Discover the causes, symptoms, and treatment options for myopia, also known as nearsightedness, on Meri Sehat.

Myopia

Humza Khizer

Overview

Myopia or nearsightedness is a refractive error of the eye that causes distant objects to appear blurry, while close objects can be seen clearly. 
&nbsp;

The term myopia comes from the Greek word &quot;muopia&quot; which means &quot;close to the eyes&quot;. 

Myopia usually presents itself during childhood and worsens until the individual enters adulthood. The condition occurs when the eyeball is too long, causing light to focus in front of the retina instead of on its surface. 
&nbsp;

Nearsightedness is measured in diopters; the higher the number, the more severe the condition. People with high myopia have an increased risk of eye problems that can lead to vision loss or blindness. Nearsightedness is the most common cause of correctable visual impairment globally<a href="#accordion">[8]</a>. 

East Asian countries have a higher prevalence of myopia, with up to 90% of young adults affected, and between 10 and 20% of them having high myopia<a href="#accordion">[8]</a>.

According to a national survey in Pakistan, 36.5% of the population has myopia. However, there is currently a lack of research on the risk factors that contribute to the increasing prevalence of myopia in Pakistan<a href="#accordion">[1]</a>. 
&nbsp;

There are two main types of myopia<a href="#accordion">[2]</a>: 
&nbsp;

<ol>
	<li>Axial Myopia&nbsp; 
	 
	It occurs when the eyeball is too long, causing light to focus in front of the retina instead of on it. This type of myopia is often inherited and tends to worsen over time. Axial myopia is the most common type of myopia. 
	&nbsp;</li>
	<li>Refractive Myopia 
	 
	It occurs when the cornea (the clear outer layer of the eye) or the lens inside the eye is too curved, causing light to focus in front of the retina. This type of myopia can also be caused by an abnormal shape of the cornea or lens, or by certain medical conditions, such as <a href="https://merisehat.pk/disease/diabetes-type-1-and-2">diabetes</a>. 
	&nbsp;</li>
</ol>

Based on the pathological condition, myopia is categorized into two sub-class<a href="#accordion">[3]</a> <a href="#accordion">[4]</a>:

<ol>
	<li>High Myopia 
	 
	High myopia is characterized by a refractive error of -6.00 diopters or greater, which means that objects at a distance of 6 meters or more are very blurry. This type of myopia is often associated with a longer-than-normal eyeball or if the cornea is too steep. It can lead to complications such as retinal detachment, <a href="https://merisehat.pk/disease/glaucoma">glaucoma</a>, and <a href="https://merisehat.pk/disease/cataract">cataracts</a>. 
	&nbsp;</li>
	<li>Degenerative Myopia 
	 
	Degenerative myopia, also known as pathological myopia, is a severe form of myopia that is often progressive and can lead to vision loss. It&rsquo;s rare and affects only 2% of the population, usually the Japanese, Chinese, and Middle Eastern people<a href="#accordion">[4]</a>. This type of myopia is characterized by structural changes in the eye such as thinning of the retina and sclera, and a higher risk of retinal detachment, macular degeneration, and other eye problems. 
	&nbsp;</li>
</ol>

Signs and Symptoms

Signs and symptoms of myopia include: 
&nbsp;

<ul>
	<li>Blurred vision when looking at distant objects</li>
	<li>Close items appear clear</li>
	<li>Difficulty seeing road signs or the chalkboard in a classroom</li>
	<li>Squinting or closing one eye to see more clearly</li>
	<li>Eye strain or fatigue, especially after prolonged reading or computer use</li>
	<li>Headaches, especially when reading or doing close work for long periods</li>
	<li>Constantly rubbing eyes due to eye fatigue</li>
	<li>Excessive blinking </li>
	<li>Difficulty seeing at night or in low-light conditions while being able to see clearly in daylight</li>
</ul>

Symptoms like short attention span, holding objects close to the face or exhibiting a need to move closer to see objects clearly, being unaware of distant objects, and poor academic performance in children are also red flags of myopia. 
&nbsp;

Note: If you experience any of these symptoms, it&#39;s important to visit an eye doctor or optometrist for a comprehensive eye exam. They can diagnose myopia and prescribe corrective lenses or other treatments as needed. 
&nbsp;

Seek Emergency Medical Care When

<ul>
	<li>Flashes of light appear in one or both eyes</li>
	<li>Sudden appearance of floaters (tiny specks drifting through the field of vision)</li>
	<li>Shadow in peripheral (side or outer) vision</li>
	<li>Shadow covering part or complete field of vision. 
	&nbsp;</li>
</ul>

Causes

The exact cause of myopia is not fully understood, but several factors have been identified that contribute to its development: 
&nbsp;

Genetics: Myopia often runs in families, suggesting that there is a genetic component to its development. If one or both parents have myopia, children are at a higher risk of developing it as well.

Environmental Factors: Certain environmental factors can also contribute to myopia, including spending long periods doing close-up work such as reading or using a computer. This is especially true for children who spend a lot of time indoors studying or playing video games as they may not get enough exposure to natural light.

Eye Shape: In people with myopia, the eyeball is typically longer than normal, causing light to focus in front of the retina instead of on it. This results in blurred vision when looking at distant objects.

Medical Conditions: Some medical conditions, such as diabetes, can also contribute to the development of myopia. 
&nbsp;

Diagnosis

The doctor will begin by taking note of the patient&rsquo;s age, medical history, and eye health following which they&rsquo;ll order a comprehensive eye exam to monitor vision and eye health: 
&nbsp;

<h5>Adults</h5>

<ul>
	<li>Visual Acuity Test &ndash; The healthcare provider covers one eye of the patient to read letters and asks them to read an eye chart that has different-sized symbols or letters. The test is then repeated for the other eye.</li>
	<li>Phoropter Test &ndash; The patient is asked to read an eye chart while looking through a device with different lenses. It helps to measure the refractive error and determine the appropriate prescription to correct vision problems.</li>
	<li>Peripheral Vision Test &ndash; The patient views images through a machine that tests their peripheral or side vision. Loss of side vision is an indication of glaucoma.</li>
	<li>Pupil Exam &ndash; The doctor shines a bright light into the patient&rsquo;s eye to test how their pupils respond.</li>
	<li>Eye Pressure Test &ndash; The eye doctor releases a puff of air into the eyes. High pressure is a sign of glaucoma. </li>
	<li>Eye Movement And Eye Health Test &ndash; This test is to examine the health of muscles that control eye movement. Moreover, the doctor looks for symptoms of damage like scratches on the cornea or conditions like cataracts that can affect eye health. </li>
	<li>Exam Of The Inner Eye &ndash; The eye specialist will probably put drops in the eyes to dilate them. This provides them a better view of the inner eye, i.e., the retina and optic nerve. 
	&nbsp;</li>
</ul>

<h5>Children</h5>

Early detection and intervention are crucial for slowing myopia progression in children.

Children with myopia may not show obvious signs or symptoms, which makes routine eye exams all the more important.

While children with a history of myopia or current myopia may need more frequent exams, the recommended eye exam schedule for children is:

<ul>
	<li>First exam at 6 months</li>
	<li>Second exam between ages 3 and 5</li>
	<li>Third exam before first grade</li>
	<li>Annual exam throughout the school period 
	&nbsp;</li>
</ul>

Prescription for myopia is written with a minus sign before a number, with a higher number indicating higher myopia. Low myopia ranges from -0.50 to -5.75, whereas high myopia is -6.00 or greater.

Eye doctors will also discuss the risk of high myopia and check for complications during exams given that the condition can lead to serious issues like posterior subcapsular cataracts, glaucoma, myopic macular degeneration, and retinal detachment. 
&nbsp;

Treatment

Prescription Lenses For Myopia Treatment

The most common and safe way to treat nearsightedness is to use corrective lenses. Eyeglasses and contact lenses are designed to help focus light on the retina, counteracting the increased curve of the cornea or the increased length of the eye. Eyeglasses can be referred to all ages with their prescription strength depending on how far the individual can see clearly. While some people may need to wear it all the time, others may require it for specific activities only, like driving. 
&nbsp;

Refractive Surgery For Myopia Treatment

Refractive surgery is another option to treat nearsightedness, which reduces the need for eyeglasses and contact lenses. This surgery uses a laser to reshape the cornea. 

Types of refractive surgery include LASIK, LASEK, PRK, and SMILE. However, surgical treatment is recommended only for adults when nearsightedness is no longer progressing. 
&nbsp;

Treatment To Slow Or Stop The Progression Of Myopia

<ul>
	<li>Atropine eye drops are used to dilate the pupil of the eye and also help slow the progression of myopia when used in low doses. </li>
	<li>Orthokeratology or corneal reshaping therapy is another nonsurgical process that involves the use of specific lenses to put pressure on the cornea to flatten it temporarily. However, it carries a risk of eye infections.</li>
	<li>Dual-focus contact lenses may also slow the progression of myopia. 
	&nbsp;</li>
</ul>

Myopia, if left untreated or uncorrected, can lead to several complications, including: 
&nbsp;

Eyestrain: People with myopia often strain their eyes to see distant objects clearly. This can lead to eye fatigue, headaches, and neck or shoulder pain.

Squinting: Squinting to see distant objects can worsen the progression of myopia and cause eyestrain.

Amblyopia: Myopia can lead to amblyopia or &quot;lazy eye&quot;, which is a condition where one eye becomes weaker and does not work as well as the other eye.

Retinal Detachment: People with high myopia are at a higher risk of developing retinal detachment, a condition where the retina pulls away from the underlying tissue and results in vision loss.

Glaucoma: Myopia can cause glaucoma, a condition where the optic nerve is damaged and leads to vision loss.

Cataracts: Myopia can develop into cataracts, a condition where the natural lens of the eye becomes cloudy and causes vision loss.

Reduced Quality Of Life: Myopia negatively impacts daily activities, including reading, driving, and participating in sports, leading to reduced quality of life. 
&nbsp;

Several risk factors can increase the likelihood of developing myopia, including: 
&nbsp;

<ul>
	<li>Family History</li>
</ul>

Myopia tends to run in families, and people with parents who have myopia are at a higher risk of developing the condition.

&nbsp;

<ul>
	<li>Age</li>
</ul>

Myopia can develop at any age, but it often develops between the ages of 6 and 14 and typically worsens until the person is in their early 20s. 

&nbsp;

<ul>
	<li>Lifestyle Factors</li>
</ul>

People who spend a lot of time reading, writing, or using electronic devices up close are at a higher risk of developing myopia. Studies have shown that spending prolonged screen time, especially during childhood, can increase the risk of myopia<a href="#accordion">[2]</a> <a href="#accordion">[9]</a>. Health conditions, like diabetes, also make a person vulnerable to myopia. 
&nbsp;

<ul>
	<li>Environmental Factors</li>
</ul>

Factors such as living in urban areas with high pollution or high population density have been linked to an increased risk of myopia. 
&nbsp;

While there is no guaranteed way to prevent myopia, there are several steps that can be taken to reduce the risk of developing myopia or slow down its progression: 
&nbsp;

Regular Eye Exams: Children and adults should have regular eye screenings to monitor their vision and detect any vision changes early.

Spend Time Outdoors: Studies have shown that spending time outdoors, especially during childhood, can reduce the risk of myopia. Spending at least 2 hours a day outside in natural light is recommended. Also, wear sunglasses with UV radiation protection and protective eyewear when engaged in certain activities, like playing sports or using chemicals.

Reduce Screen Time: Encourage breaks and reduce the amount of time spent on screens. Follow the 20/20/20 rule, i.e., for every 20 minutes spent looking at a screen, take a 20-second break and look at something 20 feet away.

Proper LIGHTING: Ensure that the lighting in the environment is adequate for the task at hand, whether it be reading, writing, or using electronic devices.

Healthy Diet: A diet rich in fruits, vegetables, and omega-3 fatty acids is beneficial for eye health. It also helps manage chronic health conditions, like diabetes and high blood pressure.

Quit Smoking: Smoking has been linked to an increased risk of myopia, so it is important to avoid smoking or exposure to second-hand smoke. 
&nbsp;

A new observational study published in the British Journal of Ophthalmology suggests that a caffeine metabolite called 7-Methylxanthine (7-MX) may slow the progression of myopia in children. 

The researchers reviewed the medical records of 711 children treated for myopia in Denmark, with 624 of them taking 7-MX tablets up to 1200 mg daily. Treatment with 7-MX was associated with a slower rate of worsening myopia and axial elongation, with higher doses being more effective. The researchers estimated that for an 11-year-old taking 1000 mg 7-MX daily would increase by -1.43 D over the next 6 years, compared with -2.27 D without treatment. 

However, the study was observational and cannot establish causality, and a randomized trial is needed to determine the causality and the size of the possible treatment effect<a href="#accordion">[10]</a>. 
&nbsp;

Key Points

<ul>
	<li>Myopia or nearsightedness is a refractive error of the eye that causes distant objects to appear blurry, while close objects can be seen clearly.</li>
	<li>The term myopia comes from the Greek word &quot;muopia&quot; which means &quot;close to the eyes&quot;. </li>
	<li>It usually presents itself during childhood and worsens until the individual enters adulthood. </li>
	<li>Nearsightedness is measured in diopters; the higher the number, the more severe the condition.</li>
	<li>People with high myopia have an increased risk of eye problems that can lead to vision loss or blindness.</li>
	<li>The most common and safe way to treat nearsightedness is to use corrective lenses. 
	&nbsp;</li>
</ul>

[1] Abdul Malik MH, Mohydin M, Saeed A, et al. Prevalence and risk factors of myopia among medical students. Pakistan Journal of Medical and Health Sciences. 2022;16(2):173-175. doi:10.53350/pjmhs22162173.

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