

Summary
Article Name
What is Myopia? Symptoms & Treatments by Natural Eye Care
Description
Myopia or nearsightedness is a refractive error: Distant objects are blurry because the eye is elongated or the cornea is distorted. Simple myopia is corrected with glasses. High myopia can lead to serious eye conditions.
Author