Myopia (Nearsightedness)

Myopia, commonly called nearsightedness, is a refractive error where close objects appear clear while distant objects appear blurry. It's the most common vision problem worldwide, affecting approximately 30% of the population in the US and even higher rates in some Asian countries. Beyond just needing glasses, high myopia is a risk factor for serious eye conditions.

How Myopia Works

In a normal eye (emmetropia), light focuses precisely on the retina. In myopia:

• The eyeball is too long, OR
• The cornea/lens has too much focusing power
• Light focuses in front of the retina instead of on it
• Distant objects appear blurry; near objects are clear

Degrees of Myopia

Classification	Diopters (D)	Notes
Low	Up to -3.00	Usually stable, lower complication risk
Moderate	-3.00 to -6.00	Some increased risk
High	> -6.00	Significantly increased eye disease risk
Pathologic	Usually > -8.00	Associated with structural eye changes

Symptoms

Vision Symptoms

• Distant objects appear blurry
• Clear vision up close (until presbyopia develops with age)
• Squinting to see distant objects (may help temporarily)
• Difficulty seeing whiteboard/projector at school
• Problems seeing road signs while driving
• Eye strain when trying to focus on distance

In Children

• Sitting very close to TV or screens
• Holding books/devices very close
• Squinting frequently
• Complaints of headaches
• Rubbing eyes frequently
• Declining academic performance (can't see board)

Causes and Risk Factors

Genetics

• Strong hereditary component
• Risk higher if one or both parents are myopic
• Multiple genes involved

Environmental Factors

• Near work—reading, screens, close work
• Limited outdoor time—outdoor light exposure appears protective
• Education level—correlates with myopia (likely due to near work)
• Early age of onset—predicts more progression

The Myopia Epidemic

Myopia rates are increasing dramatically worldwide:

• Environmental changes likely play a major role
• More screen time and near work
• Less outdoor time
• Particularly pronounced in East Asia

Diagnosis

Eye Examination

• Visual acuity testing—reading the eye chart
• Refraction—determining glasses prescription
  • Manual (phoropter and trial lenses)
  • Autorefractor (automated measurement)
• Cycloplegic refraction—dilating drops relax focusing, essential in children

What the Prescription Means

A myopia prescription is written with a minus (-) sign:

• -1.00 D = mild myopia
• -3.00 D = moderate myopia
• -6.00 D = high myopia

Higher numbers mean more nearsightedness and stronger correction needed.

Correction Options

Not sure which option is right for you? Our glasses and contacts guide walks through how to decide.

Glasses

• Safest option for all ages
• Concave (minus) lenses diverge light
• Various lens options: anti-reflective, blue light filtering, photochromic
• Easily updated as prescription changes

Contact Lenses

• Soft lenses (daily disposable or extended wear)
• Rigid gas permeable (RGP) lenses
• Specialty lenses for high myopia or irregular corneas
• Requires proper hygiene and care

Refractive Surgery

For stable adult myopia:

• LASIK—most common
• PRK—alternative procedure
• ICL (implantable collamer lens)—for high myopia
• Not recommended until prescription is stable

Myopia Control (For Children)

Since myopia often progresses during childhood, strategies to slow progression are important:

Atropine Eye Drops

• Low-dose (0.01-0.05%) atropine nightly
• Slows progression by 30-60%
• Minimal side effects at low doses
• Must be prescribed by eye doctor

Orthokeratology (Ortho-K)

• Specially designed rigid contact lenses worn overnight
• Temporarily reshape cornea
• Clear vision during day without glasses/contacts
• Also slows myopia progression

Multifocal Contact Lenses

• Soft contacts with special design
• Worn during the day
• Can slow progression

Multifocal/Executive Glasses

• Less effective than contact lens options
• May have modest benefit

Outdoor Time

• Increased outdoor time associated with reduced myopia development
• Aim for 2+ hours daily
• Bright outdoor light may be the key factor
• Doesn't slow already established myopia as effectively as preventing onset

Complications of High Myopia

When to Seek Urgent Care

Living with Myopia

For Adults

• Regular eye exams (annually or as recommended)
• Protect eyes from UV light
• Know warning signs of retinal problems
• Keep backup glasses
• Consider lifestyle modifications if vision impairs activities

For Children

• Annual exams to monitor progression
• Discuss myopia control options with eye doctor
• Encourage outdoor time
• Balance near work with breaks
• Proper lighting for reading

Frequently Asked Questions

Can myopia be cured?

Myopia cannot be cured, but it can be corrected with glasses, contacts, or refractive surgery. Myopia control treatments can slow progression in children but don't reverse existing myopia.

Will my child's myopia keep getting worse?

Myopia typically progresses during childhood and stabilizes in late teens or early twenties. Earlier onset usually means more progression. Myopia control strategies can slow this progression.

Do screens cause myopia?

Research suggests that near work in general (including screens) and reduced outdoor time contribute to myopia development. Limiting continuous near work and increasing outdoor time may help.

Is LASIK safe for high myopia?

LASIK can be performed for moderate to moderately high myopia. Very high myopia may be better treated with ICL (implantable lens) procedures. Your surgeon will advise on the best option.

Does wearing glasses make myopia worse?

No. Wearing properly prescribed glasses does not make myopia worse. Under-correction was once thought to slow progression but has been shown to either have no effect or slightly increase progression.

Why is myopia increasing so rapidly?

Environmental factors are likely responsible—particularly less time outdoors and more near work/screen time. The trend is most pronounced in urbanized Asian countries but is seen worldwide.

References