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Myopia Treatment

Warsaw · Krakow · Vienna · Zurich

Myopia (nearsightedness) causes distant objects to appear blurry, requiring squinting or glasses for daily activities. The higher the refractive error, the more difficult it is to see clearly, even at short distances.
Modern correction methods effectively restore visual acuity and the comfort of an unrestricted life.

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Myopia is one of the most common vision defects.

It is estimated that 1.6 billion people worldwide live with myopia – by 2020, this number will reach 2.5 billion.

What is Myopia (Nearsightedness)?

Myopia (nearsightedness) is a refractive error where parallel light rays entering the eye focus in front of the retina, rather than directly on it. A myopic person sees distant objects unclearly and constantly squints to sharpen the image. The higher the myopia, the shorter the distance from which objects can be seen clearly. With very low myopia (-1/-2 diopters), wearing corrective lenses or glasses is not always necessary. However, when the refractive error is higher, even reading text from a standard distance becomes difficult – letters in a book or newspaper blur, and it must be brought very close to the eyes.

Depending on its severity, it is divided into:

  • low – also called school myopia, up to -3 D,
  • moderate – between -3D and -6 D (according to some sources, between -3D and -8D)
  • high – above -6 D (according to some sources, above -8D)

Why should myopia not be underestimated?

Until recently, it was believed that with low myopia, it was better not to wear glasses so that the “eye wouldn’t get lazy and would work.” Today, this view is considered incorrect – uncorrected myopia also presents symptoms other than blurry distant vision (which is bothersome enough on its own), such as frontal headaches and dizziness, a sense of disorientation in space, and poorer vision at dusk and night. Constant rubbing and squinting of the eyes can also cause tearing, burning, and even conjunctivitis. The modern approach to myopia treatment recommends full correction of the refractive error. It has been proven that uncorrected or undercorrected vision (correction with too weak lenses) leads to faster progression of myopia.

How is myopia diagnosed?

After an initial interview, an optometrist or ophthalmologist will perform skiascopy or refractometry.

Skiascopy (retinoscopy) – involves projecting a beam of light onto the fundus of the eye and observing the direction of movement of the red reflex from the fundus within the pupil. Special rulers (strips) or a Hess screen with embedded lenses of various powers are used for the examination. To perform the examination, it is necessary to pharmacologically paralyze the ciliary muscle responsible for the eye’s accommodation.

Refractometry (“computerized eye examination”) – a computer-controlled examination of refractive error, which uses the principle of skiascopy. After the examination, a printout is obtained with the value of spherical error (myopia) and/or astigmatism.

Causes of Myopia

In the vast majority of cases, myopia is associated with an abnormal structure of the eye. We distinguish the following types of myopia:

  • Axial – caused by an excessively long eyeball and increases with its elongation and stretching at the posterior pole of the sclera, choroid, and retina. After birth, every child’s eyes exhibit so-called physiological hyperopia (the light beam focuses behind the retina), which gradually decreases as the eyeball elongates, eventually achieving emmetropia (normal vision). Sometimes, the process of eyeball elongation continues, leading to myopia.
  • Lenticular (curvature) – caused by excessive sphericity (convexity) of the lens, its swelling, or a change in its refractive power
  • Corneal – results from excessive corneal curvature

How does axial myopia develop?

Axial myopia is the most common type in the population, gradually increasing until the eye’s growth is complete (i.e., around 21 years of age). Accelerated growth occurs during adolescence, then slows down. Typically, the refractive error increases by 0.5 D to 1 D per year.

Types of Myopia: School and Refractive

In medical terminology, there are two additional terms: school myopia and refractive myopia. The former refers to low myopia appearing between the ages of 10-12 and potentially increasing due to continuous accommodative strain and prolonged close-up visual work – when a child reads too much, studies, or looks at a TV, smartphone, or computer screen. Refractive myopia, on the other hand, is not directly related to the anatomy of the eye but to the refractive index of the lens – the lens refracts incoming rays too strongly. Refractive myopia can be a result of developing diabetes or cataracts.

Eye Exercises for Myopic Individuals

High myopia, most often genetically determined, can cause degenerative changes in the eye, which is why patients should remain under constant ophthalmological supervision from the moment of diagnosis. Initially, when dealing with low myopia, the doctor may recommend various exercises and lifestyle changes. These include:

  • Frequent outdoor activity – research indicates that 2-3 hours of outdoor activity daily contribute to slowing the progression of myopia. This is most likely related to a reduced need for accommodation, pupil constriction in brighter light (better depth of field), and the direct effect of light exposure (release of retinal dopamine, known as an inhibitor of eyeball growth under certain conditions). The type of activity is not as important as the fact that it takes place in daylight.
  • Adherence to visual hygiene principles: reading in a seated position, holding text at an appropriate distance, good lighting at the workstation, and taking breaks during prolonged close-up work.
  • Repeating accommodation-relaxing exercises several times a day, such as loosely gazing at a distant object for several minutes.

Myopia and Astigmatism

Myopia can be accompanied by astigmatism, a refractive error where the eye’s optical system is unable to properly focus light rays on the retina. Parallel light rays refract in two different planes (e.g., vertical and horizontal), resulting in blurry images, distortion, waviness, and poor contrast. In cases where both defects occur together, spherocylindrical spectacle lenses or toric contact lenses are used.

Methods of Myopia Correction

  • Glasses and soft contact lenses: Myopic individuals require concave, diverging lenses, or “minus” lenses. Glasses should be adequately chosen for the refractive error – undercorrection is not recommended. An optometrist or ophthalmologist selects lenses with the lowest possible power that allow the patient to see optimally. Soft contact lenses better correct moderate to high refractive errors – they do not distort the field of vision (with glasses, one sees clearly only straight ahead) and do not reduce the size of objects, making activities like driving easier. There are scientific reports that the use of soft contact lenses in children slows down or inhibits the progression of myopia. It is believed that the pressure of the lens on the outer layers of the cornea causes its flattening. Furthermore, contact lenses reduce accommodation and slightly decrease intraocular pressure, which is one of the factors influencing the increase in eyeball length.
  • Orthokeratology/Orthocorrection: involves correcting myopia using rigid gas-permeable lenses with an inverted geometry, worn overnight. During this time, the lenses reshape (flatten) the anterior surface of the cornea, allowing for clear vision during the day without glasses. The orthocorrection method can be used for myopia ranging from 1D to 5D.
  • Laser methods: For individuals with stable refractive error, laser surgery can be performed. During myopia treatment with an ophthalmic laser, the central part of the cornea is flattened to reduce its refractive power.

Lasers

Laser Vision Correction Procedures

LASEK/PRK

The procedure involves lifting (LASEK) or removing (PRK) the upper cellular layer of the cornea (epithelium), and then appropriately reshaping the underlying corneal tissue using an excimer laser. The goal of the procedure is to precisely reshape the central corneal surface with the laser beam so that it focuses the image accurately onto the retina.

LASIK

Two-stage technique: the cornea is incised with a scalpel (microkeratome), and then the corneal surface is reshaped so that it can properly focus the image onto the retina.

Femto-LASIK

Using a precise femtosecond laser, the surgeon makes an incision in the cornea, creating a thin flap 0.1 mm thick. An excimer laser is then used to reshape the exposed cornea for a few seconds, after which the flap is repositioned; it adheres and forms a protective barrier for the cornea.

Trans-PRK smart surFace

The least invasive method of laser myopia treatment. Diopter correction occurs in the first stage of the procedure, during which the surgeon uses a high-precision excimer laser. PRK was once the standard method for laser eye treatment, but LASIK replaced it due to less pain. However, the LASIK technique failed in patients whose corneas were too thin or irregular. Modern Trans-PRK capabilities have optimized the procedure at its most critical point.