Affecting roughly one in four people, myopia (nearsightedness) is a vision condition in which distant objects appear blurry while close objects are seen clearly. Although many people think of myopia simply as "having to wear glasses," it deserves a comprehensive evaluation in terms of its causes, progression, and treatment options. In this article, we cover myopia in all its dimensions.
What Is Myopia?
Myopia is a refractive error that occurs when light focuses in front of the retina rather than directly on it. This error may result from the eyeball being longer than normal (axial myopia) or the corneal curvature being steeper than normal (refractive myopia). As a result, distant objects appear blurry while nearby objects appear relatively clear.
The degree of myopia is expressed in "minus" values: -1 D is classified as mild, -3 D as moderate, and over -6 D as high myopia. In cases of "pathological myopia" above -6 D, closer follow-up is required regarding retinal complications.
What Causes Myopia?
Genetic Predisposition
The strongest risk factor for myopia is family history. If one parent has myopia, a child's likelihood of developing myopia roughly doubles; if both parents have it, the risk increases up to fivefold.
Environmental Factors: Limited Outdoor Time and Near Work
The global "epidemic" of myopia observed over the past 30 years cannot be explained by genetics alone. Research shows that two environmental factors play a decisive role:
- Insufficient exposure to daylight: Natural daylight increases dopamine release in the retina, slowing down the elongation of the eyeball. Spending at least 2 hours outdoors daily reduces the risk of myopia in children.
- Intensive near work: Prolonged focusing on books, screens, and close objects can increase the risk of myopia through mechanisms that trigger axial elongation.
Eye Growth and Age
Myopia mostly begins between ages 6 and 14 and progresses during adolescence as the eyeball grows. In the vast majority of cases, it stabilizes after ages 18 to 21, although progression up to age 25 may be observed in some individuals.
Symptoms of Myopia
- Difficulty seeing distant road signs, the classroom board, or screens
- Squinting to see distant objects more clearly
- Tendency to hold objects or screens close to the face
- Eye strain and headaches (especially after looking at distant objects for a long time)
- Increased difficulty while driving or seeing at night
Myopia may go unnoticed in children; attentive parents may notice primary school children struggling to see the board or squinting in photographs.
How Does Myopia Progress?
The rate of myopia progression varies according to age and initial prescription. Myopia that begins in early childhood can progress most rapidly during adolescence. The relationship between age and progression is summarized in the table below:
| Age Group | Average Annual Increase | Notes |
|---|---|---|
| 6-10 years | -0.75 D/year | Fastest progression period |
| 11-14 years | -0.50 D/year | Increased risk with puberty |
| 15-18 years | -0.30 D/year | Slowdown begins |
| 18-25 years | -0.10 D/year | Stabilization in the vast majority |
| 25+ years | Stable | Further progression is not expected |
High myopia (-6 D and above) requires particularly careful monitoring due to the risk of retinal thinning, retinal tears, retinal detachment, glaucoma, and early cataracts in later years.
Myopia Treatment: What Are the Options?
1. Eyeglasses and Contact Lenses
This is the most common and immediate correction method for myopia. Glasses and contact lenses normalize vision but do not cure myopia; they do not alter the underlying cornea or eyeball structure. When removed, blurry vision returns.
Orthokeratology (Ortho-K) lenses are rigid contact lenses worn overnight while sleeping; they provide temporary clear vision during the day without glasses or contact lenses and can slow myopia progression in children.
2. Slowing Myopia Progression (In Children)
Evidence-based methods currently used to curb myopia progression include:
- Low-dose atropine eye drops (0.01-0.05%): Shown to slow myopia progression by 50-77%.
- Multifocal and bifocal glasses: Can slow eye elongation by altering peripheral retinal defocus.
- Myopia control contact lenses: Specially designed daily lenses.
- 2 hours of outdoor time in daylight daily: The most cost-effective and impactful preventive measure.
3. Laser Eye Surgery (Permanent Correction)
In individuals whose eye development is complete (generally age 21 and over) and whose prescription has been stable for the last 1-2 years, laser treatment can permanently correct myopia:
| Method | Features |
|---|---|
| LASIK / iLASIK | Laser applied after lifting a corneal flap; rapid recovery |
| SMILE Pro | Flapless, most advanced method; dry eye advantage |
| PRK / No Touch Laser | Flapless surface laser; suitable for thin corneas |
| Laser eligibility | Evaluated via corneal thickness, IOP, and pupil measurement |
4. Intraocular Lens Implants (ICL)
If corneal thickness is insufficient for laser surgery or if the degree of myopia is very high, implantable collamer lenses (ICL) placed inside the eye over the natural lens are a safe and effective alternative. Their reversibility is a significant advantage.
5. Myopia Correction During Cataract Surgery
Myopia can be corrected simultaneously during cataract surgery by selecting the appropriate artificial intraocular lens power.
Myopia and Night Vision
High myopia can cause difficulties that become particularly pronounced during night driving; halos around light sources and bright reflections can make driving at night challenging. Therefore, individuals with high myopia must always wear glasses or contact lenses when driving at night.
Can Myopia Be Prevented?
Genetic predisposition cannot be controlled, but slowing down myopia progression is possible. Ensuring children spend at least 2 hours outdoors in natural daylight daily, limiting near work sessions with the 20-20-20 rule, and maintaining adequate ambient lighting are among the most effective measures.
Conclusion
Myopia is a refractive error that can be successfully managed when properly evaluated and permanently corrected when appropriate. Early diagnosis and progression-slowing measures in children directly impact long-term vision quality. In adults, a glasses-free life is possible with laser or intraocular lens treatment. If you notice your myopia prescription progressing rapidly or your vision quality declining, do not delay — consult an ophthalmologist.
Frequently Asked Questions
Does myopia go away permanently?
Glasses and contact lenses do not cure myopia; they temporarily correct vision. For permanent correction, laser eye surgery or intraocular lens surgery is required.
Can myopia improve naturally?
Although mild myopia values have regressed on their own in very rare cases, this is not an expected process. With the onset of presbyopia (age-related near vision difficulty), older myopic individuals may feel their vision numbers have balanced out, but this is not a true recovery.
Can someone with myopia play sports?
Yes, however individuals with high myopia are advised to be cautious in contact sports that carry a risk of head trauma (boxing, martial arts, football) and to wear protective eyewear. Severe impact can trigger a retinal tear.
When can someone have laser surgery for myopia?
Laser surgery can generally be considered for individuals aged 21 and older whose prescription has remained stable over the past 1-2 years. Exact eligibility is determined through a detailed preliminary examination including corneal thickness, intraocular pressure, and pupil measurements.
Does a child with myopia have to wear glasses?
Wearing glasses is essential in cases of myopia that affect daily life and reduce visual acuity. Untreated myopia can pave the way for amblyopia (lazy eye), especially in children.
