Myopia, or short-sightedness, can mean much more than just a pair of glasses – unstable vision, eye diseases and even vision impairment. For James (not his real name), the past four decades have brought numerous ongoing eye problems associated with his myopia. These could have been lessened if there was the knowledge and professional care available in his childhood, compared to the highest expert standards accessible to the children of today.
James took up usual childhood habits of reading in the dark and sitting too close to the television, not listening to his parents’ caution otherwise. As a child, James was diagnosed with myopia – his eyesight faltered as his eyes grew at an accelerated rate, faster than the typical rate in childhood, leading to blurred vision.(1) By six years of age, James was holding his books only a few centimetres from his face to try and see clearly.
James is now in his late 40s. When he was a child, the knowledge and treatment options to properly manage childhood myopia did not exist, as they do now. Without the expert standard of care available to today’s children with myopia, James’ journey with myopia quickly became a story of continuously worsening vision which has developed into numerous eye health problems and impaired vision in his adulthood.
“My myopia progressively increased, and I changed spectacles on at least a yearly basis,” recounted James. “This was done at a neighbourhood optical shop. Each time my vision got worse, I could usually see better with the spectacles that were prescribed, but within a few months my vision had started worsening again.”
This constantly changing vision led to many issues – myopia can progress more quickly when spectacles do not properly correct vision.(2) By the time James was 19, his prescription had worsened to -12.00D (or in layman terms, 1200 degrees). Three years later, it had deteriorated again to -15.50D. Then came the “major disaster”, as James recalls.
Wearing very thick glasses was difficult for James, as they were uncomfortable and hindered his daily tasks. As a young adult, James had hoped to do away with glasses by undergoing LASIK surgery. It was a decision which brought horrendous, unintended consequences.
LASIK, or laser-assisted in situ keratomileusis, is a laser eye procedure undertaken by an eye surgeon which removes tissue from the front surface of the eye, the cornea. While LASIK can correct the vision problems of myopia, it does not correct the excessive length of the eyeball. It is this excessively long, stretched eyeball shape which leads to the major eye health and vision consequences of myopia.(3)
James emerged from the surgery with a poor result, due to his very high myopia. He had “very cloudy, distorted vision” instead of the clear vision he had hoped for. “I was told later that the reason for the problem was that my cornea was not thick enough, for so much tissue to be removed, to correct all of my myopia,” he explained.
With this shortfall in his vision correction, James was fitted with rigid gas permeable contact lenses, in a bid to correct the distortion, but the clouding still affected his vision significantly. To manage clouding on the surface of his eye, not fully corrected by the contact lenses, James was prescribed steroid eye drops.
Then things took another turn for the worse. Using the steroid eye drops led to development of early cataracts. Cataract is a clouding which occurs within the focussing lens of the eye, which can only be corrected with surgery.
A few years later, James then developed glaucoma, a disease of the optic nerve at the back of the eye where the pressure within the eye increases, impacting peripheral vision. James also suffered a haemorrhage in his retina. The risk of both glaucoma and retinal issues is another eye health problem which occurs more frequently with higher myopia.(4)
“These haemorrhages led to scar tissues which affected my vision even more. Three years later, I developed macular degeneration,” he added. “I eventually had my cataracts removed which helped my vision very slightly, but all the other complications prevented me from seeing well.”
Cataracts, glaucoma, retinal damage and macular degeneration all sound like eye conditions that occur in elderly people. James suffered each of these conditions in his early and middle adulthood – the risk of these eye diseases escalates, and can occur at much younger ages, with higher levels of myopia.(4)
As James has sought help from professional eye care experts in his adulthood, he has discovered that the technological and knowledge advancements in myopia management could have reduced his risk of all these eye diseases,(4,5) had they been available in his childhood. Today, James is a strong advocate for early, regular and comprehensive eye examinations for children and adults.
He uses his struggle with myopia and its associated eye diseases as a precautionary lesson for his friends and colleagues. He discusses the importance of regular eye examinations for children, taking steps to reduce myopia risk, and seeking expert eye care.
“I want to encourage them to ensure that none of their children will go through what I have been through,” he said.
1. Mutti DO, Hayes JR, Mitchell GL, Jones LA, Moeschberger ML, Cotter SA, Kleinstein RN, Manny RE, Twelker JD, Zadnik K; CLEERE Study Group. Refractive error, axial length, and relative peripheral refractive error before and after the onset of myopia. Invest Ophthalmol Vis Sci. 2007 Jun;48(6):2510-9.
2. Logan NS, Wolffsohn JS. Role of un-correction, under-correction and over-correction of myopia as a strategy for slowing myopic progression. Clin Exp Optom. 2020 Mar;103(2):133-137.Tideman JW, Snabel MC, Tedja MS, van Rijn GA, Wong KT, Kuijpers RW, Vingerling JR, Hofman A, Buitendijk GH, Keunen JE, Boon CJ, Geerards AJ, Luyten GP, Verhoeven VJ, Klaver CC. Association of Axial Length With Risk of Uncorrectable Visual Impairment for Europeans With Myopia. JAMA Ophthalmol. 2016 Dec 1;134(12):1355-1363.
3. Tideman JW, Snabel MC, Tedja MS, van Rijn GA, Wong KT, Kuijpers RW, Vingerling JR, Hofman A, Buitendijk GH, Keunen JE, Boon CJ, Geerards AJ, Luyten GP, Verhoeven VJ, Klaver CC. Association of Axial Length With Risk of Uncorrectable Visual Impairment for Europeans With Myopia. JAMA Ophthalmol. 2016 Dec 1;134(12):1355-1363.
4. Flitcroft DI. The complex interactions of retinal, optical and environmental factors in myopia aetiology. Prog Retin Eye Res. 2012 Nov;31(6):622-60.
5. Jonas JB, Ang M, Cho P, Guggenheim JA, He MG, Jong M, Logan NS, Liu M, Morgan I, Ohno-Matsui K, Pärssinen O, Resnikoff S, Sankaridurg P, Saw SM, Smith EL 3rd, Tan DTH, Walline JJ, Wildsoet CF, Wu PC, Zhu X, Wolffsohn JS. IMI Prevention of Myopia and Its Progression. Invest Ophthalmol Vis Sci. 2021 Apr 28;62(5):6.