Myopia: Not Just a Refractive Error

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Written by Optometrist Megan Lafferty, contact us to book an appointment with Megan.

Myopia, commonly known as nearsightedness, is a widespread refractive error that affects over 1 billion people worldwide1. While many individuals consider myopia a mere inconvenience2 to be corrected by glasses, contact lenses or LASIK surgery, it is crucial to understand that myopia is more than just a vision issue. Projections show that by the year 2050 nearly 5 billion people will have myopia1 (around 50% of the world’s population) with the highest rates being in East Asia. Recent research has shed light on the potential risks and complications associated with high myopia, emphasising the importance of proactive measures and regular eye care.

The Basics of Myopia

Myopia occurs when the eyeball is too long or the cornea (the clear window at the front of the eye) is too curved resulting in blurred distance vision while near vision remains clear. While glasses or contact lenses can usually correct this refractive error, it’s essential to recognise the potential consequences to eye health of leaving myopia unaddressed or allowing it to progress.

Progressive Myopia and Its Risks3,4

One significant concern associated with myopia is its potential to progress over time. Progressive myopia is when nearsightedness worsens with age due to the elongation of the eyeball5. It is well documented that as the eyeball elongates, the risk of developing sight-threatening conditions greatly increases6 and the term Pathological Myopia is now widely used to signify these complications which are now a major cause of irreversible vision loss and blindness7, especially in Singapore and East Asia2,8.

Retinal Detachment

One of the most serious complications of high myopia is retinal detachment. The stretched and elongated eyeball can lead to the thinning of the retina, making it more prone to tearing or detaching. Retinal detachment requires immediate medical attention and can result in permanent vision loss if not addressed promptly. The risk of developing retinal detachment is 5-6 times higher in people with high myopia compared to those with low myopia4.

Glaucoma

High myopia also increases the risk of developing glaucoma by nearly 50%4. If left untreated, glaucoma can cause irreversible damage to the optic nerve and result in vision loss. One local study by Singapore Eye Research Institute (SERI) and Singapore National Eye Centre (SNEC) found that Chinese Singaporeans with moderate myopia (3.00-6.00D) were 5 times more likely to develop glaucoma than those without and Chinese with severe myopia (> 6.00D) were 15 times more likely to develop glaucoma9.

Cataracts

Myopia has been associated with an earlier onset of cataracts, a clouding of the eye’s natural lens. While cataracts are a common age-related condition, individuals with high myopia may experience cataract development at a younger age, potentially requiring surgical intervention earlier.

Macular Degeneration

The risk of macular degeneration rises sharply with age and increasing myopia4 which can lead to a complete loss of central vision. There is currently no treatment for the atrophic form of macular degeneration. One report showed Singapore has one of the highest rates of Myopia Macular Degeneration worldwide at 3.8% of the population with the highest rates being in Chinese patients10.

Economic & Social Burden

Not only does myopia have potential pathological side effects which can be detrimental to eye health and vision, but it can also cause financial and social issues for some people. If uncorrected, myopia can lead to poor academic performance in children as well as affecting their quality of life and psychological well being11. With pathological myopia there is a higher chance of vision loss which has also been linked to lower quality of life scores and higher odds of depression12.
Spectacles, contact lenses, and especially LASIK treatments are not cheap and some families may struggle to keep up with the cost demands to provide adequate visual correction for myopia. This can pose a great financial burden on parents, in particular those with children who have highly progressive myopia where the degree frequently increases and requires change.
As the global prevalence of myopia increases, the levels of pathology associated with myopia are also likely to increase leading to higher demand for optical services and treatment. One study showed the current estimated annual economic burden of myopia to be SGD$959 million in Singapore and if costs were similarly extrapolated across populations this could reach SGD$417 billion in urban Asia13.

Myopia In Singapore

It is important that the potential dangers of this condition are understood, especially here in Singapore as the rates of childhood myopia (which has a higher likelihood of progression into pathological myopia14) are amongst the highest in the world with 65% of our children being myopic by Primary 6 and 83% by young adulthood15.

Conclusion

Myopia is not just a refractive error; many now label it as a disease due to its potential risks that can impact the long-term health of the eyes and vision16. Even if the degree of refractive error is well corrected with glasses, contact lenses or LASIK surgery, the physiological changes that occur to the eyeball with increasing degrees of myopia are irreversible. The risks of developing potentially sight threatening conditions increases greatly, even with low levels of myopia17 therefore recognizing the importance of regular eye care, early intervention, and myopia management strategies is essential for minimising the associated complications. By taking proactive measures, individuals with myopia or myopic children can safeguard their vision and reduce the risk of serious eye conditions in the future and potentially change the lives of their children for the better.
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References:

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