About Myopia

What is Myopia?

Myopia is a refractive error characterized by poor distance vision with clear near vision. The myopic eye is a large, elongated eye. Light rays converge and form an image in front of the retina. Normally, the light beam should reach the retina level. Thus, the patient perceives a blurry image of distant objects.

What Are the Causes of Myopia?

Genetic myopia is the most common. This refractive error can be inherited. It frequently appears in families where one or both parents are myopic. It usually begins in children during early childhood or the first years of school.

Myopia can be associated with genetic syndromes or metabolic conditions. This is a form of progressive myopia that often reaches high diopter values. It is accompanied by degenerative retinal changes.

There is also myopia caused by environmental factors. Intense, prolonged near visual effort leads to excessive contraction of the ciliary muscle inside the eye involved in accommodation. This promotes the onset of myopia even at older ages, after 20 years. Thus, prolonged use of tablets, phones, laptops or reading in poor lighting can lead to the onset and progression of myopia.

Congenital myopia is myopia present from birth. Most affected are premature babies, who may develop a certain degree of retinopathy of prematurity.

How is Myopia Classified?

There is a classification of myopia based on diopter value, so we can speak of:

• low myopia (under 3 diopters)
• moderate myopia (between 3-6 diopters)
• high myopia (between 6-9 diopters)
• a separate category is severe myopia, myopia with diopter values over 10 diopters. It has early onset, from birth or the first years of life and progresses progressively. It can reach very high values, sometimes exceeding 30 diopters.

Of all forms of myopia, the most common is the so-called "school myopia". It manifests around 6-7 years of age and progresses until around 20 years. It does not progress very much (values up to 6 diopters), without producing fundus alterations. Myopia increase is more significant between 8 and 12 years, but does not stop definitively after this period.

This myopia correlates with the child's development process. As the body develops, so will the eye. Thus, the anteroposterior axis of the eye increases, so there is a risk of myopia progression.

Symptoms of Myopia

The first and most important sign of myopia onset is blurriness in distance vision. To compensate for this lack, myopic people squint their eyes to see more clearly.

Often myopia patients present to the ophthalmologist for headaches and visual fatigue during near work. Children frequently complain that they cannot see clearly what is written on the board. At school they squint and rub their eyes. They tend to get closer when watching television.

At the end of the day, a myopic person may experience visual fatigue that can be accompanied by headache, dizziness, photophobia. Also, myopic people have difficulty seeing at night, when driving.

How is Myopia Diagnosed?

The diagnosis of myopia is established during the ophthalmological consultation.

Through visual acuity testing, the level of the vision defect is evaluated.

Subsequently, diopters are measured with a special device (dioptron or autorefractometer). For correct measurement of diopters in children and young people, cycloplegic drops must be administered. Their role is to cancel the spasm of the intraocular muscles, allowing correct measurement of diopters. Without these drops, errors may occur in correcting the vision of myopia patients.

The ophthalmological consultation accompanied by administration of drops that dilate the pupils ensures a correct and complete diagnosis of the eyes. This detects whether there are other eye conditions associated with myopia.

How is Myopia Progression Monitored?

Once myopia is established, it does not regress; on the contrary, over time, it can increase as the eye grows.

For Children with Myopia

For children with myopia who wear glasses or contact lenses, periodic check-ups every 6 months are recommended. The purpose is to observe diopter evolution and prescribe optical correction so that the child's vision is good at all times. Undercorrection of vision (prescribing diopters with lower values than measured) is not recommended. Undercorrection, besides not allowing clear vision, is also a factor in myopia progression.

In addition to periodic diopter measurement, monitoring myopia progression also includes measuring the anteroposterior axis of the eye.

For Adults with Myopia

For adults with myopia, whose diopters are stabilized, annual diopter monitoring is sufficient. Fundus examination is done to detect possible retinal problems. The onset of other complications that can be associated with myopia, such as glaucoma and cataract, is monitored.

Complications of Myopia

Low and moderate myopia is usually not accompanied by other eye problems. In patients with values greater than 5-6 diopters, complications may occur, with frequency increasing as diopters increase. An eye with high diopters is a larger eye, in which ocular structures are modified, thinned, fragile.

Thus, complications such as retinal changes (myopic choroidosis, Fuchs spot, retinal tears or detachment) may occur. Scleral changes (scleral staphyloma), retinal hemorrhages, and neovascular membrane formation occur. These complications require specific treatment, which may mean laser treatment, intraocular injections or surgical treatment.

Myopia can be associated with earlier onset of open-angle glaucoma. This requires treatment with drops, laser or classic surgery.

Also, cataract develops earlier in myopic patients. Following surgical treatment of cataract, vision can be significantly improved.

Patients with myopia, especially with high values, should avoid major physical efforts. Contact sports (e.g., boxing), jumping from heights, carrying weights are not recommended. In these situations, the fragile structures of the myopic eye may undergo sudden changes. Thus, retinal tears, vitreous disorders or retinal detachment may occur.

Myopia and Pregnancy

A special mention is needed for myopia patients who are pregnant. Diopters may increase as a result of hormonal changes specific to this period of life.

It is also important to know that natural childbirth is contraindicated in patients with high diopters (over 5-6 diopters). It is also not indicated for those with degenerative retinal changes, regardless of myopia value. In these situations, there is a risk of retinal detachment.

How is Myopia Treated? Can Myopia Be Cured?

Myopia is a refractive error, an optical defect of the eye. Treatment in most cases aims at optical correction of vision in myopia, and not correction of myopia itself. That is, myopia is "not cured" by wearing glasses or contact lenses.

Optical Correction

The most commonly used treatment method for myopia is optical correction. This can be achieved with spectacle lenses (glasses) or contact lenses.

Most commonly glasses with divergent lenses (lenses with minus "-") are prescribed. Lenses with the lowest value that give the best vision are prescribed.

Contact Lenses

Another treatment method is wearing contact lenses with diopters (occasional or permanent wear). These are soft contact lenses. Lenses can be for daily/monthly use (removed at night, before sleep) or for extended wear.

Advantages of contact lenses: patients perceive a much wider visual field compared to wearing glasses. They can practice more sports where glasses can be an impediment and additional risk. Also, when there are large diopter differences between the two eyes (anisometropia). Appropriate diopters can be prescribed for each eye, being better tolerated than in the case of glasses. Of course, it is very important to follow hygiene rules when wearing contact lenses, to avoid complications.

Night Lens

A new variant of myopia treatment is the "night" contact lens – a hard lens. The lens is placed on the eye at bedtime and removed in the morning. Worn during sleep, the role of the lens is to flatten the cornea, modifying its shape. Thus, the patient no longer needs to wear glasses during the day. An additional advantage of this method, used in children, is also slowing myopia progression. Of course, in this case too, lens care standards must be followed. Additionally, the periodic eye check-up schedule must be observed.

Laser Surgery for Diopter Reduction in Myopia

For people who do not want to wear glasses or lenses, there is laser surgery for diopter reduction. These can be laser surgeries at the cornea level – the lens in the front of the eye. Or they can be intraocular surgeries at the crystalline lens level – the lens inside the eye.

Laser surgery is among the safest at present, and complications are extremely rare. Laser techniques achieve corneal reshaping, a "polishing" with diopter removal. Postoperatively, there is no need to wear glasses or contact lenses.

Currently there are several types of laser surgeries, painless, applied to the corneal surface, non-invasive. They are extremely precise, last a few minutes and ensure patients rapid postoperative visual recovery.

For patients who want laser diopter reduction, a series of measurements are made before surgery. The purpose is to see if the eye can support this type of intervention.

Other Surgeries for Myopia

There are situations where laser surgeries cannot be performed (cornea is too thin or myopia is too high). Surgical extraction of the natural transparent crystalline lens is considered. This is replaced with an artificial lens implant, measured preoperatively, so as to correct the patient's refractive error.

The ophthalmologist is the only one able to indicate which is the best method of myopia correction. The decision is made following consultation and specific investigations.

At Clario we apply vision correction methods for myopia patients, appropriate for age and individual needs of each patient.