Myopia - ugh.
April 24, 2019 8:46 AM   Subscribe

The Impact of Myopia and High Myopia. (PDF) A WHO report. "The prevalence of myopia and high myopia are increasing globally at an alarming rate, with significant increases in the risks for vision impairment from pathologic conditions associated with high myopia, including retinal damage, cataract and glaucoma. The impact of myopia is difficult to determine, because there are no standard definitions of myopia and high myopia, and recognition that myopia can lead to vision impairment is limited by the absence of a defined category of myopic retinal disease that causes permanent vision impairment. A further impediment to progress in this area is insufficient evidence of the efficacy of various methods for controlling myopia."
posted by storybored (48 comments total) 23 users marked this as a favorite
 
The rate of increase in Myopia is shocking, 2050 forcast of 52% of adults worldwide. (charts pgs 5 and 6).
posted by Dr Ew at 8:59 AM on April 24 [1 favorite]


I never knew I had high myopia. I guess in comparing with other glasses wearers -6.75 & -6.50 didn't seem that bad. Although that may be more with people online . . . in person I'm usually the one with the worst prescription.
posted by carrioncomfort at 9:07 AM on April 24 [2 favorites]


What's really shocking is that like 80+% of all Chinese kids and teens are myopic right now.
posted by seanmpuckett at 9:12 AM on April 24 [1 favorite]


Keep flexing that neck downwards and eyes gazing into the screen abyss.
posted by Burhanistan at 9:14 AM on April 24 [2 favorites]


Back in the early 1970s I was part of a study using atropine drops to see if they would slow or halt progression of myopia. Interesting to see that this approach is now seen as one of the most effective. I hadn't ever heard of definite results from that or other similar studies since I participated in the study back in grade school.

If I recall, we used 1% atropine and I can testify that is a giant pain in the #$@. It keeps your eyes dilated wide all the time, and going out into bright sunlight was downright painful, even with sunglasses etc.

Interesting to see that 0.1% atropine seems more widely used now--I can see why.
posted by flug at 9:28 AM on April 24 [5 favorites]


This overview article has an interesting take on the causes of ever-increasing myopia:
Myopia is an adaption of modernity. There is no argument that the prevalence of nearsightedness is much higher today than it was even 30 years ago. The rapid increase in prevalence alone answers the nature vs. nurture question. Myopia genes didn’t suddenly come out of hiding and start turning half the population into myopes. But don’t myopic parents have myopic children? Not exactly. Myopic parents have children who are more susceptible to becoming myopic.

It’s a predisposition, not a destiny.

That leaves the environment as the culprit. But, there remains a heck of a lot of potential factors. Is it the light? Is it the near work? Is it the exercise? Is it the diet? Is it retinal defocus? Yes, no, and maybe. . .

Single Vision Distance Rx is [t]he “gold standard.”

Also, probably the worst “control” strategy. Progression of children with full time correction is greater than those who were not corrected at all.
So, perhaps (?) the greatest single cause of increased nearsightedness is that fact that worldwide as time moves forward, we are putting more (single-focus) glasses on kids earlier in their lives to correct their vision.

Most interesting simple takeaway from all this is the giving kids "executive bifocal" lenses instead of single-focus lenses may make a major positive difference. "Executive bifocal" lenses (photo) are the half-and-half near/far lenses like the kind Benjamin Franklin invented.
posted by flug at 9:34 AM on April 24 [6 favorites]


There was a lot of discussion of time spent outdoors as part of the causes section, but does outdoors just mean focusing on things farther away? Like could time spent playing basketball or whatever in a gym have the same effects?
posted by Wretch729 at 9:36 AM on April 24


Get your kids outside, focusing their eyes on things farther away than arm length, folks.
posted by Bee'sWing at 9:39 AM on April 24 [2 favorites]


From the pdf section 8.2 Time spent outdoors and behavioral influences:
The total time spent outdoors appeared to be the important factor, rather than time playing sports, because time spent indoors playing sports was not beneficial. Thus, the nature of the outdoor actives does not seem to be critical.
Reminded me of this previous FPP regarding the rise of short-sightedness and the connection to outdoor light exposure.
posted by zinon at 9:40 AM on April 24 [5 favorites]


Guess we should have seen that coming.
posted by biogeo at 9:46 AM on April 24 [25 favorites]


How much of this is better reporting bias?
posted by Ironmouth at 9:49 AM on April 24 [4 favorites]


> short-sightedness and the connection to outdoor light exposure

There are a lot of reasons outdoor light exposure could be important and possibly several factors that could contribute.

But by far the single most obvious and likely explanation is the very, very large difference in light levels between indoor and outdoor light.

Check out these example lux levels:
  • 111,000 lux - Bright outdoor sunlight
  • 20,000 lux - Shade on a cloudless day
  • 1,000 - 2,000 lux - Typical overcast day
  • 320-500 lux - typical office lighting
  • 80 lux - office building hallway/toilet lighting
  • 50 lux - family living room lighting
Sources: 1, 2

So . . . being outside in the shade has 400X the light intensity of a typical home interior.

Typical office light intensity is 1/4 that of a typical overcast day, 1/40 that of outdoor shade, and 1/200 that of bright outdoor sunlight.

FYI something like an indoor gym or rec center is going to be more towards the low end of the lux range--maybe 100-200 lux at best.

We don't consciously notice this rather amazingly large range of variation in brightness, because our eyes are able to adjust to the large differences.

But . . . that is rather the point. Large differences in light intensity affect our eyes in a rather dramatic way. It's not too surprising this may have significant long-term effects.
posted by flug at 9:59 AM on April 24 [14 favorites]


Hmm - I wonder what would happen if they gave children glasses to use only for tasks that require extended periods of elbow-to-arms-length viewing? To take off during other parts of their lives that involve continually focusing on things near to far away?
posted by King Sky Prawn at 10:09 AM on April 24


So what this tells me, as someone who made very high grades in myopia class, is that there will be more kids hearing, "Stop reading so much, it's bad for your eyes! Get out there and play!" And no doubt that is best, but it gives me a sympathetic shudder. I don't think my mother would have had the heart to tell me to do such a thing. Tell a child not to read as much as they want? What are they saving their eyes for? (I know, I know. Myopia != intelligence or high reading levels. It's just a thought.)

When I worked in my college archives, I filed away a number of records for students who had attended between 1890 and 1910. I took the chance to read the ones that had extensive notes. I noticed that young women might ease up on studies or leave the school entirely due to "eyestrain." At the time I thought this was benevolent medical sexism, a failure to treat (or to encourage perseverance) that young men would not have encountered. But possibly that was the standard of care at the time.

Is there anything on God's green earth we haven't fucked into oblivion?


I won't go so far as to call myopia an adaptation, but it's been with us, and it has its uses. You can see enormously fine work on small scales (such as coins or stone scarabs) made during antiquity, before the development of magnifying lenses. There's a strong argument that only myopic craftsmen could have made such things. Like white skin, myopia mostly makes you fragile and inconvenient, but if it didn't have a use of some kind, it would kill us outright.
posted by Countess Elena at 10:25 AM on April 24 [16 favorites]


Get your kids outside, focusing their eyes on things farther away than arm length, folks.

Eh, I honestly can't say that I at all regret spending my childhood reading a lot of books. Glasses seem like a fair trade.
posted by ubersturm at 10:31 AM on April 24 [16 favorites]


It ain't a zero-sum thing so we probably don't even need to take positions there.
posted by Burhanistan at 10:33 AM on April 24 [3 favorites]


Datapoint of one, but I spent most of my childhood outside and am extremely myopic. Eyes are otherwise quite healthy.
posted by aspersioncast at 10:37 AM on April 24 [4 favorites]


If I had known this before I spent much of my childhood indoors reading, rather than outside in Missouri's miserably hot and humid summers... I'm not sure I'd have done anything differently. Maybe developed a system of holding the books farther away somehow, and brighter lights.

Now I spend most of my day staring at the computer... other than giving up my current job / career and going into doing... some kind of outdoor manual labor, I'm really not sure how to fix the problem.
posted by jzb at 10:37 AM on April 24


Tiny brain: normal vision

Human brain: myopia

Galaxy brain: myopia AND presbyopia.
posted by GCU Sweet and Full of Grace at 10:57 AM on April 24 [4 favorites]


My gut say that the “being outdoors” thing has a lot to do with the manner in which you use your eyes outdoors. When you’re outdoors, you’re more apt to be using your eyes fully, moving your focus constantly from long distance to short distance, to mid distance, over and over., exercising them. Your eyes aren’t locked on a fixed or restricted distance the way they would be indoors, and especially at a screen.
posted by Thorzdad at 11:18 AM on April 24 [5 favorites]


I'm pretty suspicious of the "screens are causing myopia" theory, absent more evidence. It's a little too just-so for my taste. It reminds me of the stuff about TVs causing cancer or video games causing ADHD—every generation needs its technological bogeyman to blame health problems on. And while sometimes technology does have serious negative side-effects, in many cases it's a big correlation/causation error. (My grandmother thought that TVs caused cancer, probably because we got good at diagnosing cancer and people started living long enough to die of cancer at about the same time as TVs proliferated. But nothing was gonna convince her that it wasn't the TVs.)

There is at least a potential causative path as a result of earlier diagnosis of myopia leading to more severe myopia later in life. Earlier diagnosis leads to prescription lenses earlier, which seems to cause faster progression of myopia, with the result of more adults with severe/high myopia.

You would expect to see that effect the most strongly in countries that have rapidly industrialized and where you're going from a parental generation of no correction at all (well, other than squinting—the solution 10 out of 10 insurance companies prefer!), to children who are getting 100% vision exams and corrective lenses at young ages. That seems likely to be what's going on in China.

I've seen lots of very young kids—infants, in some cases—with glasses, which is not something I remember seeing when I was a kid. The earliest I knew people to get glasses was sometime in early elementary school, and even that was fairly rare; most glasses-wearing people I know got them sometime in middle school, generally when a teacher caught them squinting to see the chalkboard. That's probably not the best way to catch nascent vision problems, but it does have the benefit of delaying corrective lenses, which seems to lead to less-severe myopia as an adult.

Whether the tradeoff of being able to see more clearly as a young child, in return for potentially having a heftier prescription later on in life, is a good one or not, probably needs to be examined. I'm not sure what the right decision is there—not being able to see well in elementary school probably has some long-term negative educational effects, but it also means you're less of a candidate for surgical correction once your eyes stabilize, and even modern high-index glasses tend to get a bit obnoxiously thick beyond +/- 6 or 7, so it's not a totally cost-free trade.
posted by Kadin2048 at 11:30 AM on April 24 [7 favorites]


Single datapoint: I'm slightly myopic. I started having to wear glasses to drive in my late 20s. Then I spent over a year with no screentime and largely outdoors. My vision improved significantly. Now that I'm back doing computer-focused work...my myopia has come back to where it was before. :/
posted by ananci at 11:31 AM on April 24 [2 favorites]


We did spend thousands of years evolving to look at things further than 2ft away.
posted by Damienmce at 11:35 AM on April 24


I guess in comparing with other glasses wearers -6.75 & -6.50 didn't seem that bad. Although that may be more with people online . . . in person I'm usually the one with the worst prescription.

fwiw, my -7.5 and -6.75 fits right in there with you
posted by hugbucket at 12:01 PM on April 24 [2 favorites]


I wonder what would happen if they gave children glasses to use only for tasks that require extended periods of elbow-to-arms-length viewing? To take off during other parts of their lives that involve continually focusing on things near to far away?

Data point of one: I received glasses in 2nd grade so I could see the board in class and other distant things. I maybe spent a few days swapping on and off. And then they stayed on for good. It'd be a hard thing to get kids to do even if you could get solid adult support.
posted by carrioncomfort at 12:06 PM on April 24 [4 favorites]


I'll second that data point, same grade.
posted by hugbucket at 12:11 PM on April 24


carrioncomfort - to be clear, I am suggesting giving glasses to normal sighted children before they develop myopia, to prevent myopia from happening. The focus should be such that the child's focusing muscles are relaxed during viewing of close objects.
posted by King Sky Prawn at 12:37 PM on April 24


Here's my hot take. Our genes don't code for eyes that focus near-to-infinity. They code for eyes that configure themselves to focus based on what you look at as a child. Optics are HARD, you know? It would make a lot more sense for a biological eye capsule to simply be able to configure itself in size during "boot-up" to match the optical equation of the lens, retina and intra-ocular fluid. Right? Because something in this system has to be changeable, and aside from the lens, which is a short-term accommodation system with limited focusing ability, the eye capsule can configure itself to a baseline of "most things are in focus."

So if you mostly look at close-up shit when you're a kid, that's what your eye assumes the world is like. It doesn't know from "distance" or "near" it just knows from "in focus" or "not in focus."

This is a systems approach.

Wouldn't want to try to design an ethical study to prove/disprove this though.
posted by seanmpuckett at 12:42 PM on April 24 [2 favorites]


There's a lot of research on myopia, both in human patients (where the goal is detection and treatment) and in animal models (where the goal is understanding how it develops). It's not my corner of vision science, but I've bumped into it a little.

The general idea that seanmpuckett and others have mentioned, that it's influenced by what the organism is looking at in early development, is, to my understanding, basically right. We totally can't do the experiments in humans, but they have been done in a variety of animal species (here's Norton, 1999 which has a good review of the research as it was 20 years ago, and here's Schaeffel & Feldkaemper, 2015, reviewing more recent literature and cautioning against trying to map results from animal models to human vision too closely).

A quick glance at these papers says that, yes, early regulation of focal distance is probably a factor: if kids spend all their time looking at nearby objects, that seems to provide a signal that we don't entirely understand that pushes eye growth towards myopia.

There's also some evidence that ambient illumination is a signal, which flug brought up earlier (a quick bit of hunting brought up Norton and Siegwart, 2013). Now, it's pretty easy, all things considered, to do luminance restriction experiments in the lab, but simulating outdoor luminance levels in the lab is hard. I've had to do a little of this for some work I've done on text legibility, and just getting 5000 lux a meter and a half from the illuminator was fun (and made vastly easier by the availability of big LED light panels, which means you can have an environment that's bright but not boiling hot), but 50,000 or 100,000 lux? Even in a really small space? That's a challenge. I have no idea if anyone is doing this work for myopia research at the moment, but it would be interesting.

My best guess is that the rise in myopia diagnoses we're seeing is a combination of a whole host of factors: increased early focusing on near objects, increased time indoors, better diagnosis and earlier diagnosis. It's certainly something to be concerned about, but at the same time, the best thing we can do for kids' developing visual systems is to make sure they get a wide variety of input, since that's important for visual development broadly (not just for avoiding myopia). Having that input include quite a bit of time outside wouldn't be a bad thing.
posted by Making You Bored For Science at 1:13 PM on April 24 [7 favorites]


I'm pretty suspicious of the "screens are causing myopia" theory, absent more evidence.
Again, datapoint of one, but we didn't even own a tv when I was diagnosed as near-sighted.

We did spend thousands of years evolving to look at things further than 2ft away.
Here in the mid-Atlantic it can't be much further than the bumper of the nearest car, IME.
posted by aspersioncast at 1:35 PM on April 24


I know, I know. Myopia != intelligence or high reading levels. It's just a thought.

From what I've seen of the research there does appear to be a modest positive correlation between degree of nearsightedness and IQ - but the mechanism of the relationship and direction of causation is quite unknown. There are multiple plausible answers going in both directions, directly or indirectly. Just for example, I'm pretty sure untreated farsightedness is well established as a cause of reading delays - but I've also seen people suggest that there could be a genetic or environmental factor that affects both eye shape and brain structure.
posted by atoxyl at 2:06 PM on April 24


Ooh, never knew I was high myopic. I was diagnosed at 5, now 45 years later am -7.50 and -8.0.
posted by andraste at 2:59 PM on April 24


Earlier diagnosis leads to prescription lenses earlier, which seems to cause faster progression of myopia, with the result of more adults with severe/high myopia.

From the linked paper:
Although there is a widely held clinical view that undercorrection of myopia is beneficial in preventing its progression, the available evidence does not support this idea. Recent reports show that undercorrection is associated with a higher rate of progression of myopia.
posted by mosst at 3:03 PM on April 24 [3 favorites]


(As someone who was intentionally under-corrected for several years in late elementary school, it was awful and isolating and please don't do that to your kid. Even if it did help my vision, it was not worth it. Being able to see things is pretty important.)
posted by mosst at 3:06 PM on April 24 [7 favorites]


The little kids with glasses are likely to be premies who are surviving at much much higher and earlier birth rates than ever but with corresponding eye issues.
posted by dorothyisunderwood at 3:11 PM on April 24 [2 favorites]


As another datapoint of one: I was hypermyopic by the time I was a teenager in the early 80s. Did a lot of reading, but also spent a lot of time outside...so it appears to be a wash. I apparently owe my eyes to my father (uh, thanks?). Right now, my vision is such that I can't see clearly more than one or two inches away from my face and am perfectly capable of walking straight into a wall if I have my contact lenses out in an unfamiliar place, like a hotel room. (Bonus: astigmatism!) Bizarrely, my eyes are otherwise in great shape. ("You have such strong eyes!" enthuses my optometrist. "If only I could actually see out of them," I respond.)
posted by thomas j wise at 3:13 PM on April 24 [5 favorites]


Uh. My prescription is -11.25. I'm only 25 years old. Which, like, I knew was bad, but I was sure going in "high myopia" would refer to at least -8, probably more like -10.

My family often jokes that I got both my parents' eyes compounded, because they're both bad, but neither is this bad. I always say it's probably because they kept grounding me from reading and I subsequently read way too many books by moonlight.

I agree with Countess Elena, though. Reading is what my eyes are for. It's probably going to get worse, but what am I supposed to do? Not read? I don't like audiobooks, never have. I guess I could use a Kindle, text blown up to a bajillion, and hold it as far away from my face as possible? Hm. I'll test it out.
posted by brook horse at 4:10 PM on April 24 [2 favorites]


I won't go so far as to call myopia an adaptation, but it's been with us, and it has its uses. You can see enormously fine work on small scales (such as coins or stone scarabs) made during antiquity, before the development of magnifying lenses. There's a strong argument that only myopic craftsmen could have made such things.

I'm overall very happy with having had my vision corrected, but the super sharp near-vision is something I do miss. Reading glasses do not give the same effect.

I was another of those bookish kids who ended up super myopic. I wouldn't want to have given up the reading even if it had meant no glasses, but I have to wonder if more balance (ie, more outdoor time) would have mitigated things.
posted by Dip Flash at 4:22 PM on April 24


Bookish person who first got glasses at 9, screen-reading computer professional adult, vision has gradually crept through the -7 range to -9 according to my eye exam last year. Also spent plenty of time outside and not reading, both as a kid and as an adult.

If we can prevent myopia from developing in kids, theoretically, why can’t we treat it as adults? This article is the first time I’ve ever heard that myopia could be treated, and I’m in my mid-40s (bemoaning my loss of super close vision, now that astigmatism has seemingly made that too difficult).

At any rate, I imagine nearsightedness has been around for the reading population for as long as we’ve had written language. But what are we supposed to do? Not teach kids to read and write until they’re teenagers so that they don’t develop nearsightedness?
posted by Autumnheart at 4:43 PM on April 24




My poor eyesight is something that I've dealt with most of my life. I have the worst eyes in my family, and the most complications from it. I always knew I was at higher risk for stuff like glaucoma, but I always hoped I could avoid it. Around when I was 26 or so, I started having some lattice degeneration, which is basically a fun precursor to a retinal tear. It was weird going to the ophthalmologist and being the youngest one there. If you can at all avoid getting lasers shot at the back of your eye, you should. It is easily the most painful thing I have ever experienced. I've had multiple procedures done now over the course of the past eight years or so, and now going to the ophthalmologist is just something I do. As painful and scary as it is, I would much rather have those little tears sealed than risk a retinal detachment and potentially lose my sight.
posted by clockbound at 6:47 PM on April 24


I'm a little confused why so many commenters seem to think that reading and being outdoors are oppositional activities. There is no rule that says you can only read indoors, or only play outside if you doing organized sports and hate to read. If what is needed is more light and intermittent longer focus, you can get that just by taking your book outside to read. (I spent a lot of time reading outdoors as a kid, because why would you sit inside on a nice day, but also, who wants to stop in the middle of an exciting book?) There were a spate of articles on this topic a few years ago, and at least a few of them specifically suggested, based on early trials, that intermittent outdoor classes or just sending your child outside with book or gameboy might be all that was needed.
posted by Dorothea Ladislaw at 6:15 AM on April 25


I had a nephew that got glasses at around 4-5 and he wouldn't take them off after that. He essentially had not been able to see his whole life and once he could, he wasn't going to stop.

My eyes are -5.5 and -6.5, I'm usually the worst eyes in the room, I read alot and also played outside alot as a child. I don't like contacts because I lose that detailed super close vision. Actually my eyes are so bad that with contacts I'd need reading glasses to focus on anything closer than 6 inches from my face.
posted by LizBoBiz at 8:44 AM on April 25


I was already pretty myopic by the time I learned to read at age 8, even though I spent almost every possible minute outside in a very bright location (Colorado Springs), and I ended up at -10 in both eyes with no astigmatism in my mid-twenties.

My experience as a kid was that I'd get a new prescription every 6-8 months, and for two weeks the world was absolutely glorious – I would wander around just peering at things in awe. But then the edges would start to soften, and a month after that, the world was back to blur.

I'd usually get new glasses at the end of summer, which meant that I had to play baseball without being able to see the baseball much of the time. I was the best pitcher on my teams for six years of little league and the best hitter, but I had to pretend that I could only throw fastballs because I couldn't see how many fingers the catcher might be holding down, and almost all my hits as a right handed batter were to right field because couldn't pick up the ball out of the pitcher's hand and didn't know where it was until about a third of the way to the plate. When the coach put me in the outfield because of my bat when I wasn't pitching, I looked like a complete fool, because while I could see the batter swing and hear the crack of the bat, I couldn't tell a fly ball was coming in my direction until it was almost out of the infield, at which point I'd start sprinting toward it like I'd gotten an electric shock.

I never saw the Milky Way till I was 21 and got my first pair of contacts.
posted by jamjam at 11:29 AM on April 25 [6 favorites]


Here is a very nice short history of myopia from 400 B.C. to 1905.
posted by jamjam at 1:43 PM on April 25


The little kids with glasses are likely to be premies who are surviving at much much higher and earlier birth rates than ever but with corresponding eye issues.

They could also be kids who are wearing glasses as a preventative/treatment. I know an 18-month old kid who wears glasses which treat his lazy eye; the hope is that he won't need them in the future. Similarly, my SO wore glasses as a small child for a condition that was permanent corrected by the glasses - he doesn't wear them anymore.
posted by jb at 1:49 PM on April 25


This whole conversation - and especially the links to the research - has me very worried. My prescription is -13 and -11. And, yes, I already have one cataract (though that is related to an eye condition I had when I was younger).
posted by jb at 1:51 PM on April 25 [1 favorite]


Bizarrely, my eyes are otherwise in great shape.
Me too! My optometrist always makes me feel much like I feel at the dentist, who will say things like "you have nice healthy teeth" while giving me a filling.

why so many commenters seem to think that reading and being outdoors are oppositional activities

I don't think that's actually what's going on; there are a few commenters for whom that was clearly the case. Many more, including moi, read the correlation between being outside (doing whatever activity, potentially including reading) and lower rates of myopia, and pointed out ironically that this didn't seem to be the case for us.

IIRC reading in bright sunlight is actually pretty bad for your eyes, and I definitely did lots of that.
posted by aspersioncast at 6:51 AM on April 26


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