Normal vision for a achromatopsic colour-blind person. Courtesy NIH National Eye InstituteThe same view when achromatopsic and myopic.
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Myopia

Myopia is a refractive defect of the eye in which light focuses in front of the retina. Those with myopia are often described as nearsighted or short-sighted in that they typically can see nearby objects clearly but distant objects appear blurred because the lens cannot flatten enough. The opposite of myopia is hyperopia or "farsightedness". more...

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Myopia is the most common eyesight problem in the world. About one quarter of the adult population in the United States has myopia. In places like Japan, Singapore and Taiwan, as many as 44% of the adult population is myopic.

Myopia is measured in diopters; specifically, the strength of the corrective lens that must be used to enable the eye to focus distant images correctly on the retina. Myopia of 6.00 diopters or greater is considered high, or severe, myopia. People with high myopia are at greater risk of more acute eye problems such as retinal detachment or glaucoma. They are also more likely to experience floaters.

Mainstream ophthalmologists and optometrists most commonly correct myopia through the use of corrective lenses, such as glasses or contact lenses. It may also be corrected by refractive surgery, such as LASIK. The corrective lenses have a negative dioptric value (i.e. are concave) which compensates for the excessive positive diopters of the myopic eye.

Prevalence

A recent Australian study found that less than 1 in 10 (8.4%) children between the ages of 4 and 12 were myopic . According to an American study published in Archives of Ophthalmology, nearly 1 in 10 children between the ages of 5 and 17 have myopia , and a recent Brazilian study found that nearly 1 in 8 (13.3%) of the students in one city were myopic .

A recent study involving first-year undergraduate students in the United Kingdom found that 50% of British whites and 53.4% of British Asians were myopic.

The prevalence of myopia in adults in the United States has been estimated to be approximately 25%, however, a study of Jordanian adults aged 17 to 40 found that over half (53.7%) were myopic .

Myopia is more common in Asians and Jews than in Whites, and more common in Whites than in Blacks (Jensen, 1998).

Pathogenesis

Theories

  • Genetic Factors - The most widely held theory of the cause of myopia is that it is mainly hereditary. Measures of the heritability of myopia have yielded figures as high as 89%, and recent research has identified genes that may be responsible: defective versions of the PAX6 gene seem to be associated with myopia in twin studies . Under this theory, the eye is slightly elongated front to back as a result of faults during development, causing images to be focused in front of the retina rather than directly on it. It is usually discovered during the pre-teen years between eight and twelve years of age. It most often worsens gradually as the eye grows during adolescence and then levels off as a person reaches adulthood. Genetic factors can work in various biochemical ways to cause myopia, a weak or degraded connective tissue is a very essential one. Genetic factors include an inherited, increased susceptibility for environmental influences like excessive near work, and the fact that some people do not develop myopia in spite of very adverse conditions is a clear indication that heredity is involved somehow in any case.
  • Environmental Factors - Another theory is that myopia is caused by a weakening of the ciliary muscle which controls the eye's lens. The weak muscle is unable to adjust the lens enough to see far distances, causing far-off things to be blurred. This theory states that the muscle's weakness is usually caused by doing lots of "nearwork", like reading books or using a computer screen. Since the eye rarely has to focus on far distances, the muscle is rarely used and, as a result, becomes weak. Since corrective lenses do the ciliary muscle's work for it, proponents of this theory suggest that they make it even weaker, increasing the problem. Instead, they recommend a variety of eye exercises to strengthen the muscle. A problem with this theory is that mainstream ophthalmology and medicine hold that the ciliary muscle is used when focussing at close distances, and is relaxed when accommodating for distant vision. Other theories suggest that the eyes become strained by the constant extra work involved in "nearwork" and get stuck in the near position, and eye exercises can help loosen the muscles up thereby freeing it for far vision. These primarily mechanical models appear to be in contrast to research results, which show that the myopic elongation of the eye can be caused by the image quality, with biochemical processes as the actuator. Common to both views is, however, that extensive near work and corresponding accommodation can be essential for the onset and the progression of myopia. A variation of this theory was touted by William Bates in the early 1900s. Bates claimed that with nearwork and other "stresses", the extraocular muscles would squeeze the eyeball causing it to elongate.
  • Near work. Near work has been implicated as a contributing factor to myopia in many studies. New research from NSU College of Optometry shows that students exposed to extensive "near work" are at a higher risk of developing myopia, whereas taking summer or winter vacations (which amount to extended breaks from near work) will either reduce or stop myopic progression .
  • Combination of Genetic and Environmental Factors - Regardless of the accuracy of the ciliary muscle theory, a high heritability of myopia (as for any other condition) does not mean that environmental factors and lifestyle have no effect on the development of the condition. High heritability simply means that most of the variation in a particular population at a particular time is due to genetic differences. If the environment changes - as, for example, it has by the introduction of televisions and computers - the incidence of myopia can change as a result, even though heritability remains high. From a little bit different point of view it could be concluded that – determined by heritage – some people are at a higher risk to develop myopia when exposed to modern environmental conditions with a lot of extensive near work like reading. In other words, it is often not the myopia itself, which is inherited, but the reaction to specific environmental conditions - and this reaction can be the onset and the progression of myopia. In China, myopia is more common in those with higher education background ; some studies suggesting that nearwork may exacerbate a genetic predisposition to develop myopia .
  • Diet and nutrition - One 2002 article suggested that myopia may be caused by over-consumption of bread in childhood, or in general by diets too rich in carbohydrates, which can lead to chronic hyperinsulinemia. Various other components of the diet, however, were made responsible for contributing to myopia as well, as summarized in a documentation.

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Myopia
From Gale Encyclopedia of Alternative Medicine, 4/6/01 by Mai Tran

Definition

Myopia is the medical term for nearsightedness. People with myopia see objects more clearly when they are close to the eye, while distant objects appear blurred or fuzzy. Reading and close-up work may be clear, but distance vision is blurry.

Description

Myopia affects about 30% of the population in the United States. To understand myopia it is necessary to have a basic knowledge of the main components involved in the eye's focusing system: the cornea, lens, and retina. The cornea is a tough, transparent, dome-shaped tissue that covers the front of the eye (not to be confused with the white, opaque sclera). The cornea lies in front of the iris (the colored part of the eye). The lens is a transparent, double-convex structure located behind the iris. The retina is a thin membrane that lines the rear of the eyeball. Light-sensitive retinal cells convert incoming light rays into electrical signals that are sent along the optic nerve to the brain, which then interprets the images. In people with normal vision, parallel light rays enter the eye and are bent by the cornea and lens (a process called refraction) to focus precisely on the retina, providing a crisp, clear image. In the myopic eye, the focusing power of the cornea (the major refracting structure of the eye) and the lens is too great with respect to the length of the eyeball. Light rays are bent too much, and they converge in front of the retina. This results in what is called a refractive error. In other words, an overly focused, fuzzy image is sent to the brain.

There are many types of myopia. Some common types include:

  • physiologic
  • pathologic
  • acquired

By far the most common, physiologic myopia develops sometime between the ages of five to 10 years and gradually progresses until the eye is fully grown. This may include refractive myopia (cornea and lens-bending properties are too strong) and axial myopia (the eyeball is too long). Pathologic myopia is a far less common abnormality. This condition begins as physiologic myopia, but rather than stabilizing, the eye continues to enlarge at an abnormal rate (progressive myopia). This more advanced type of myopia may lead to degenerative changes in the eye, or degenerative myopia. Acquired myopia occurs after infancy. This condition may be seen in association with uncontrolled diabetes and certain types of cataracts. Antihypertensive drugs and other medications can also affect the refractive power of the lens.

Causes & symptoms

Myopia is said to be caused by an elongation of the eyeball. This means that the oblong (as opposed to normal spherical) shape of the myopic eye causes the cornea and lens to focus at a point in front of the retina. A more precise explanation is that there is an inadequate correlation between the focusing power of the cornea and lens and the length of the eye.

Myopia is considered to be primarily a hereditary disorder, meaning that it runs in families. People are generally born with a small amount of hyperopia (farsightedness), but as the eye grows this decreases and myopia does not become evident until later. Because of this, it is sometimes argued that myopia is not inherited, but acquired. Some eyecare professionals believe that a tendency toward myopia may be inherited, but the actual disorder results from a combination of environmental and genetic factors. Environmental factors include close work, stress, and eye strain.

The symptoms of myopia are blurred distance vision, eye discomfort, squinting, and eye strain.

Diagnosis

The diagnosis of myopia is typically made during the first several years of elementary school when a teacher notices a child having difficulty seeing the chalkboard, reading, or concentrating. The teacher or school nurse often recommends an eye exam by an ophthalmologist or optometrist. An ophthalmologist--M.D. or D.O. (Doctor of Osteopathy)--is a medical doctor trained in the diagnosis and treatment of eye problems. Ophthalmologists also perform eye surgery. An optometrist (O.D.) diagnoses and manages and/or treats eye and visual disorders. In many states, optometrists are licensed to use diagnostic and therapeutic drugs.

A patient's distance vision is tested by reading letters or numbers on a chart posted a set distance away (usually 20 ft, or 6 m). The doctor has the patient view images through a variety of lenses to obtain the best correction. The doctor also examines the inside of the eye and the retina. An instrument called a slit lamp is used to examine the cornea and lens. The eyeglass prescription is written in terms of diopters (D), which measure the degree of refractive error. Mild to moderate myopia usually falls between -1.00D and -6.00D. Normal vision is commonly referred to as 20/20 to describe the eye's focusing ability 20 ft away from an object. For example, 20/50 means that a myopic person must be 20 ft away from an eye chart to see what a normal person can see at 50 ft (15 m). The larger the bottom number, the greater the myopia.

Treatment

Nutritional therapy

The following nutritional supplements may help improve vision:

  • Vitamin A: essential vitamin for healthy eyes.
  • Bioflavonoids. These plant chemicals can help myopic people see better, especially at night
  • Zinc: may improve night vision
  • Ginkgo extract: increases blood supply to the eye. It may help prevent deterioration in vision.

Eye exercises

Some eye care professionals recommend exercises to help improve circulation, reduce eye strain, and relax the eye muscles. The Bates method is a common set of exercises. It is possible that by combining exercises with changes in behavior, the progression of myopia may be slowed or prevented. Alternative treatments include: visual therapy (also referred to as vision training or eye exercises); discontinuing close work; reducing eye strain (taking a rest break during periods of prolonged near vision tasks); and wearing bifocals to decrease the need to accommodate when doing close-up work.

Acupuncture

Acupuncture, by acting on eye muscles, causes changes in the shape of the eyeball and thus, may be able to correct nearsightedness. Approximately 10 sessions followed by daily eye exercises are needed to see significant and prolonged results.

Allopathic treatment

People with myopia have three main options for treatment: eyeglasses, contact lenses, and for those who meet certain criteria, refractive eye surgery.

Eyeglasses

Eyeglasses are the most common method used to correct myopia. Concave glass or plastic lenses are placed in frames in front of the eyes. The lenses diverge the light rays so they focus further back, directly upon the retina, producing clear distance vision.

Contact lenses

Contact lenses are a second option for treatment. Contact lenses are extremely thin round discs of plastic that are worn on the eye in front of the cornea. Contact lenses offer several benefits over glasses, including: better vision, less distortion, clear peripheral vision, and cosmetic appeal. In addition, contacts don't steam up from changes in temperature or perspiration.

Refractive eye surgery

Recommended for people who find glasses and contact lenses inconvenient and uncomfortable, refractive eye surgery improves myopic vision by permanently changing the shape of the cornea so light rays focus properly on the retina. These procedures are performed on an outpatient basis and generally take 10-30 minutes. There are three types of corrective surgeries available as of 1998: (1) radial keratotomy, (2) photorefractive keratectomy, and (3) laser-assisted in-situ keratomileusis (LASIK), which is still under clinical evaluation by the Food and Drug Administration (FDA).

Radial keratotomy

Radial keratotomy (RK), the first of these procedures made available, is considered the riskiest. The surgeon uses a delicate diamond-tipped blade, a microscope, and microscopic instruments to make several spoke-like, "radial" incisions in the non-viewing (peripheral) portion of the cornea. The slits surgically alter the curve of the cornea, making it flatter, which may improve the focus of images onto the retina.

Photorefractive keratectomy

Photorefractive keratectomy (PRK) involves the use of a computer to measure the shape of the cornea. Using these measurements, the surgeon applies a computer-controlled laser to make modifications to the cornea. The PRK procedure flattens the cornea by vaporizing small amounts of tissue from the cornea's surface. Photorefractive keratectomy can be used to treat mild to moderate forms of myopia. The cost is approximately $2,000 per eye.

Laser-assisted in-situ keratomileusis

Laser-assisted in-situ keratomileusis (LASIK) is the newest of these procedures and, as of early 1998, was still under clinical investigation. It is recommended for moderate to severe cases of myopia. A variation on the PRK method, LASIK uses lasers and a cutting tool called a microkeratome to form a circular flap on the cornea. The flap is flipped back to expose the inner layers of the cornea. The cornea is treated with a laser to change the shape and focusing properties, then the flap is replaced.

Myopia treatments under research include corneal implants and permanent, surgically placed contact lenses.

Expected results

Glasses and contact lenses can (but not always) bring vision to 20/20. Refractive surgery can make permanent improvements for the right myopic candidate. Alternative treatments have not been widely studied.

Prevention

Myopia is generally considered a hereditary condition, which means that it runs in families. From this perspective there is nothing that can be done to prevent this disorder. However, because the percentage of people with myopia in the United States has steadily increased over the last 50 years, some believe that the condition results from a combination of genetic and environmental factors. If this is true, then it may be possible to prevent or control myopia by reducing close work, reading and working in good light, maintaining good nutrition, and practicing visual therapy (when recommended).

Eye strain can be prevented by using sufficient light for reading and close work, and by wearing corrective lenses as prescribed. Everyone should have regular eye exams to see if the prescription has changed or if any other problems have developed. This is particularly important for people with high (degenerative) myopia who may be at a greater risk of developing retinal detachments or other problems.

Key Terms

Accommodation
The ability of the lens to change its focus from distant to near objects. It is achieved through the action of the ciliary muscles that change the shape of the lens.
Cornea
The outer, transparent tissue that covers the front of the eye. The cornea is part of the eye's focusing system.
Diopter (D)
A unit of measure for describing refractive power.
Laser-assisted in-situ keratomileusis (LASIK)
A procedure that uses a cutting tool and a laser to modify the cornea and correct moderate to high levels of myopia. As of early 1998, the eximer laser is not approved by the FDA for this use.
Lens
The transparent, elastic, curved structure behind the iris (colored part of the eye) that helps focus light on the retina.
Ophthalmologist
A medical doctor (M.D or D.O.) who specializes in the diagnosis and medical and surgical treatment of eye diseases and disorders.
Optic nerve
A bundle of nerve fibers that carries visual messages in the form of electrical signals to the brain.
Optometrist
A doctor of optometry (O.D.) is trained and licensed to examine and test the eyes for disease and to treat visual disorders by prescribing corrective lenses and/or vision therapy. In many states, optometrists are licensed to use diagnostic and therapeutic drugs, and if so, they can treat certain ocular diseases.
Orthokeratology
A method of reshaping the cornea using a contact lenses. It is not considered a permanent method to reduce myopia.
Peripheral vision
The ability to see objects and movement to the side, outside of the direct line of vision.

Photorefractive keratectomy (PRK)
A procedure that uses a laser to make modifications to the cornea and permanently correct myopia. As of early 1998, only two lasers have been approved by the FDA for this purpose.
Radial keratotomy (RK)
A surgical procedure involving the use of a diamond-tipped blade to make several spoke-like slits in the peripheral (non-viewing) portion of the cornea to improve the focus of the eye and correct myopia by flattening the cornea.
Refraction
The bending of light rays as they pass from one medium through another. Used to describe the action of the cornea and lens on light rays as they enter they eye. Also used to describe the determination and measurement of the eye's focusing system by an optometrist or ophthalmologist.
Refractive eye surgery
A general term for surgical procedures that can improve or correct refractive errors by permanently changing the shape of the cornea.
Retina
The light-sensitive membrane that lines the back of the eye. The retinal cells process and send visual signals to the brain through the optic nerve.
Visual acuity
The ability to distinguish details and shapes of objects.

Further Reading

For Your Information

Books

  • Birnbaum, Martin H. Optometric Management of Nearpoint Vision Disorders. Boston: Butterworth-Heinemann, 1993.
  • Curtin, Brian J. The Myopias: Basic Science and Clinical Management. Philadelphia: Harper & Row, 1985.
  • Rosanes-Berrett, Marilyn B. Do You Really Need Eyeglasses? Barrytown, NY: Station Hill Press, 1990.
  • The Burton Goldberg Group. "Vision Disorders." Alternative Medicine: The Definitive Guide. Tiburon, CA: Future Medicine Publishing, Inc., 1999.
  • "Vision Disorders." Reader's Digest Guide to Medical Cures & Treatments. Canada: The Reader's Digest Association, Inc., 1996.
  • Zinn, Walter J., and Herbert Solomon. Complete Guide to Eyecare, Eyeglasses, and Contact Lenses. Hollywood, FL: Lifetime Books, 1996.

Periodicals

  • Carey, Benedict. "Goodbye Glasses: New Surgery Can Deliver Sharp Vision to the Nearsighted-Without a Single Cut of the Scalpel (Photorefractive Keratotomy)." Health 10 (September 1996): 46.
  • "Catching Your Eye (Photorefractive Keratotomy Evaluation.)" People's Medical Society Newsletter 15 (August 1996): 6.
  • "Insight on Eyesight: Seven Vision Myths: Blind Spots About Vision Can Cause Needless Worry, Wasted Effort, and Unnecessary Treatment." Consumer Reports on Health 9 (April 1997): 42.
  • "9 Ways to Look Better: If You Want to Improve Your Vision--Or Just Protect What You Have--Try These Eye Opening Moves." Men's Health 13 (Jan.-Feb. 1998): 50.
  • Schwartz, Leslie. "Visionquest (Use of Lasers in Treatment of Nearsightedness or Myopia)." Shape 16 (March 1997): 28.

Organizations

  • American Academy of Ophthalmology. P.O. Box 7424, San Francisco, CA 94120-7424. (415) 561-8500. http://www.eyenet.org.
  • American Optometric Association. 243 N. Lindbergh Blvd., St. Louis, MO 63141. (314) 991-4100. http://www.aoanet.org.
  • Myopia International Research Foundation. 1265 Broadway, Room 608, New York, NY 10001. (212) 684-2777.
  • National Eye Institute. NIH Bldg. 31, 9000 Rockville Pike, Bethesda, MD 20892. (301) 496-5248. http://www.nei.nih.gov.

Gale Encyclopedia of Alternative Medicine. Gale Group, 2001.

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