Nearsightedness (Myopia): Causes, Symptoms & Treatment

Myopia causes blurred vision when looking into the distance. Myopia can have different causes and is treated accordingly in different ways.

What is myopia?

Myopia is a refractive error in which objects that are far away from the observer are seen out of focus. In contrast, when myopia is present, things that are close to the viewer are seen sharply. People who suffer from myopia, but do not wear appropriate optical aids (glasses or contact lenses), often show a squinting of the eyes when looking far away; thus, vision may improve in the short term with myopia. Myopia owes its name to this fact, because the Greek name for myopia is based on the word ‘myops’, which means ‘blinking face’ in German. The degree of myopia is individually expressed in units of diopters; myopia is characterized by diopter values in the negative range, e.g., -0.5 diopters.

Causes

A myopia can be based on various causes. Among them, the most common cause of myopia in Germany is an eyeball that is too long in relation to its refractive power (this form of myopia is also referred to as axial myopia). In this form of myopia, the light rays falling on the eye are focused before they reach the retina, and the image on the retina becomes blurred as a result. Axis myopia as a form of myopia can be hereditary, but it is also frequently observed in people who were born prematurely. Another possible cause of myopia is excessive refractive power or a curvature of the cornea or lens; this form of myopia is called refractive myopia. This form of myopia is less common in Germany.

Symptoms, complaints, and signs

Nearsightedness often manifests itself in early childhood, more rarely it develops in adulthood. In this case, the symptoms of myopia are usually such that they increase with time. This means that vision becomes more and more limited over time. However, with vision aids, the progression of myopia can be well contained until eventually no further deterioration occurs. The first signs are usually that those affected unconsciously squint their eyes when looking at something further away. This is caused by the attempt to compensate the insufficient accommodation of the lens by a lower incidence of light. Correspondingly, this is first seen with distant objects, and later with objects that are quite close. There are increasing problems with the recognition of faces, lettering and so on. Reading a book, on the other hand, does not cause any difficulties. Illuminated objects are perceived as particularly blurred. If the focus is directed for a longer time on distant objects – for example on a lecture or a TV set several meters away – [[[headache]]] or dizziness may occur. In addition, the eyes may begin to hurt at times. Also, nearsighted people are more prone to perceive shadows or streaks in their own field of vision. This is due to liquefied portions in the eyeball, which occur earlier in nearsighted people than in people with entirely healthy eyes.

Disease progression

Schematic diagram showing the anatomy of the eye with myopia and after treatment. Click to enlarge. Myopia usually develops within the first three decades of life and then stops progressing or progresses much more slowly. However, if myopia is severe, significant deterioration may still occur after the completion of the 3rd decade of life. If myopia is in the form of axial myopia (i.e., if the eyeball is relatively elongated), the risk of retinal thinning increases with the severity of the myopia or the length of the eyeball. As a result, severe myopia may lead to retinal detachment. This also increases the risk of going blind if the retinal detachment is not treated by an ophthalmologist in a timely manner.

Complications

As a rule, myopia does not lead to any particular complications in the patient.However, in most cases, the disease cannot be cured causally, so that patients are dependent on glasses or contact lenses. There is also no self-healing. Those affected suffer from visual disturbances due to the myopia and can no longer recognize objects correctly. As a rule, complications only occur if the myopia is not treated and the affected person also does not wear any visual aids. In this case, the muscles of the eyes continue to be strained, so that the defective vision can become even more pronounced. In the worst case, this can also lead to complete blindness of the patient. In adulthood, myopia can be treated with the help of laser surgery. There are no complications and the symptoms disappear after the procedure. However, it is also possible to wear glasses or contact lenses. The affected person may not be able to perform certain professions or activities due to the myopia. However, the patient’s life expectancy is not affected or reduced.

When should you see a doctor?

A visit to the doctor is advisable as soon as there is a reduction in the usual vision. If objects or people can no longer be recognized as usual when looking into the distance, a doctor should be consulted. If one’s own vision has deteriorated considerably in direct comparison with people in the near environment, a doctor should be informed of the observations. If the vision is blurred or if targeted contours are only recognized in a blurred manner, an eye test will provide information about the existing impairments. If vision decreases suddenly or gradually, there is cause for concern. A doctor should also be consulted if the ability to see far is only sporadically reduced. Stress triggers, taking medication or other causes can lead to temporary myopia. To prevent permanent damage, a follow-up visit to a doctor is recommended. If the affected person suffers from sleep disturbances, headaches or perceives a sensation of pain in the eye, a visit to the doctor is necessary. If there is a feeling of pressure in the head, inner restlessness, a decrease in concentration or performance, a doctor should be consulted. If the abnormalities of reduced vision occur despite the presence of a visual aid, a doctor must be consulted. Corrective adjustments are necessary to prevent further deterioration of vision.

Treatment therapy

Visual impairment is experienced by many more people today than a century ago. Only an eye test brings certainty as to how the eyes are performing. Nearsightedness can be treated in several ways. One of them is the use of optical aids (glasses or hard and soft contact lenses). Lenses used for myopia are diverging lenses. They are characterized by negative refractive power. So-called OK contact lenses can be used against mild myopia; they can temporarily flatten the cornea slightly. Other treatment options (according to the form of myopia present) are surgical procedures to correct myopia; in the case of axial myopia, a surgical procedure can take the form of laser treatment, for example. One of these procedures is LASIK (laser in situ keratomileusis). In this procedure, a narrow layer of the cornea is lifted by a scalpel and folded upwards; subsequently, in the case of myopia, fine portions of the center of the cornea are vaporized by laser so that incident light is first focused on the retina, thus enabling sharper vision. The procedure is usually performed on an outpatient basis and takes a few minutes. An improvement in distance vision is often noticeable after a few hours. The chances of success in completely compensating for nearsightedness are usually higher the less pronounced the nearsightedness.

Outlook and prognosis

Myopia offers a relatively good prognosis. Myopia can be completely corrected with vision aids and surgical procedures. Affected individuals have the option of undergoing laser treatment or taking other measures to reduce myopia. The prognosis is worse when myopia occurs as part of a chronic condition that continues to progress. For example, myopia in a hereditary condition can be treated symptomatically, but vision continues to decline.The patient eventually goes completely blind. As a result, the quality of life decreases considerably, since former activities can now no longer be performed. Often the profession has to be changed and financial burdens occur, since the health insurance does not cover the consequences of a sudden illness. In general, however, the prognosis for myopia is positive. As long as the affected person wears a visual aid or undergoes an operation, a normal continuation of life is possible. Life expectancy is not affected by myopia. In the case of congenital myopia, laser treatment or other intervention is often not possible. Those affected are usually dependent on visual aids. However, this is at most an optical blemish and usually does not result in further health complaints.

Prevention

There are few ways to effectively prevent myopia. However, depending on the form of myopia, it is possible to prevent possible consequences (for example, in the case of severe myopia, regular visits to the ophthalmologist can help prevent or correct detachment of the retina at an early stage); the course of some forms of refractive myopia can be positively influenced by consistent treatment of underlying problems (for example, cataracts).

Follow-up care

Follow-up care aims at the early treatment of a disease that has reappeared. This is known, for example, from tumors. With myopia, however, the situation is different. It is permanent and therefore cannot reoccur. Furthermore, it is not a life-threatening disease. In this case, aftercare is aimed more at supporting the person affected in their everyday life and preventing complications. This is primarily done by providing suitable aids such as glasses and contact lenses. Sufficient vision is not only a prerequisite for participation in road traffic, but is indispensable for almost all areas of life. However, since changes in visual acuity are not uncommon in the course of life, ophthalmologists recommend an annual checkup. During this check-up, other secondary diseases are also clarified. The acute extent of the complaint forms the basis for the scope of an examination. In the meantime, there is also the possibility of surgical correction. However, the result of such an operation cannot always be predicted. If the desired goal in the form of one hundred percent vision is achieved, no follow-up care is necessary in the long term. Only in case of acute loss of vision the patient turns to an ophthalmologist. In the event that surgical intervention does not achieve the desired effect, a visual aid must continue to be used.

What you can do yourself

If intense, prolonged eye work cannot be avoided, temporary relaxation of the eye muscles will help. Affected people should direct their gaze to a point in the distance from time to time. This changes the curvature of the lens, the eyes are “readjusted” and temporarily relieved. When working at the computer, a minimum distance of 50 cm from the monitor is recommended. Numerous settings, such as an optimally selected contrast, a magnified display of objects and selectively selectable magnifying lenses, make it easier for nearsighted people to work at the computer. In extreme cases, a Braille keyboard is recommended. Special computer programs read screen texts aloud; in leisure time, audio books or audio magazines make self-reading unnecessary. In everyday life at home, it is advisable to keep things tidy and to mark objects well. Patients can mark sharp, pointed or fragile utensils with brightly colored marking tape. Marking dots in different colors, shapes and sizes help on electrical appliances such as stoves or washing machines. They can be used to identify switch settings. To prevent serious mix-ups with medications, there are medication dispensers from the pharmacy. Relatives can sort the required daily dose into these. In the case of harmless substances, such as drinks or food, it helps to use other sensory perceptions. Many things can be identified by their texture, size, weight and smell. Glare-free, flicker-free lighting supports vision. In public spaces, there are special services for the visually impaired. For example, some airlines offer an escort at the airport. Visually impaired rail passengers can book transfer assistance in advance, and many timetables have a text mode.